How do cohabitation and marital status affect mortality risk? Results from a cohort study in Thailand.

OBJECTIVE: To examine the relationship between baseline union status (ie, including marriage and cohabitation) and mortality, paying attention to gender differentials, through an 11-year follow-up of a large cohort in Thailand. DESIGN: Cohort data from Thai Cohort Study (TCS) were linked official death records over an 11-year follow-up period. SETTING: Community-based adults in Thailand. PARTICIPANTS: 87 151 Thai adults participated in TCS cohort. METHOD: Cox regression models measured longitudinal associations between union status and 11-year mortality. RESULTS: From 2005 (baseline) to 2016, persons who cohabited and lived with a partner, married persons but not living with a partner and separated/divorced/widowed people were more likely to die compared with those married and living together with a partner. Those who did not have good family support had a higher death risk than those having good family support.Single or cohabiting women had higher risks of mortality than women who were married and living together with a partner throughout follow-up, while separated/divorced/widowed men had higher risks of mortality than counterpart males. CONCLUSIONS: Our study reveals the protective effect of marriage and living together on mortality in Thailand, an understudied setting where institutionalisation of cohabitation is low leading to a limited mortality protection. Public policies for moderating mortality should thus be gender nuanced, culturally and institutionally specific. Also, we demonstrate that in settings such as Thailand, where marital status is not always defined in the same way as in western cultures, the need to measure cohabitation in locally relevant terms is important.

Factors relating to depressive symptoms of caregivers for older care recipients in Indonesia.

Objectives: Family care is a large part of an informal workforce and there are increasing unmet demands for ageing populations, particularly in low and middle-income country settings. This study investigates relationships and care requirements for older care recipients and their caregivers within the household and identifies factors relating to depressive symptoms among caregivers of older persons.Method: Data were derived from the Indonesian Family Life Survey (IFLS Wave 5). Multiple logistic regressions were used for analyses. Outcomes were Center for Epidemiologic Studies Depression Scale (CES-D score ≥10 as having moderate to severe depressive symptoms).Results: Over half of care recipients aged 50 years and over reported requiring intermediate or high-level care intensity. Primary caregivers were most often spouses for older males and adult children for older females. Factors associated with depressive symptoms among caregivers were not working (adjusted odds ratio, AOR 1.86; 95% Confidence Interval 1.19- 2.90), primary school education (AOR 5.01; 1.96-12.8), living in rural area (AOR 1.38; 1.01-1.88), and having multiple older care recipients in the household (AOR 1.98; 1.43-2.75). Having care recipients with medium or high functional limitation levels (AORs 2.27; 1.51-3.42 and 3.36; 2.00-5.63, respectively) and not receiving household co-resident support were associated with caregivers' depressive symptoms (AOR 1.32; 1.01-1.89).Conclusion: To meet the anticipated future demands for elderly care, addressing factors relating to depressive symptoms, especially amongst those not working, low education, living in rural areas could help mitigate adverse effects for caregivers. Caregivers could benefit from the provision of adequate support, including screening for depressive symptoms.

Social networking sites: a new source of child feeding information for parents in Thailand.

Social networking sites (SNSs) provide opportunities for health and nutrition communication. Data are lacking on whether these SNSs influence Thai parent's food provisioning to young children. In the current study, we examined the prevalence and characteristics of Thai parents who reported participating in child food and nutrition-SNSs and investigated the association between participation in these sites and parents' perceptions and feeding practices. A sample of 379 Thai parents completed a survey about the use of child food and nutrition-SNSs, and feeding practices and child eating behavior. Around 70% of participants, especially female millennials with their first child, have participated in SNSs that provide information about children's diets. High engagement was more common among younger and less educated participants, as well as rural dwellers and those with abnormal body mass index. Among these SNSs' participants, those with higher engagement had higher levels of trust in the nutritional information shared on SNSs. Further analyses showed that parents who have joined these sites had positive associations with not only providing children with more fresh fruits and vegetable but also more processed meats. Further investigations are needed to explore the information these SNSs provided and what influences they have on parents' perceptions around feeding children.

Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument.

BACKGROUND: Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient health service use amongst older people in Mongolia. METHODS: Data were collected using a questionnaire developed for the World Health Organization's Study on global AGEing and adult health (WHO SAGE). There were 478 participants from rural areas and 497 participants from Ulaanbaatar (further divided into 255 ger/yurt district and 242 apartment district residents). Multivariable logistic regression analyses were used to investigate determinants of outpatient and inpatient health service use with reported adjusted Odds Ratios (AORs) and 95 % Confidence Intervals (CIs). RESULTS: Participants were aged 60 to 93 years. About 55 % of respondents used outpatient services in the past 12 months and 51 % used inpatient services in the past three years. Hypertension was the most common reason for health service use. Rural residents had longer travel times and were more likely to incur out-of-pocket expenditure (OOP). Multivariable logistic regression revealed that women were more likely to use outpatient services (AOR 1.88; 1.34-2.63). Compared to apartment residents in urban areas, ger residents in urban areas were less likely to use outpatient services (AOR 0.54; 0.36-0.83). There was no statistically significant differences in inpatient service by location. Increasing numbers of chronic conditions (1 and 2+ compared to none) were associated with both outpatient (AORs 2.59 and 2.78) and inpatient (AORs 1.97 and 3.01) service use. CONCLUSIONS: This study highlights the needs to address disparities in outpatient service use for rural and urban ger populations. Compared with other WHO-SAGE countries, older Mongolians have relatively higher use of inpatient health care services. With a high prevalence of hypertension and an ageing population, efforts to achieve UHC would benefit from reorienting care services towards prevention and primary care management of NCDs to reduce the costs from hospital-based care.

Recipe Components and Parents' Infant and Young Child Feeding Concerns: A Mixed-Methods Study of Recipe Posts Shared in Thai Facebook Groups for Parents.

Social media is increasingly becoming a significant source of information for parents, including about feeding young children. However, little attention has been given to the characteristics of recipes for infants and young children and how they interact with parental perceptions regarding food decisions shared by users on social media. Building on findings related to shared recipe components and parental food choices, between December 2019 and July 2020, this study retrospectively collected 80 shared recipes each from five Thai Facebook groups. This extraction created 379 shared recipes with 1751 peers' commentaries on the shared recipes' posts. The shared recipes were classified and components quantified across child age groups, then the textual contents around the reasons behind the food choices were described qualitatively. The results showed that there were differences in meal types, food ingredients, and seasoning used across child age groups. Further analysis found that food allergy awareness was one driving concern behind parental perceptions on food choices in children's diets. These concerns resulted in delays in the introduction of animal-source foods. Moreover, peers' commentaries on shared recipes offered a venue for exchanging experiences with food products. Because of the potential influence on parental beliefs and perceptions, further studies are required to understand the impact of existing online communities on actual feeding practices.

Child feeding practices and concerns: Thematic content analysis of Thai virtual communities.

Parents' child feeding practices are influenced not only by family but also by a broader circle of networks, including online groups. Peer-to-peer platforms such as Facebook groups facilitate a learning environment and may influence the transmission of user-generated content into practice. These digital data not only benefit participants but also offer new opportunities for researchers to study related phenomena. Therefore, this study employs thematic content analysis to investigate peer-exchanging discourse conveyed in Facebook peer-support groups in children's diets in Thailand. To identify the area of interest, we classified and quantified the initial posts and investigated the relationship between initial posts' contents and community engagement. Thematic analysis was used to qualitatively describe the peer-exchanging content that responded to the initial posts. Of the five approved Facebook groups, 200 initial posts with their 1964 comments were extracted anonymously. Results revealed that Facebook groups devoted to diets for children have become a platform for Thai parents to seek informational and emotional support. The top-ranked initial posts were related to requesting knowledge and skills about age-appropriate food and meal preparation. Parents have also expressed anxiety about feeding and tension related to food fussiness which created the need for emotional support. Age-appropriate feeding, homemade baby foods, concerns about food seasonings and food allergy awareness were observable within online groups. However, a shift from traditional child feeding practices to new ideas created cultural gaps which lead to arguments in some families. Understanding these views would help guide to address parental concerns better.

