Heavy alcohol consumption is an established risk factor for non-communicable diseases (NCDs) but few studies have investigated drinking and disease risk in middle income, non-western countries. We report on the relationship between alcohol consumption and NCDs in Thailand. A nationwide cross sectional survey was conducted of 87,151 Thai adult open university students aged 15 to 87 years (mean age 30.5 years) who were recruited into the Thai Cohort Study. Participants were categorized as never having drunk alcohol (n = 22,527), as being occasional drinkers who drank infrequently but heavily (4+ glasses/occasion - occasional heavy drinkers, n = 24,152) or drank infrequently and less heavily (<4 glasses/occasion - occasional light drinkers, n = 26,861). Current regular drinkers were subdivided into those who either drank heavily (4 + glasses per occasion - regular heavy drinkers, n = 3,675) or those who drank less (<4 glasses/occasion -regular light drinkers, n = 490). There were 7,548 ex-drinkers in the study. Outcomes were lifetime diagnoses of self-reported NCDs and obesity (body mass index ≥ 25). Most women were never drinkers (40 % among females) or occasional light drinkers (39 %), in contrast to men (11 % and 22 %, respectively). Alcohol consumption was associated with urban in-migration and other recognized risks for NCDs (sedentary lifestyle and poor diet). After adjustment for these factors the odds ratios (ORs) for several NCDs outcomes - high cholesterol, hypertension, and liver disease - were significantly elevated among both occasional heavy drinkers (1.2 to 1.5) and regular heavy drinkers (1.5 to 2.0) relative to never drinkers. Heavy alcohol consumption of 4 or more glasses per occasion, even if the occasions were infrequent, was associated with elevated risk of NCDs in Thailand. These results highlight the need for strategies in Thailand to reduce the quantity of alcohol consumed to prevent alcohol-related disease. Thailand is fortunate that most of the female population is culturally protected from drinking and this national public good should be endorsed and supported.

This chapter reviews the likely consequences of dietary change for human health and wellbeing in Asia where a transition is occurring from diets dominated by low fat, high fibre foods to increased consumption of processed and packaged convenience foods. These foods are higher in fats, sugars and salt and are linked to increased rates of diet-related non-communicable disease. The chapter traces between-country differences and considers the drivers of dietary change including economic growth and rising incomes, the effects of urbanization and changing family size, the industrialization of food systems and the liberalization of world trade. While levels of malnutrition have declined throughout the region, rates of obesity ad overweight have increased raising challenging questions for nutrition policy planners.

We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis (MDR-TB). We searched for publications in the Medline, Embase, Scopus, and Web of Science databases. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Hazard ratio (HR) for sputum culture conversion and odds ratio (OR) for end-of-treatment outcomes, with 95% CI, were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger's tests. Of the 2358 records screened, 63 studies comprising a total of 31,583 people with MDR-TB were included. Undernutrition was significantly associated with a longer time to sputum culture conversion (HR 0.7, 95% CI 0.6-0.9, I² = 67·1%), and a higher rate of mortality (OR 2.8, 95% CI 2.1-3.6, I² = 21%) and unsuccessful treatment outcomes (OR 1.8, 95% CI 1.5-2.1, I² = 70%). There was no significant publication bias in the included studies. Undernutrition was significantly associated with unsuccessful treatment outcomes, including mortality and longer time to sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardized TB drugs.

As obesity increases, middle-income countries are undergoing a health-risk transition. We examine the association between socioeconomic status (SES) and emerging obesity in Thailand, and ascertain if an inverse relationship between SES and obesity has appeared. The data derived from 87 134 individuals (54% female; median age, 29 years) in a national cohort of distance-learning Open University students aged 15-87 years and living throughout Thailand. We calculated adjusted odds ratios for associations of SES with obesity (body mass index, >or=25) across 3 age groups by sex, after controlling for marital status, age, and urbanization. Obesity increased with age and was more prevalent among males than females (22.7% vs 9.9%); more females were underweight (21.8% vs 6.2%). Annual income was 2000 to 3000 US dollars for most participants. High SES, defined by education, income, household assets, and housing type, associated strongly with obesity-positively for males and inversely for females-especially for participants younger than 40 years. The OR for obesity associated with income was as high as 1.54 for males and as low as 0.68 for females (P for trend <0.001). Our national Thai cohort has passed a tipping point and assumed a pattern seen in developed countries, ie, an inverse association between SES and obesity in females. We expect the overall population of Thailand to follow this pattern, as education spreads and incomes rise. A public health problem of underweight females could emerge. Recognition of these patterns is important for programs combating obesity. Many middle income countries are undergoing similar transitions.

Thailand has the second-highest rates of road traffic mortality globally. Detailed information on the combination of human, vehicle, and environmental risks giving rise to each incident is important for addressing risk factors holistically. This paper presents the result of forensic road traffic investigation reports in Thailand and determines risk factor patterns for road traffic injuries. Detailed forensic reports were extracted for 25 serious traffic accident events. The Haddon matrix was used to analyze risk factors in three phases stratified by four agents. The 25 events analyzed involved 407 victims and 47 vehicles. A total of 65.8% of victims were injured, including 14.5% who died. The majority (66.1%) of deaths occurred at the scene. Human-error-related factors included speeding and drowsiness. Passenger risks included not using the seat belt, sitting in the cargo area and the cab of pickups. Overloaded vehicles, unsafe car modifications, no occupant safety equipment and having unfixed seats were vehicular risks. Environmental risks included fixed objects on the roadside, no traffic lights, no guard rails, no traffic signs, and road accident black spots. At present, traffic accidents cause much avoidable severe injury and death. The outcome of this paper identifies a number of preventable risk factors for traffic injury, and importantly examines them in conjunction. Road traffic safety measures need to consider how human, vehicle, and environmental risks intersect to influence injury likelihood and severity. The Haddon matrix is useful in identifying these pre- and post-accident risk factors. Furthermore, the sustainable preventions of road traffic injury need to address these risks together with active law enforcement.

Purpose: – The purpose of this paper is to investigate whether the food retail transition underway in Thailand, a transitional middle-income setting, is associated with increased consumption of processed foods high in fat, salt and energy. Such “problem foods” are important risks for avoidable cardio-vascular disease and diabetes burdens.Design/methodology/approach: – The source population were members of the nationwide Thai Cohort Study (TCS) followed since 2005 (n=87,151) for a study of the health-risk transition. For this report we used a multi-region sub-sample (n=1,516) of TCS members responding to an additional questionnaire about food environments, shopping patterns and food consumption. By using a TCS sub-sample we gained access to four years (2005-2009) of longitudinal observations on a wide array of variables related to health and wellbeing from an informative group.Findings: – Overall 85 per cent of the sample now have access to supermarkets; ten years ago the figure was 47 per cent, and when aged ten years, 5 per cent. Now half the participants regularly visit supermarkets and convenience stores, especially urban dwellers with higher incomes. Frequent shopping at supermarkets and convenience stores associated with consumption of six “problem foods” (soft drinks, snack foods, processed meats, western style bakery items, instant foods and deep fried foods). Frequent fresh market shopping was associated with increased vegetable intake. There was no association between food shopping and body mass index , diabetes or hypertension but supermarket shopping was related to hyperlipidaemia.Research limitations/implications: – Modernization of food retailing is changing Thai diets and creating diet-related health risks.Originality/value: – The paper addresses a knowledge gap on links between modernizing food retail in Asia and consumption of unhealthy foods, revealing strong linkage in transitional Thailand.