The relationship between smoking, body weight, body mass index, and dietary intake among Thai adults: results of the national Thai Food Consumption Survey.

This study examined the relationship between dietary intake, body weight, and body mass index (BMI) in adult Thais as a function of smoking status. A cross-sectional, nationally representative survey using health and dietary questionnaires and anthropometric measurements were used. Participants were 7858 Thai adults aged 18 years and older recruited from 17 provinces in Thailand. Results demonstrated that smoking is associated with lower weights and BMI. However, when smokers were stratified by smoking intensity, there was no dose-response relationship between smoking and body weight. There is no conclusive explanation for weight differences across smoking groups in this sample, and the results of the present study did not clearly support any of the purported mechanisms for the differences in body weight or BMI. In addition, because the substantial negative health consequences of smoking are far stronger than those associated with modest weight differences, smoking cannot be viewed as an appropriate weight management strategy.

Socioeconomic status and smoking among thai adults: results of the National Thai Food Consumption Survey.

The authors examined the relationship between socioeconomic status and smoking in Thai adults. A nationally representative sample of 7858 Thais adults (18 years and older) was surveyed during 2004 to 2005. Four demographic/socioeconomic indicators were examined in logistic models: gender, education, occupational status, and annual household income. Overall, 22.2% of the participants were smokers. Men were more likely to be smokers across all age groups and regions. Compared with nonsmokers, current smokers were less educated, more likely to be employed, but had lower household income. When stratified by gender, education and job levels were strongly associated with smoking prevalence among males. A significant relationship was found between annual household income and smoking. Those who lived under the poverty line were more likely to smoke than persons who lived above the poverty line in both genders. The present study demonstrated that socioeconomic factors, especially education level and occupational class, have a strong influence on smoking behavior in Thai adults.

Comparison of cardiovascular risk factors in five regions of Thailand: InterASIA data.

BACKGROUND: Age- and sex- standardized mortality rate of cardiovascular disease (CVD) was high in Bangkok and central Thailand in the year 2000. This may partially be related to differences in risk factors. OBJECTIVE: To compare prevalence of CVD risk factors among regions in Thailand in the same period. MATERIAL AND METHOD: From a survey in 2000 (InterASIA) which involved 5 regions in Thailand, conventional CVD risk factors were compared multivariate-wise among regions and subsequently aligned with CVD deaths obtained within similar regions from the registry. RESULTS: Bangkok and a central province had a higher prevalence of the following: hypertension, elevated body mass index, large waist circumference, elevated lipid associated with low density lipoprotein cholesterol and diabetes mellitus. The Northeast had a higher prevalence of smoking, low values of high density lipoprotein cholesterol and high triglyceride. CONCLUSION: Definite regional differences existed of CVD risks and death in Thailand in 2000. Some of the metabolic risk factors may be more important than smoking in the link with CVD death in Thailand

Risk factors for overweight and obesity among Thai adults: results of the National Thai Food Consumption Survey.

We evaluated the associations between overweight and obesity and socio-economic status (SES), behavioral factors, and dietary intake in Thai adults. A nationally representative sample of 6,445 Thais adults (18-70 years) was surveyed during 2004-2005. Information including demographics, SES characteristics, dietary intake, and anthropometrics were obtained. Overall, 35.0% of men, and 44.9% of women were overweight or obese (BMI ≥ 23 kg/m2) using the Asian cut-points. Regression models demonstrated that age was positively associated with being overweight in both genders. In gender-stratified analyses, male respondents who were older, lived in urban areas, had higher annual household income, and did not smoke were more likely to be classified as overweight and obese. Women who were older, had higher education, were not in a marriage-like relationship and were in semi-professional occupation were at greater risk for being overweight and obese. High carbohydrate and protein intake were found to be positively associated with BMI whereas the frequent use of dairy foods was found to be negatively associated with BMI among men. The present study found that SES factors are associated with being classified as overweight and obese in Thai adults, but associations were different between genders. Health promotion strategies regarding obesity and its related co-morbidity are necessary.

The relationship between smoking, BMI, physical activity, and dietary intake among Thai adults in central Thailand.

