The discrimination of dyslipidaemia using anthropometric measures in ethnically diverse populations of the Asia-Pacific Region: the Obesity in Asia Collaboration.

Dyslipidaemia is a major risk factor for cardiovascular disease and is only detectable through blood testing, which may not be feasible in resource-poor settings. As dyslipidaemia is commonly associated with excess weight, it may be possible to identify individuals with adverse lipid profiles using simple anthropometric measures. A total of 222 975 individuals from 18 studies were included as part of the Obesity in Asia Collaboration. Linear and logistic regression models were used to assess the association between measures of body size and dyslipidaemia. Body mass index, waist circumference, waist : hip ratio (WHR) and waist : height ratio were continuously associated with the lipid variables studied, but the relationships were consistently stronger for triglycerides and high-density lipoprotein cholesterol. The associations were similar between Asians and non-Asians, and no single anthropometric measure was superior at discriminating those individuals at increased risk of dyslipidaemia. WHR cut-points of 0.8 in women and 0.9 in men were applicable across both Asians and non-Asians for the discrimination of individuals with any form of dyslipidaemia. Measurement of central obesity may help to identify those individuals at increased risk of dyslipidaemia. WHR cut-points of 0.8 for women and 0.9 for men are optimal for discriminating those individuals likely to have adverse lipid profiles and in need of further clinical assessment.

Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension.

Recent estimates indicate that two billion people are overweight or obese and hence are at increased risk of cardiovascular disease and its comorbidities. However, this may be an underestimate of the true extent of the problem, as the current method used to define overweight may lack sensitivity, particularly in some ethnic groups where there may be an underestimate of risk. Measures of central obesity may be more strongly associated with cardiovascular risk, but there has been no systematic attempt to compare the strength and nature of the associations between different measures of overweight with cardiovascular risk across ethnic groups. Data from the Obesity in Asia Collaboration, comprising 21 cross-sectional studies in the Asia-Pacific region with information on more than 263,000 individuals, indicate that measures of central obesity, in particular, waist circumference (WC), are better discriminators of prevalent diabetes and hypertension in Asians and Caucasians, and are more strongly associated with prevalent diabetes (but not hypertension), compared with body mass index (BMI). For any given level of BMI, WC or waist:hip ratio, the absolute risk of diabetes or hypertension tended to be higher among Asians compared with Caucasians, supporting the use of lower anthropometric cut-points to indicate overweight among Asians.

High prevalence of chronic kidney disease in Thailand.

We describe the prevalence of stage III and IV chronic kidney disease in Thailand from a representative sample of individuals aged 35 years and above using a stratified, multistage, cluster-sampling method. Population estimates were calculated by applying sampling weights from the 2000 Thai census. Glomerular filtration rates were estimated from serum creatinine using the Cockroft-Gault and the simplified Modification of Diet in Renal Disease (MDRD) formulae. The prevalence of stage III disease among individuals aged 35 years and above was estimated to be about 20% using the Cockroft-Gault formula and about 13% from the MDRD formula. Stage IV disease was present in about 0.9 and 0.6% of this population using the respective formulae. The highest prevalence rates were observed in less well-developed rural areas and the lowest in developed urban areas. The prevalence of chronic kidney disease was significantly higher than that reported in individuals over 40 years old from the United States for both stage III and IV disease and higher than the reported incidence in Taiwan and Australia. This high prevalence of chronic kidney disease in Thailand has obvious implications for the health of its citizens and for the allocation of health-care resources.

Obesity indices and cardiovascular risk factors in Thai adults.

OBJECTIVE: To examine the relationship of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) with cardiovascular risk factors and diabetes in Thai population. DESIGN: A national cross-sectional survey of cardiovascular risk factors. SUBJECTS: Five thousand and three hundred five Thai adults aged > or =35 years. MEASUREMENTS: Body weight, height, waist and hip circumference and cardiovascular risk factors including blood pressure, total plasma cholesterol, high-density lipoprotein, triglyceride and fasting plasma glucose were measured. Age- and sex-specific means and prevalence of cardiovascular risk factors were calculated and compared among anthropometric measurements. RESULTS: There were increasing trends of severity of cardiovascular risk factors and prevalence of morbidity conditions across increasing levels of BMI, WC, WHpR and WHtR categories. For age group > or =65 years, WC, WHpR and WHtR provided more consistent association with cardiovascular risk factors than BMI. Area under the curve indicated that measurement of central obesity could predict cardiovascular risk better than BMI. The optimal cutoff points for anthropometric measurements were in line with the Asia-Pacific recommendation; however, similar cutoff point for men and women between 82 and 85 cm was observed. CONCLUSION: Central obesity indices were slightly better associated with cardiovascular risk factors compared to BMI in Thai adults aged > or =35 years.

