แนวโน้มการเปลี่ยนแปลงดัชนีมวลกาย และระดับไขมันในเลือด ในช่วงเวลา 5 ปี (พ.ศ.2550-2554) by nontalee verachai

∫ ∑ «‘ ∑ ¬ “ ° “ √

∫ ∑ «‘ ∑ ¬ “ ° “ √ ·π«‚πâ¡°“√‡ª≈’Ë¬π·ª≈ß¥—™π’¡«≈°“¬ ·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π™à«ß‡«≈“ 5 ªï (æ.».2550-2554) „π°≈ÿà¡‡®â“Àπâ“∑’Ë »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æ

ÿπ’¬å «ß»å‡®√‘≠ ‚√ßæ¬“∫“≈ àß‡ √‘¡ ÿ¢¿“æ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æ¡À“π§√

∫∑§—¥¬àÕ °“√»÷°…“π’È‡ªìπ°“√»÷°…“‡™‘ßæ√√≥π“ ¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ»÷°…“·π«‚πâ¡°“√‡ª≈’Ë¬π·ª≈ß¢Õß¥—™π’¡«≈°“¬ ·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π°≈ÿà¡‡®â“Àπâ“∑’Ë∑’ËÕ“¬ÿ¡“°°«à“ 35 ªï ∑’Ë∑”ß“π„π»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æ„π™à«ß‡«≈“ 5 ªï µ—Èß·µàªï æ.». 2550-2554 º≈°“√»÷°…“æ∫«à“ ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫ªï æ.».2554 ·≈–ªï æ.».2550 ¥—™π’¡«≈°“¬‡©≈’Ë¬ (mean BMI) ‡æ‘Ë¡¢÷Èπ 0.31 kg/m2 ‚¥¬‡æ»™“¬‡æ‘Ë¡¡“°°«à“‡æ»À≠‘ß (0.5,0.31 kg/m2 µ“¡≈”¥—∫) §«“¡™ÿ°¢Õß ¿“«–Õâ«π (BMI ≥25 kg/m2) ·≈–Õâ«π¡“° (BMI ≥30 kg/m2) ‡ª≈’Ë¬π·ª≈ß‰ª„π·π«‚πâ¡∑’Ë‡æ‘Ë¡¢÷Èπ‡™àπ°—π ‚¥¬ æ∫„π‡æ»™“¬ ¡“°°«à“‡æ»À≠‘ß √–¥—∫‰¢¡—π‡©≈’Ë¬ ¡’°“√‡ª≈’Ë¬π·ª≈ß∑’Ë≈¥≈ßµ√ß¢â“¡°—∫§à“¥—™π’¡«≈°“¬‡©≈’Ë¬∑’Ë‡æ‘Ë¡ ¢÷Èπ ‚¥¬≈¥≈ß∑—Èß§à“‰¢¡—π∑’Ë‰¡à¥’§◊Õ Cholesterol, Triglyceride, LDL-C ·≈–‰¢¡—π™π‘¥∑’Ë¥’§◊Õ HDL-C §à“ ‰¢¡—π‡©≈’Ë¬¢Õß Cholesterol ≈¥≈ß¡“°∑’Ë ÿ¥‡∑à“°—∫ 6.51 mg/dl ‚¥¬‡æ»™“¬≈¥≈ß¡“°°«à“‡æ»À≠‘ß (19.52 ·≈– 5.41 mg/dl µ“¡≈”¥—∫) §” ”§—≠ : ¥—™π’¡«≈°“¬, §«“¡º‘¥ª°µ‘¢Õß‰¢¡—π, ·π«‚πâ¡„π™à«ß 5 ªï, °√ÿß‡∑æ

Trend of changes in body mass index and lipid profile of Health care and Office workers in Health Promotion Center, Region one, Bangkok in 5 years, 2007-2011 Sunee Wongcharoen MD. Health Promotion Center, Region 1, Bangkok

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°√¡Õπ“¡—¬ àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

·π«‚πâ¡°“√‡ª≈’Ë¬π·ª≈ß¥—™π’¡«≈°“¬ ·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π™à«ß‡«≈“ 5 ªï (æ.».2550-2554) œ

Abstract The purpose of this descriptive study was to examine trend of changes in body mass index and lipid profile of Health care and Office workers, age more than 35 years old, in Health Promotion Center, Region 1, Bangkok in 5 year, 2007-2011. The results of study showed in 5 years, mean BMI was increasing about 0.31 kg/m2, men 0.5 kg/m2 and women 0.31 kg/m2. Similarly, prevalence of obesity and extreme obesity was increasing especially in men than women. But mean lipid profile ex. Cholesterol, Triglyceride, HDLC and LDL-C had trend to decrease, especially decrease most in mean Cholesterol about 6.51 mg/dl, men more than women (19.52 and 5.41 mg/dl respectively) Key Words: Body mass index, Lipid profile, Trend in 5 years, Bangkok

∫∑π” ¿“«–πÈ”Àπ—°‡°‘π·≈–‚√§Õâ«π ‡ªìπªí≠À“ ÿ¢¿“æ∑’¡Ë §’ «“¡ ”§—≠·≈–¡’·π«‚πâ¡∑’‡Ë æ‘¡Ë ¡“°¢÷πÈ ¡’°“√ª√–¡“≥°“√«à“ „πªï §.».20081 ∑—Ë«‚≈°¡’ ®”π«πª√–™“°√∑’Ë¡’¿“«–πÈ”Àπ—°‡°‘π ¡“°°«à“ 1,500 ≈â“π§π ·≈–ª√–¡“≥ 500 ≈â“π§π¡’‚√§Õâ«π Õß§å°“√Õπ“¡—¬‚≈° §“¥«à“„πªï §.».20152 ¡’ ®”π«πª√–™“°√∑’Ë ¡’ ¿ “«–πÈ” Àπ— ° ‡°‘ π ¡“°°«à “ 2,300 ≈â“π§π·≈–ª√–¡“≥ 700 ≈â“π§π¡’‚√§Õâ«π „πª√–‡∑» À√—∞Õ‡¡√‘°“ ¡’°“√ ”√«® ÿ¢¿“æ¢Õß ª√–™“°√ (National Health and Nutrition Examination Survey, NHANES) „πªï§.».198819943 ‡ª√’¬∫‡∑’¬∫°—∫ ªï §.». 2007-20084 æ∫ §«“¡™ÿ°¢Õß¿“«–πÈ”Àπ—°‡°‘π (overweight) √âÕ¬≈– 33.1 ‡æ‘Ë¡‡ªìπ 34.2 ‚√§Õâ«π (obesity) √âÕ¬≈– 22.9 ‡æ‘¡Ë ‡ªìπ 33.8 ‚√§Õâ«π¡“° (extreme obesity) √âÕ¬≈– 2.9 ‡æ‘Ë¡‡ªìπ 5.7 µ“¡≈”¥—∫ „π ‡Õ‡™’¬ ¢âÕ¡Ÿ≈ª√–‡∑»®’π„πªï§.». 19975 ‡ª√’¬∫ ‡∑’ ¬ ∫°— ∫ ªï §.». 2000 6 æ∫§«“¡™ÿ ° ¢Õß‚√§ Õâ«π(BMI ≥25 kg/m2)„π‡æ»À≠‘ßæ∫√âÕ¬≈– 16.2 ‡æ‘¡Ë ‡ªìπ 31.1 ·≈–‡æ»™“¬√âÕ¬≈– 14.5 ‡æ‘¡Ë ‡ªìπ 26.9 µ“¡≈”¥—∫ à«π„πª√–‡∑»‰∑¬ ‰¥â¡’ °“√ ”√«® ÿ ¢ ¿“æª√–™“°√‰∑¬ (National Health Examination Survey, NHES)„πªï æ.».