Pain and Its Impact on Functional Health: 7-Year Longitudinal Findings among Middle-Aged and Older Adults in Indonesia.

Pain is a growing public health issue worldwide, but there is limited population-based evidence in low- and middle-income country settings. Using nationwide Indonesian Family Life Survey (IFLS) data in 2007 and 2014, this research sets out to investigate the associations between changes in pain status between two time points and its impact on functional health outcomes among middle-aged and older adults in Indonesia. Analyses focused on 7936 adults aged 50 years and older in 2014 who responded to both waves. Functional health was assessed using a composite score of functional limitations (range 20-100), representing difficulty in performing activities of daily living, and grip strength (kilograms). Multivariate linear regression models were used to analyse associations between pain measured in 2007 and 2014 and functional health in 2014. Severe pain in the latest wave of IFLS was associated with older age, female, lower education, having chronic conditions or depressive symptoms. Notably, those who reported 'low-medium' pain in 2007 and 'severe' pain in 2014 belonged to the most vulnerable group with worst functional health outcomes (4.96 points higher limitation scores and 1.17 kg weaker average grip strength). Findings have implications for public health policy in monitoring and management of pain including related co-morbidities as an increasingly critical component of population ageing.

Associations Between a History of Depression and Cognitive Performance Among Older Adults in Shandong, China.

This study investigates the relationships between depression and cognitive performance among older adults living in Shandong province. Data were derived from the World Health Organization's Study on global AGEing and adult health (WHO-SAGE) China Wave 1 aged 50 and over residing in Shandong province (n = 1926). Cognitive performance was assessed by overall cognitive score. Data were analysed by multivariate linear regression. In rural Shandong, having a history of depression (- 4.0; p < 0.001), female (- 9.3; p < 0.001), and poor household wealth (- 8.9; p < 0.001) and primary level of education (- 6.4; p < 0.001) were main factors associated with their poor cognitive performance. Notably, in urban Shandong, lowest household wealth (- 12.5; p < 0.001) and not having health insurance (- 9.7; p < 0.001) were significant predictors of adverse cognitive performance. Findings could help inform policy in monitoring depressive symptoms and cognitive performance among older adults in China.

Non-communicable Diseases and Cognitive Impairment: Pathways and Shared Behavioral Risk Factors Among Older Chinese.

Population aging has brought about a number of challenges to public health and primary health care systems due to increases in the prevalence of non-communicable diseases (NCDs). As a country with one of the largest populations globally, China is confronting a rising number of chronic NCDs including cardiometabolic related conditions. This mini-review investigates the link between NCDs and cognitive impairment through common risk factors. Identifying risk factors is important for the prevention and management of these chronic conditions. In addition, this review also identifies the role of primary health care services in reducing behavioral risk factors for NCDs and cognitive impairment. Addressing shared determinants and pathways is important in the design of public health interventions and primary health care services in China. Monitoring and management of NCD biomarkers and behavioral risk factors may also be beneficial for cognitive health among older Chinese.

Utilization of Traditional Chinese Medicine Practitioners in Later Life in Mainland China.

Mainland China is one of the world's most rapidly aging countries, and yet there is very limited literature on traditional Chinese medicine (TCM) use in older individuals. This study aimed to determine the national and provincial prevalence of TCM practitioner utilization in later life and associated factors. We used World Health Organization China Study on Global Aging and Adult Health Wave 1 data to determine descriptive statistics of the study population of participants aged 50 years and over. Multivariate logistic regression was conducted controlling for sociodemographic and health factors. A total of 14% of participants utilized a TCM practitioner, and the prevalence of utilization varied significantly by locality. Utilization was more likely in participants living in rural areas [adjusted odds ratio (OR) = 12.96; p < 0.001], Hubei (OR = 7.17; p < 0.001), or Shandong provinces (OR = 4.21; p < 0.001) and being diagnosed with chronic lung disease (OR = 1.97; p = 0.005). Hence, rurality, provincial influence, and chronic lung diseases are significant factors associated with TCM practitioner utilization among older individuals in China. These findings may inform policy for preservation and development of TCM nationally as well as its sustainability in an increasingly aging society.