OBJECTIVE: Evaluate dietary intake, physical activity, and BMI in adult Thais stratified by smoking status, living in the central region of Thailand. MATERIAL AND METHOD: Participants (n = 1,027) were administered a health questionnaires, 24-h dietary recall, and anthropometric measurements were obtained. RESULTS: Compared to ex-smokers (24.5 +/- 4.3 kg/m2) and non-smokers (24.8 +/- 4.0 kg/m2), current smokers (22.6 +/- 3.8 kg/m2) had significantly lower BMIs, regardless of gender (p < 0.001). In addition, male smokers had smaller waist circumferences than non-smokers. There were no statistically significant differences in nutrient intake or physical activity based on smoking status. Results from this study are consistent with others reports showing that smoking is associated with lower weights and BMI when compared to non-smokers. The mechanism for this association may be related to the potential for nicotine to increase metabolic rate rather than appetite suppression in smokers. CONCLUSION: Because the substantial negative health consequences of smoking are far stronger than those associated with modest weight differences, smoking cannot be viewed as an appropriate weight management strategy.

The association of dietary calcium, bone mineral density and biochemical bone turnover markers in rural Thai women.

OBJECTIVE: To investigate the relative contribution of dietary calcium intake on bone mineral density (BMD) and biochemical bone turnover markers in rural Thai women. MATERIAL AND METHOD: A cross-sectional investigation was designed in 255 rural Thai women. Usual dietary calcium intake was determined by 3-day food records and quantitative food-frequency questionnaire. BMD was measured by DXA. The three markers for bone turnover event: serum total alkaline phosphatase, serum N-mid osteocalcin and type I collagen C-telopeptide, including serum calcium and were determined in 125 women in the present study. RESULTS: An average daily calcium intake in the present study was 265 mg/day. Two hundred and thirty three out of 255 women (87%) consumed dietary calcium less than half of the recommended value and only 3% of women (n = 7) had calcium intake > 800 mg/day. After controlling certain parameters: age and body mass index, women who consumed higher amount of dietary calcium had significantly higher BMD at all sites. Moreover highly increased bone turnover markers were observed in those with lowest quartile calcium intake. Women with osteopenia and osteoporosis were older, lower BMI, consumed less calcium and had significantly higher values of all biochemical bone turnover markers than those who had normal BMD. CONCLUSION: The present study showed that a habitual diet of the rural Thai population might not provide enough calcium as needed for bone retention and for prevention of bone loss in the following years. Modification of eating pattern by promotion of increased consumption of locally available calcium rich food may be beneficial for prevention of osteoporosis among this population.

Dietary calcium intake among rural Thais in Northeastern Thailand.

OBJECTIVES: The present study examined the amount and relative contribution of calcium from the habitual diet among rural Thais. MATERIAL AND METHOD: Calcium intake was assessed using 3-day food records and interviewer-administered quantitative food-frequency questionnaire, containing 73 food items. RESULTS: The authors recruited 436 healthy participants (181 men and 255 women), between 20 and 85 years of age. Averaged daily calcium intake among men and women were 378.6 and 265.6 mg, respectively. Sixty-seven percent of men and eighty seven percent of women had less dietary calcium intake than half of the recommended level (< 400 mg/day) whereas only 6 and 3% had an intake more than 800 mg/day. The major food sources of dietary calcium was glutinous rice (32 percent) followed by small animals with edible bones (31 percent) and fresh and fermented fish (20 percent). Dairy products and vegetables constituted only 8 and 5% of dietary calcium, respectively. CONCLUSION: The habitual diet among rural Northeast Thais does not meet the recommended calcium intake level. To promote more consumption of dairy products and locally-available calcium-rich foods would be beneficial to prevent osteoporosis among this population.

Factors associated with dual form of malnutrition in school children in Nakhon Pathom and Bangkok.

