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

∫ ∑ «‘ ∑ ¬ “ ° “ √

∫ ∑ «‘ ∑ ¬ “ ° “ √ ·π«‚πâ¡°“√‡ª≈’ˬπ·ª≈ߥ—™π’¡«≈°“·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π™à«ß‡«≈“ 5 ªï (æ.».2550-2554) „π°≈ÿࡇ®â“Àπâ“∑’Ë »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿ߇∑æ

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∫∑§—¥¬àÕ °“√»÷°…“π’ȇªìπ°“√»÷°…“‡™‘ßæ√√≥π“ ¡’«—µ∂ÿª√– ߧå‡æ◊ËÕ»÷°…“·π«‚πâ¡°“√‡ª≈’ˬπ·ª≈ߢÕߥ—™π’¡«≈°“·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π°≈ÿࡇ®â“Àπâ“∑’Ë∑’ËÕ“¬ÿ¡“°°«à“ 35 ªï ∑’Ë∑”ß“π„π»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿ߇∑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≈’ˬπ·ª≈߉ª„π·π«‚πâ¡∑’ˇæ‘Ë¡¢÷Èπ‡™àπ°—π ‚¥æ∫„π‡æ»™“¬ ¡“°°«à“‡æ»À≠‘ß √–¥—∫‰¢¡—π‡©≈’ˬ ¡’°“√‡ª≈’ˬπ·ª≈ß∑’Ë≈¥≈ßµ√ߢⓡ°—∫§à“¥—™π’¡«≈°“¬‡©≈’ˬ∑’ˇæ‘Ë¡ ¢÷Èπ ‚¥¬≈¥≈ß∑—Èß§à“‰¢¡—π∑’ˉ¡à¥’§◊Õ Cholesterol, Triglyceride, LDL-C ·≈–‰¢¡—π™π‘¥∑’Ë¥’§◊Õ HDL-C §à“ ‰¢¡—π‡©≈’ˬ¢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‘¢Õ߉¢¡—π, ·π«‚πâ¡„π™à«ß 5 ªï, °√ÿ߇∑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

66

‡¡…“¬π - ¡‘∂ÿπ“¬π 2555

°√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

·π«‚πâ¡°“√‡ª≈’ˬπ·ª≈ߥ—™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 Õߧ尓√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≠‘߇∑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 °”≈—߇æ‘Ë¡¢÷Èπ ∑—Èß„πª√–‡∑»∑’Ëæ—≤π“·≈â« ·≈–°”≈—ßæ—≤π“Õ¬à“ß µàÕ‡π◊ËÕß ¥â«¬«‘∂’™’«‘µ∑’ˇª≈’ˬπ·ª≈߉ª„πªí®®ÿ∫—𠧔𑬓¡¢Õß‚√§Õâ«π9 (obesity) §◊Õ‚√§‡√◊ÈÕ√—ß ™π‘¥Àπ÷Ë߇°‘¥®“°°“√∑’Ë¡’ª√‘¡“≥‰¢¡—π„π√à“ß°“(body fat) ¡“°°«à“ª°µ‘®π¡’º≈°√–∑∫µàÕ ÿ¢¿“æ ∑”„À⇰‘¥‚√§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’∫·¢ÁߢÕßÀ≈Õ¥‡≈◊Õ¥·¥ß (Atherosclerosis) ·≈–°“√‡°‘¥ Insulin Resistance ∑”„Àâ ‡°‘¥‚√§‡∫“À«“𠧫“¡¥—π‚≈À‘µ Ÿß ‚√§À≈Õ¥ ‡≈◊Õ¥À—«„®µ’∫ ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õßµ’∫ ¥—ßπ—Èπ°“√ µ√«® ÿ¢¿“æª√–®”ªï ‚¥¬‡©æ“–°≈ÿࡧπ∑’ËÕ“¬ÿ ¡“°°«à“ 35 ªï ·≈–Õ“»—¬Õ¬Ÿà„π‡¡◊Õß ´÷Ë߇ªìπ°≈ÿà¡ ‡ ’¬Ë ßµàÕ°“√‡°‘¥‚√§À≈Õ¥‡≈◊Õ¥·¥ß·¢Áß10 ‡ªìπ°“√ §—¥°√Õß∑’Ë®–™à«¬∑”„Àâ‡√“µ√«®æ∫§«“¡º‘¥ª°µ‘ ¢Õß√à“ß°“¬ ‡™àπ ¥—™π’¡«≈°“¬∑’ˇæ‘Ë¡¢÷È𠧫“¡