Functional limitations and life satisfaction dynamics among Asian-born migrants and Australian-born participants in the HILDA study.

OBJECTIVE: To investigate functional limitations and life satisfaction among Asian-born migrants and Australian-born participants in the Household, Income and Labour Dynamics in Australia (HILDA) study. METHODS: Information on 10 167 Australian-born participants and 650 Asian-born migrants from Waves 6 to 16 (2006-2016) of HILDA was analysed using multivariate linear regressions, adjusting for baseline covariates. RESULTS: Middle-aged and older Asian-born migrants had a lower decline in functional limitations compared to the Australian-born participants (-1.74 vs -4.47 during the 5-year period and -5.66 vs -8.50 during the 10-year period). Decline in life satisfaction scores was relatively stable among older Australian-born participants, but there was a steeper decline among Asian-born migrants in the 5-year period. Notably, relative change was not statistically significant for both outcomes. CONCLUSION: This study reveals that middle-aged and older Asian-born migrants had less decline in physical health but not in life satisfaction. Monitoring health and well-being of migrants as they age could help to minimise health disparities in Australia.

Geographical variations in self-rated health and functional limitations among older Chinese in eight WHO-SAGE provinces.

BACKGROUND: The proportion of population ageing in China will grow significantly in the next few decades but the pace of population ageing and social change vary considerably across regions. Notably, Eastern coastal areas are economically more advanced compared to the Western region. These economic disparities could result in differing adverse health outcomes. METHODS: We investigate geographical variations in self-rated overall health and functional limitations in a national representative sample of Chinese aged 50 years and older (n = 13,175) using the WHO Study on global AGEing and adult health (WHO SAGE). We used multivariable logistic regression to investigate urban-rural inequalities across regions, adjusting for sociodemographic and health covariates. Two main outcomes were self-rated overall health and functional limitations based on the WHO Disability Assessment Schedule 2.0 for a range of daily activities. RESULTS: The largest urban-rural differences in adverse health outcomes were in Shandong (AORs for urban versus rural of 6.32 [95% Confidence Interval 4.53-8.82] for poor or very poor self-rated overall health and 5.14 [CI 3.55-7.44] for functional limitations), followed by Jilin (AORs 2.71 [CI 2.04-3.61] and 4.72 [CI 3.43-6.49]), and Hubei (AORs 2.36 [CI 1.82-3.07] and 4.11 [CI 2.80-6.04]), respectively. Covariates significantly associated with both adverse health outcomes were older age, poor income, no health insurance, and increasing number of chronic diseases. CONCLUSION: Our study reveals substantial disparities between urban and rural areas observed in both the well-developed areas (eg Shandong) and also the lower end of the economic spectrum (eg Hubei and Jilin). Targeted economic development policy and systematic health prevention and healthcare policies could be beneficial in improving health in later life whilst minimising geographical inequalities.

Dietary patterns associated with hypertension risk among adults in Thailand: 8-year findings from the Thai Cohort Study.

