Rural-urban difference in lipid levels and prevalence of dyslipidemia: a population-based study in Khon Kaen province, Thailand.

OBJECTIVES: To determine the lipid levels and examine the effect of an urban lifestyle on dyslipidemia, by comparing the lipid levels and the prevalence of dyslipidemia of rural vs. urban dwellers in Thailand MATERIAL AND METHOD: A cross-sectional study was conducted in both rural and urban areas of Khon Kaen province. After a 12-hour fast, blood was drawn for assessment of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. The classification of dyslipidemia was based on the NCEP A TP III guidelines. RESULTS: The authors recruited 916 subjects (595 urban; 321 rural), ranging between 20 and 88 years of age. In both the men and women, the mean TC and LDL-C were significantly higher in urban vs. rural subjects (TC; 207 vs. 169 for men and 204 vs. 192 mg/dl for women and LDL-C; 120 vs. 87 for men and 122 vs. 110 mg/dl for women, p < 0.001). The rural women had a significantly higher mean TG (159 vs. 111 mg/dl, p < 0.001) but lower HDL-C (51 vs. 59, mg/dl, p < 0.001) than urban women. The TG and HDL-C between urban and rural men was not significantly different. Urban men had a significantly higher prevalence of dyslipidemia (TC > or =240 and LDL-C > or = 60 mg/dl) than rural men (25.9 vs. .3.7 per cent for TC and 16.7 vs. 3.7 percent for LDL-C, p < 0.001) while the prevalence of hypertriglyceridemia (> or =200 mg/dl) and low HDL-C (< 40 mg/dl) was significantly higher in rural women (18.2 vs. 7.9 percent for TG and 15.0 vs. 3.8 per cent of HDL-C, p < 0.001). The results were unchanged after matching for age and sex between the urban and rural populations. CONCLUSION: This present study demonstrated a significant difference in urban vs. rural lipid levels and the prevalence of dyslipidemia. Migration to urban centers and adopting an urban lifestyle is likely related to the rising lipid level and prevalence of dyslipidemia.

Association between waist circumference and percentage body fat among rural Thais.

OBJECTIVE: Determine the association between waist circumference (WC) and percentage body fat (%BF) and to develop cut-off values and evaluate the accuracy of WC in the definition of obesity in rural Thai population. MATERIAL AND METHOD: A cross-sectional, epidemiologic study in 181 men and 255 women aged 50+/-16 yr (mean+/-SD; range: 20-84 yr) sampled by stratified clustering sampling method, was designed. Percentage body fat was measured by dual energy X-ray absorptiometry (GE Lunar Corp, Madison, WI). The "golden standard"for defining obesity was%BF > or = 25 in men and%BF > or = 35 in women. Waist circumference in centimeter was measured. RESULTS: In this study, the %BF-based prevalence of obesity in men and women was 8.3% and 44%, respectively. However using the WC cut-off (WHO) of 102 cm in men and 88 cm in women, only 1.7% of men and 24% of women were classified as obese. WC was a significant predictor of %BF, such that in men, a WC of 93 cm would predict a %BF of25%, and in women a WC of 84 cm would correspond to a %BF of 35%. The area under the receiver operating characteristic curve was 0. 87 and 0. 88 in men and women, respectively. In conclusion, waist circumference is a reasonably useful indicator of obesity. CONCLUSION: The cut-off values of WC for diagnosing obesity should be lower in Thailand than in Western countries.

Prevalence of osteoporosis in Thai men.