25477, 25528 æ∫§«“¡™ÿ°¢Õß‚√§Õâ«π(BMI ≥ 25 kg/m2) „π‡æ»À≠‘ß‡∑à“°—∫√âÕ¬≈– 34.4 ‡æ‘Ë¡ ‡ªìπ 40.7 ·≈–‡æ»™“¬√âÕ¬≈– 22.5 ‡æ‘Ë¡‡ªìπ 28.4 µ“¡≈”¥—∫ ®“°¢âÕ¡Ÿ≈∑—ÈßÀ¡¥π’È ®–‡ÀÁπ‰¥â«à“·π« ‚πâ¡∑’Ë¿“«–πÈ”Àπ—°‡°‘π·≈–‚√§Õâ«π °”≈—ß‡æ‘Ë¡¢÷Èπ ∑—Èß„πª√–‡∑»∑’Ëæ—≤π“·≈â« ·≈–°”≈—ßæ—≤π“Õ¬à“ß µàÕ‡π◊ËÕß ¥â«¬«‘∂’™’«‘µ∑’Ë‡ª≈’Ë¬π·ª≈ß‰ª„πªí®®ÿ∫—π §”π‘¬“¡¢Õß‚√§Õâ«π9 (obesity) §◊Õ‚√§‡√◊ÈÕ√—ß ™π‘¥Àπ÷Ëß‡°‘¥®“°°“√∑’Ë¡’ª√‘¡“≥‰¢¡—π„π√à“ß°“¬ (body fat) ¡“°°«à“ª°µ‘®π¡’º≈°√–∑∫µàÕ ÿ¢¿“æ ∑”„Àâ‡°‘¥‚√§µà“ßÊ µ“¡¡“ ‡™àπ ¿“«–‰¢¡—π„π ‡≈◊Õ¥º‘¥ª°µ‘ ¡—°®–¡’‰¢¡—πTriglyceride„π‡≈◊Õ¥ Ÿß HDL-Cholesterol µË” LDL-Cholesterol ¡—° ª°µ‘ ·µà LDL-Cholesterol ™π‘¥‡≈Á°·≈–Àπ“·πàπ (small dense) ®–‡æ‘Ë¡¢÷Èπ ∑—ÈßÀ¡¥π’È —¡æ—π∏å°—∫ °“√‡°‘¥°“√µ’∫·¢Áß¢ÕßÀ≈Õ¥‡≈◊Õ¥·¥ß (Atherosclerosis) ·≈–°“√‡°‘¥ Insulin Resistance ∑”„Àâ ‡°‘¥‚√§‡∫“À«“π §«“¡¥—π‚≈À‘µ Ÿß ‚√§À≈Õ¥ ‡≈◊Õ¥À—«„®µ’∫ ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õßµ’∫ ¥—ßπ—Èπ°“√ µ√«® ÿ¢¿“æª√–®”ªï ‚¥¬‡©æ“–°≈ÿà¡§π∑’ËÕ“¬ÿ ¡“°°«à“ 35 ªï ·≈–Õ“»—¬Õ¬Ÿà„π‡¡◊Õß ´÷Ëß‡ªìπ°≈ÿà¡ ‡ ’¬Ë ßµàÕ°“√‡°‘¥‚√§À≈Õ¥‡≈◊Õ¥·¥ß·¢Áß10 ‡ªìπ°“√ §—¥°√Õß∑’Ë®–™à«¬∑”„Àâ‡√“µ√«®æ∫§«“¡º‘¥ª°µ‘ ¢Õß√à“ß°“¬ ‡™àπ ¥—™π’¡«≈°“¬∑’Ë‡æ‘Ë¡¢÷Èπ §«“¡

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

April - June 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ º‘¥ª°µ‘¢ÕßπÈ”µ“≈ ·≈–‰¢¡—π„π‡≈◊Õ¥ ∑”„Àâ “¡“√∂·°â ‰ ¢¿“«–º‘ ¥ ª°µ‘ ‡ À≈à “ π’È ‰ ¥â °à Õ π∑’Ë ® – °≈“¬‡ªìπ‚√§‡√◊ÈÕ√—ß ·≈–°“√√«∫√«¡¢âÕ¡Ÿ≈ ¥—™π’ ¡«≈°“¬·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥ „π™à«ß‡«≈“ 5 ªï „π°≈ÿà¡‡®â“Àπâ“∑’Ë»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æ Õ“¬ÿ ¡“°°«à“ 35 ªï µ—Èß·µà æ.». 2550-2554 ®–∑”„Àâ ‡√“ “¡“√∂¡Õß‡ÀÁ π ¿“æ√«¡·≈–·π«‚πâ ¡ ¢Õß ¿“«– ÿ¢¿“æ¢Õß‡®â“Àπâ“∑’Ë‡æ◊ËÕπ”¡“‡ªìπ¢âÕ¡Ÿ≈„π °“√«“ß·ºπ°“√√≥√ß§å‡æ◊ËÕ≈¥¿“«–πÈ”Àπ—°‡°‘π ‚√§Õâ«π ·≈–æ—≤π“·ºπß“π‡°’Ë¬«°—∫ ÿ¢¿“æ ‡æ◊ËÕ „Àâ‡®â“Àπâ“∑’Ë¡’ ÿ¢¿“æ∑’Ë¥’·≈–∑”„Àâ∑”ß“π‰¥âÕ¬à“ß ¡’ª√– ‘∑∏‘¿“æ‡æ‘Ë¡¢÷Èπ

«—µ∂ÿª√– ß§å°“√»÷°…“ ‡æ◊Ë Õ «‘ ‡ §√“–Àå · π«‚πâ ¡ °“√‡ª≈’Ë ¬ π·ª≈ß ¢Õß¥—™π’¡«≈°“¬·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥¢Õß‡®â“ Àπâ“∑’Ë∑’ËÕ“¬ÿ¡“°°«à“ 35 ªï ∑’Ë∑”ß“π„π»Ÿπ¬å Õπ“¡—¬∑’Ë 1 °√ÿß‡∑æ „π°“√µ√«® ÿ¢¿“æª√–®”ªï „π™à«ß‡«≈“ 5 ªï µ—Èß·µàªï æ.».2550-2554

«‘∏’°“√»÷°…“ √Ÿ ª ·∫∫°“√«‘ ®— ¬ : °“√»÷ ° …“‡™‘ ß æ√√≥π“·≈–‡°Á∫¢âÕ¡Ÿ≈¬âÕπÀ≈—ß ª√–™“°√·≈–¢π“¥µ—«Õ¬à“ß : 1. ¢âÕ¡Ÿ≈°“√µ√«® ÿ¢¿“æª√–®”ªï ¢Õß ‡®â“Àπâ“∑’»Ë πŸ ¬åÕπ“¡—¬∑’Ë 1 ∑—ßÈ ‡æ»À≠‘ß·≈–‡æ»™“¬ ∑’Ë¡’Õ“¬ÿ¡“°°«à“À√◊Õ‡∑à“°—∫ 35 ªï„π™à«ßªï æ.». 2550-2553 2. ‡®â“Àπâ“∑’Ë∑’Ë∑”ß“π„π»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æ ∑—Èß‡æ»À≠‘ß·≈–‡æ»™“¬ ∑’Ë¡’Õ“¬ÿ‡∑à“°—∫ À√◊ Õ ¡“°°«à “ 35 ªï ¢÷È π ‰ª ∑’Ë ¡ “√— ∫ °“√µ√«® ÿ¢¿“æª√–®”ªï „πªï æ.». 2554 ‡§√◊ËÕß¡◊Õ„π°“√‡°Á∫¢âÕ¡Ÿ≈ : · ∫ ∫ µ √ « ® ÿ ¢ ¿ “ æ ª √ – ®” ªï ¢ Õ ß ‚ √ ß 68