OBJECTIVE: The present study examined the influence of family characteristics and maternal feeding practices on eating behaviors, food consumption and nutritional status of children living in 6 districts of Nakhon Pathom province and 3 surrounding districts of Bangkok. MATERIAL AND METHOD: One hundred and ninety nine families were enrolled in the present study. Four specific mother-child pair groups were purposively selected: 62 obese child/overweight mother pairs, 49 obese child/ normal weight mother pairs, 37 wasted child/overweight mother pairs, and 51 normal weight child/normal weight mother pairs. Anthropometric measurements were performed on all subjects. Biological data, socioeconomic status, maternal feeding practices, as well as eating and lifestyle behaviors of the children were obtained from mothers and children using structured questionnaires and interviews. RESULT: Most mothers from all groups, 40.8%-62.2%, had a primary education, were non-manual workers, with families containing 4-6 persons per household, and a family income of < or = 20,000 baht per month. Multivariate logistic regression analysis showed that maternal overweight prior to pregnancy (OR11.85, 95%CI 2.16-64.99) child's high birth weight (OR 4.53, 95%CI 1.09-18.73) as well as maternal control over the consumption of high caloric food (OR13.07, 95%CI 4.08-41.86) and large amounts of food consumed by the children (OR12.58, 95%CI 4.30-36.80) were significant factors associated with childhood obesity. Compared to normal weight children, a higher proportion of obese children were not breast-fed and a higher proportion of normal weight mothers controlled the consumption of high caloric food in their obese children. Overweight mothers with wasted children also controlled their children's food intake. Higher proportion of wasted children had a higher snack consumption frequency but lower energy food intake than the normal weight children. CONCLUSION: Understanding the underlying causes of dual form of malnutrition in the households would have implication for policy makers to address and implement a nutrition action plan. It is suggested that a malnutrition, (under and over-nutrition) prevention program must involve strategies within families that focus on providing nutrition education and the powerful guidance to help parents foster appropriate patterns of food choice and eating in their children. Promotion of increased physical activity in children is also essential. These strategies are aimed to promote the optimal child's weight and health.

Defining obesity by body mass index in the Thai population: an epidemiologic study.

The objective of this study was to develop cut-off values and evaluate the accuracy of body mass index (BMI) in the definition of obesity in the Thai population. A cross-sectional, epidemiologic study in 340 men and 507 women aged 50 +/- 16 yr (mean +/- SD; range: 20-84 yr), were sampled by stratified clustering sampling method. Body composition, including percentage body fat (%BF), was measured by dual energy X-ray absorptiometry (GE Lunar Corp, Madison, WI). BMI was obtained by dividing weight (in kg) by height (in m2). The "golden standard "for defining obesity was %BF > or =25% in men and %BF > or =35% in women. The %BF-based prevalence of obesity in men and women was 18.8% and 39.5%, respectively. However, using the BMI cut-off of > or =30, only 2.9% of men and 8.9% of women were classified as obese. In the cubic regression model, BMI was a significant predictor of %BF, such that in men a BMI of 27 kg/m2 would predict a %BF of 25%, and in women a BMI of 25 kg/m2 would correspond to a %BF of 35%. The area under the receiver operating characteristic curve for BMI was approximately 0.87 (95% CI: 0.82-0.92) and 0.86 (95% CI: 0.83-0.90) in men and women, respectively. In conclusion, for the Thai population, BMI is a reasonably useful indicator of obesity; however, the cut-off values of BMI for diagnosing obesity should be lowered to 27 kg/m2 in men and 25 kg/m2 in women.

Contribution of lean tissue mass to the urban-rural difference in bone mineral density.

While the urban-rural difference in bone mineral density (BMD) has been shown in some, but not all, Western populations, such a difference and the reason for the difference is largely unknown, particularly in developing countries. This cross-sectional, epidemiologic study was designed to examine the hypothesis that differences in measures of body composition such as lean mass (LM) and fat mass (FM) contribute to the urban-rural difference in BMD. Lean mass, fat mass, lumbar spine and femoral neck BMD were measured by DXA (GE Lunar Corp, Wis.) in 411 urban (Bangkok city) and 436 rural (Khon Kaen province) Thai subjects, aged 20-84 years. Rural men and women had significantly higher LM and lower FM than their urban counterparts. In multiple linear regression analysis, age, LM, menopausal status (in women) and residence were independent determinants of BMD. After adjusting for age, menopause and LM, rural subjects were found to have significantly higher femoral neck BMD, but not lumbar spine BMD, than urban subjects. Furthermore, to alleviate the potential effect of multicolinearity of LM and FM, each rural subject was matched with each urban subject for FM and age, which resulted in 46 pairs of men and 91 pairs of women. In this matched-pair analysis, the femoral necks in rural men and women were, respectively, 7.3+/-2.1% (mean+/-SE; P<0.01) and 6.3+/-2.8% (P<0.02) higher than in urban men and women. The urban-rural difference in LM accounted for approximately 23 and 5% of the urban-rural difference in femoral neck BMD in men and women, respectively. These data are thus consistent with the hypothesis that the urban-rural difference in BMD at a weight-bearing site is in part associated with the urban-rural difference in lean mass.