BACKGROUND: Osteoporosis is a growing health problem not only in women but also in men. However, there is a scarcity of epidemiologic data to study osteoporosis in Thai men. OBJECTIVES: To examine the bone mineral density (BMD) and to determine the prevalence of osteoporosis in Thai men. MATERIAL AND METHOD: A total of 412 men (159 from Bangkok and 253 from Khon Kaen, respectively) averaging 51 +/- 16 years of age, were measured for BMD at the femoral neck and lumbar spine by dual energy X-ray absorptiometry (LUNAR Corporation, WI, USA). RESULTS: The peak BMD was observed in men 20-29 years of age at both the femoral neck (mean +/- SD, 1.10 +/- 0.15 g/cm2) and lumbar spine (mean +/- SD, 1.17 +/- 0.13 g/cm2). The prevalence of osteoporosis in the entire group of subjects was 12.6, 4.6 and 3.9 per cent at the femoral neck, lumbar spine and both sites, respectively. The prevalence of osteoporosis increased with advancing age and was significantly higher at the femoral neck in urban men than rural men (18.2 vs 9.2 per cent, p < 0.05) but comparable at the lumbar spine (5.0 vs 4.3 per cent, p = 0.81). The correlation between femoral neck and lumbar spine BMDs was 0.53 (p < 0.001). In univariate analysis, increased age, lower weight and lesser height were each associated with lower femoral neck BMD, whereas only lower weight and lesser height were associated with lower lumbar spine BMD. However, when the three factors were entered simultaneously, only increased age and lower weight were significantly associated with lower femoral neck BMD and only lower weight had a significant association with lower lumbar spine BMD. CONCLUSION: The present study demonstrated descriptive BMD data, normal BMD reference values for diagnosis and reported the prevalence of osteoporosis in Thai men.

Prevalence of dyslipidemia in rural Thai adults: an epidemiologic study in Khon Kaen province.

Dyslipidemia is an important, modifiable CHD risk factor. Previous studies have reported the prevalence of dyslipidemia particularly in urban populations. However, its prevalence in rural Northeast Thailand has not been well documented since extensive dietary and lifestyle transitions induced by the rapid socio-economic development of the late 1990s and early 2000s. The authors, therefore, conducted a cross-sectional assessment for the prevalence of dyslipidemia among rural Thais (in Khon Kaen province) using the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) Guidelines. The 325 subjects recruited (136 men; 189 women) averaged 53.8 +/- 17.6 years of age (range, 20-88). After having the subjects fast 12 hours, serum samples were collected. Total cholesterol, triglycerides, low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) cholesterols were measured. The prevalence of hypercholesterolemia (> 200 mg/dL), hypertriglyceridemia (> 150 mg/dL), high LDL-C (> 130 mg/dL) and low HDL-C (< 40 mg/dL) was 31, 40, 20 and 14 per cent, respectively. Women had a 2- to 3.5-fold higher prevalence of hypercholesterolemia and high LDL-C than men, while the prevalence of hypertriglyceridemia was comparable. The prevalence of dyslipidemia increased with advancing age and increasing BMI; notwithstanding, a high prevalence of dyslipidemia was observed in the youngest tertile as well. In conclusion, the present study demonstrated a high prevalence of dyslipidemia in rural Thai adults; consequently, primary lipid screening should be considered for all ages.

Development and validation of a new clinical risk index for prediction of osteoporosis in Thai women.

The objective of this study was to develop and validate a new simple tool for identifying Thai women who are at high risk of having osteoporosis. A total of 322 women, aged > or = 45 years, were randomly divided into two cohorts: a development (n = 130) and a validation cohort (n = 192). Femoral neck and lumbar spine BMD were measured by LUNAR DPX-IQ densitometer. The prevalence of osteoporosis (defined by BMD T-scores < or = -2.5) was 33 per cent by either femoral neck or lumbar spine BMD. Khon Kaen Osteoporosis Study (KKOS), scoring based on age and weight was calculated and applied to the development cohort. Individuals with KKOS score < or = -1 were defined as "high risk"; otherwise a "low risk" was defined. In the validation cohort, the sensitivity and specificity of KKOS was 70 and 73 per cent, respectively. Furthermore, if the high risk individuals identified by KKOS are to be treated, and if the treatment reduces fracture incidence by 50 per cent and assuming that treatment cost is 10 bahts per day, then the cost to prevent one fracture is estimated to be 466,695 bahts per year. These data suggest that although age and body weight can be used to identify Thai women who are at high risk of having osteoporosis, its application to the general population requires further research to arrive at the optimal cost-benefit for the community.