BACKGROUND AND AIMS:Childhood obesity is a considerable public health issue. Recent research has shown that alterations in gut microbiota can have an impact on developing obesity and other metabolic health problems in children. This study aimed to investigate whether the characteristics of gut microbiota in obese children and adolescents are associated with the severity of obesity and any metabolic complications. METHODS AND RESULTS:During May 2022 to May 2023, a total of 56 children and adolescents with obesity, aged 6-18 years, were recruited at Thammasat Hospital, situated in provincial Pathumthani in central Thailand. Participants were allocated into two groups, characterized by the severity of their obesity. Demographic data, body composition, along with resting energy expenditures were determined. Serum samples were collected for the metabolic profile and inflammatory markers. Fecal samples were obtained for gut microbiota analysis via 16S rRNA Illumina. The obese group exhibited notably greater relative abundance of Actinobacteriota in comparison to the severely obese group, along with a lower abundance of Bacteroidota. There were no statistically significant differences in the relative abundance of Firmicutes and the Firmicutes to Bacteroidota ratio between the two cohorts. Bacteroidota positively correlated with FMI, while Actinobacteriota showed a negative correlation with FMI. CONCLUSION:The data gathered from this study illustrated that children and adolescents with obesity and severe obesity in Thailand showed differences in the relative abundance of Actinobacteriota and Bacteroidota. Certain microbiome taxa showed correlations with various body and metabolic parameters.

BACKGROUND:Infants with cow's milk protein allergy (CMPA) are at risk for nutrient inadequacy and impaired growth. OBJECTIVE:To evaluate the effect of a new amino acid-based formula (nAAF) compared with commercial amino acid-based formula (cAAF) on growth and protein status of cow's milk protein (CMP)-allergic infants and to compare their growth with those of healthy infants. METHODS:Infants less than 6 months of age with CMPA were enrolled in the nAAF or cAAF groups. Healthy infants fed breast milk (BM) or infant formula (IF) were controls. They remained on their formula/milk until day 28 of the study. Anthropometric evaluation was performed at birth, day 0 and day 28 of the study and calculated to z-scores of weight-for-age (WAZ), length-for-age (LAZ) and head circumference-for-age (HAZ). Plasma amino acids, albumin, urea nitrogen, and creatinine were assessed for infants with CMPA on day 0 and day 28. RESULTS:The nAAF and cAAF groups did not differ in increases in WAZ [regression coefficient (95%CI): 0.088 (-0.619, 0.796), p = 0.791], LAZ [0.045 (-0.789, 0.880, p = 0.909], and HAZ [-0.645 (-2.082, 0.793), p = 0.337] between day 0 and day 28. The increases in WAZ and LAZ during 28 days in the nAAF group did not differ from the controls. The changes in the blood chemistry values, except albumin, were not different between CMPA groups. CONCLUSIONS:The nAAF, similar to the cAAF, supports growth and protein status for infants with CMPA, and it might be used as a substitute for the cAAF.

Background The accuracy of an atopy patch test (APT) for fresh cow’s milk allergy is controversial. Few studies have focused on commercial extract solutions. We aimed to evaluate the diagnostic performance of the APT in cow’s milk allergic children using fresh cow’s milk and commercial extracts of cow’s milk and its components including casein, α-lactalbumin, and β-lactoglobulin. Methods A prospective study was carried out in children with a history of cow’s milk allergy. Children underwent the skin prick test (SPT) and APT with fresh cow’s milk, powdered cow’s milk, and commercial extracts of cow’s milk, casein, α-lactalbumin, and β-lactoglobulin. Oral food challenge (OFC) was confirmed in all children. Results A total of 37 patients participated (mean age 13.14 ± 7.26 months). Only 5 (13.51%) patients had positive OFC to cow’s milk. The sensitivity of the APT using fresh cow’s milk was 40%, specificity was 65.6%, PPV was 15.4%, and NPV was 87.5%. The sensitivity of the APT using powdered cow’s milk was 40%, 60.7% for specificity, 15.4% for PPV, and 58% for NPV. The sensitivity and PPV of the APT using commercial solutions of cow’s milk, casein, α-lactalbumin, and β-lactoglobulin were zero. The specificities were 90.6%, 93.8%, 100%, and 100% for α-lactalbumin, cow’s milk, casein, and β-lactoglobulin, respectively. Conclusions APT using commercial solutions showed higher specificity than fresh milk. The specificity increased using a protein component allergen.