OBJECTIVE: Dietary intake is a leading risk factor for hypertension. We aimed to assess longitudinal associations between overall dietary patterns and incident hypertension among adults in Thailand. DESIGN: Prospective large Thai Cohort Study (TCS) conducted nationwide from 2005 to 2013. Dietary patterns were identified using factor analysis based on usual intake of fourteen food groups. Multivariable logistic regression assessed associations between dietary patterns and hypertension prevalence and incidence. SETTING: Emerging hypertension and changing diets in Thailand. SUBJECTS: TCS participants who were normotensive at baseline in 2005. RESULTS: Among 36293 participants without hypertension at baseline, 1831 reported incident hypertension (5·1 % incidence) at follow-up. Two dietary patterns were identified: 'Modern' and 'Prudent'. The Modern dietary pattern (high intakes of roasted/smoked foods, instant foods, canned foods, fermented fruits/vegetables, fermented foods, soft drinks, deep-fried foods) was associated with increased incident hypertension (comparing extreme quartiles, OR for incident hypertension=1·51; 95 % CI 1·31, 1·75 in 2013). The Prudent dietary pattern (high intakes of soyabean products, milk, fruits, vegetables) was not associated with incident hypertension in a fully adjusted model. The association between the Modern dietary pattern and hypertension was attenuated by BMI. CONCLUSIONS: Modern dietary pattern was positively associated with hypertension among Thai adults. BMI had a great impact on the relationship between the Modern dietary pattern and incidence of hypertension. Reduction of Modern diets would be expected to prevent and control hypertension. Such a strategy would be worth testing.

Impacts of persistent general and site-specific pain on activities of daily living and physical performance: A prospective analysis of the English Longitudinal Study of Ageing.

AIM: Pain is an increasingly common phenomenon as people age; pain over a long period can result in limited functioning. The present study investigated the impacts of general and multisite-specific pain on activities of daily living and physical performance among older adults. METHODS: Data were analyzed from the English Longitudinal Study of Ageing, a representative sample of the population aged ≥50 years. Face-to-face interview and nurse records were used from waves 2-6 (2004-2012) for analyses. General and site-specific pain (back, hip and knee) were measured biennially between 2004 and 2008 (n = 5010). Impaired activity of daily living and physical performance measures (chair rise and grip strength) between 2008 and 2012 were aggregated across assessments as outcomes. Multinomial logistic regressions were used for the former and linear regression for the latter, adjusting for potential covariates. RESULTS: General pain (moderate-to-severe) was prevalent, with close to one-quarter of participants reporting pain at least twice during the follow-up period. Multisite pain reports were strong predictors of subsequent limited activities of daily living (adjusted odds ratio range 1.86-3.97 for back and hip, 2.04-4.19 for back and knee, and 2.08-5.16 for hip and knee). Persistent pain was also strongly associated with worse physical performance outcomes. CONCLUSIONS: Our data confirm the longitudinal impacts of persistent pain among older adults. The findings highlight the value of monitoring and management of both general and site-specific pain in order to promote sustained independence at older ages. Geriatr Gerontol Int 2018; 18: 1051-1057.

Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data.

Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I 2=45.1%, P=0.004). A moderate association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13-2.01), a weaker association in Europe (1.11, 95% CI 1.00-1.22), and no association in North America (0.97, 95% CI 0.70-1.34) or Australia (0.95, 95% CI 0.70-1.29). Differences by other characteristics were small. Conclusions This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.

Social capital dynamics and health in mid to later life: findings from Australia.

PURPOSE: The influence of social capital has been shown to improve health and wellbeing. This study investigates the relationship between changes in social capital and health outcomes during a 6-year follow-up in mid to later life in Australia. METHODS: Nationally representative data from the Household, Income and Labour Dynamics in Australia (HILDA) survey included participants aged 45 years and over who responded in 2006, 2010 and 2012 (N = 3606). Each of the three components of social capital (connectedness, trust and participation) was measured in Waves 2006 and 2010 and categorised as: 'never low', 'transitioned to low', 'transitioned out of low' and 'consistently low'. Health outcomes in 2012 included self-rated overall health, physical functioning, and mental health based on the Short Form 36-item health survey (SF-36). Multivariable logistic regression assessed changes in social capital (measured in 2006 and 2010) predicted poor health (measured in 2012), adjusting for covariates. RESULTS: Consistently low trust was significantly associated with higher odds of transitions into poor physical functioning (AOR 1.54; 95% Confidence Interval 1.06-1.22), poor mental health (AOR 1.59; 95% CI 1.08-2.36) and poor self-rated health (AOR 1.86; 95% CI 1.27-2.72). Transition into low trust was also a predictor of poor self-rated health after adjusting for covariates (AOR 1.74; 95% CI 1.11-2.73). Changes in social connectedness in both directions (transitioned out of and into low) were statistically associated with poor self-rated health (AORs 1.40; 95% CI 1.00-1.97 and 1.61; 95% CI 1.11-2.34, respectively) after adjusting for confounders as well as other social capital components. CONCLUSIONS: Our longitudinal findings reveal social capital dynamics and effects on health in mid to later life. Social trust and connectedness could be important enablers for older persons to be more active in the community and potentially benefit their health and wellbeing over time.

