The nutrition and health
transitions in Thailand
Vongsvat Kosulwat
Institute of Nutrition, Mahidol University
Kosulwat, Public Health Nutrition, Feb 2002
Percentage of population by
age group and dependency ratios
120
100
80
Aged 15-59
60
Aged >60
Dependency ratio
40
20
0
1960
1970
1980
1990
2000
2010
2020
Year
80
70
Estimated of population in
urban and rural areas
60
50
%
%
Aged 0-14
Rural population
Urban population
40
30
20
10
0
1990
1995
2000
2005
2010
Year
Kosulwat, Public Health Nutrition, Feb 2002
Gross National Product per
Capita in US Dollars, 1960-1998
3500
3000
US$
2500
2000
GNP/capita
1500
1000
500
98
19
96
19
92
19
88
19
84
19
80
19
76
19
72
19
68
19
64
19
19
60
0
Year
70
60
50
Distribution of Occupation
Industrial
Agriculture
Others
40
(%)
30
20
10
0
1960 1964 1968 1972 1976 1980 1984 1988 1992 1998
Kosulwat, Public Health Nutrition, Feb 2002
Per capita food consumption
g/d
500
450
400
Cereals&Tubers
Meat&Poultry
Fish&Shellfish
Egg
Vegetables
Fruits
Fats&Oils
Sugar
350
300
250
200
150
100
50
0
1960
1975
1986
1995
100
90
Trends in nutrient intake
80
70
60
%
50
Protein
Fat
Carbohydrate
40
30
20
10
0
1960
1975
1986
1995
Year
Kosulwat, Public Health Nutrition, Feb 2002
Prevalence of malnutrition among school children
from different socioeconomic classes (Thai
reference, 1987)
35
8
Private
School
30
First semester
20
Second semester
6
Public
school in
BKK
Northeastern
(Rural)
25
%
Prevalence of underweight in primary school children in
Bangkok public school
%
15
10
4
2
5
0
0
Stunted (<P10)
Wasted (<P3)
Obese >P97)
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
Underweight
(<P10)
Prevalence of obesity in primary school children in Bangkok public school
8
Prevalence of obesity in school children (1994-1995)
Source: Nutrition Division, Ministry of Public Health
8
First Semester
Urban
Rural
Total
Second Semester
6
6
3.6
%4
%4
2
2
0
0
1995
1996
1997
Kindergarten
Primary
Secondary
Total
Urban+Rural
Kosulwat, Public Health Nutrition, Feb 2002
Cause specific death rate among Thai
population, 1967-1997
Death rate per 100,000 population
90
80
Heart diseases
Accidents
Cancer
AIDS
Pneumonia
Diarrhea
70
60
50
40
30
20
10
0
67 972 977 982 986 987 988 989 990 991 992 993 994 995 996 997
9
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Year
Kosulwat, Public Health Nutrition, Feb 2002
Morbidity trend
100000
80000
No. of cases
60000
40000
20000
0
1979
Acute rheumatic fever
Hypertension
Cerebrovascular disease
1987
1993
1997
Chronic rheumatic heart disease
Ischemic heart disease
Kosulwat, Public Health Nutrition, Feb 2002
Age standardized prevalence of cardiovascular risk
factors for cardiovascular disease (1991 vs 1995)
%
70
60
50
Male
40
NHES I
NHES II
30
20
10
0
DM
Hyperchol.
HT
Obesity
Smoking
NHES I
NHES II
%
35
30
Female
25
20
15
10
5
0
DM
Hyperchol.
HT
Obesity
Smoking
Kosulwat, Public Health Nutrition, Feb 2002
Nutrition in Transition in Thailand:
Challenges for Healthy Thais
Undernutrition
‘decreasing’
• vulnerable
groups
• PEM, A,
I, Fe*
HEALTHY
THAIS
Food safety
& toxicity
• Acute
- poisoning
• Chronic
- cancers
Overnutrition
‘increasing’
• children &
adults
• Obesity,
NCD,CVD
Kosulwat, Public Health Nutrition, Feb 2002
Problems remained and emerging
1. Under-nutrition
1.1 IUGR
1.2 Infant and young child feeding
1.3 Iron deficiency anemia
2. Over-nutrition
2.1 Obesity
2.2 NCDs
3. Food safety
3.1 poisoning &contaminants
3.2 chronic toxicity -- cancers
Kosulwat, Public Health Nutrition, Feb 2002
Challenges ahead to achieve
HEALTHY THAIS
1. Thailand decentralization process and
important reforms (Health, Education,
Civil service) and structural adjustment
2. Shifting paradigms
2.1 From ‘Vulnerable groups’ to ‘Life cycle
approach’
2.2 From ‘Deficiency diseases’ to ‘human
functions and prevention of risks of
diet-related chronic diseases’
Kosulwat, Public Health Nutrition, Feb 2002
Behaviors
Genetics
Environments
Intake and output
Foods
Others
Intervention
Obesity
Diagnostic tools
Intervention
complications
Suprasongsin, Chittiwat, July 2001
Kosulwat, Public Health Nutrition, Feb 2002