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- Chalermsri, Chalobol, 1982-
(författare)
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Dietary diversity and its relation with health among the older population in Thailand
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The role of dietary diversity (DD) in the health status among older people has been recognised. However, the evidence from lower-and-middle-income countries is scarce. The aim of this thesis was to explore the food choice, and dietary diversity, the associated factors and the health consequences of low dietary diversity among older people in Thailand.Study I was a qualitative study, using focus group discussions and individual interviews of people aged 60 years and older informal caregivers in Samut Sakhon Province, Thailand. A deductive thematic analysis approach was used. Studies II–IV acquired the data from the fifth Thai National Health Examination Survey, which was conducted between 2013 to 2015. Dietary diversity score (DDS) comprised eight food groups, including grains, white roots and tubers; pulse and beans, nuts and seeds; dairy products; meat, poultry, or fish; eggs; vegetables; fruits; and fats and oils. Socio-demographic characteristics included age, sex, educational level, wealth index, place of residence and living arrangement. The risk of cardiovascular disease (CVD) was determined using the Thai CV risk score. The cardiometabolic risk factors included hypertension, diabetes mellitus (DM) and lipid profiles. The mortality data was extracted from the Vital Statistics System in 2021. The data analyses used linear, logistic and proportional hazard regressions, which were adjusted for the complex survey design. We found that older people’s food choices relied on several factors, including health, social factors, the food environment and the economic factors. Regarding DD, a higher educational level, a higher wealth index and living in an urban area had a positive association, whereas living alone had a negative association with DDS. Regarding health, DDS had a negative association with log-Thai CV risk score, hypertension, DM and log-TG levels, whereas DDS was positively associated with TC and LDL-C levels. Additionally, DDS was inversely associated with mortality. The association between DDS and mortality was stronger in people aged 70 years and older. Finally, there was an inverse association between DDS and mortality in the underweight subgroup, while there was a positive association between DDS and mortality in the overweight and obesity sub-groups.In conclusion, this thesis showed the associations between DD and several socio-demographic factors and health outcomes. However, the effect of DD on mortality varied, depending on the individual’s age and BMI. Thus, the nutritional policies aimed at improving DD should be focused on the specific target groups to reduce mortality.
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| 2. |
- Chalermsri, Chalobol, et al.
(författare)
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Dietary diversity associated with risk of cardiovascular diseases among community-dwelling older people : A national health examination survey from Thailand
- 2022
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Ingår i: Frontiers in Nutrition. - : Frontiers Media S.A.. - 2296-861X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cardiovascular diseases (CVD) are the common comorbidities in older people. Healthy diet is an essential strategy to alleviate the risk of developing CVD. Dietary diversity (DD) is an indicator of diet quality. Currently, limited research exists regarding DD and CVD in older people in developing countries, such as Thailand, despite rapid growth of older population. Therefore, this study aims to determine associations of DD with the risk of CVD and the cardiometabolic risk factors among Thai older people.Methods: This cross-sectional study used the sub-sample of the fifth Thai National Health Examination Survey conducted from 2013 to 2015. A total of 6,956 older people aged 60 years and older and no pre-existing CVD were included. Dietary diversity score (DDS) was assessed the consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4. The DDS was calculated as the sum of the scores (0-32). The risk of CVD was calculated by using a Thai cardiovascular (CV) risk score. The cardiometabolic risk factors included hypertension, diabetes mellitus (DM), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels. Data were adjusted for a complex survey design and analysed using linear and logistic regression models. Results: In the adjusted model, DDS had a significant negative association with log-Thai CV risk score, with adjusted β (95% CI) values of -0.01 (-0.01, -0.01). Regarding the cardiometabolic risk factors, DDS had a significant negative association with hypertension, DM and log-TG levels, with adjusted OR (95% CI) values of 0.97 (95% CI 0.97, 0.98) for hypertension, 0.94 (0.93, 0.95) for DM, and adjusted β (95% CI) values of -0.002 (-0.004, -0.001) for log-TG level. DDS was positively associated with TC and LDL-C, with adjusted β (95% CI) values of 0.59 (0.38, 0.80) for TC and 0.59 (0.38, 0.79) for LDL-C levels, while DDS was not associated with HDL-C level. Conclusion: Higher DD was associated with a lower risk of CVD among Thai older people. The nutritional policies or interventions should encourage a diverse food intake for the prevention of CVD in this population.
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| 3. |
- Chalermsri, Chalobol, et al.
