Ecological system theory and community participation to promote healthy food environments for obesity and non-communicable diseases prevention among school-age children.

OBJECTIVES: To implement and evaluate the effectiveness of the community participatory program between school and family based on ecological system theory and participatory action research. The intervention covers three levels at the individual, family and school levels and involves educating students and parents by using technology, reducing sedentary behaviours, increasing exercise and changing to healthy food environments at school and at home. DESIGN: A quasi-experimental design was used in this study. SETTING: Public primary school in Thailand. SUBJECTS: The participants in the study included 138 school-age children in grades 2-6 with their parents/guardians. The control group consisted of 134 school-age children at a school of the same size with their parents/guardians. RESULTS: Results show that nutritional status was significantly improved within the experimental group (P value = 0·000) and between groups during follow-up (P value = 0·032). Students' knowledge about obesity and non-communicable chronic diseases (NCD) prevention, as well as physical activity and exercise behaviours, in the experimental group was significantly higher than that in the control group (P value = 0·000 and 0·044, respectively). Parents' perceptions of child obesity and family modelling behaviours in the experimental group were also significantly higher than that in the control group; P value = 0·013 and 0·000, respectively). CONCLUSION: The community participation program was found to be successful. Not only students, families and schools improved health behaviours and healthy food environments at home and school, but the students' long-term nutritional status also improved.

Evaluation of a questionnaire to assess nutritional knowledge, attitudes and practices in a Thai population.

BACKGROUND: The rapid increase in non-communicable chronic diseases in people of working age has had a major effect on health care utilization, productivity and economy. Lifestyle and diet are recognized as being major risk determinants involved. Disease prevention strategies need to be based on people's understanding of nutritional knowledge, attitudes and practice. This study evaluates the validity of a new nutritional knowledge and practice questionnaire specifically developed for assessing individuals of working age in a Thai population. METHODS: The questionnaire was constructed and based on previous relevant literature and its content validity was scrutinized by an expert panel. An exploratory factor analysis (EFA) was performed to reduce the number of questions included. Subsequently, data from a cross-sectional study of 1,032 participants were used to evaluate the reliability and validity of this questionnaire. The validity of the questionnaire constructed for assessing knowledge and attitude was evaluated using Confirmatory Factor Analysis (CFA). For the practice component, set criteria were applied to determine the final variables used. RESULTS: CFA of the nutritional knowledge component suggested that all the variables in the model fitted with the data (χ2 = 80.17, df = 66, p > 0.05, CFI = 0.99, RMSEA = 0.01, SRMR = 0.02). The CFA final model for the nutritional knowledge included three factors (food recommendation, nutrients related to diseases, and healthy diet) with a total of 14 questions. For nutrition attitude, CFA also revealed a good fit (χ2 = 178.14, df = 93, p < 0.001, CFI = 0.99, RMSEA = 0.03, SRMR = 0.03). The final CFA model for nutritional attitude included three factors (food choice, healthy diet and food recommendation) with a total of 16 questions. For practice items, the number of questions was reduced from 76 to 60. CONCLUSIONS: Questionnaire development should use a logical, systematic and structured approach. Results from our evaluation process demonstrates the construction validity of the nutritional knowledge and practice questionnaire developed. This questionnaire can be further modified for use in other countries within the region.

Efficacy of dietary modification following the National Cholesterol Education Program (NCEP) recommendation on lipid profiles among hyperlipidemia subjects.

