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Iron deficiency anemia (IDA) is prevalent in exclusively breastfed (EBF) Thai infants. However, in Thailand, iron supplementation guidelines for EBF infants are not available. This prospective open-label study aimed to estimate the prevalence of IDA in 9-month-old EBF infants after receiving iron supplementation from 4 months of age until they consumed adequate iron-rich food. Forty-seven healthy, 4-month-old EBF infants were prescribed 1 mg/kg/day ferrous sulfate. Their complementary food records from 6 to 9 months were calculated for daily iron intake. Complete blood count and iron study were performed at 9 months of age. The results showed that the prevalence of IDA at 9 months was 6.4%. An employed caregiver and the male sex of the baby were significantly associated with iron deficiency. The food record revealed that the median daily iron intake was less than the Thai dietary reference intake recommendation. In summary, the prevalence of IDA in infants with 9 months of exclusive breastfeeding who received iron supplementation was lower than the background rate (25.7%) when iron was not prescribed. Most infants did not have adequate iron in complementary foods. Iron supplementation should be prescribed routinely during 4–9 months of age in healthy Thai EBF infants.

Inulin might improve body composition in obese children. We aimed to determine the effects of inulin supplementation on body composition and metabolic outcomes in obese children. A randomized, double-blinded placebo-controlled study was conducted in obese Thai children aged 7–15 years. Participants were assigned to 3 treatment groups for 6 months: 13 g of extracted inulin powder from Thai Jerusalem artichoke, isocaloric maltodextrin, and dietary fiber advice groups. Body composition was assessed by bioelectrical impedance analysis. One-hundred and fifty-five children completed the study (mean age 10.4 ± 2.2 years, BMI z-score 3.2 ± 1.0, 59% male). The drop-out rate was 6%. The inulin extract yielded more than 90% compliance without significant gastrointestinal side effects. All three groups demonstrated a significant decrease in BMI z-score, fat mass index (FMI), and trunk FMI, but the differences between groups were not observed. Fat-free mass index significantly increased only in the inulin group (16.18 ± 1.90 vs. 16.38 ± 1.98 kg/m 2 , P = 0.009). There were no significant differences in the metabolic profiles between groups. Despite showing no substantial effect on adiposity, inulin may increase fat-free mass in obese children. Further research in the change of gut microbiota composition is needed to determine inulin’s impact on host-microbe interaction in pediatric obesity.

Background: Pediatric chylothorax poses management challenges, with conservative treatment as the first-line approach and surgery reserved for persistent cases. However, data remain limited on factors related to conservative treatment success and optimal surgical timing.Purpose: This study aimed to evaluate the success rate of conservative treatment, identify the associated factors, and determine the optimal timing for surgical intervention.Methods: We retrospectively reviewed pediatric chylothorax cases at Siriraj Hospital treated between January 2012 and December 2022. Clinical and laboratory parameters, treatment modalities, and outcomes were analyzed.Results: Thirty pediatric patients were included (median age, 1.7 months); 67% were male. Conservative treatment had an overall success rate of 83.3% (25 of 30) and a 95% (19 of 20) success rate among patients with chylothorax after congenital heart disease surgery. Among the factors associated with successful conservative treatment, chylothorax caused by surgery was associated with a significantly higher success rate than nonsurgical causes (91.7% vs. 50%, respectively; P=0.04). The successful group exhibited a significantly lower peak pleural fluid flow rate than the unsuccessful group (26.8 mL/kg/day vs. 91 mL/kg/day, P=0.002). A time-to-event analysis showed that the success rate of conservative treatment for postsurgical chylothorax was 78% at 14 days, suggesting that 2 weeks may be the optimal timing for surgical intervention.Conclusion: Conservative treatment is an effective first-line treatment for pediatric chylothorax. The etiology and peak flow rate of pleural fluid drainage are associated with its success. Optimized surgical intervention timing is crucial for improving outcomes.