‡¡…“¬π - ¡‘∂ÿπ“¬π 2555

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æ¬“∫“≈ àß‡ √‘¡ ÿ¢¿“æ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æ ·≈–»÷°…“‡©æ“– ‡æ» Õ“¬ÿ πÈ”Àπ—° §«“¡ Ÿß ¥—™π’ ¡«≈°“¬ ·≈–º≈°“√µ√«®‡≈◊Õ¥À“√–¥—∫‰¢¡—π À≈—ßÕ¥Õ“À“√ 12 ™—Ë«‚¡ß„πªï æ.». 2554 «‘∏’∑’Ë„™â „π°“√‡°Á∫¢âÕ¡Ÿ≈ : 1. °“√√«∫√«¡¢â Õ ¡Ÿ ≈ °“√µ√«® ÿ ¢ ¿“æ ª√–®”ªï¢Õß‡®â“Àπâ“∑’Ë»Ÿπ¬åÕπ“¡—¬∑’Ë 1 ∑—Èß‡æ» À≠‘ß·≈–‡æ»™“¬ ∑’Ë¡’Õ“¬ÿ¡“°°«à“À√◊Õ‡∑à“°—∫ 35 ªï„π™à«ßªï æ.». 2550-2553 2. ¢â Õ ¡Ÿ ≈ °“√µ√«® ÿ ¢ ¿“æª√–®”ªï ¢ Õß ‡®â“Àπâ“∑’Ë »Ÿπ¬åÕπ“¡—¬∑’Ë 1 ∑’¡Ë “√—∫°“√µ√«® ÿ¢¿“æ „πªï æ.». 2554 ∫—π∑÷°‚¥¬ ‡®â“Àπâ“∑’ËÀπà«¬ µ√«®ºŸâ ªÉ « ¬πÕ°∑—Ë « ‰ª ª√–°Õ∫¥â « ¬ ·æ∑¬å æ¬“∫“≈ ºŸâ ™à « ¬æ¬“∫“≈ ¢Õß‚√ßæ¬“∫“≈ à ß ‡ √‘¡ ÿ¢¿“æ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿß‡∑æ °“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ : „π°“√»÷°…“π’È „™â‡°≥±å°“√·∫àß¥—™π’¡«≈ °“¬µ“¡ Asia Pacific perspective: Redefining obesity and its treatment 11 ‚¥¬„™â§à“®ÿ¥ µ—¥¢Õß¥—™π’¡«≈°“¬∑’Ë‡À¡“–°—∫§π‡Õ‡™’¬ ∑’Ë¡’√Ÿª √à“ß‡≈Á°·µà¡√’ Õâ ¬≈–¢Õß‰¢¡—π„π√à“ß°“¬ Ÿß°«à“12 ¥—ß µ“√“ß‡¡◊ËÕ‡∑’¬∫°—∫§”π‘¬“¡¢ÕßÕß§å°“√Õπ“¡—¬ ‚≈°‡¥‘¡13 ∑’Ë„™â®ÿ¥µ—¥¢Õß¥—™π’¡«≈°“¬·∫∫ Caucasian-based cut off value ·≈– ∂‘µ‘„™â§à“√âÕ¬ ≈– ·≈–§à“ à«π‡∫’Ë¬ß‡∫π¡“µ√∞“π

º≈°“√»÷°…“ ¢âÕ¡Ÿ≈¢Õß°≈ÿà¡ª√–™“°√∑’Ë»÷°…“ ¡’ 2 à«π ·∫àß‡ªìπ¢âÕ¡Ÿ≈¥â“π°“√µ√«®«—¥∑“ß√à“ß°“¬ ·≈– °“√µ√«®«—¥∑“ß™’«‡§¡’ 1. ¢â Õ ¡Ÿ ≈ ∑—Ë « ‰ª ¥â “ π°“√µ√«®«— ¥ ∑“ß √à“ß°“¬¢Õß°≈ÿ¡à ª√–™“°√∑’»Ë °÷ …“„π™à«ß‡«≈“ 5 ªï æ∫«à“ - °≈ÿà¡ª√–™“°√∑’Ë»÷°…“ ‡ªìπ‡æ»À≠‘ß

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√âÕ¬≈– 90.34 ·≈–‡æ»™“¬ √âÕ¬≈– 9.66 - à«π Ÿß‚¥¬‡©≈’Ë¬¢Õß‡æ»À≠‘ß 155.82 ‡´πµ‘‡¡µ√ ·≈–‡æ»™“¬ 166.94 ‡´πµ‘‡¡µ√ - πÈ”Àπ—° ‚¥¬‡©≈’Ë¬¢Õß‡æ»À≠‘ß 59.03

°‘‚≈°√—¡ ·≈–‡æ»™“¬ 70.05 °‘‚≈°√—¡ ·≈–πÈ” Àπ—°‡©≈’Ë¬„π·µà≈–ªï‡ªìπ¥—ßµ“√“ß∑’Ë 1 - ¥—™π’¡«≈°“¬‡©≈’Ë¬ „π·µà≈–ªï‡ªìπ¥—ß µ“√“ß∑’Ë 2

Classification of BMI

Asia-Pacific Perspective

WHO 1997

Underweight Normal Range Overweight At risk Obese I Obese II Obese III

<18.5

18.5-22.9 ≥23 23-24.9 25-25.9 ≥30 _

18.5-24.9 ≥25 25-29.9 30-34.9 35-35.9 ≥40

µ“√“ß∑’Ë 1 πÈ”Àπ—°‡©≈’Ë¬¢Õßª√–™“°√∑’Ë»÷°…“„π™à«ßªï æ.». 2550-2554 À≠‘ß Mean weight 2550 2551 2552 2553 2554 º≈µà“ß 5 ªï

X 58.88 58.25 58.91 59.27 59.82

™“¬ SD 9.18 9.43 9.87 9.87 1.08

X 68.03 69.75 72.14 69.92 70.41

+0.94

SD 1.18 1.27 1.26 1.19 1.55 +2.38

X §◊Õ§à“‡©≈’Ë¬ SD §◊Õ à«π‡∫’Ë¬ß‡∫π¡“µ√∞“π º≈µà“ß 5 ªï §◊Õ§à“‡©≈’Ë¬„πªï æ.».2554 ≈∫¥â«¬§à“‡©≈’Ë¬„πªï æ.».2550

µ“√“ß∑’Ë 2 ¥—™π’¡«≈°“¬‡©≈’Ë¬ (mean BMI) ¢Õßª√–™“°√∑’Ë»÷°…“„π™à«ß 5 ªï ·∫àßµ“¡‡æ» Mean BMI (kg/m2) 2550 2551 2552 2553 2554 ‡©≈’Ë¬ 5 ªï º≈µà“ß 5 ªï

À≠‘ß X 24.19 23.97 24.32 24.43 24.50 24.28

™“¬ SD 3.73 3.85 3.96 3.99 4.37 3.98

X 24.88 24.48 25.51 25.28 25.38 25.11

+0.31

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

SD 3.64 3.95 3.73 3.99 4.08 3.89 +0.50 April - June 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ ¿“æ∑’Ë 1 ·π«‚πâ¡°“√‡ª≈’Ë¬π·ª≈ß„π™à«ß 5 ªï¢Õß§à“ mean BMI ¢Õß°≈ÿà¡ª√–™“°√∑’Ë»÷°…“

µ“√“ß∑’Ë 3 °≈ÿà¡¥—™π’¡«≈°“¬¢Õßª√–™“°√∑’Ë»÷°…“„π™à«ß 5 ªï ·∫àßµ“¡‡æ» 3.1 °≈ÿà¡¥—™π’¡«≈°“¬ (‡æ»À≠‘ß) BMI ªïæ.».