BACKGROUND: Hyperlipidemia has adverse effects on atherosclerosis, causing it to develop into cardiovascular disease. The prevalence of hyperlipidemia has been increasing among those in the working-age group and may be caused by inappropriate dietary patterns. Dietary modification should form the basis of lipid management. OBJECTIVE: Evaluate the effects of a dietary modification following the NCEP-ATP III recommendation on lipid profiles among hyperlipidemia subjects. MATERIAL AND METHOD: The design was a quasi-experimental study, with a pre-test/post-test two-group design. Each group consisted of 31 hyperlipidemia subjects aged 30 to 59 years old with total cholesterol (TC) greater than or equal to 240 mg/dl or low-density lipoprotein cholesterol (LDL-C) greater than or equal to 130 mg/dl. The present study was conducted between January and June 2009. The research procedure included 6-week nutrition counseling and a 2-week follow-up for 12 weeks. Data were collected by self-reported questionnaire and a 3-day food record. Dietary and biological assessments were compared before and after the experiment. Statistical analysis was performed using means, standard deviations, independent and paired t-tests, Friedman test, Mann-Whitney U test, and Wilcoxon signed-rank test. RESULTS: The intervention group had a significant reduction of TC and LDL-C at the end of the experiment (p < 0.05). Moreover this group had a significantly higher percentage reduction of TC and LDL-C than the control group (8.5% vs. 3.0%, and 10.8% vs. 2.4%, respectively) (p < 0.05). Distributions of monounsaturated fatty acids (MUFAs) in the intervention group were significantly higher than in the control group (p < 0.05). Distribution of saturated fatty acids (SFAs):MUFAs:polyunsaturated fatty acids (PUFAs) were 12.0:13.4:6.3% in the intervention group and 12.3:9.2:5.6% in the control group. Neither group was able to reduce SFAs intake to < 7% as recommended. Neither the recommended one-third of vegetable protein nor two-thirds of complex carbohydrate was achieved Dietary fiber was less than 10 g/1,000 kcal. The cholesterol intake in the intervention group was less than in the control group (155.9 vs. 206.3 mg/d). CONCLUSION: The dietary modification in the present study significantly lowered TC and LDL-C. However compliance with the recommendation of high MUFAs intake was difficult to achieve. The dietary modification might be focused instead on lowering intake of SFAs, replacing animal protein with vegetable protein, and increasing complex carbohydrates, fruits, and vegetables to raise dietary fiber.

A Community Health Volunteer Involvement Program for Glycated Hemoglobin Reduction Among Thai Patients With Uncontrolled Type 2 Diabetes: A Mixed-Method Study.

BACKGROUND: Diabetes mellitus is increasing and a shortage exists of nurses to care for patients. Community health volunteers (CHVs) pose potential supportive networks in assisting patients to perform healthy behaviors. AIM: The study aimed to develop and investigate the effects of a CHV involvement program on reducing glycated hemoglobin (HbA1c) levels among Thai patients with uncontrolled type 2 diabetes. METHODS: This sequential mixed-method study was conducted from January to June 2019. Sixty patients with HbA1c exceeding 7% were recruited from 2 communities assigned as the intervention and comparison groups. Using King's General Systems Framework as a basis to develop the program, the study initially explored the perceptions of diabetes and its management among patients, family members, and CHVs. Then, a quasi-experimental study with 2 groups pretest-posttest design was conducted and compared with usual care. The intervention included educational sessions, home visits, and activities created by CHVs including a campaign, broadcasting, and health food shops. Quantitative data were collected at baseline and 20-week follow-up and analyzed by descriptive statistics, Independent t-test, and paired t-test. RESULTS: The intervention group exhibited a lower mean HbA1c (p < .001) and reported significant, improvement concerning diabetes knowledge, self-efficacy, perceived support, and behavior compared with the comparison group at the end of the study (Cohen's d > 1.0, effect size large). CONCLUSION: Applying this framework to develop the program could benefit glycemic control among patients with uncontrolled diabetes residing in communities. Further studies should be conducted on a large sample to demonstrate the efficacy of the program.

Rice Bran Oil Containing Gamma-Oryzanol Improves Lipid Profiles and Antioxidant Status in Hyperlipidemic Subjects: A Randomized Double-Blind Controlled Trial.