Background Childhood-onset systemic lupus erythematosus (cSLE) is associated with significant morbidity and mortality. Dyslipidemia and metabolic syndrome are recognized risk factors for premature atherosclerosis. This study aimed to determine the prevalence of dyslipidemia and metabolic syndrome, and to explore the relationships between lipid profiles, anthropometry, and disease status in cSLE. Methods This cross-sectional study was conducted at a university-based tertiary referral center from April 2023-March 2024. Patients aged 10–19 years with cSLE diagnosed before 18 years and at least 1 year follow-up were enrolled, excluding those with other autoimmune disorders, chronic kidney disease, infections, receiving lipid lowering drugs prior, and pregnancy. Demographic data, metabolic laboratory tests, disease status, dietary intake, anthropometry, and body composition via bioelectric impedance analysis were evaluated. The prevalence of dyslipidemia and metabolic syndrome were documented. Variables were compared between patients with and without dyslipidemia. Correlations between lipid profiles, metabolic laboratory variables, and SLE disease-related variables were explored. Results A total of 132 cSLE patients (94.7% female, mean age 11.6 ± 2.6 years) were included. Dyslipidemia was present in 48.5%, hypertriglyceridemia being the most common (28.8%); metabolic syndrome and hyperuricemia were present in 3.8% and 20.5%, respectively. Patients with dyslipidemia were significantly younger at cSLE diagnosis, had higher percentage of hypertension and active features of organ involvement, lower percentage of Lupus Low Disease Activity State, more use of mycophenolate mofetil and antihypertensive medications, higher uric acid level, higher waist circumference, body mass index, body mass index z-score, and fat mass ( P  < 0.05). Triglycerides, low-density lipoprotein cholesterol, and total cholesterol correlated positively with urine protein-to-creatinine ratio ( r  = 0.472, 0.469, and 0.591, respectively; P  < 0.001) and negatively with serum albumin ( r = -0.372, -0.506, and − 0.528, respectively; P  < 0.001). Total cholesterol and low-density lipoprotein cholesterol correlated positively with cumulative prednisolone equivalent dose (rho = 0.350 and rho = 0.351, respectively, P  < 0.001). Conclusions Nearly half of cSLE patients had dyslipidemia, especially those with younger age at diagnosis, higher body mass index, proteinuria, and suboptimal-controlled disease. Metabolic syndrome and hyperuricemia were present. Lipid profile assessment in early adolescents is recommended to identify metabolic comorbidities in cSLE.

Alteration of nutrient metabolism during hospital stay may cause a deterioration in patients’ nutritional status. The aim of this study was to determine the prevalence and possible risk factors for nutritional deterioration in hospitalized children. A multicentre prospective study was conducted among the patients aged 1 month to 18 years in tertiary-care hospitals, between December 2018 and May 2019. Demographic data, illness, and nutritional assessment on the first and the last day of admission were collected. There were 623 patients enrolled in this study with the median age of 4.3 years. Two thirds of the patients had at least one underlying disease. Eighty-eight percent of the patients were admitted with mild medical conditions including a scheduled cycle of chemotherapy or immunosuppressive drugs, minor infection, and non-invasive procedures. The prevalence of nutritional deterioration (reduction in body mass index ≥ 0.25 Z-score) was 24% and was associated with a significantly higher rate of nosocomial infection (24% vs. 11%, p < 0.001) compared to patients without hospital-acquired malnutrition. Risk factors included moderate to severe medical conditions (AOR 1.90, 95% CI 1.09–3.31, p = 0.024), pneumonia (AOR 1.85, 95% CI 1.05–3.28, p = 0.034), seizure (AOR 2.82, 95% CI 1.28–6.19, p = 0.01), and surgery (AOR 2.98, 95% CI 1.60–5.56, p = 0.001). Nutritional management showed a significant reduction in the incidence of hospital-acquired malnutrition and a trend towards a 60% decrease in infectious complications in patients with moderate to severe medical conditions.Conclusions: Approximately one fourth of paediatric patients developed malnutrition during hospitalization. Nutritional screening, assessment, and treatment should be implemented to improve the outcomes of hospitalized paediatric patients. What is Known:• Malnutrition at admission has a negative impact on outcomes of patients, including prolonged hospitalization, increased costs of care, and a higher rate of nosocomial infection.What is New:• Hospital-acquired malnutrition can occur regardless of prior nutritional status and is predominantly related to illness severity.• Malnourished patients with nutritional intervention experience an improvement in their nutritional status as well as a lower risk of developing hospital morbidity during hospitalization.

Background: Thiamin deficiency (TD) manifesting clinically as wet beriberi can significantly impair a patient's cardiac function. Children with heart disease who are receiving diuretic treatment may be at increased risk for severe clinical manifestations of TD.Purpose: This study aimed to determine the prevalence of TD and evaluate the association between various factors with thiamin status in pediatric patients with heart disease undergoing diuretic treatment.Methods: Children with heart disease aged 1 month to 15 years who exhibited increased pulmonary blood flow or congestive heart failure (CHF) and had been taking diuretics for at least 1 month were recruited. Data regarding their heart condition, treatment, dietary intake, anthropometry, and symptoms and signs of TD were collected. An erythrocyte transketolase activity assay after the addition of exogenous thiamin pyrophosphate was used to assess thiamin status. Left ventricular ejection fraction and N-terminal pro-brain natriuretic peptide levels were indicators of cardiac function and laboratory evidence of CHF, respectively.Results: A total of 68 participants were recruited, of whom 10 (15%) had TD. TD was not associated with a CHF exacerbation. An adequate dietary thiamin intake was associated with a better thiamin status (β=-0.37, P=0.003), while increasing age was linked to a poorer thiamin status (β=+0.40, P=0.001).Conclusion: TD was present in 15% of pediatric patients with heart disease who were receiving diuretic treatment. An adequate dietary thiamin intake appeared to have a protective effect against TD, while increasing age was associated with a poorer thiamin status.