<18.5 §π %

2550 2551 2552 2553 2554 %‡©≈’Ë¬

2 4 4 4 2

1.4 2.7 3.00 2.5 1.6 2.24

≥30

18.5-22.99 §π %

23-24.99 §π %

25-29.99 §π %

57 41.3 59 41.3 45 33.8 63 38.9 52 41.3 39.32

29 21.0 37 25.9 40 30.1 39 24.1 25 19.8 24.18

38 27.5 31 21.7 32 24.1 40 24.6 34 27.0 24.98

23-24.99 §π %

25-29.99 §π %

§π

6 4 5 6 4

1 2 2 3 2

§π 12 12 12 16 13

√«¡ %

8.8 8.4 9.0 9.9 10.3 9.28

§π

138 100.0 143 100.0 133 100.0 162 100.0 126 100.0 100.00

3.2 °≈ÿà¡¥—™π’¡«≈°“¬ (‡æ»™“¬) BMI ªïæ.».

<18.5 §π %

2550 2551 2552 2553 2554 %‡©≈’Ë¬

0 1 0 0 1

0.0 6.3 0.00 0.0 9.0 3.06

‡¡…“¬π - ¡‘∂ÿπ“¬π 2555

18.5-22.99 §π % 4 26.7 5 31.2 3 23.1 5 23.8 2 18.2 24.60

4 4 3 7 2

26.7 25.0 23.1 33.3 18.2 25.26

°√¡Õπ“¡—¬ àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

40.0 25.0 38.5 28.6 36.4 33.70

≥30

√«¡ %

6.6 12.5 15.3 14.3 18.2 13.38

§π

15 100.0 16 100.0 13 100.0 21 100.0 11 100.0 100.00

·π«‚πâ¡°“√‡ª≈’Ë¬π·ª≈ß¥—™π’¡«≈°“¬ ·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π™à«ß‡«≈“ 5 ªï (æ.».2550-2554) œ

¿“æ∑’Ë 2 ‡ª√’¬∫‡∑’¬∫§«“¡™ÿ°¢Õß¿“«–Õâ«π (BMI 25-29.99 kg/m2) „π™à«ß 5 ªï

¿“æ∑’Ë 3 ‡ª√’¬∫‡∑’¬∫§«“¡™ÿ°¢Õß¿“«–Õâ«π¡“° (BMI ≥30 kg/m2) „π™à«ß 5 ªï

®“°µ“√“ß∑’Ë 1-3 ·≈– ·ºπ¿“æ∑’Ë 1-3 æ∫ «à“ „πª√–™“°√∑’Ë»÷°…“„π™à«ß‡«≈“ 5 ªï - ‡æ»™“¬¡’§à“πÈ”Àπ—°·≈–¥—™π’¡«≈°“¬ ‡©≈’Ë¬ (Mean weight & BMI) ¡“°°«à“ °≈ÿà¡ ‡æ»À≠‘ß - §à“πÈ”Àπ—° ·≈–¥—™π’¡«≈°“¬‡©≈’Ë¬ „π ‡«≈“ 5 ªï ¡’·π«‚πâ¡‡æ‘Ë¡¢÷Èπ∑—Èß„π‡æ»À≠‘ß·≈– ‡æ»™“¬ ‚¥¬‡æ»™“¬¡’§à“‡©≈’Ë¬∑’Ë‡æ‘Ë¡¢÷Èπ¡“°°«à“ ‡æ»À≠‘ß - °≈ÿà ¡ ¥— ™ π’ ¡ «≈°“¬„π‡æ»™“¬ à « π „À≠àÕ¬Ÿà„π°≈ÿà¡ BMI 25-29.99 kg/m2 √âÕ¬≈–

33.70 °≈ÿà¡¥—™π’¡«≈°“¬„π‡æ»À≠‘ß à«π„À≠à Õ¬Ÿà„π°≈ÿà¡ BMI 18-22.99 kg/m2 √âÕ¬≈– 39.32 - §«“¡™ÿ ° ¢Õß¿“«–Õâ « π(BMI 2529.99 kg/m2) ·≈–Õâ«π¡“° (BMI _30 kg/m2) ¡’·π«‚πâ¡∑’Ë‡æ‘Ë¡¢÷Èπ ·≈–æ∫„π‡æ»™“¬¡“°°«à“ ‡æ»À≠‘ß 2. ¢âÕ¡Ÿ≈¥â“π°“√µ√«®«—¥∑“ß™’«‡§¡’ ¢Õß °≈ÿà¡ª√–™“°√∑’Ë»÷°…“„π™à«ß‡«≈“ 5 ªï ¥—ßµ“√“ß∑’Ë 4 ®“°µ“√“ß∑’Ë 4.1-4.4 ·≈–·ºπ¿“æ∑’Ë 4

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

April - June 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ µ“√“ß∑’Ë 4 §à“‰¢¡—π‡©≈’Ë¬ ¢Õßª√–™“°√∑’Ë»÷°…“„π™à«ß 5 ªï (·∫àßµ“¡‡æ») 4.1‰¢¡—π Cholesterol ‡æ» CHOL 2550 2551 2552 2553 2554 ‡©≈’Ë¬ 5 ªï º≈µà“ß 5 ªï

À≠‘ß

™“¬

213.80 215.56 217.96 209.46 208.39 213.03

4.09 4.42 4.05 4.11 4.03 4.14

212.07 215.44 212.69 205.24 192.55 207.60

SD 2.77 4.82 5.29 3.86 3.91 4.13

-5.41

-19.52

À≠‘ß

™“¬

4.2 ‰¢¡—π Triglyceride ‡æ» TC 2550 2551 2552 2553 2554 ‡©≈’Ë¬ 5 ªï º≈µà“ß 5 ªï

105.34 113.22 117.05 108.73 103.31 109.53

5.39 6.31 6.89 5.90 6.34 6.17

139.27 164.31 189.69 164.05 127.27 156.92

SD 7.81 1.07 1.18 8.08 7.22 5.07

-2.03

-12.00

À≠‘ß

™“¬

‡¡…“¬π - ¡‘∂ÿπ“¬π 2555

60.26 63.31 61.08 57.65 57.12 59.88

1.54 1.78 1.61 1.52 1.40 1.57

59.73 53.86 50.32 53.50 50.26 53.53

-3.14

°√¡Õπ“¡—¬ àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

SD 1.68 1.70 1.87 1.02 1.02 1.49 -9.47

·π«‚πâ¡°“√‡ª≈’Ë¬π·ª≈ß¥—™π’¡«≈°“¬ ·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π™à«ß‡«≈“ 5 ªï (æ.».2550-2554) œ