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

April - June 2012

67

∫ ∑ «‘ ∑ ¬ “ ° “ √ 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°≈ÿࡇ®â“Àπâ“∑’Ë»Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿ߇∑æ Õ“¬ÿ ¡“°°«à“ 35 ªï µ—Èß·µà æ.». 2550-2554 ®–∑”„Àâ ‡√“ “¡“√∂¡Õ߇ÀÁ π ¿“æ√«¡·≈–·π«‚πâ ¡ ¢Õß ¿“«– ÿ¢¿“æ¢Õ߇®â“Àπâ“∑’ˇæ◊ËÕπ”¡“‡ªìπ¢âÕ¡Ÿ≈„π °“√«“ß·ºπ°“√√≥√ߧå‡æ◊ËÕ≈¥¿“«–πÈ”Àπ—°‡°‘π ‚√§Õâ«π ·≈–æ—≤π“·ºπß“π‡°’Ë¬«°—∫ ÿ¢¿“æ ‡æ◊ËÕ „À⇮â“Àπâ“∑’Ë¡’ ÿ¢¿“æ∑’Ë¥’·≈–∑”„Àâ∑”ß“π‰¥âÕ¬à“ß ¡’ª√– ‘∑∏‘¿“æ‡æ‘Ë¡¢÷Èπ

«—µ∂ÿª√– ߧ尓√»÷°…“ ‡æ◊Ë Õ «‘ ‡ §√“–Àå · π«‚πâ ¡ °“√‡ª≈’Ë ¬ π·ª≈ß ¢Õߥ—™π’¡«≈°“¬·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥¢Õ߇®â“ Àπâ“∑’Ë∑’ËÕ“¬ÿ¡“°°«à“ 35 ªï ∑’Ë∑”ß“π„π»Ÿπ¬å Õπ“¡—¬∑’Ë 1 °√ÿ߇∑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 °√ÿ߇∑æ ∑—È߇æ»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

°√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

欓∫“≈ à߇ √‘¡ ÿ¢¿“æ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿ߇∑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¢Õ߇®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“∑’ËÀπ૵√«®ºŸâ ªÉ « ¬πÕ°∑—Ë « ‰ª ª√–°Õ∫¥â « ¬ ·æ∑¬å 欓∫“≈ ºŸâ ™à « ¬æ¬“∫“≈ ¢Õß‚√ß欓∫“≈ à ß ‡ √‘¡ ÿ¢¿“æ »Ÿπ¬åÕπ“¡—¬∑’Ë 1 °√ÿ߇∑æ °“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ : „π°“√»÷°…“π’È „™â‡°≥±å°“√·∫àߥ—™π’¡«≈ °“¬µ“¡ Asia Pacific perspective: Redefining obesity and its treatment 11 ‚¥¬„™â§à“®ÿ¥ µ—¥¢Õߥ—™π’¡«≈°“¬∑’ˇÀ¡“–°—∫§π‡Õ‡™’¬ ∑’Ë¡’√Ÿª √à“߇≈Á°·µà¡√’ Õâ ¬≈–¢Õ߉¢¡—π„π√à“ß°“¬ Ÿß°«à“12 ¥—ß µ“√“߇¡◊ËÕ‡∑’¬∫°—∫§”𑬓¡¢ÕßÕߧ尓√Õπ“¡—‚≈°‡¥‘¡13 ∑’Ë„™â®ÿ¥µ—¥¢Õߥ—™π’¡«≈°“¬·∫∫ Caucasian-based cut off value ·≈– ∂‘µ‘„™â§à“√âÕ≈– ·≈–§à“ à«π‡∫’ˬ߇∫π¡“µ√∞“π

