Panwadee Putwatana

Prevalence and Management of Diabetes and Metabolic Risk Factors in Thai Adults: The Thai National Health Examination Survey IV, 2009

OBJECTIVE To determine the prevalence of impaired fasting glucose (IFG) and undiagnosed and diagnosed diabetes in Thai adults in 2009 and examine the extent of changes in proportions of diagnosis, treatment, and control for blood glucose, high blood pressure, and high total cholesterol between 2004 and 2009. RESEARCH DESIGN AND METHODS Data from the multistage cross-sectional National Health Examination Survey (NHES) IV of 18,629 Thai adults aged ≥20 years conducted in 2009 were used to analyze and compare with the data from NHES III in 2004. RESULTS The prevalence of IFG and diabetes was 10.6 and 7.5%, respectively. Of all diabetes diagnoses, 35.4% were not previously diagnosed, and the proportion was higher in men than in women (47.3 vs. 23.4%, P < 0.05). Compared with those in year 2004, the proportions of individuals with diabetes and concomitant hypertension did not significantly decrease in 2009 in both sexes, but the proportions of women with diabetes who were abdominally obese or had high total cholesterol (≥5.2 mmol/L) significantly increased in 2009 by 18.0 and 23.5%, respectively (all P < 0.01). The rates of treatment and control of blood glucose, high blood pressure, and high total cholesterol were favorably improved in 2009. However, in substantial proportions of individuals with diabetes these concomitants were still controlled suboptimally. CONCLUSIONS The prevalence of diabetes and IFG remained high in Thai adults. Improvement in detection and control of diabetes and associated metabolic risk factors, particularly obesity and high serum cholesterol, are necessary.

Changes in prevalence, awareness, treatment and control of hypertension in Thai population, 2004-2009: Thai National Health Examination Survey III-IV.

Objective: To determine the changes in prevalence, awareness, treatment and control of hypertension and their metabolic risk factors in Thai population between 2004 and 2009. Methods: The Thai National Health Examination Survey (NHES) in 2004 and 2009 data were used. Blood pressure and anthropometric measurements were performed. Prevalence, awareness, treatment and control of hypertension of Thai population aged at least 15 years were calculated. Analyses were weighted to the probability of sampling. Results: The prevalence of hypertension in 2004 and 2009 were relatively stable at approximately 21.0%. There was improvement in awareness of hypertension, from 18.2% for men and 33.0% for women in 2004 to 39.5 and 59.4% in 2009, respectively. The high blood pressure control rates improved from 4.8 to 14.4% for men and from 10.8 to 27.2% for women, respectively (all P < 0.05). The improvement in awareness, treatment and control of hypertension was also observed in individuals with diabetes, obesity and hypercholesterolemia. However, among hypertensive individuals, there were increases in proportions of obesity (BMI ≥ 25 kg/m2) between two surveys: from 39.1 to 47.5% in men and from 54.6 to 62.9% in women, respectively (all P < 0.05). Conclusion: Despite improvement in awareness and control of hypertension in Thai population, a large proportion of hypertensive individuals remained suboptimally controlled. Strengthening measures to control high blood pressure and metabolic risk factors, especially obesity and hypercholesterolemia, in individuals with hypertension are needed.

Urban and rural variation in clustering of metabolic syndrome components in the Thai population: results from the fourth National Health Examination Survey 2009

BackgroundInformation on the distribution of Metabolic syndrome (MetS) and its combinations by urban/rural areas in lower-middle income countries has been limited. It is not clear how the various combinations of MetS components varied by urban/rural population and if particular combinations of MetS are more common. This study aimed to estimate the prevalence of MetS and combinations of MetS components according to sex and urban/rural areas from a nationally representative sample of Thai adults.MethodsData from the fourth National Health Examination Survey of 19,256 Thai adults aged 20 years and over were analyzed. MetS was defined using the harmonized criteria of six international expert groups with Asian-specific cut-point for waist circumference.ResultsThe prevalence of MetS was 23.2% among adults aged ≥ 20 years (19.5% in men and 26.8% in women). Among men, the prevalence of MetS in urban was higher than those in rural areas (23.1% vs 17.9%, P < 0.05), but among women, the prevalence was higher in rural areas (27.9% vs 24.5%, P < 0.05). Overall, an individual component of low high density lipoprotein (HDL) and hypertriglyceridemia were more common in rural areas, while obesity, high blood pressure and hyperglycemia were more common in urban areas. The most common combination of MetS components in men was the clustering of low HDL, hypertriglyceridemia, and high blood pressure (urban: 3.4% vs. rural: 3.9%, adjusted OR 0.9, 95%CI 0.7, 1.1). Among women, the most common combination was the clustering of obesity, low HDL, and hypertriglyceridemia (urban: 3.9% vs rural: 5.9%, adjusted OR 0.8, 95%CI 0.6, 0.9), followed by the clustering of these three components with high blood pressure (urban: 3.1% vs. rural 4.5%, adjusted OR 0.8, 95%CI 0.7, 0.9).ConclusionMetabolic syndrome affects both urban and rural population with different pattern of MetS combinations. Dyslipidemia and obesity were the most common components among women in rural areas, hence, interventions to prevent and control these factors should be strengthened.