À≠‘ß

™“¬

131.90 129.50 133.09 129.43 130.02 130.79

3.53 3.68 3.59 3.76 3.57 3.63

124.67 128.81 125.31 123.66 116.91 123.87

-1.88

æ∫«à“ „πª√–™“°√∑’Ë»÷°…“ - ‡æ»À≠‘ß¡’§à“ Cholesterol, HDLCholesterol ·≈– LDL-Cholesterol ‡©≈’Ë¬ Ÿß°«à“‡æ»™“¬ - ‡æ»™“¬ ¡’§à“ Triglyceride ‡©≈’Ë¬ Ÿß °«à“‡æ»À≠‘ß

SD 2.29 4.25 4.16 3.06 3.75 3.50 -7.76

- §à“‰¢¡—π‡©≈’Ë¬¡’·π«‚πâ¡≈¥≈ß∑ÿ°™π‘¥ ·≈–‡√’¬ßµ“¡≈”¥—∫§◊Õ Cholesterol > HDL >Triglyceride >LDL ·≈–‡æ»™“¬¡’°“√≈¥≈ß¢Õß §à“‰¢¡—π‡©≈’Ë¬¡“°°«à“‡æ»À≠‘ß

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

April - June 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ «‘®“√≥åº≈°“√»÷°…“ 1. ®“°°“√»÷°…“π’È ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫ªï æ.».2554 ·≈–ªï æ.».2550 ‡ªìπ™à«ß‡«≈“ 5 ªï ª√–™“°√∑’Ë»÷°…“¡’°“√‡ª≈’Ë¬π·ª≈ß¢ÕßπÈ”Àπ—° µ—«‡©≈’Ë¬‡æ‘Ë¡¢÷Èπ 0.89 °‘‚≈°√—¡ ‡æ»™“¬¡’πÈ”Àπ—° µ—«‡©≈’Ë¬ ‡æ‘Ë¡¡“°°«à“‡æ»À≠‘ß (2.38 ·≈– 0.94 °‘‚≈°√—¡ µ“¡≈”¥—∫) ¥—™π’¡«≈°“¬‡©≈’Ë¬ (mean BMI) „π‡æ»À≠‘ß·≈–™“¬‡∑à“°—∫ 24.28 ·≈– 25.11 kg/m2 µ“¡≈”¥—∫ ´÷Ëß§à“∑’Ë‰¥âÕ¬Ÿà„π‡°≥±å πÈ”Àπ—°‡°‘π„π‡æ»À≠‘ß ·≈–¿“«–Õâ«π„π‡æ»™“¬ °“√‡ª≈’Ë¬π·ª≈ß¢Õß§à“ mean BMI „π™à«ß 5 ªï „πª√–™“°√∑’»Ë °÷ …“ ‡æ‘¡Ë ¢÷πÈ 0.31 kg/m2 ·∫àß‡ªìπ ‡æ»À≠‘ß‡æ‘Ë¡ 0.31 kg/m2 ·≈–‡æ»™“¬‡æ‘Ë¡ 0.5 kg/m2 ´÷Ëß§à“∑’Ë‰¥âπ”¡“‡ª√’¬∫‡∑’¬∫°—∫º≈°“√ »÷°…“ Systemic Analysis: National, regional and global trends in body-mass index since 19801 ∑’Ëæ∫«à“„π™à«ß‡«≈“ 10 ªï ∑—Ë«‚≈°¡’°“√ ‡æ‘Ë¡¢÷Èπ¢Õß mean BMI „π‡æ»À≠‘ß 0.5 kg/m2 ·≈–™“¬ 0.4 kg/m2 ·≈–„π à«π¢Õß‡Õ‡™’¬µ–«—π ÕÕ°‡©’¬ß„µâ „π‡æ»À≠‘ß‡æ‘Ë¡ 1 kg/m2 ·≈–™“¬ 0.7 kg/m2 ·≈â«æ∫«à“¡’∑‘»∑“ß∑’Ë‡æ‘Ë¡¢÷Èπ‰ª„π ∑“ß‡¥’¬«°—π ·µà„π°≈ÿà¡ª√–™“°√∑’Ë»÷°…“π’È ‡æ» ™“¬¡’°“√‡æ‘Ë¡¢Õß mean BMI ¡“°°«à“‡æ»À≠‘ß πà“®–¡“®“°¢âÕ®”°—¥¢Õß°“√»÷°…“π’È ∑’Ë¡’°≈ÿà¡ ª√–™“°√∑’Ë»÷°…“‡ªìπ·∫∫ ¡—§√„® ·≈–¢π“¥ µ—«Õ¬à“ß¢Õß‡æ»™“¬πâÕ¬¡“° ∑”„Àâ‰¡à “¡“√∂ ‡ªìπµ—«·∑π¢Õß‡æ»™“¬‰¥â∑—ÈßÀ¡¥ ¥â“π§«“¡ ™ÿ°¢Õß¿“«–Õâ«π(BMI ≥ 25 kg/m2)·≈–Õâ«π ¡“°(BMI ≥ 30 kg/m2)„πª√–™“°√∑’Ë»÷°…“ ¡’ ·π«‚πâ ¡ ‡æ‘Ë ¡ ¢÷È π (¥— ß ·ºπ¿“æ∑’Ë 2) ´÷Ë ß °“√ ‡ª≈’Ë¬π·ª≈ßπ’È ‡À¡◊Õπ°—∫·π«‚πâ¡∑—Ë«‚≈°∑’Ë¿“«– Õâ«π ·≈–Õâ«π¡“° ¡’·π«‚πâ¡∑’Ë‡æ‘Ë¡¢÷Èπ ¥—ß∑’Ë°≈à“« ‰«â„π∫∑π” 2. °“√‡ª≈’¬Ë π·ª≈ß¢Õß‰¢¡—π‡©≈’¬Ë æ∫«à“ 74

‡¡…“¬π - ¡‘∂ÿπ“¬π 2555

°√¡Õπ“¡—¬ àß‡ √‘¡„Àâ§π‰∑¬ ÿ¢¿“æ¥’