(författare)
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Dietary diversity predicts the mortality among older people : Data from the fifth Thai national health examination survey
- 2023
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 110
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the association between dietary diversity (DD) and mortality among Thai older people and to investigate whether age, sex, and nutritional status modify this association.Methods: The national survey conducted from 2013 to 2015 recruited 5631 people aged > 60 years. Dietary diversity score (DDS) was assessed for the consumption of eight food groups using food frequency questionnaires. The Vital Statistics System provided the data on mortality in 2021. The association between DDS and mortality was analyzed by Cox proportional hazard model and adjusted for the complex survey design. Interaction terms between DDS and age, sex, and BMI were also tested.Results: The DDS was inversely associated with mortality (HR adj 0.98, 95%CI: 0.96–1.00). This association was stronger in people aged > 70 years (HR adj 0.93, 95%CI: 0.90–0.96 for aged 70–79 years, and HR adj 0.92, 95%CI: 0.88–0.95 for aged > 80 years). Inverse association between DDS and mortality was also found in the underweight older population (HR adj 0.95, 95%CI: 0.90–0.99). A positive association was found between DDS and mortality in the overweight/obese group (HR adj 1.03, 95%CI: 1.00–1.05). However, the interaction between the DDS with sex to mortality was not statistically significant.Conclusion:Increasing DD reduces mortality among Thai older people, especially in those above 70, and underweight. In contrast, an increase in DD also meant an increase in mortality among the overweight/obese group. Focus should be placed on the nutritional interventions aimed to improve DD for those 70 and over and underweight to reduce mortality.
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| 4. |
- Chalermsri, Chalobol, et al.
(författare)
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Exploring the Experience and Determinants of the Food Choices and Eating Practices of Elderly Thai People : A Qualitative Study.
- 2020
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 12:11
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Tidskriftsartikel (refereegranskat)abstract
- Over the past decade, Thailand has experienced a rapid increase in its elderly population. Many unfavorable health outcomes among elderly people are associated with nutrition. Nutrition in elderly people is affected by physical, mental, and social factors. This study explored the food choices and dietary practices among community-dwelling elderly people in Thailand from the perspective of both caregivers and the elderly people themselves. Six focus group discussions and six semistructured interviews were conducted in the Samut Sakhon Province of Thailand. Deductive thematic analyses were conducted based on the "food choice process model framework." The results show that physical and mental factors and societal factors are important determinants of food choices. Moreover, a changing food environment and economic factors were found to affect food choices. Issues of trust in food safety and food markets were highlighted as growing issues. Therefore, fostering healthy food choice interventions that consider both environmental and societal aspects is necessary.
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| 5. |
- Chalermsri, Chalobol, et al.
(författare)
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Socio-demographic characteristics associated with the dietary diversity of Thai community-dwelling older people : results from the national health examination survey
- 2022
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Ingår i: BMC Public Health. - : Springer Nature. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Dietary diversity (DD) is an indicator of nutrient intake and is related to health outcomes in older people. Currently, limited research exists regarding factors associated with DD in older people in developing countries, such as Thailand, despite rapid growth in this population. Therefore, this study aims to examine the association between socio-demographic characteristics and DD in Thai older people. Methods A cross-sectional study based on the fifth Thai National Health Examination Survey (NHES-V) conducted between 2013 and 2015 was performed. A total of 7,300 nationally representative older participants aged >= 60 years were included. The individual-level dietary diversity score (DDS) was assessed as the frequency of consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4 according to the frequency of consumption. The DDS was calculated as the sum of the scores, ranging from 0 to 32. Socio-demographic characteristics, including age, sex, highest education level, wealth index, living conditions, and residential area, were assessed. Data were analyzed using multiple linear regression and adjusted for complex survey design. Results The participants had a mean age of 69.7 (SD 7.6) years. The mean DDS of participants was 18.4 (SD 3.9). In the adjusted model, a higher educational level, a higher wealth index, and living in an urban area were positively associated with DDS, with adjusted beta (95% CI) values of 1.37 (1.04, 1.70) for secondary education or higher, 0.81 (0.55, 1.06) for the richest group, and 0.24 (0.10, 0.44) for living in an urban area. Nevertheless, living alone had negative associations with DDS, with a beta (95% CI) of - 0.27 (- 0.53, - 0.00). Conclusions This study showed that a higher educational level, a higher wealth index, and living in an urban area had a positive association, whereas living alone had a negative association with DD among Thai older participants. Interventions aiming to improve dietary diversity among older people might benefit from targeting more vulnerable groups, particularly those with less education and wealth, those living alone, or those in rural areas.
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