Nutrition label experience, obesity, high blood pressure, and high blood lipids in a cohort of 42,750 Thai adults.

INTRODUCTION: Nutrition labels have been promoted for nearly two decades in Thailand to educate people about healthy eating and to combat nutrient-related non-communicable diseases (NCDs). But little is known about how nutrition labels are experienced and whether they are linked with better health. Our objective was to investigate the associations between nutrition label experience, obesity and nutrient-related NCDs in Thai consumers. METHODS: A cross-sectional study was undertaken with a nationwide cohort of 42,750 distance learning Thai adult students enrolled in an Open University in 2013. We measured exposure as nutrition label experience (read, understand, use). Health outcomes were high blood pressure, high blood lipids, and high Body Mass Index (overweight at risk and obesity). Multivariate logistic regression was used to determine the association between nutrition label experience and health outcome adjusting for sociodemographic attributes, physical activity, smoking, and alcohol intake. RESULTS: Frequent nutrition label use varied by cohort attributes and health outcomes and was least for those with low physical activity and high blood pressure. Being male, older, an urban resident or with low physical activity was associated with increasing high blood pressure and high blood lipids. Compared to those who read, understand and use nutrition labels, participants who did not (read, understand, and use), were more likely to report high blood pressure (Adjusted Odds Ratio 1.33; 1.17-1.51), high blood lipids (AOR 1.26; 1.14-1.39), and obesity (AOR 1.23; 1.13-1.33), but were not more likely to be overweight at risk (AOR 1.06; 0.97-1.16). CONCLUSIONS: We found cross-sectional associations between low nutrition label experience and increased likelihood of high blood pressure, high blood lipids, and obesity among Thai adults. Nutrition label education should be promoted as part of a public health approach to appropriate food choices and better lifestyles to reduce obesity and nutrient-related NCDs.

Social Demography of Transitional Dietary Patterns in Thailand: Prospective Evidence from the Thai Cohort Study.

In recent decades, a health-risk transition with changes in diet and lifestyle in low and middle-income countries (LMICs) led to an emergence of chronic diseases. These trends in Southeast Asian LMICs are not well studied. Here, we report on transitional dietary patterns and their socio-demographic predictors in Thai adults. Dietary data in 2015 were from a random sub-sample (N = 1075) of 42,785 Thai Cohort Study (TCS) members who completed all three TCS surveys (2005, 2009, 2013). Principle Component Analysis identified dietary patterns and multivariable linear regression assessed associations (Beta estimates (ß) and confidence intervals (CIs)) between socio-demographic factors and dietary intake pattern scores. Four dietary patterns emerged: Healthy Transitional, Fatty Western, Highly Processed, and Traditional. In women, higher income (≥30,001 Baht/month vs. ≤10,000) and managerial work (vs. office assistant) was associated with lower scores for Traditional (ß = -0.67, 95% CI -1.15, -0.19) and Fatty Western diets (ß = -0.60, 95% CI -1.14, -0.05), respectively. University education associated with lower Highly Processed (ß = -0.57, 95% CI -0.98, -0.17) and higher Traditional diet scores (ß = 0.42, 95% CI 0.03, 0.81). In men and women, urban residence associated with higher Fatty Western and lower Traditional diets. Local policy makers should promote healthy diets, particularly in urban residents, in men, and in low-SEP adults.

Relationship between 8-year weight change, body size, and health in a large cohort of adults in Thailand.