º≈°“√»÷°…“ ¢âÕ¡Ÿ≈¢Õß°≈ÿࡪ√–™“°√∑’Ë»÷°…“ ¡’ 2 à«π ·∫à߇ªìπ¢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“ - °≈ÿࡪ√–™“°√∑’Ë»÷°…“ ‡ªìπ‡æ»À≠‘ß

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

√âÕ¬≈– 90.34 ·≈–‡æ»™“¬ √âÕ¬≈– 9.66 - à«π Ÿß‚¥¬‡©≈’ˬ¢Õ߇æ»À≠‘ß 155.82 ‡´πµ‘‡¡µ√ ·≈–‡æ»™“¬ 166.94 ‡´πµ‘‡¡µ√ - πÈ”Àπ—° ‚¥¬‡©≈’ˬ¢Õ߇æ»À≠‘ß 59.03

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

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—°‡©≈’ˬ¢Õߪ√–™“°√∑’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“‡©≈’ˬ SD §◊Õ à«π‡∫’ˬ߇∫π¡“µ√∞“π º≈µà“ß 5 ªï §◊Õ§à“‡©≈’ˬ„πªï æ.».2554 ≈∫¥â«¬§à“‡©≈’ˬ„πªï æ.».2550

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

˭ԧ 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

69

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

µ“√“ß∑’Ë 3 °≈ÿà¡¥—™π’¡«≈°“¬¢Õߪ√–™“°√∑’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 %‡©≈’ˬ

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 %‡©≈’ˬ

0 1 0 0 1

70

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“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

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≈’ˬπ·ª≈ߥ—™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’¡«≈°“‡©≈’ˬ (Mean weight & BMI) ¡“°°«à“ °≈ÿà¡ ‡æ»À≠‘ß - §à“πÈ”Àπ—° ·≈–¥—™π’¡«≈°“¬‡©≈’ˬ „𠇫≈“ 5 ªï ¡’·π«‚π⡇æ‘Ë¡¢÷Èπ∑—Èß„π‡æ»À≠‘ß·≈– ‡æ»™“¬ ‚¥¬‡æ»™“¬¡’§à“‡©≈’ˬ∑’ˇæ‘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¡∑’ˇæ‘Ë¡¢÷Èπ ·≈–æ∫„π‡æ»™“¬¡“°°«à“ ‡æ»À≠‘ß 2. ¢âÕ¡Ÿ≈¥â“π°“√µ√«®«—¥∑“ß™’«‡§¡’ ¢Õß °≈ÿࡪ√–™“°√∑’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

71

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

˭ԧ

™“¬

X

SD

X

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

˭ԧ

™“¬

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

X

SD

X

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

˭ԧ

™“¬

4.3 ‰¢¡—π HDL-Cholesterol ‡æ» HDL 2550 2551 2552 2553 2554 ‡©≈’ˬ 5 ªï º≈µà“ß 5 ªï 72

‡¡…“¬π - ¡‘∂ÿπ“¬π 2555

X

SD

X

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“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

SD 1.68 1.70 1.87 1.02 1.02 1.49 -9.47

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

4.4 ‰¢¡—π LDL-Cholesterol ‡æ» LDL 2550 2551 2552 2553 2554 ‡©≈’ˬ 5 ªï º≈µà“ß 5 ªï

˭ԧ

™“¬

X

SD

X

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 ‡©≈’ËŸß°«à“‡æ»™“- ‡æ»™“¬ ¡’§à“ Triglyceride ‡©≈’ˬ Ÿß °«à“‡æ»À≠‘ß

SD 2.29 4.25 4.16 3.06 3.75 3.50 -7.76

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

¿“æ∑’Ë 4 · ¥ß§à“‡©≈’ˬ¢Õ߉¢¡—π™π‘¥µà“ßÊ „π™à«ß 5 ªï ·¬°µ“¡‡æ»

