Dietary diversity and its relation with health among the older population in Thailand

Sammanfattning: 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.