Prediction of percentage body fat in rural thai population using simple anthropometric measurements.

OBJECTIVE: To develop and validate sex-specific equations for predicting percentage body fat (%BF) in rural Thai population, based on BMI and anthropometric measurements. RESEARCH METHODS AND PROCEDURES: %BF (DXA; GE Lunar Corp., Madison, WI) was measured in 181 men and 255 women who were healthy and between 20 and 84 years old. Anthropometric measures such as weight (kilograms), height (centimeters), BMI (kilograms per meter squared), waist circumference (centimeters), hip circumference (centimeters), thickness at triceps skinfold (millimeters), biceps skinfold (millimeters), subscapular skinfold (millimeters), and suprailiac skinfold (millimeters) were also measured. The sample was randomly divided into a development group (98 men and 125 women) and a validation group (83 men and 130 women). Regression equations of %BF derived from the development group were then evaluated for accuracy in the validation group. RESULTS: The equation for estimating %BF in men was: %BF(men) = 0.42 x subscapular skinfold + 0.62 x BMI - 0.28 x biceps skinfold + 0.17 x waist circumference - 18.47, and in women: %BF(women) = 0.42 x hip circumference + 0.17 x suprailiac skinfold + 0.46 x BMI - 23.75. The coefficient of determination (R2) for both equations was 0.68. Without anthropometric variables, the predictive equation using BMI, age, and sex was: %BF = 1.65 x BMI + 0.06 x age - 15.3 x sex - 10.67 (where sex = 1 for men and sex = 0 for women), with R2 = 0.83. When these equations were applied to the validation sample, the difference between measured and predicted %BF ranged between +/-9%, and the positive predictive values were above 0.9. DISCUSSION: These results suggest that simple, noninvasive, and inexpensive anthropometric variables may provide an accurate estimate of %BF and could potentially aid the diagnosis of obesity in rural Thais.

Effect of urbanization on bone mineral density: a Thai epidemiological study.

BACKGROUND: The incidence of fractures in rural populations is lower than in urban populations, although the reason for this difference is unclear. This cross-sectional study was designed to examine the difference in bone mineral density (BMD), a primary predictor of fracture risk, between urban and rural Thai populations. METHODS: Femoral neck and lumbar spine BMD was measured by dual-energy X-ray absorptiometry (GE Lunar, Madison, WI) in 411 urban and 436 rural subjects (340 men and 507 women), aged between 20 and 84 years. Body mass index (BMI) was calculated from weight and height. RESULTS: After adjusting for age and body weight in an analysis of covariance model, femoral neck BMD in rural men and women was significantly higher than those in urban men and women (P < 0.001), but the difference was not observed at the lumbar spine. After stratifying by sex, age group, and BMI category, the urban-rural difference in femoral neck BMD became more pronounced in men and women aged <50 years and with BMI > or = 25 kg/m2. CONCLUSIONS: These data suggest that femoral neck BMD in rural men and women was higher than their counterparts in urban areas. This difference could potentially explain part of the urban-rural difference in fracture incidence.

Bone mineral density in rural Thai adults living in Khon Kaen province.