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

April - June 2012

73

∫ ∑ «‘ ∑ ¬ “ ° “ √ «‘®“√≥åº≈°“√»÷°…“ 1. ®“°°“√»÷°…“π’È ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫ªï æ.».2554 ·≈–ªï æ.».2550 ‡ªìπ™à«ß‡«≈“ 5 ªï ª√–™“°√∑’Ë»÷°…“¡’°“√‡ª≈’ˬπ·ª≈ߢÕßπÈ”Àπ—° µ—«‡©≈’ˬ‡æ‘Ë¡¢÷Èπ 0.89 °‘‚≈°√—¡ ‡æ»™“¬¡’πÈ”Àπ—° µ—«‡©≈’ˬ ‡æ‘Ë¡¡“°°«à“‡æ»À≠‘ß (2.38 ·≈– 0.94 °‘‚≈°√—¡ µ“¡≈”¥—∫) ¥—™π’¡«≈°“¬‡©≈’ˬ (mean BMI) „π‡æ»À≠‘ß·≈–™“¬‡∑à“°—∫ 24.28 ·≈– 25.11 kg/m2 µ“¡≈”¥—∫ ´÷Ëߧà“∑’ˉ¥âÕ¬Ÿà„π‡°≥±å πÈ”Àπ—°‡°‘π„π‡æ»À≠‘ß ·≈–¿“«–Õâ«π„π‡æ»™“°“√‡ª≈’ˬπ·ª≈ߢÕß§à“ mean BMI „π™à«ß 5 ªï „πª√–™“°√∑’»Ë °÷ …“ ‡æ‘¡Ë ¢÷πÈ 0.31 kg/m2 ·∫à߇ªìπ ‡æ»À≠‘߇æ‘Ë¡ 0.31 kg/m2 ·≈–‡æ»™“¬‡æ‘Ë¡ 0.5 kg/m2 ´÷Ëߧà“∑’ˉ¥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¢Õ߇Շ™’¬µ–«—π ÕÕ°‡©’¬ß„µâ „π‡æ»À≠‘߇æ‘Ë¡ 1 kg/m2 ·≈–™“0.7 kg/m2 ·≈â«æ∫«à“¡’∑‘»∑“ß∑’ˇæ‘Ë¡¢÷Èπ‰ª„π ∑“߇¥’¬«°—π ·µà„π°≈ÿࡪ√–™“°√∑’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“ߢÕ߇滙“¬πâÕ¬¡“° ∑”„Àâ‰¡à “¡“√∂ ‡ªìπµ—«·∑π¢Õ߇滙“¬‰¥â∑—ÈßÀ¡¥ ¥â“𧫓¡ ™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≈’ˬπ·ª≈ßπ’È ‡À¡◊Õπ°—∫·π«‚πâ¡∑—Ë«‚≈°∑’Ë¿“«– Õâ«π ·≈–Õâ«π¡“° ¡’·π«‚πâ¡∑’ˇæ‘Ë¡¢÷Èπ ¥—ß∑’Ë°≈à“« ‰«â„π∫∑π” 2. °“√‡ª≈’¬Ë π·ª≈ߢÕ߉¢¡—π‡©≈’¬Ë æ∫«à“ 74

‡¡…“¬π - ¡‘∂ÿπ“¬π 2555

°√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

§à“‰¢¡—π‡©≈’ˬ≈¥≈ß∑ÿ°™π‘¥∑—Èß§à“ Cholesterol, Triglyceride, HDL-C ·≈– LDL-C ‚¥‡æ»™“¬¡’§à“‡©≈’ˬ∑’Ë≈¥≈ß¡“°°«à“‡æ»À≠‘ß §à“ mean Cholesterol ‡ªìπ§à“‡©≈’ˬ≈¥≈ß¡“°∑’Ë ÿ¥ §◊Õ≈¥≈ß 6.51 mg/dl ·∫à߇ªìπ‡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«‚≈°„𠇫≈“ 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 ∑’ˉ¥â§à“‡©≈’Ëmean cholesterol ‡ª≈’Ë¬π‰ª„π∑‘»∑“ß∑’ˇæ‘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°—∫°“√»÷°…“∑’ˉ¥â ®“°·π«‚πâ¡∑—«Ë ‚≈° ·µà·µ°µà“ß®“°§à“ mean cholesterol ∑’ˇæ‘Ë¡¢÷Èπ„πª√–‡∑»·∂∫‡Õ‡™’¬µ–«—π ÕÕ°·≈–‡Õ‡™’¬µ–«—πÕÕ°‡©’¬ß„µâ ·≈–°“√»÷°…“ „πª√–‡∑»‰∑¬‡Õß πà“®–‡ªìπ‡æ√“–ª√–™“°√∑’Ë »÷°…“π’ȇªìπ°≈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“‡©≈’ˬ 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≈’ˬπ·ª≈ߥ—™π’¡«≈°“¬ ·≈–√–¥—∫‰¢¡—π„π‡≈◊Õ¥„π™à«ß‡«≈“ 5 ªï (æ.».2550-2554) œ