Dietary Pattern and Metabolic Syndrome in Thai Adults

Objectives. To determine the dietary patterns of middle-aged Thais and their association with metabolic syndrome (MetS). Methods. The Thai National Health Examination Survey IV data of 5,872 participants aged ≥30–59 years were used. Dietary patterns were obtained by factor analysis and their associations with Mets were examined using multiple logistic regression. Results. Three major dietary patterns were identified. The first, meat pattern, was characterized by a high intake of red meat, processed meat, and fried food. The second, healthy pattern, equated to a high intake of beans, vegetables, wheat, and dairy products. The third, high carbohydrate pattern, had a high intake of glutinous rice, fermented fish, chili paste, and bamboo shoots. Respondents with a healthy pattern were more likely to be female, higher educated, and urban residents. The carbohydrate pattern was more common in the northeast and rural areas. Compared with the lowest quartile, the highest quartile of carbohydrate pattern was associated with MetS (adjusted odds ratio: 1.82; 95% CI 1.31, 2.55 in men and 1.60; 95% CI 1.24, 2.08 in women), particularly among those with a low level of leisure time physical activity (LTPA). Conclusion. The carbohydrate pattern with low level of LTPA increased the odds of MetS.

Prevalence and Trends of Obesity and Association with Socioeconomic Status in Thai Adults: National Health Examination Surveys, 1991–2009

We determined the prevalence of obesity in Thai adults aged 20 and over in 2009 and examined trends of body mass index (BMI) between 1991 and 2009. Data from Thai National Health Examination Survey for 19,181 adults in 2009 and 64,480 adults between 1991 and 2004 were used to calculate age-adjusted mean and prevalence. Logistic regression was used to examine the association of obesity with education level. In 2009, age-adjusted prevalence of obesity classes I (BMI 25–29.9 kg/m2) and II (BMI ≥30 kg/m2) in Thai adults aged ≥20 years were 26.0% and 9.0%, respectively. Compared with primary education, the odds of obesity class I were highest in men with university education. For women, the odds of obesity classes I and II were highest in those with primary education. BMI significantly increased from 21.6 kg/m2 in men and 22.8 kg/m2 in women in 1991 to 23.3 kg/m2 and 24.4 kg/m2 in 2009, respectively. The average BMI increases per decade were highest in men with secondary education (1.0 kg/m2, P < 0.001) and in women with primary education with the same rate. There were increasing trends in BMI with slight variation by SES groups in Thai men and women during 1991–2009.

Impact of an integrated health education and exercise program in middle-aged Thai adults with osteoarthritis of the knee.

PURPOSE: To examine the impact of an integrated health education and exercise program on knee osteoarthritis knowledge, self-efficacy expectations, behaviors, and health outcomes including severity of knee symptoms, muscle strength, joint range of motion, and body mass index in middle-aged adults with knee osteoarthritis. DESIGN/METHOD: Sixty-five participants were assigned to either Group 1 or Group 2. Both groups received a 1-day health education program followed by a facilities-based exercise program for Group 1 and a supervised home-based exercise program for Group 2, 3 times a week for 12 weeks. RESULTS: Participants in each group had a significant improvement in study variables at 2-, 8- and 12-week follow-ups compared with baseline assessment. There were no significant differences in study variables between the 2 groups, except muscle strength and right knee flexion. IMPLICATION: Integrated health education with either a facilities-based or supervised home-based exercise program is beneficial for patients with knee osteoarthritis.

Educational needs of family caregivers of persons living with HIV/AIDS in Thailand.