OBJECTIVES: To define the bone status and pattern of bone loss in a normal adult population living in a rural area of Khon Kaen province. STUDY DESIGN: A descriptive study. SETTINGS: Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand. Subjects 436 subjects (181 men and 255 women), aged 20-80 years. MAIN OUTCOME MEASURES: Bone parameter including total bone mineral density (BMD), the bone mineral density at different sites such as forearm, lumbar spine and hip, bone mineral content (BMC) were measured by dual energy X-ray absorptiometry (DEXA). RESULTS: The result revealed that women had lower bone mass at various bone sites than men. The peak bone mass in women was observed between 30-39 years of age except at the distal radius which occurred between 20-29 years of age while the peak bone mass in men was observed between 20-29 years of age. It was also shown that bone loss occurred in both men and women with advancing age. The rate of decline at all sites in women was greater than men especially when they were over 60 years old. When comparisons were made between pre and post-menopausal women, the mean of bone mineral density in pre-menopausal women was 1.18 +/- 0.08, 0.69 +/- 0.06, 0.69 +/- 0.06, 1.0 +/- 0.13, 1.15 +/- 0.13 g/cm2 at total body, mid-shaft radius, ultra distal radius, femoral neck and lumbar spine, respectively while the mean of bone mineral density in post-menopausal women was 1.02 +/- 0.12, 0.54 +/- 0.11, 0.54 +/- 0.11, 0.75 +/- 0.16, 0.88 +/- 0.2 g/cm2 at total body, mid-shaft radius, ultra distal radius, femoral neck and lumbar spine, respectively which were lower than BMD in pre-menopausal women (p<0.05). The mean bone mineral content (BMC) in pre-menopausal women was 2401+318.3 g while in post-menopausal women it was 1915.4+421.7 g (p<0.05). The rate of bone loss correlated with the duration after menopause. In this study, using World Health Organization criteria for diagnosis of osteopenia and osteoporosis and a reference value obtained from Khon Kaen young adults, the prevalence of osteopenia in Khon Kaen women subjects was 37.4 per cent at femoral neck, 30.2 per cent at lumbar spine, 44.5 per cent at ultra distal radius, 31.5 per cent at mid-shaft radius and the prevalence of was osteoporosis 19.3 per cent at femoral neck, 24.7 per cent at lumbar spine, 18.5 per cent at ultra distal radius and 26.4 per cent at mid-shaft radius. CONCLUSION: The result of this study demonstrated the bone parameters in rural Thai adults living in Khon Kaen province, the pattern of bone loss, the difference between men and women and finally the prevalence of osteopenia and osteoporosis.

The nutrition and health transition in Thailand.

OBJECTIVE: To explore and describe the nutrition and health transition in Thailand in relation to social and economic changes, shifts in food consumption patterns and nutritional problems, as well as morbidity and mortality trends. DESIGN: This report reviews the nutrition and health situation and other related issues by compiling information from various reports and publications from several sources. Yearly statistics and reports from the National Statistical Office were used as well as data from the Food and Agriculture Organization (FAO) and national surveys on the nutrition and health situation of the Thai population. RESULTS: Thailand has undergone social and economic transitions during the past three decades and is approaching the post-demographic transitional period. These are evidenced by an increase in life expectancy at birth of the population, and declines in the total fertility and infant mortality rates. The economic structure has also moved from agricultural to industrial. Industrial growth has surpassed that of the agricultural sector as indicated by a steady rise in the share of the industrial sector in the gross domestic product, which is greater than that of other sectors. At the same time, results from several nation-wide surveys indicate that the food consumption pattern of the population has changed considerably; Thai staples and side dishes are being replaced by diets containing a higher proportion of fats and animal meat. A shift in the proportion of expenditure on food prepared at home and that expended on purchased, ready-to-eat food, in both rural and urban settings, gives another reflection of the change in food consumption of the Thai population. The prevalence of overweight and obesity among children and adolescents has increased dramatically during the past 20 years and is more pronounced in children from private schools and urban communities than in those from public schools or rural areas. Among adults, results from two national surveys in 1991 and 1996 indicated that the problem of overweight and other risk factors for cardiovascular disease have increased significantly. In considering the overall causes of death among the Thai population, the leading causes are diet-related chronic degenerative diseases. Diseases of the circulatory system have become the number one cause of death in Thailand and cancer has ranked as the number three cause of death since the late 1980s. CONCLUSIONS: The rapid changes in food intake and lifestyle patterns in Thailand clearly demonstrate a significant impact on the shifting pattern of disease burden of the population. These changes should be monitored carefully and must be reversed through appropriate behaviour modification and the promotion of appropriate eating practices and physical activities.