™“¬¡’§à“‡©≈’ˬ Ÿß°«à“‡æ»À≠‘ß (167 ·≈– 137.5 mg/dl µ“¡≈”¥—∫) æ∫«à“¡’≈—°…≥–„°≈⇧’¬ß°—π ·µàº≈„πª√–™“°√∑’»Ë °÷ …“π’¡È §’ “à mean triglyceride ∑’˵˔°«à“ ¥â“π§à“ mean HDL-C „π°≈ÿà¡ ª√–™“°√∑’Ë»÷°…“π’È „π‡æ»À≠‘ß ¡’§à“‡©≈’ˬ Ÿß°«à“ ‡æ»™“¬ (59.88 ·≈– 53.53 mg/dl µ“¡≈”¥—∫) ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫√“¬ß“π«‘®—¬¢â“ßµâπ „π‡æ» À≠‘ß¡’§à“‡©≈’ˬ Ÿß°«à“‡æ»™“¬ (48.9 ·≈– 45.2 mg/dl µ“¡≈”¥—∫) æ∫«à“¡’≈—°…≥–„°≈⇧’¬ß°—π ·µàº≈„πª√–™“°√∑’»Ë °÷ …“π’¡È §’ “à mean HDL-C ∑’Ë Ÿß°«à“ 3. ‚¥¬√«¡·≈â«„π°≈ÿࡪ√–™“°√∑’Ë»÷°…“π’È „π‡«≈“ 5 ªï (æ.».2550-2554) ¡’§“à πÈ”Àπ—°‡©≈’¬Ë ¥—™π’¡«≈°“¬‡©≈’ˬ §«“¡™ÿ°¢Õß¿“«–Õâ«π·≈– Õâ«π¡“° ¡’·π«‚πâ¡∑’ˇæ‘Ë¡¢÷Èπ‡À¡◊Õπ°—∫·π«‚πâ¡ ∑’ˇæ‘Ë¡¢÷Èπ®“°°“√»÷°…“∑’Ë∑”„πª√–‡∑»‰∑¬ ·≈– ®“°∑—Ë«‚≈°¥—ß∑’ˉ¥âÕâ“ßՑ߉«â„π¢âÕ1 ·µà§à“‰¢¡—𠇩≈’ˬ¢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 ∑’ˇæ‘Ë¡¢÷Èπ ¥—ß∑’ˉ¥âÕâ“ßՑ߉«â„π¢âÕ 2 „π à«π¢Õ߉¢¡—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“‡©≈’ˬ∑’Ë Ÿß°«à“§à“∑’ˉ¥â®“° °“√ ”√«® ÿ¢¿“æª√–™“™π‰∑¬„πªï æ.».255125528 ‡™àπ°—π ∑”„Àâ‡ÀÁπ«à“∑’˺à“π¡“ ·ºπß“π ¢Õß»Ÿ π ¬å Õ π“¡— ¬ ∑’Ë 1 ∑’Ë ‡ °’Ë ¬ «¢â Õ ß°— ∫ °“√ à ß ‡ √‘¡ ÿ¢¿“懮â“Àπâ“∑’Ë ‡™à𠂧√ß°“√§π‰∑¬‰√âæÿß °“√π”«‘∑¬“°√¡“„À⧫“¡√Ÿâ¥â“πÕ“À“√ ·≈–°“√ ÕÕ°°”≈—ß°“¬ ‡ªìπ√–¬– ·≈–°“√ à߇ √‘¡°“√ÕÕ° °”≈—ß ‚¥¬„™âÀà«ß¬“ß„π™à«ßÀ≈—߇≈‘°ß“𠇪ìπµâπ