§à“‰¢¡—π‡©≈’Ë¬≈¥≈ß∑ÿ°™π‘¥∑—Èß§à“ Cholesterol, Triglyceride, HDL-C ·≈– LDL-C ‚¥¬ ‡æ»™“¬¡’§à“‡©≈’Ë¬∑’Ë≈¥≈ß¡“°°«à“‡æ»À≠‘ß §à“ mean Cholesterol ‡ªìπ§à“‡©≈’Ë¬≈¥≈ß¡“°∑’Ë ÿ¥ §◊Õ≈¥≈ß 6.51 mg/dl ·∫àß‡ªìπ‡æ»À≠‘ß≈¥≈ß 5.41 mg/dl ·≈–‡æ»™“¬≈¥≈ß 19.52 mg/dl („π‡«≈“ 5 ªï) ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫°“√»÷°…“ Systemic Analysis: National, regional and global trends in serum cholesterol since 198014 ∑—Ë«‚≈°„π ‡«≈“ 10 ªï ∑’Ëæ∫§à“ mean cholesterol ≈¥≈ß 0.1 mmol/L (3.867 mg/dl) ∑—Èß„π‡æ»À≠‘ß ·≈– ‡æ»™“¬ ·µà„πª√–‡∑»·∂∫‡Õ‡™’¬µ–«—πÕÕ°·≈– ‡Õ‡™’¬µ–«—πÕÕ°‡©’¬ß„µâ ¡’§à“ mean cholesterol ‡æ‘¡Ë ¢÷πÈ „π‡æ»À≠‘ß‡æ‘¡Ë ¢÷πÈ 0.09 mmol/L (3.480 mg/dl) ·≈–„π‡æ»™“¬‡æ‘Ë¡¢÷Èπ 0.08 mmol/L (3.093 mg/dl) √«¡∂÷ß°“√»÷°…“∑’Ë∑”„πª√–‡∑» ‰∑¬ ®“°°“√ ”√«® ÿ¢¿“æª√–™“™π‰∑¬‚¥¬ °“√µ√«®√à“ß°“¬ §√—Èß∑’Ë 37 ·≈– 48 ∑’Ë‰¥â§à“‡©≈’Ë¬ mean cholesterol ‡ª≈’Ë¬π‰ª„π∑‘»∑“ß∑’Ë‡æ‘Ë¡¢÷Èπ „π‡æ»À≠‘ß‡æ‘¡Ë ®“° 197.5 ‡ªìπ 208.6 mg/dl ·≈– ‡æ»™“¬‡æ‘Ë¡®“° 188.9 ‡ªìπ 199.2 mg/dl ®– ‡ÀÁ π ‰¥â «à “ §à “ mean cholesterol ∑’Ë ≈ ¥≈ß„π ª√–™“°√∑’Ë»÷°…“π’È Õ¥§≈âÕß°—∫°“√»÷°…“∑’Ë‰¥â ®“°·π«‚πâ¡∑—«Ë ‚≈° ·µà·µ°µà“ß®“°§à“ mean cholesterol ∑’Ë‡æ‘Ë¡¢÷Èπ„πª√–‡∑»·∂∫‡Õ‡™’¬µ–«—π ÕÕ°·≈–‡Õ‡™’¬µ–«—πÕÕ°‡©’¬ß„µâ ·≈–°“√»÷°…“ „πª√–‡∑»‰∑¬‡Õß πà“®–‡ªìπ‡æ√“–ª√–™“°√∑’Ë »÷°…“π’È‡ªìπ°≈ÿà¡ Health care workers ∑’Ë¡’ §«“¡√Ÿâ‡√◊ËÕß ÿ¢¿“æ ·≈– “¡“√∂‡¢â“∂÷ß°“√√—°…“ ‰¥âßà“¬ ¥â“π§à“ mean triglyceride „π°≈ÿà¡ ª√–™“°√∑’Ë»÷°…“π’È„π‡æ»™“¬¡’§à“‡©≈’Ë¬ Ÿß°«à“ ‡æ»À≠‘ß (156.92 ·≈– 109.53 mg/dl µ“¡≈”¥—∫) ‡¡◊Ë Õ ‡ª√’ ¬ ∫‡∑’ ¬ ∫°— ∫ √“¬ß“π°“√ ”√«® ÿ ¢ ¿“æ ª√–™“™π‰∑¬§√—Èß∑’Ë 4 æ.».2551-25528 „π‡æ»

·π«‚πâ¡°“√‡ª≈’Ë¬π·ª≈ß¥—™π’¡«≈°“¬ ·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π™à«ß‡«≈“ 5 ªï (æ.».2550-2554) œ

™“¬¡’§à“‡©≈’Ë¬ Ÿß°«à“‡æ»À≠‘ß (167 ·≈– 137.5 mg/dl µ“¡≈”¥—∫) æ∫«à“¡’≈—°…≥–„°≈â‡§’¬ß°—π ·µàº≈„πª√–™“°√∑’»Ë °÷ …“π’¡È §’ “à mean triglyceride ∑’ËµË”°«à“ ¥â“π§à“ mean HDL-C „π°≈ÿà¡ ª√–™“°√∑’Ë»÷°…“π’È „π‡æ»À≠‘ß ¡’§à“‡©≈’Ë¬ Ÿß°«à“ ‡æ»™“¬ (59.88 ·≈– 53.53 mg/dl µ“¡≈”¥—∫) ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫√“¬ß“π«‘®—¬¢â“ßµâπ „π‡æ» À≠‘ß¡’§à“‡©≈’Ë¬ Ÿß°«à“‡æ»™“¬ (48.9 ·≈– 45.2 mg/dl µ“¡≈”¥—∫) æ∫«à“¡’≈—°…≥–„°≈â‡§’¬ß°—π ·µàº≈„πª√–™“°√∑’»Ë °÷ …“π’¡È §’ “à mean HDL-C ∑’Ë Ÿß°«à“ 3. ‚¥¬√«¡·≈â«„π°≈ÿà¡ª√–™“°√∑’Ë»÷°…“π’È „π‡«≈“ 5 ªï (æ.».2550-2554) ¡’§“à πÈ”Àπ—°‡©≈’¬Ë ¥—™π’¡«≈°“¬‡©≈’Ë¬ §«“¡™ÿ°¢Õß¿“«–Õâ«π·≈– Õâ«π¡“° ¡’·π«‚πâ¡∑’Ë‡æ‘Ë¡¢÷Èπ‡À¡◊Õπ°—∫·π«‚πâ¡ ∑’Ë‡æ‘Ë¡¢÷Èπ®“°°“√»÷°…“∑’Ë∑”„πª√–‡∑»‰∑¬ ·≈– ®“°∑—Ë«‚≈°¥—ß∑’Ë‰¥âÕâ“ßÕ‘ß‰«â„π¢âÕ1 ·µà§à“‰¢¡—π ‡©≈’Ë¬¢Õß Cholesterol „πª√–™“°√∑’Ë»÷°…“¡’ ·π«‚πâ¡∑’Ë≈¥≈ß ´÷Ëßµà“ß®“°°“√»÷°…“∑’Ë ”√«®„π ª√–‡∑»‰∑¬8 ·≈–®“°¢âÕ¡Ÿ≈∑’Ë¡“®“°‡Õ‡™’¬µ–«—π ÕÕ°·≈–‡Õ‡™’¬µ–«—πÕÕ°‡©’¬ß„µâ14 ∑’¡Ë §’ “à ‰¢¡—π‡©≈’¬Ë Cholesterol ∑’Ë‡æ‘Ë¡¢÷Èπ ¥—ß∑’Ë‰¥âÕâ“ßÕ‘ß‰«â„π¢âÕ 2 „π à«π¢Õß‰¢¡—π Triglyceride „πª√–™“°√°≈ÿà¡ ∑’Ë »÷ ° …“ ¡’ §à “ ‡©≈’Ë ¬ ∑’Ë πâ Õ ¬°«à “ §à “ ∑’Ë ‰ ¥â ® “°°“√ ”√«® ÿ¢¿“æª√–™“™π‰∑¬„πªï æ.».2551-25528 ·≈–§à “ ‰¢¡— π ∑’Ë ¥’ HDL-Cholesterol „π ª√–™“°√∑’Ë»÷°…“¡’§à“‡©≈’Ë¬∑’Ë Ÿß°«à“§à“∑’Ë‰¥â®“° °“√ ”√«® ÿ¢¿“æª√–™“™π‰∑¬„πªï æ.».255125528 ‡™àπ°—π ∑”„Àâ‡ÀÁπ«à“∑’Ëºà“π¡“ ·ºπß“π ¢Õß»Ÿ π ¬å Õ π“¡— ¬ ∑’Ë 1 ∑’Ë ‡ °’Ë ¬ «¢â Õ ß°— ∫ °“√ à ß ‡ √‘¡ ÿ¢¿“æ‡®â“Àπâ“∑’Ë ‡™àπ ‚§√ß°“√§π‰∑¬‰√âæÿß °“√π”«‘∑¬“°√¡“„Àâ§«“¡√Ÿâ¥â“πÕ“À“√ ·≈–°“√ ÕÕ°°”≈—ß°“¬ ‡ªìπ√–¬– ·≈–°“√ àß‡ √‘¡°“√ÕÕ° °”≈—ß ‚¥¬„™âÀà«ß¬“ß„π™à«ßÀ≈—ß‡≈‘°ß“π ‡ªìπµâπ