Background. Dysbiosis of intestinal microbiota may be linked to pathogenesis of obesity and metabolic disorders. Objective. This study compared the gut microbiome of obese Thai children with that of healthy controls and examined their relationships with host lifestyle, adiposity, and metabolic profiles. Methods. This cross-sectional study enrolled obese children aged 7–15. Body composition was evaluated using bioelectrical impedance analysis. Stool samples were analyzed by 16S rRNA sequencing using the Illumina MiSeq platform. Relative abundance and alpha- and beta-diversity were compared with normal-weight Thai children from a previous publication using Wilcoxon rank-sum test and ANOSIM. Relationships of gut microbiota with lifestyle activity, body composition, and metabolic profiles were assessed by canonical correlation analysis (CCA) and Spearman correlation. Results. The study enrolled 164 obese children with a male percentage of 59%. Mean age was 10.4 ± 2.2 years with a BMI z-score of 3.2 ± 1. The abundance of Bacteroidetes and Actinobacteria were found to be lower in obese children compared to nonobese children. Alpha-diversity indices showed no differences between groups, while beta-diversity revealed significant differences in the family and genus levels. CCA revealed significant correlations of the relative abundance of gut microbial phyla with sedentary lifestyle and certain metabolic markers. Univariate analysis revealed that Actinobacteria and Bifidobacterium were positively correlated with HDL-C and negatively correlated with body weight and screen time. Additionally, Actinobacteria was also negatively associated with fasting insulin and HOMA-IR. Lactobacillus showed positive correlation with acanthosis nigricans and adiposity. Cooccurrence analysis revealed 90 significant bacterial copresence and mutual exclusion interactions among 43 genera in obese children, whereas only 2 significant cooccurrences were found in nonobese children. Conclusions. The composition and diversity of gut microbiota in obese Thai children were different from those of their normal-weight peers. Specific gut microbiota were associated with lifestyle, adiposity, and metabolic features in obese children. An interventional study is needed to support causality between specific gut microbiota and obesity.

Introduction. Obesity is a major threat to public health. Eating behavior and dietary intake of especially high energy-dense food with low nutrients contribute to the current epidemic of childhood obesity. However, the relationship between eating behavior and body composition has yet to be examined in Thai children and adolescents with obesity. We assessed the association between children’s eating behaviors and their body composition in prerandomized patients who participated in the randomized trial titled “Impact of Dietary Fiber as Prebiotics on Intestinal Microbiota in Obese Thai Children”. Methods. During the prerandomization process, a cross-sectional study was conducted. We recruited children and adolescents aged 7 to 15 years from Bangkok, Thailand. Eating behaviors were assessed by the Children’s Eating Behavior Questionnaire (CEBQ), which is a parent or self-reported research instrument conducted by face-to-face interviews. Body mass index (BMI), BMI-for-age Z-score, waist and hip circumferences, and body compositions were assessed. Pearson’s correlation coefficients were used to assess associations between the study variables. Results. Ninety-seven Thai children and adolescents with obesity participated in the study; 59 (61%) were male. Median [IQR] of age and BMI z-score were 10.5 [9.0, 12.2] years and 3.0 [2.6, 3.7], respectively. Subscale for Enjoyment of Food had the highest score. There were no associations between eating behaviors and BMI z-score. However, Emotional Overeating was associated with fat-free mass index (correlation coefficient = 0.24, p=0.02) and girls with obesity had lower scores in “Slowness in Eating” compared to boys [mean 2.1 versus 1.8, 95% CI: (−0.06, −0.01), p=0.04]. Conclusion. Among Thai children and adolescents with obesity, the difference in multidimensional eating behavior might be affected by fat-free mass. Additional study with a larger sample size needed to explore underlying mechanisms and findings can be used to develop future behavior modification program.

Fat overload syndrome is a rare but serious complication associated with intravenous lipid emulsion in parenteral nutrition. Timely identification of causes, recognition of symptoms, close monitoring of complications, and appropriate management are vital for improving outcomes and preventing recurrence. This case series reviews etiologies, complications, management, and outcomes in pediatric patients who developed fat overload syndrome as well as those identified to be at risk of this condition. A retrospective chart review was performed over a five-year period at a tertiary care hospital, including 11 pediatric patients who received lipid emulsions at infusion rates exceeding the recom-mended limit. Data on patient demographics, lipid emulsion details, clinical presentations, laboratory results, managements, and outcomes were collected and analyzed. Eleven patients were included, ranging in age from 9 months to 15 years, with a male-to-female ratio of 7:4. The identified causes of intravenous lipid administration incidents were inadvertent switching of infusion rates between the parenteral nutrition solution bag and the lipid bag, and incorrect infusion pump programming. Fat overload syndrome was identified in one patient, presenting with oliguria and metabolic acidosis. Management primarily consisted of discontinuing intravenous lipid emulsions and providing supportive care. Although most patients had no complications, four required additional supportive interventions. Although uncommon, fat overload syndrome requires prompt recognition and timely intervention. This case series underscores the importance of careful parenteral lipid administration and vigilant monitoring of at-risk patients. Root cause analysis is critical to preventing recurrence of such incidents.