¡’ª√– ‘∑∏‘¿“æ∑’Ë¥’„π√–¥—∫Àπ÷Ëߧ◊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∑’ˉ¥âÕâ“߉«â ·≈â«®“°°“√ ”√«®¢â“ßµâπ ·µà„π¥â“π°“√≈¥πÈ”Àπ—° ·≈–¥—™π’¡«≈°“¬ √«¡∂÷ß°“√≈¥¿“«–Õâ«π ·≈– Õâ«π¡“° ¬—߉¡à¡’ª√– ‘∑∏‘¿“æ‡∑à“∑’˧«√‡æ√“–¬—ß ¡’·π«‚πâ¡∑’ˇæ‘Ë¡¢÷Èπ ∂÷ß·¡â«à“·π«‚πâ¡∑’ˇæ‘Ë¡¢÷Èπ®– §≈â “ ¬°— ∫ ·π«‚πâ ¡ ∑’Ë ‡ æ‘Ë ¡ ¢÷È π ∑—Ë « ‚≈°·≈–ª√–‡∑» ‰∑¬‡Õߥ—ß°“√»÷°…“∑’ˉ¥âÕâ“ßՑ߉«â„π¢âÕ 1 ·≈– ”À√—∫√–¥—∫‰¢¡—π Cholesterol, Triglyceride ·≈– HDL-Cholesterol ‡©≈’ˬ∑’Ë¡’·π«‚πâ¡≈¥≈ß ‚¥¬∑’˧à“πÈ”Àπ—°‡©≈’ˬ ¥—™π’¡«≈°“¬‡©≈’ˬ ¡’·π« ‚πâ ¡ ∑’Ë ‡ æ‘Ë ¡ ¢÷È π „πª√–™“°√°≈ÿà ¡ ∑’Ë »÷ ° …“π’È ‡ ªì π ‡æ√“–°“√≈¥√–¥—∫‰¢¡—π Cholesterol ·≈– Triglyceride “¡“√∂∑”‰¥â ‚ ¥¬°“√ª√— ∫ ‡ª≈’Ë ¬ π 惵‘°√√¡„π°“√¥”‡π‘π™’«‘µ (Total lifestyle change, TLC) ´÷ËßÀ¡“¬∂÷ß °“√°”®—¥§«“¡‡ ’Ë¬ß ¢Õß°“√‡°‘¥√–¥—∫‰¢¡—π∑’˺‘¥ª°µ‘∑’ˇ°‘¥®“°°“√ ¥”‡π‘π™’«‘µª√–®”«—π„ÀâÀ¡¥‰ª ‡™àπ °“√ Ÿ∫∫ÿÀ√’Ë °“√π—Ë߬◊πÕ¬Ÿà°—∫∑’ˇªìπ 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·≈⫬—ß¡’ √–¥—∫‰¢¡—π„π‡≈◊Õ¥∑’Ë Ÿß “¡“√∂√—°…“‰¥â‚¥¬°“√ „™â¬“≈¥‰¢¡—π15 ‡™à𠬓°≈ÿà¡ Statin, Fibrate ´÷Ëß “¡“√∂≈¥√–¥—∫‰¢¡—π Cholesterol ·≈– Triglyceride ‰¥â¥’(‚¥¬¬“°≈ÿà¡ Statin ≈¥√–¥—∫‰¢¡—π Cholesterol ≈߉¥â√âÕ¬≈– 30-50 ·≈–¬“°≈ÿà¡ Fibrate ≈¥√–¥—∫‰¢¡—π Triglyceride ≈߉¥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 欓∫“≈∑’Ë„À⧔