Background: Few studies had focused on the epidemiological and clinical characteristics of pediatric COVID-19 (SARS-CoV-2) during Delta and pre-Delta eras in Asia, despite it being a pandemic. Objective: To study the epidemiological and clinical characteristics of three waves of pediatric COVID-19 infections in a tertiary-care setting in Thailand. Methods: This retrospective study reviewed all PCR-confirmed pediatric (0-18 years of age) COVID-19 infections between January 13th, 2020 and October 31st, 2021, in a tertiary care system, Thailand. Results: There were 1,019 patients, aged 0.02 - 18 years, median age of 9.2 years, with no gender differences. Asymptomatic cases accounted for 35.7%, of which 18.9% had abnormal chest X-ray findings. The majority of cases were classified as having mild clinical symptoms, with only 0.8 and 0.4% developing severe and critical illness, respectively. There were no deaths. The Delta dominant group appeared more transmissible, but we did not see any difference in disease severity. Upper respiratory tract symptoms were predominant, while few cases had lower respiratory signs. The sensitivity and specificity of dyspnea symptoms to predict pneumonia (abnormal chest X-ray) were 14% and 95%, respectively, with a likelihood ratio 3.37. The overall prognosis was good, with only 0.01 % needing respiratory equipment. All cases showed clinical improvement with a decent recovery. Conclusion: Pediatric COVID-19 during Delta era appeared generally more transmissible but benign. One-fifth of cases had pneumonia, but few cases needed respiratory support. Prevention remains important for disease control. Keywords: Pediatric, COVID-19, SARS-CoV-2, Delta, Epidemiology

Background Due to the possibility of asymptomatic pneumonia in children with COVID-19 leading to overexposure to radiation and problems in limited-resource settings, we conducted a nationwide, multi-center study to determine the risk factors of pneumonia in children with COVID-19 in order to create a pediatric pneumonia predictive score, with score validation. Methods This was a retrospective cohort study done by chart review of all children aged 0–15 years admitted to 13 medical centers across Thailand during the study period. Univariate and multivariate analyses as well as backward and forward stepwise logistic regression were used to generate a final prediction model of the pneumonia score. Data during the pre-Delta era was used to create a prediction model whilst data from the Delta one was used as a validation cohort. Results The score development cohort consisted of 1,076 patients in the pre-Delta era, and the validation cohort included 2,856 patients in the Delta one. Four predictors remained after backward and forward stepwise logistic regression: age < 5 years, number of comorbidities, fever, and dyspnea symptoms. The predictive ability of the novel pneumonia score was acceptable with the area under the receiver operating characteristics curve of 0.677 and a well-calibrated goodness-of-fit test (p = 0.098). The positive likelihood ratio for pneumonia was 0.544 (95% confidence interval (CI): 0.491–0.602) in the low-risk category, 1.563 (95% CI: 1.454–1.679) in the moderate, and 4.339 (95% CI: 2.527–7.449) in the high-risk. Conclusion This study created an acceptable clinical prediction model which can aid clinicians in performing an appropriate triage for children with COVID-19.

The infant and child feeding index (ICFI) is a single summary World Health Organization influenced index to assess feeding quality in infants and young children aged 6–36 months. This study aimed to demonstrate any associations between ICFI and nutritional status in a single Thai center.

Mitochondrial 3-hydroxy-3 methylglutaryl-CoA synthase-2 deficiency (HMGCS2D) is a rare autosomal recessive inborn error of hepatic ketogenesis, caused by mutations in HMGCS2. As its clinical and laboratory manifestations resemble many other metabolic disorders, HMGCS2D definite diagnosis presents a challenge, frequently requiring molecular tests. Only 26 patients with HMGCS2 mutations have been previously described, and this study reports the first two unrelated Thai patients, a 9-month-old male and an 8-month-old female, with HMGCS2D. During acute episodes, steatorrhea and dyslipidemia occurred, both previously unreported. Increased serum levels of triglycerides, very low density lipoproteins (VLDL), and low density lipoproteins (LDL), along with a decreased serum level of HDL were found. Both patients had hypophosphatemic encephalopathy, and the female had metabolic acidosis without hypoglycemia. Trio whole-exome sequencing (WES) revealed that the male harbored two HMGCS2 mutations, a novel c.1480C>T (p.Arg494*) and a previously reported c.1502G>C (p.Arg501Pro), while the female was compound heterozygous for the c.1502G>C (p.Arg501Pro) and a previously reported mutation, c.520T>C (p.Phe174Leu). Interestingly, c.1502G>C (p.Arg501Pro) was not only found in both of our patients but also detected heterozygously in 9 out of 1081 unrelated individuals (allele frequency of 9/2162; 0.42%) in our in-house Thai exome database. Discovery of this common mutation suggests there could be about 14 babies with HMGCS2D within 800,000 newborns in Thailand annually. Therefore, awareness of HMGCS2D among medical personnel in Thailand should be raised.