BACKGROUND: Overweight and obesity have been shown to be risk factors for a range of non-communicable diseases, especially cardio-metabolic conditions, worldwide. But less is known about the effects of weight change on adults' overall health and wellbeing, particularly in transitional low- and middle-income countries. This study aimed to assess the relationship between 8-year weight change and measures of self-assessed health among Thai adults. METHODS: Data were collected from Thai adults aged 25-40 years (n = 27,003) enrolled in the Thai cohort Study and surveyed in 2005, 2009, and 2013. We used self-reported weight and height measurements at baseline and 2013, as well as three standard health questions regarding overall health, energy, and emotion asked at the two time points, to investigate the effects of weight change on health. RESULTS: Between 2005 and 2013, 6.0% of participants lost more than 5% of their baseline weight; 38.5% were stable (<5% loss to 5% gain); 23.0% slightly gained weight (>5%-10%); 22.8% gained moderate weight (>10%-20%); and 9.4% had heavy weight gain (>20%). Moderate (>10%-20%) and heavy weight gain (>20%) were both associated with an increased risk of reporting 'poor or very poor' overall health in 2013 among participants who had a normal body mass index (BMI) (adjusted odds ratio [AOR] 1.39; 95% confidence interval [CI], 1.13-1.71 and AOR 1.44; 95% CI, 1.09-1.90, respectively), were overweight (AOR 1.53; 955 CI, 1.01-2.29 and AOR 1.82; 95% CI, 1.04-3.19, respectively) or had obesity (AOR 2.47; 95% CI, 1.74-3.51 and AOR 3.20; 95% CI, 2.00-5.16, respectively) in 2005. Weight gain of over 20% also had a negative impact on energy level among cohort members with a normal BMI in 2005 (AOR 1.36; 95% CI, 1.11-1.65) and among participants with obesity in 2005 (AOR 1.93; 95% CI, 1.38-2.71). For those who were underweight, had a normal BMI, or had obesity at baseline, weight loss of more than 5% was associated with reporting emotional problems. Excessive weight gain adversely impacted participants who were underweight or had obesity at baseline. CONCLUSION: Our study found that weight change, in particular weight gain, was associated with negative health outcomes, and this effect appeared to increase at higher levels of body size. The present findings may be useful to promote weight maintenance and healthy lifestyles.

Nutrition label experience and consumption of transitional foods among a nationwide cohort of 42,750 Thai adults.

PURPOSE: The purpose of this paper is to assess the usefulness of nutrition labels in Thailand during nutrition transition from traditional to modern diets that increase salt, sugar, and calorie intake and to note socio-demographic interactions and associations with consumption of transitional processed foods. DESIGN/METHODOLOGY/APPROACH: The authors studied 42,750 distance learning Open University adults aged 23-96 years in 2013 residing nationwide and participating in an ongoing community-based prospective cohort study. The authors used multivariable logistic regression to relate nutrition label experiences ("read", "good understand", "frequent use"), socio-demographic factors, and consumption of four transitional foods. These foods included "unhealthy" instant foods, carbonated soft drinks, and sweet drinks, or "healthy" milk. FINDINGS: Overall, two-thirds reported good understanding and frequent use of nutrition labels. Unhealthy transition-indicator processed foods were frequently consumed: instant foods (7 per cent), (carbonated) soft drinks (15 per cent), and sweet drinks (41 per cent). Frequent users of nutrition labels (e.g. females, older persons, professionals) were less likely to consume unhealthy indicator foods. Those with the most positive overall nutrition label experience ("read" + "good understanding" + "frequent use") had the best indicator food profiles: instant foods (odds ratio (OR) 0.63; 95%CI, 0.56-0.70); soft drinks (OR 0.56; 95%CI, 0.52-0.61); sweet drinks (OR 0.79; 95%CI, 0.74-0.85); milk (OR 1.87; 95%CI, 1.74-2.00). ORIGINALITY/VALUE: Knowledge protected - those with most nutrition label experience were least likely to consume unhealthy foods. Results support government regulated nutrition labels, expanding to include sweet drinks. The study is remarkable for its large size and nationwide footprint. Study subjects were educated, represent Thais of the future, and show high awareness of transition-indicator foods.