As the AIDS epidemic continues to overwhelm the acute care hospital system in Thailand, an increasing number of family members are required to provide care for persons living with AIDS (PLWA) in their homes. In response to the increasing demand for home care, a qualitative study using focus group methodology was conducted to learn more about the need for education and support for family caregivers of PLWA in Thailand. Eighteen family caregivers and 18 nurses caring for PLWA participated in four focus group discussions. The major themes identified were fear, stigma, sorrow, empathy, hopelessness, and hope. In addition, participants voiced a need for education to improve the knowledge and skills related to care of PLWA. These findings will be used to guide the development of a training program for family caregivers.

Prevalence of Dyslipidemia and Management in the Thai Population, National Health Examination Survey IV, 2009

This study determined the prevalence and management of dyslipidemia in Thai adults using data from the Thai National Health Examination Survey IV in 2009. Dyslipidemia was defined based on the Third Adult Treatment Panel guidelines. A total of 19,021 adults aged 20 yr and over were included. Mean (SE) levels of total cholesterol, HDL-C, LDL-C, and triglycerides were 206.4 (1.03), 46.9 (0.34), 128.7 (1.09), and 131.4 (2.20) mg/dL, respectively. Prevalence of high LDL-C, low HDL-C, and high triglycerides were 29.6 %, 47.1 %, and 38.6%, respectively. Compared with individuals in the north and northeast, residents in Bangkok and Central region had significant higher levels of LDL-C but lower level of HDL-C. Triglyceride level was the highest in the northeast residents. Overall, 66.5% of Thais had some forms of dyslipidemia. Awareness and treatment of high LDL-C among those with high LDL-C were 17.8% and 11.7%, respectively. Among individuals aware of high LDL-C, those at highest CHD risk compared with those at low risk had higher percentage of treatment (73.1% versus 51.7%, resp.) but lower percentage of control at goal (32.9% versus 76.4%, resp.). Various forms of dyslipidemia are common in Thai adults, with a low level of awareness and treatment of high LDL-C.

Health behaviors among short- and long- term ex-smokers: results from the Thai National Health Examination Survey IV, 2009.

BACKGROUND Although numerous studies have shown the health behaviors of ex-smokers to be better than those in regular smokers, the differences in health behaviors among ex-smokers at varying durations of cessation have not been investigated. This study aims to examine the relationship between different durations of smoking cessation and health behaviors. METHODS Data on dietary intake, alcohol consumption, physical activity, and smoking behavior from the Thai National Health Examination Survey IV for subjects aged 15-98 years (n=19 371) were included in the analysis. Trends between health behaviors among regular smokers, ex-smokers with different durations of smoking (<1 year, 1-10 years, >10 years), and never smokers were tested. Logistic regression models adjusted for sex, age, and economic status were used. RESULTS The prevalences of regular smoking, ex-smoking, and never smoking were 22.3%, 12% , and 65.7%, respectively. A trend was found for consumption of fruit, beans and meats, dairy and soy milk, whole-grain products, nutritional supplements, and eating habits. Average daily alcohol consumption (g) was lowest among ex-smokers who had quit for>10 years ex-smokers (16.4) followed by 1-10 years ex-smokers (27.2), and <1 year ex-smokers (33.7). CONCLUSION A longer duration of smoking cessation correlated with better health behaviors.

Religious affiliation and disparities in risk of non-communicable diseases and health behaviours: findings from the fourth Thai National Health Examination Survey.

This study aims to compare the health-related behaviours and risk of non-communicable diseases (NCDs) between Muslims and non-Muslims in Thailand, a predominantly Buddhist country in which Muslims are the second largest religious group. Data from the fourth Thai National Health Examination Survey (NHES IV) conducted in 2009 were used to run multivariate survey logistic regression models with adjustment for age, gender and socio-economic status indicators. Data from 20,450 respondents, of whom 807 (3.9%) were Muslims, were included in the study. Muslims were significantly more likely to have daily consumption of deep-fried food (adjusted odds ratio [OR] = 1.35; 95% confidence interval [CI] = 1.15−1.58) and packaged snacks (adjusted OR = 1.55; 95% CI = 1.30−1.86), and have inadequate control of hypercholesterolemia (adjusted OR = 2.95; 95% CI = 1.30−6.68). In conclusion, we found disparity in the majority of risk factors for NCDs between Muslim and non-Muslim Thais.