OBJECTIVES: Rice bran oil (RBO) is a major source of monounsaturated fatty acid and gamma-oryzanol, which may assist in lowering blood lipids and oxidative stress. This study examined the effects of RBO containing different amounts of gamma-oryzanol on blood lipid, antioxidant, and inflammatory markers. MATERIALS AND METHODS: A total of 59 hyperlipidemic subjects completed the study. They were divided into four groups: RBO1 (4,000 ppm gamma-oryzanol, n = 14), RBO2 (8,000 ppm gamma-oryzanol, n = 15), RBO3 (11,000 ppm gamma-oryzanol, n = 15), and control (soybean oil, n = 15). The assigned oil (30 mL) was incorporated into three cooked meals each day for 4 weeks. Anthropometrical measurements and blood samples were taken to evaluate body weight, body composition, lipid parameters, antioxidant status, and inflammatory markers before and after the intervention. RESULTS: Compared with the control, consumption of RBO significantly decreased low-density lipoprotein cholesterol (LDL-C) levels (percentage change: -0.8% [control]; -8% [RBO1]; -11.8% [RBO2]; and -12.2% [RBO3], p = 0.012) with the greatest change found in RBO2 and RBO3. In addition, antioxidant status also improved significantly. Levels of oxygen radical absorbance capacity (ORAC) and ferric reducing antioxidant power (FRAP) increased after consumption of a diet with RBO compared with consumption of a diet with soybean oil (ORAC: -2.7% [control]; 4.1% [RBO1]; 8.6% [RBO2]; and 10.1% [RBO3], p < 0.001; FRAP: -4.4% [control]; 4.7% [RBO1]; 7.4% [RBO2]; and 7.6% [RBO3], p < 0.001). CONCLUSIONS: RBO with gamma-oryzanol could decrease LDL-C levels and increase antioxidant capacity in hyperlipidemic subjects. Therefore, RBO consumption may reduce cardiovascular disease risk factors.

Effectiveness of a Weight Management Program Applying Mobile Health Technology as a Supporting Tool for Overweight and Obese Working Women.

This study aimed to evaluate the effectiveness of a weight management program applying mobile health (mHealth) technology as a supporting tool. A quasi-experimental research with a 1-group pretest and posttest design was conducted. Thirty-eight overweight and obese working women, aged 25 to 52 years, who were ready to take action on weight loss participated in a 12-week weight management program. Repeated-measures analysis of variance was used to examine the mean differences in related variables. The results showed that the mean weight and waist circumference of the participants significantly decreased from baseline to post-intervention (week 6) and follow-up (week 12; 72.2 ± 10.4, 71.6 ± 10.8, 71.4 ± 11.0 kg, P = .008, and 92.1 ± 10.1, 89.9 ± 9.9, 87.8 ± 10.7 cm, P < .001, respectively). Moreover, they had significantly improved self-efficacy for healthy eating and physical activity, eating behaviors, dietary intake patterns, and frequency of taking stairs. This weight management program was effective for the prevention and control of overweight and obesity.

Black tea consumption improves postprandial glycemic control in normal and pre-diabetic subjects: a randomized, double-blind, placebo-controlled crossover study.

BACKGROUND AND OBJECTIVES: Postprandial glycemic control is important for prevention of diabetes. Black tea consumption may improve postprandial glycemic control. The major bioactive compounds are polyphenols, black tea polymerized polyphenol (BTPP).This study examined the effect of black tea consumption on postprandial blood glucose and insulin response following sucrose loading in normal and pre-diabetes subjects. METHODS AND STUDY DESIGN: This study was a randomized, double-blind, placebo-controlled crossover study. Twenty-four subjects, male and female aged 20-60 years, normal and pre-diabetic, randomly ingested a sucrose solution with a low dose (110 mg BTPP), a high dose (220 mg BTPP) of black tea drink or a placebo drink (0 mg BTPP). Blood samples were collected at 0, 30, 60, 90, and 120 min from commencement of drink ingestion to measure blood glucose and insulin levels. RESULTS: The drink containing low dose and high dose BTPP significantly decreased incremental blood glucose area under the curve (AUC) after sucrose intake compared with placebo in the normal (T0-60 min 3,232±356 vs 3,295±312 vs 3,652±454 mg.min/dL; p=0.016) and pre-diabetic subjects (T0-60 min 2,554±395 vs 2,472±280 vs 2,888±502 mg.min/dL; p=0.048). There was no statistically significant difference of changes in insulin levels between the placebo and black tea groups (p>0.05). No significant differences in adverse effects were observed with the placebo, low dose and high dose of BTPP groups. CONCLUSION: Black tea consumption can decrease postprandial blood glucose after sucrose intake.

Maternal return to paid work and breastfeeding practices in Bangkok, Thailand.