BACKGROUND AND OBJECTIVES Iron deficiency (ID) is the most common micronutrient deficiency worldwide and usually leads to impaired neurodevelopment. Appropriate introduction of complementary foods is mandatory for all infants to prevent iron insufficiency. We aimed to demonstrate feeding behaviors in relation to infant iron status and also identify potential concomitant nutrient inadequacies. METHODS AND STUDY DESIGN A cross-sectional descriptive study of infants 6-12 months old was performed at the Well Baby Clinic at Thammasat University Hospital, Pathumthani. Demographic data, feeding practices and nutritional status were obtained. Dietary intake was evaluated using general and food frequency questionnaires. Blood samples for complete blood count and iron studies were investigated. RESULTS We enrolled 206 infants (mean age 8.552.1 months). Prevalence of ID and iron deficiency anemia (IDA) was 34.0% and 25.7%, respectively. In multivariable ordinal continuation ratio logistic regression analysis for risk of iron depletion severity among the 3 groups (normal, ID and IDA infants), we found a stepwise increase in odds ratios for iron depletion with lower family income, longer duration of breastfeeding, delayed introduction of meat, and lower dietary iron intake. IDA infants had significantly lower intakes of energy, protein, fat and various micronutrients, compared to those with normal iron status. CONCLUSIONS Infants with ID may have low intakes of other nutrients due to reduced complementary food intake. Nutritional education for appropriate feeding practices should be provided to prevent ID and other possible micronutrient deficiencies.

Background: Lifestyle intervention is the cornerstone of the treatment in pediatric obesity. Various interventions have resulted in different degrees of reduction in body weight and cardiovascular outcomes. Objective: To demonstrate the real-life effectiveness of obesity treatment in weight reduction among lifestyle intervention and usual care in our center and improvement of the cardiovascular risk factors. Materials and Methods: A retrospective data of 170 first diagnosed, obese children and adolescents, aged 2 to 18 years were collected. All had been followed up for at least 12 months. Sixty-three patients received intensive nutrition education in the nutrition clinic and 107 received usual care in the general pediatric clinic and other subspecialty clinics of the Out-Patient Department of Thammasat Hospital. Results: The overall BMI significantly reduced with the mean of 0.41 SDS (p<0.001). The mean BMI-SDS in the patients from the nutrition clinic had a significantly greater reduction as compared to the patients from the other clinics [–0.8 (95% CI –1.2 to –0.4) and –0.3 (95% CI –0.5 to 0), respectively; p=0.009]. The patients in the nutrition education program had 1.5 greater rate of the successful treatment than the patients that received usual care [RR 1.5 (95% CI 1.0 to 2.1); p=0.05]. There were significant improvements of total cholesterol and HDL-cholesterol at the end of the 1-year period. Conclusion: Intensive nutrition education program promoted a greater rate of successful weight reduction as compared to usual care. Patients who successfully reduced their weight had a greater improvement in some cardio-metabolic parameters. Keywords: Cardiovascular risk, Childhood obesity, Lifestyle modification, Pediatric obesity, Weight loss Received 24 Dec 2018 | Revised 20 Mar 2019 | Accepted 21 Mar 2019

A 13-year-old, obese girl presented with acute abdominal pain with abdominal distension for a year. The physical examination revealed marked abdominal distension with a large well-circumscribed mass sized 13×20 cm. Her body mass index (BMI) was 37.8 kg/m2. An abdominal CT scan revealed a huge multiloculated cystic mass and a left adnexal mass. She had an abnormal fasting plasma glucose and low HDL-C. Laparotomy, right salpingooophorectomy, left cystectomy, lymph node biopsies and partial omentectomy were performed. The left ovary demonstrated multiple cystic follicles over the cortex. The histologic diagnosis was a mucinous cystadenoma of the right ovary and a matured cystic teratoma of the left ovary. Both obesity and polycystic ovary syndrome (PCOS) are associated with a greater risk of ovarian tumours, where PCOS could be either the cause or as a consequence of an ovarian tumour. We report an obese, perimenarchal girl with bilateral ovarian tumours coexistent with a polycystic ovary and the metabolic syndrome.

OBJECTIVEGalactogogue food has been frequently used among lactating women without reported efficacy data. The present study was aimed to address the outcome of hospital-based food programs as defined by the onset of lactation and infant's weight loss.MATERIAL AND METHODA Quasi-experimental design was done to compare the maternal breast fullness/heaviness and infants' body weight among 106 women in galactogogue group and 127 controls. Data was gathered daily from the 1st day of postpartum through the date discharged regarding timing of first breast feeding, nursing frequency, LATCH score, nonbreast-milk fluid, breast fullness/hardness, leakage of colostrum/breast milk, let-down reflex and infants' body weight.RESULTSMaternal report of breast fullness/heaviness within the first 48 hours in galactogogue group was significantly more than control (71.7% and 56.7%, respectively; p < 0.001). Proportion of infant who had an excessive weight loss, as defined by weight loss more than 7% within the first 48 hours, in galactogogue group was significantly lower than controls (15.1% and 24.4%, respectively; p = 0.043).CONCLUSIONThe use of traditional food as hospital-based food program had some efficacies in the early period of lactation, regarding presence of breast fullness and reduction of infant's weight loss. However the efficacy in maintaining breast milk production should be further studied. Likewise, frequent breastfeeding and thorough emptying of breasts definitely result in increased milk production and should be evaluated in all lactating women.