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

April - June 2012

75

∫ ∑ «‘ ∑ ¬ “ ° “ √ ª√÷°…“ °“√√—°…“ ·≈–¡’°“√®—¥°‘®°√√¡‚§√ß°“√ §π‰∑¬‰√âæÿß ¡’°“√ à߇ √‘¡°“√ÕÕ°°”≈—ß°“¬À≈—ß ‡≈‘°ß“π „À⧫“¡√Ÿâ¥â“π‚¿™π“°“√ ∑’ˉ¥âº≈¥’„π √–¥—∫Àπ÷Ëß ∑”„Àâ√–¥—∫‰¢¡—π Cholesterol ·≈– Triglyceride ¡’·π«‚πâ¡∑’Ë≈¥≈ß à«π¿“«–‰¢¡—π HDL-Cholesterol ∑’˵˔ (Low HDL-Cholesterol)15 ¡’ “‡Àµÿ®“°§«“¡º‘¥ª°µ‘∑“ßæ—π∏ÿ°√√¡ (Genetic factor) æ∫‰¥â √â Õ ¬≈– 50 ·≈– “‡Àµÿ∑’ˉ¥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∑’ˉ¥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 ‡ªì𠓇Àµÿ∑’ˉ¥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∑’ˬ—ß¡’·π«‚πâ¡∑’ˇæ‘Ë¡¢÷Èπ ¥—ßπ—Èπ»Ÿπ¬åÕπ“¡—¬∑’Ë 1 ‚¥¬‡©æ“–ºŸâ∑’ˇ°’ˬ«¢âÕß°—∫ °“√ à߇ √‘¡ ÿ¢¿“懮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¢Õ߇®â“Àπâ“∑’Ë ‡æ◊ËÕ ÿ¢¿“æ∑’Ë ¥’ ·≈–∑”„Àâ°“√∑”ß“π¡’ª√– ‘∑∏‘¿“æ∑’Ë¥’ ·≈–π” §«“¡√Ÿâπ’ȉª∂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≈’ˬπ·ª≈ߥ—™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%

·≈⫇√“®–‰¥â°≈ÿࡧπ∑’Ë¡’‚Õ°“ ‡ ’ˬ߄π°“√‡°‘¥‚√§ À≈Õ¥‡≈◊Õ¥À—«„®·∫à߇ªì𧫓¡‡ ’¬Ë ß¡“° ª“π°≈“ß ·≈–πâÕ¬ ‡ªìπ 3 °≈ÿà¡ ·≈–°≈ÿࡧπ∑’Ë¡’§«“¡‡ ’Ë¬ß „π°“√‡°‘¥‚√§À—«„®·≈–À≈Õ¥‡≈◊Õ¥¡“°∑’ Ë ¥ÿ (High Risk) §◊Õ 10-years risk for coronary heart disease >20% µ“¡ Framingham Risk Score

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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°…墓¡ æ√æ√√≥ ∫ÿ≥¬√—µæ—π∏ÿå ∫√√≥“∏‘°“√ °“√ ”√«® ÿ¢¿“æÕπ“¡—¬¢Õߪ√–™“°√‰∑¬‚¥¬°“√µ√«®√à“ß°“¬ §√—ßÈ ∑’Ë 3 æ.». 25462547 °√ÿ߇∑æ: ”π—°ß“π°‘®°“√‚√ßæ‘¡æåÕߧ尓√ ߇§√“–Àå∑À“√ºà“π»÷°„πæ√–∫√¡√“™Ÿª∂—¡¿å; 2549 8. «‘™—¬ ‡Õ°æ≈“°√ ‡¬“«√—µπå ª√ªí°…墓¡ ∫√√≥“∏‘°“√ √“¬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·Ààߪ√–‡∑»‰∑¬;2546 10. ÿ√®‘µ ÿπ∑√∏√√¡ «‘∑¬“ »√’¥“¡“ °Õ∫™—¬ æ—««‘‰≈ ·π«∑“ß°“√µ√«® ÿ¢¿“æ ”À√—∫ºŸâ„À≠à Clinical Practice Guideline ∑“ßÕ“¬ÿ√°√√¡ æ.».

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