This study explored the association between mothers' work-related factors and breastfeeding practices in Bangkok, Thailand. Data were collected from 84 working mothers with a child aged 6 to 24 months who visited the breastfeeding mobile clinic at a nursery goods exhibition. Thai interviewers collected data using a structured questionnaire. Analysis of the data showed that exclusive breastfeeding for 3 months was 78.6%, and for 6 months it was 38.1%. Mothers who returned to work 3 months or more after giving birth exclusively breastfed more than the mothers who returned to work in less than 3 months (crude odds ratio [OR] = 4.26, 95% confidence interval [CI] = 1.39-13.05; adjusted OR = 4.15, 95% CI = 1.15-14.95). Moreover, mothers who worked at self-employed or family-owned businesses and some mothers working at private companies showed tendencies of returning to work in less than 3 months. Results suggest that longer maternity leave would help extend the duration of exclusive breastfeeding. In addition, the improvement of a breastfeeding supportive environment in the workplace would be valuable and may be an effective means to improve breastfeeding practices and infant health.

The intake of energy and selected nutrients by thai urban sedentary workers: an evaluation of adherence to dietary recommendations.

Rapid changes in Thailand's nutrition and lifestyles have led to increasing diet-related pathologies among people with sedentary occupations. This study examines the extent to which the dietary intake of nutrients and energy by a sample of Thai sedentary workers conforms to the Thai Dietary Reference Intakes (Thai DRIs). The nutrients and energy intake estimates were based on self-reported information collected with a single 24-hour dietary recall and nonweighed 2-day food record. The study participants were Thai adults aged 20-50 years employed in sedentary occupations. A convenience sample of 215 healthy individuals (75 males and 140 females) was based on four randomly selected worksites in the Bangkok metropolitan area. For male participants, the study found a median energy intake of 1,485 kcal/day, with 54.4% of energy coming from carbohydrate, 15.9% from protein, and 29.6% from fat. Females' median energy intake was 1,428 kcal/day, 56% of which came from carbohydrate, 16.2% from protein, and 28.6% from fat. Both genders showed insufficient intake of fiber and most micronutrients. This study provides the material for preventive public health interventions focusing on nutrition-related diseases affecting Thailand's rapidly growing sedentary workforce.

Participatory action project in reducing childhood obesity in Thai primary schools.

UNLABELLED: The project aimed to improve nutrition and activity among primary schoolchildren via targeted activities. A preliminary nutritional survey was carried out involving 5126 children in 4 Bangkok public schools. Participatory action research involving students, teachers, and parents was conducted. After a 2-day training course, teachers integrated project concepts into their course curriculum. Seminars on weight management were given separately to parents and students. After 8 months, postnutritional survey was conducted. Preprogram and postprogram evaluation of obese and normal groups was done using questionnaires on dietary intake and exercise. RESULTS: showed that high caloric dietary intake significantly decreased for the obese group (P < .001). Aerobic exercise activity also increased in both groups (P < .001) and prevalence of obesity declined from 19.3% to 16.8%. Thus, a long-term, participatory effort to promote healthy diets and physical exercise could be effective with primary school students and may establish habits that last to later life.

Do Thai women of child bearing age need pre-conceptional supplementation of dietary folate?

Recent studies in western countries have indicated that women with low serum folate before pregnancy have greater risk of giving birth to babies with neural tube defects, and preconceptional folate supplementation has been recommended to prevent such defects. To determine whether Thai women needed folate supplementation before pregnancy, we carried out a cross-sectional study from September 2001 to January 2002. The objectives were to determine serum folate levels among women of child-bearing age and their relationship to dietary folate intake. One hundred and sixty-five apparently healthy, volunteer women aged 15 - 45 years were recruited from the Family Planning Clinic, Mother and Child Hospital, Health Promotion Centre, Region I, Bangkok. Data on general characteristics, nutritional status and dietary folate intake were recorded while venous blood was drawn for serum folate analysis. Results showed that 65.5% of the study group had low dietary folate intake, that 18% had low serum folate, and that there was a significant correlation between dietary intake and serum level (r = 0.68, P<0.001). There were also significant correlations between serum level and body mass index, (r =0.13, P<0.001). However, there were no significant associations between serum level and age, educational level, occupation, family income, or duration vegetables were stored in the refrigerator before consumption. In conclusion, there is preliminary evidence that some pregnant Thai women may have sufficiently low serum folate levels to put their babies at risk. We recommend further study on a larger scale to confirm whether folate supplementation is needed for Thai women at child bearing age. In the interim, it may be wise for obstetricians to measure serum folate in pregnant women to determine whether folate supplementation is required.