Is a single definition of the metabolic syndrome appropriate?--A comparative study of the USA and Asia.

The metabolic syndrome has been identified as an increasingly important precursor to cardiovascular diseases in many Asian populations. Our objective was to compare the contribution of component risk factors to the diagnosis of the metabolic syndrome, as defined by the Third report of the National Cholesterol Education Program Expert Panel Adult Treatment Panel (NCEP-ATPIII), in the US and selected Asian populations. Nationally representative survey data from Hong Kong, Taiwan, Thailand and the US were used. Analyses were restricted to men and women aged > or = 35 years. The age-standardized prevalence of the NCEP-ATPIII defined metabolic syndrome was highest in the US (31% in men, 35% in women), and lowest in Taiwan (11% in men, 12% in women). The component risk factors that defined the presence of the metabolic syndrome varied between countries. As expected, abnormal waist circumference was considerably more prevalent among individuals with the metabolic syndrome in the US (72% in men, 94% in women) compared with their Asian counterparts, but substantial variation was also observed between the Asian populations (13-22% in men, 38-63% in women). Furthermore, the relative contribution of other risk factors to the metabolic syndrome was also substantially different between countries. The NCEP-ATPIII definition identifies a heterogeneous group of individuals with the metabolic syndrome in different populations.

Fat distribution is strongly associated with plasma glucose levels and diabetes in Thai adults-the InterASIA study.

AIMS/HYPOTHESIS: Asian populations have high risks of disease at low levels of BMI and weight, possibly because of high rates of abdominal obesity. In such populations, waist circumference and WHR (measures of fat distribution) may better capture the effects of adiposity. METHODS: The strengths of the associations between different measures of adiposity and glucose levels and diabetes were investigated in the Thai component of the International Collaborative Study of Cardiovascular Disease in Asia (InterASIA), a multi-stage cross-sectional survey of risk factors in Thai adults aged 35 years or over. The analyses included 5,302 men and women. RESULTS: All four measures of adiposity were positively associated with plasma glucose and the odds of having diabetes (all p<0.001), but the associations were stronger for measures of fat distribution. The age- and sex-adjusted fasting plasma glucose level increased linearly across each fifth of weight, BMI, waist and WHR by 0.12 mmol/l (SE 0.02), 0.12 (0.02), 0.17 (0.02) and 0.16 (0.02), respectively. The corresponding odds ratios for diabetes were 1.41 (95% CI 1.27-1.56), 1.43 (1.28-1.59), 1.64 (1.47-1.83) and 1.70 (1.52-1.90), respectively. Multivariate analyses incorporating different combinations of adiposity measures, as well as analyses of receiver operating characteristics, confirmed the greater predictive value of measures of fat distribution. CONCLUSIONS/INTERPRETATION: Waist circumference and WHR were more strongly associated with fasting plasma glucose and diabetes than were weight and BMI. These measures of abdominal adiposity are likely to be more useful for assessing the obesity-related risk of cardiovascular diseases in Asian populations.

Quality of life and functional status of patients with hip fractures in Thailand.

Measurement of quality of life and functional status provides important additional information for priority setting in health policy formulation and resource allocation. Hip fracture has been a concern in health planning in developing countries due to an increasing trend, as reported in several studies. Ironically, in developing countries, studies of the impacts of hip fracture on quality of life and functional status are rare. This prompted our team to seek evidence of the impacts using a longitudinal follow-up approach in a Thai setting. In this study, health-related quality of life (HRQOL) before and after hip fractures was evaluated in 250 Thai patients. Measurement of HRQOL was based on a modified SF-12 questionnaire, which was developed with a realization of the following demands: 1) cultural sensitivity of measurement tools; 2) disease-specific HRQOL measurement and 3) feasibility of conducting field work. Functional status was measured using an adapted version of the Index of Activity of Daily Living (ADL), which was previously developed in another setting in Thailand. Mild, moderate and severe deficits in quality of life were found in 36%, 60%, and 4% respectively, of surviving patients. The number of patients with physical functioning dependency, as measured by the ADL, also increased significantly in all 10 activities assessed. Comorbidities were associated with deficits in health-related quality of life but age, sex, income, education level, and surgery were not. Our findings indicate that hip fracture could lead to crippling consequences, with a pronounced effect on the quality of life of Thai patients. Further studies using control groups and longitudinal design are needed to validate the results of this study.

Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population.