¡’ª√– ‘∑∏‘¿“æ∑’Ë¥’„π√–¥—∫Àπ÷Ëß§◊Õ „π¥â“π°“√≈¥ §à“‰¢¡—π∑—Èß Cholesterol ·≈– Triglyceride √«¡ ∑—Èß ∑”„Àâ§à“‰¢¡—π∑’Ë¥’ HDL-Cholesterol ‡©≈’Ë¬ ¡’§à“∑’Ë Ÿß°«à“„πª√–™“°√‰∑¬∑—Ë«‰ª¥—ß∑’Ë‰¥âÕâ“ß‰«â ·≈â«®“°°“√ ”√«®¢â“ßµâπ ·µà„π¥â“π°“√≈¥πÈ”Àπ—° ·≈–¥—™π’¡«≈°“¬ √«¡∂÷ß°“√≈¥¿“«–Õâ«π ·≈– Õâ«π¡“° ¬—ß‰¡à¡’ª√– ‘∑∏‘¿“æ‡∑à“∑’Ë§«√‡æ√“–¬—ß ¡’·π«‚πâ¡∑’Ë‡æ‘Ë¡¢÷Èπ ∂÷ß·¡â«à“·π«‚πâ¡∑’Ë‡æ‘Ë¡¢÷Èπ®– §≈â “ ¬°— ∫ ·π«‚πâ ¡ ∑’Ë ‡ æ‘Ë ¡ ¢÷È π ∑—Ë « ‚≈°·≈–ª√–‡∑» ‰∑¬‡Õß¥—ß°“√»÷°…“∑’Ë‰¥âÕâ“ßÕ‘ß‰«â„π¢âÕ 1 ·≈– ”À√—∫√–¥—∫‰¢¡—π Cholesterol, Triglyceride ·≈– HDL-Cholesterol ‡©≈’Ë¬∑’Ë¡’·π«‚πâ¡≈¥≈ß ‚¥¬∑’Ë§à“πÈ”Àπ—°‡©≈’Ë¬ ¥—™π’¡«≈°“¬‡©≈’Ë¬ ¡’·π« ‚πâ ¡ ∑’Ë ‡ æ‘Ë ¡ ¢÷È π „πª√–™“°√°≈ÿà ¡ ∑’Ë »÷ ° …“π’È ‡ ªì π ‡æ√“–°“√≈¥√–¥—∫‰¢¡—π Cholesterol ·≈– Triglyceride “¡“√∂∑”‰¥â ‚ ¥¬°“√ª√— ∫ ‡ª≈’Ë ¬ π æƒµ‘°√√¡„π°“√¥”‡π‘π™’«‘µ (Total lifestyle change, TLC) ´÷ËßÀ¡“¬∂÷ß °“√°”®—¥§«“¡‡ ’Ë¬ß ¢Õß°“√‡°‘¥√–¥—∫‰¢¡—π∑’Ëº‘¥ª°µ‘∑’Ë‡°‘¥®“°°“√ ¥”‡π‘π™’«‘µª√–®”«—π„ÀâÀ¡¥‰ª ‡™àπ °“√ Ÿ∫∫ÿÀ√’Ë °“√π—Ëß¬◊πÕ¬Ÿà°—∫∑’Ë‡ªìπ à«π„À≠à„π·µà≈–«—π (Sedentary life) §«“¡‡§√’¬¥ √à«¡°—∫°“√ÕÕ°°”≈—ß°“¬ ·≈–°“√√—∫ª√–∑“πÕ“À“√Õ¬à“ß∂Ÿ°µâÕß ‚¥¬‡¡◊ËÕ §«∫§ÿ¡‚¥¬«‘∏’π’È„π™à«ß‡«≈“ 3-6 ‡¥◊Õπ·≈â«¬—ß¡’ √–¥—∫‰¢¡—π„π‡≈◊Õ¥∑’Ë Ÿß “¡“√∂√—°…“‰¥â‚¥¬°“√ „™â¬“≈¥‰¢¡—π15 ‡™àπ ¬“°≈ÿà¡ Statin, Fibrate ´÷Ëß “¡“√∂≈¥√–¥—∫‰¢¡—π Cholesterol ·≈– Triglyceride ‰¥â¥’(‚¥¬¬“°≈ÿà¡ Statin ≈¥√–¥—∫‰¢¡—π Cholesterol ≈ß‰¥â√âÕ¬≈– 30-50 ·≈–¬“°≈ÿà¡ Fibrate ≈¥√–¥—∫‰¢¡—π Triglyceride ≈ß‰¥â√Õâ ¬≈– 25-50 ) √à«¡°—∫°“√∑’ªË √–™“°√°≈ÿ¡à ∑’»Ë °÷ …“π’È ‡ªìπ °≈ÿ¡à Health care workers ∑’¡Ë §’ «“¡√Ÿ‡â √◊ÕË ß ÿ¢¿“æ “¡“√∂‡¢â“∂÷ß°“√√—°…“‰¥âßà“¬‡π◊ËÕß®“°∑”ß“π „π»Ÿπ¬åÕπ“¡—¬∑’Ë 1 ∑’Ë¡’·æ∑¬å æ¬“∫“≈∑’Ë„Àâ§”