The purpose of this study was to clarify the relation between psychological and other risk factors, notably helicobacter pylori (H. pylori) infection, in contributing to the occurrence of peptic ulcer (PU) disease. A retrospective case-control study was conducted at Siriraj Hospital, Bangkok from March to December 2000. Seventy endoscopically diagnosed patients with new PU or peptic perforation were compared with 70 patients with other diseases as well as blood donors control matched for age and sex. Historical risk factors, H. pylori Immunoglobulin G antibody (H. pylori IgG Ab), stress (Perceived Stress Questionnaire) and hostility (MMPI Hostility Scale) were assessed. Data were analyzed using logistic regression analysis. The results showed that PU was associated with chronic stress (aOR 2.9, p = 0.01; 95% CI, 1.3-6.5) and family history of PU (aOR 2.4, p < 0.03; 95% CI, 1.1-5.1), with an interaction effect between stress and irregular mealtimes (aOR 4.8, p = 0.01; 95% CI, 1.3-16.9). The incidence rate of H. pylori infection in PU patients was similar to the control group (61.4% and 50.0%, respectively, OR 1.2). The authors conclude that stress and family history, not H. pylori infection, are important risk factors for PU in this population. This finding supports previous studies in Thailand, showing a high prevalence of H. pylori in the population but a low association with PU, in contrast to developed countries. It remains to be seen whether the impact of a family history is due to genetic factors or shared life-style patterns.

Physical activity and risk factors for hip fractures in Thai men.

To test the hypothesis that hip fracture is associated with physical activity in Thai elderly men, a case-control study was conducted in Bangkok, Thailand. A total of 187 men aged 51 years over, resident in Bangkok, admitted consecutively with a radiologically confirmed first hip fracture were studied. 177 age-matched community controls were randomly recruited from the same neighborhood of the cases. Physical activity was independently associated with reduced risk of hip fracture after controlling for confounding factors. Very active and active past physical activity markedly reduced risk of hip fracture in comparison to subjects with inactive past physical activity. Recent active physical activity was also protective against hip fracture. This prompts a need to identify strategy to promote physical activity among the elderly and at an early age.

Prevalence estimation of dementia among Thai elderly: a national survey.

OBJECTIVE: To determine the prevalence of dementia and its associated factors among Thai elderly. DESIGN: A one-stage cross-sectional national survey. SETTING: National communities in Thailand. SUBJECTS: 4,048 elderly subjects aged 60 and above. RESULTS: There were 668 (16.5%) elderly with a CMT score below 15. Among these elderly, 132 were dependent as to certain aspects of self-care. According to the definition of dementia used in this one-stage survey design (i.e. subjects with a low CMT score and self-care dependence), 3.3 per cent of Thai elderly (95% confidence interval = 2.7-3.8) were classified as having dementia. After adjusting to geographic and municipal area, the prevalence rate was 3.4 per cent (95% confidence interval = 2.8-4). Age-specific prevalence rate increased dramatically from 1.0 per cent in the 60-64 age-group to 31.3 per cent in the 90+ age-group. The prevalence rate of dementia among Thai elderly found in this study did not differ from the prevalence rates among the elderly in other Asian and developed countries. Using a logistic regression analysis, 3 independent factors associated with dementia were age, literacy (writing) and geographic area. CONCLUSION: With a one-stage survey design for determining the prevalence of dementia, the prevalence rate and age-specific prevalence rate among the Thai elderly did not differ from those found in other Asian and developed countries.

Physical activity and risk factors for hip fractures in Thai women.

Hip fractures are among the most important causes of ill health and death among elderly people. Several potentially modifiable risk factors have been reported. Most claimed physical activity as a promising, inexpensive preventive measure for hip fracture. However, knowledge about risk factors for hip fracture in Asian populations is very limited. We therefore conducted a case-control study to assess the relationships between physical activity and risk of hip fractures in Thai women. From 14 hospitals in Thailand, 229 cases with a radiologically confirmed first hip fracture were enrolled. Two hundred and twenty-four controls were randomly recruited from the same neighborhood and were matched to the cases by age within a 5 year range. Information on physical activity as well as other potential confounders was obtained through personal interviews. Multivariate logistic regression revealed that past physical activity was protective in both very active and active women (OR = 0.67, 95% CI = 0.40-1.12 for moderately active women and OR = 0.20, 95% CI = 0.10-0.38 for very active women; p value for trend < 0.01). Recent physical activity reduced the risk to about two-thirds (OR = 0.33, 95% CI = 0.19-0.60 and OR = 0.35, 95% CI = 0.18-0.69 for moderately and very active women respectively). In addition, breastfeeding was identified to be a protective factor (OR = 0.87, 95% CI = 0.80-0.94). In contrast, the following risk factors were identified: current use of antihistamine (OR = 13.96, 95% CI = 1.38-141.13) or traditional medicine (OR = 7.66, 95% CI = 2.71-21.63), underlying cerebrovascular diseases (OR = 6.53, 95% CI = 2.10-20.34), history of fracture (OR = 4.04, 95% CI = 1.26-12.99), parental Chinese racial background (OR = 2.52, 95% CI = 1.49-4.23), alcohol consumption (OR = 2.30, 95% CI = 1.04-5.09).

Compliance with the law on car seat-belt use in four cities of Thailand.

Surveys to determine the scope of compliance with the law requiring seat-belt use in Thailand were conducted by observation and interviews with drivers in four cities: namely, Bangkok Metropolis, Chiang Mai, Phuket and Nakhon Ratchasima. The work was carried out in two separate sessions: during the first month following enactment of the law, and six months after its enactment. The sample comprised 46,949 vehicles in the first session (January 1996) and 76,188 vehicles in the second session (July 1996). The results showed that 42.7 per cent of drivers used seat-belts in January and 30.7 per cent in July. When the data were disaggregated according to cities, it was found that more Bangkok drivers complied with the seat-belt law than in Phuket, 24.6 per cent; Chiang Mai, 22.1 per cent; and Nakhon Ratchasima, 18.3 per cent relatively low compliance rate was encountered among drivers of pick-up trucks (including those with modified roofs) and vans, particularly farmers and the self-employed. Women drivers tended to abide by the law more often than men (OR = 1.7, 95% CI = 1.12, 1.23). Inter-city travelers wore seat-belts more than those traveling in the city (OR = 1.74, 95% CI = 1.68, 1.80). About one-fifth of non-users or those who rarely used seat-belts were unsure of the effectiveness of seat-belts in preventing serious injury or death in the case of an accident. Discomfort associated with using seat-belts and the perception that they were rendered unnecessary because of slow traffic in cities were other reasons for non-compliance in 50.6 per cent and 43.9 per cent of cases, respectively. The decline in compliance with the law six months after its enactment indicates that there may be a problem with uniform and consistent enforcement of the law.

Use of AUDIT for alcohol screening among emergency room patients in Thailand. Alcohol Use Disorders Identification Test.

This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood alcohol levels and medical diagnoses. The population under study included 695 current drinkers admitted to emergency rooms of four regional Thailand hospitals. The AUDIT positivity rate was 61% among 343 patients who drank prior to admission and 32% among 352 patients who did not drink alcohol before admission. Breath alcohol levels were positively associated with AUDIT scores. The sensitivity against a previous or current alcohol-related medical diagnosis was 89%. We concluded that the AUDIT is a satisfactory instrument for alcohol screening in this population.

Prevalence of alcohol problems among emergency room patients in Thailand.

AIMS: To determine prevalence rates of alcohol problems among emergency room patients. DESIGN: This was a cross-sectional survey including patient interviews and record reviews. The questionnaire included the Alcohol Use Disorders Identification Test to screen for hazardous or harmful alcohol use (alcohol problems). It also contained questions regarding the chief complaint and factors precipitating the admission. SETTING: Emergency rooms of three regional hospitals in Thailand. PARTICIPANTS: Consecutive emergency room admissions aged 14 and older, admitted from 18.00-02.00 h. FINDINGS: Risk factors for alcohol problems included male gender, age 20-49, higher monthly income, less than university graduate education status and admission to the northeast regional ER. Among non-trauma patients, those with alcohol-related diagnoses and certain gastrointestinal disorders had the highest rates of alcohol problems. Patients with transportation injuries were twice as likely, and those with assault-, fall-, or burn-related injuries were at least three times more likely to screen positive compared to the non-injured comparison group. The estimated overall prevalence rate of alcohol problems for this population, adjusted for age and diagnostic classification, was 0.39 for males and 0.08 for females. CONCLUSION: Especially among patients with specified diagnoses, the emergency room is an ideal setting for implementing alcohol screening and intervention programmes in Thailand.

Coverage of public reimbursement scheme for traffic accident victims in Thailand.

Traffic injury is a major threat to public health. Loss of lives and property due to traffic accidents raise concern not only among the public but also the government. As a result, the Motor Vehicle Accident Victim Protection Act was enacted in order to provide compensation for traffic accident victims and their relatives in 1992. Three years after the Accident Victim Protection Act came into effect, this study, through telephone survey, revealed that less than 10 per cent of traffic accident victims were reimbursed for medical care cost by the law. The process of reimbursement was found to be cumbersome. In addition, only 18 per cent of motor vehicles were found holding insurance policies as required by the law.