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

April - June 2012

∫ ∑ «‘ ∑ ¬ “ ° “ √ ª√÷°…“ °“√√—°…“ ·≈–¡’°“√®—¥°‘®°√√¡‚§√ß°“√ §π‰∑¬‰√âæÿß ¡’°“√ àß‡ √‘¡°“√ÕÕ°°”≈—ß°“¬À≈—ß ‡≈‘°ß“π „Àâ§«“¡√Ÿâ¥â“π‚¿™π“°“√ ∑’Ë‰¥âº≈¥’„π √–¥—∫Àπ÷Ëß ∑”„Àâ√–¥—∫‰¢¡—π Cholesterol ·≈– Triglyceride ¡’·π«‚πâ¡∑’Ë≈¥≈ß à«π¿“«–‰¢¡—π HDL-Cholesterol ∑’ËµË” (Low HDL-Cholesterol)15 ¡’ “‡Àµÿ®“°§«“¡º‘¥ª°µ‘∑“ßæ—π∏ÿ°√√¡ (Genetic factor) æ∫‰¥â √â Õ ¬≈– 50 ·≈– “‡Àµÿ∑’Ë‰¥â√—∫¡“¿“¬À≈—ß(Acquired factor) √âÕ¬≈– 50 ‡™àπ ¿“«–πÈ”Àπ—°‡°‘π·≈–Õâ«π °“√ √—∫ª√–∑“πÕ“À“√∑’Ë¡’§“√å‚∫‰Œ‡¥√µ Ÿß (¡“°°«à“ √âÕ¬≈– 60 ¢Õß√–¥—∫æ≈—ßß“π∑’Ë‰¥â√—∫„π·µà≈–«—π) °“√ Ÿ∫∫ÿÀ√’Ë °“√∑’Ë¡’°“√ÕÕ°°”≈—ßπâÕ¬ (Physical inactivity) ‚√§‡∫“À«“π™π‘ ¥ ∑’Ë 2 ‡ªì π µâ π ‚¥¬¿“«–πÈ”Àπ—°‡°‘π·≈–Õâ«π ‡ªìπ “‡Àµÿ∑’Ë‰¥â√—∫ ¡“¿“¬À≈—ß (Acquired factor) ∑’Ë ”§—≠∑’Ë ÿ¥ ¢Õß¿“«– Low HDL-Cholesterol16-18 ¥—ßπ—Èπ √–¥—∫‰¢¡—π HDL-Cholesterol ∑’Ë¡’·π«‚πâ¡ ≈¥≈ß„πª√–™“°√∑’Ë»÷°…“π’È ‡ªìπ‡æ√“–¿“«–πÈ” Àπ—°‡°‘π ·≈–¿“«–Õâ«π∑’Ë¬—ß¡’·π«‚πâ¡∑’Ë‡æ‘Ë¡¢÷Èπ ¥—ßπ—Èπ»Ÿπ¬åÕπ“¡—¬∑’Ë 1 ‚¥¬‡©æ“–ºŸâ∑’Ë‡°’Ë¬«¢âÕß°—∫ °“√ àß‡ √‘¡ ÿ¢¿“æ‡®â“Àπâ“∑’Ë µâÕßæ—≤π“·ºπß“π ∑’®Ë –‰¥âº≈„π à«ππ’§È Õ◊ °“√≈¥πÈ”Àπ—° ≈¥¿“«–Õâ«π „Àâ ‡ ªì π √Ÿ ª ∏√√¡ ·≈–®√‘ ß ®— ß ¡“°¢÷È π ‡æ◊Ë Õ ∑’Ë ® – ‡ªìπ°“√µàÕ¬Õ¥‡æ‘Ë¡¢÷Èπ®“°°“√≈¥§à“‰¢¡—π‡©≈’Ë¬ ¡“ª√– ∫§«“¡ ”‡√Á®„π°“√≈¥πÈ”Àπ—° ¥—™π’¡«≈ °“¬ ¿“«–§«“¡Õâ«π¢Õß‡®â“Àπâ“∑’Ë ‡æ◊ËÕ ÿ¢¿“æ∑’Ë ¥’ ·≈–∑”„Àâ°“√∑”ß“π¡’ª√– ‘∑∏‘¿“æ∑’Ë¥’ ·≈–π” §«“¡√Ÿâπ’È‰ª∂à“¬∑Õ¥„Àâ°—∫ª√–™“™π·≈–ºŸâªÉ«¬ ∑’Ë¡“√—∫∫√‘°“√„π»Ÿπ¬åÕπ“¡—¬∑’Ë 1 µàÕ‰ª

¢âÕ‡ πÕ·π– ®“°°“√»÷°…“π’È ®–‡ÀÁπ‰¥â«à“ °“√µ√«® ÿ ¢ ¿“æª√–®”ªï „ π·µà ≈ –ªï ∑”„Àâ ‡ √“‰¥â ¢â Õ ¡Ÿ ≈ 76

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·π«‚πâ¡°“√‡ª≈’Ë¬π·ª≈ß¥—™π’¡«≈°“¬ ·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π™à«ß‡«≈“ 5 ªï (æ.».2550-2554) œ

High Risk

10-years risk for coronary heart disease >20%

Moderate Risk

10-years risk for coronary heart disease 10-20%

Low Risk

10-years risk for coronary heart disease < 10%

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‡Õ° “√Õâ“ßÕ‘ß 1. Finucane MM, Stevens GA, Cowan MJ. National, Regional, and Global trends in body mass index since 1980: systemic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011, 377:557-567 2. Obesity and overweight. [Fact sheet No.311]2006 Sep [cited 2010 Oct 2]. Available from http://www.who.int/mediacentre/ factsheets/fs311/en/index.html 3. Carroll MD, Ogden CL. Prevalence of Overweight, Obesity and Extreme Obesity among Adults: United States, Trends 1976-1980 through 2007-2008. [cited 2011 Jan 5]. Available from: http://www.cdc.gov/NCHS/data/hestat/obesity_adult_07_08/ obesity_adult_07_08.pdf 4. Flegal KM, Carroll MD, Ogden CL. Prevalence and Trends in Obesity among US Adults, 1998-2009. JAMA 2010; 303(3):235241 5. Du S, Lu B, Zhai F, Popkin BM. A new stage of the nutrition transition in China. Public Health Nutr. 2002; 5:169-174 6. Reynolds K, Gu D, Whelton PK. Prevalence and risk factors of overweight and obesity in China. OBESITY 2007; 15(1): 10-18 7. ‡¬“«√—µπå ª√ªí°…å¢“¡ æ√æ√√≥ ∫ÿ≥¬√—µæ—π∏ÿå ∫√√≥“∏‘°“√ °“√ ”√«® ÿ¢¿“æÕπ“¡—¬¢Õßª√–™“°√‰∑¬‚¥¬°“√µ√«®√à“ß°“¬ §√—ßÈ ∑’Ë 3 æ.». 25462547 °√ÿß‡∑æ: ”π—°ß“π°‘®°“√‚√ßæ‘¡æåÕß§å°“√ ß‡§√“–Àå∑À“√ºà“π»÷°„πæ√–∫√¡√“™Ÿª∂—¡¿å; 2549 8. «‘™—¬ ‡Õ°æ≈“°√ ‡¬“«√—µπå ª√ªí°…å¢“¡ ∫√√≥“∏‘°“√ √“¬ß“π°“√ ”√«® ÿ¢¿“æª√–™“°√‰∑¬‚¥¬°“√µ√«®√à“ß°“¬ §√—Èß∑’Ë 4 æ.». 2551-2552 ππ∑∫ÿ√’: ‡¥Õ– °√“øî‚° ´‘ ‡µ¡ å; 2552 9. «‘™—¬ µ—π‰æ®‘µ√ Õ¿‘™“µ «‘™≠“≥√—µπå ™—¬™“≠ ¥’‚√®π«ß»å ·π«∑“ß°“√«‘π‘®©—¬‚√§Õâ«π Guideline √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààßª√–‡∑»‰∑¬;2546 10. ÿ√®‘µ ÿπ∑√∏√√¡ «‘∑¬“ »√’¥“¡“ °Õ∫™—¬ æ—««‘‰≈ ·π«∑“ß°“√µ√«® ÿ¢¿“æ ”À√—∫ºŸâ„À≠à Clinical Practice Guideline ∑“ßÕ“¬ÿ√°√√¡ æ.». 2542-2543 ‚§√ß°“√µ”√“®ÿÃ“Õ“¬ÿ√»… µ√å; 2542 11. WHO/IASO/IOTF. The Asia Pacific perspective: Redefining obesity and its treatment. Health Communications Australia: Melbourne. ISBN 0-9577082-1-1 2000 12. Wang J, Thorton Jc, Russel M, Burastero S, Heymsfield SB, Pierson RN jr. Asian have lower body mass index but higher percent body fat than do white: comparisons of anthropometric measurements. Am J Clin Nutr 1994; 60: 23-28 13. World Health Organization. Obesity. Preventing and managing the global epidemic. Report on a WHO consultant on obesity, Geneva, 3-5 June, 1997 14. Farshad F, Finucane MM, Goodarz D, Pelizzari PM, Cowan MJ. National, Regional, and Global trends in serum cholesterol since 1980: systemic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Lancet 2011, 377(9765):578-586 15. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III); JAMA 2001; 285: 2486-97. 16. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. NIH Pub. No. 98-4083. Bethesda, MD: National Heart, Lung and Blood Institute;1998: 288 17. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. Obesity Res 1998; 6(suppl 2): 51S-209S 18. Brown CD, HigginsM, Donato KA, Rohde FC, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res 2000; 8: 605-619

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