Retailers' compliance to the law banning cigarette sale to minors.

In order to prevent smoking addiction, a law banning cigarette sales to minors was enacted in 1992. In market economy countries, studies have shown that enforcement of such a law is not effective(1,2). Almost three years after enactment of the law in this country, there is no evidence regarding the extent of law enforcement. If law enforcement is going to be effective, concerns of politicians and authorities must be mobilized. This study aims at testing retailer compliance to the law. Students aged 9-17 years were sent into 773 stores to buy a pack of cigarettes. The stores were located on main streets in 5 major cities. It was found that nearly all (90.6%) of the retailers violated the law. Ten per cent of the stores showed a sticker stating that "cigarette sale to children under 18 years is banned". However, all of them did sell cigarettes to the students. A set of intervention will be tested to find out effective approaches for law enforcement.

A multicenter study on hip fractures in Thailand.

The present study is a multicenter study on hip fractures aimed at estimating the incidence among Thais. It also describes treatment modalities, associated medical care costs, complications, outcome of orthopedic care, length of stay in hospitals and duration of delay in seeking orthopedic care after occurrence of fractures. An extremely low hip fracture incidence of 7.05 per 100,000 population was found. Hip fracture was shown to increase steeply with age. An average of 26.44 days of delay in seeking orthopedic care following occurrence of hip fractures was reported. In contrast to the belief in Western countries that almost all hip fractures will seek orthopedic care, 7.8 per cent of these Thai cases denied orthopedic care during admission to hospitals. Median of charge to patients was 11205.00 baht, over one fourth of the national income per capita (36,563).

Situation of hypertension in some Bangkok slums.

A cross-sectional epidemiologic survey was undertaken in slums in the catchment areas of two health centers in Bangkok. Two hundred and sixty representative households were randomly selected. All adults (993) aged 20 years and over who lived in the households were asked to participate. The results were, however, based on 809 subjects (89%) who responded and whose data were completed. It was found that prevalence of hypertension (blood pressure > or = 160/95 mmHg) was 14 per cent with a 95 per cent confidence interval of 11.8 and 16.4 per cent. Nearly half of the hypertensives were found to be mild cases (diastolic blood pressure = 95-105 mmHg). Less than half of the hypertensives were aware of their condition. Even a lower proportion was under treatment and had their blood pressure controlled. The results confirmed earlier studies that slum inhabitants seem to be at high risk of hypertension. Furthermore, the status of hypertensives in terms of awareness, treatment and control was unacceptably poor. This prompts a need to develop community programmes to cope with the problems.

An investigation of hypertension in a slum of Nakhon Ratchasima.

There is evidence that Thai people living in slums may be at high risk of developing hypertension. The present study was undertaken on a random sample of 1,000 subjects aged 20 and over living in a slum in Muang district of Nakhon Ratchasima during 1 February to 31 may 1988. This study consisted of measurements of blood pressure and body build, with administration of an interview on demographic characteristics, sociocultural factors and food frequency patterns. The results were based on 804 respondents. It was found that the prevalence of hypertension was 16.9%, nearly half of the hypertensives being mild cases. Only a low proportion of the proven cases was both aware of their condition and receiving treatment. About one fifth of the treated cases had blood pressure under 160 mm Hg systolic and 95 mm Hg diastolic. Based on these findings, it is concluded that these slum inhabitants are at high risk of developing hypertension. Community interventions are needed in order to prevent complications related to hypertension. Health education aimed at increasing community awareness of hypertension should be a major component of the community intervention.

Prevalence, detection and control of hypertension in Thai population of a central rural community.

Epidemiolagical survey of hypertension was carried out on 2,374 villagers, aged 15 years and above, residing in Bang-Pa-in district, Ayutthaya province. The overall prevalence of hypertension was 11.3 per cent. The prevalence rate of pure systolic hypertension rose with age up to elderly; whereas the prevalence rate of diastolic hypertension increased with age up to late middle age, then declined in the elderly. Regarding the detection of hypertension, only 41.6 per cent of the cases were previously detected. And only 30.1 per cent of the cases were under current treatment. Females had a greater proportion of previously detected and currently treated cases than males. Among those currently treated hypertensive patients, 50.5 per cent went to see a physician, 29.5 per cent went to the local health centers; the rest sought the services of local quacks, traditional healers and drug stores. It yielded only 24.7 per cent of the treated cases whose BP were under control. Since the people prefer seeking help from local personnel, the role of community health personnel should be strengthened to bring more effective control of the disease.