IJE Advance Access originally published online on January 8, 2007
International Journal of Epidemiology 2007 36(3):518-521; doi:10.1093/ije/dyl288
Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.
Dietary diversity in Khon Kaen, Thailand, 1988–2006
Jane Dixon1,
Cathy Banwell1,*,
Sam-ang Seubsman2,
Wundee Kanponai,
Sharon Friel1 and
Robert MacLennan3
1National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Australia.
2School of Human Ecology, Sukhothai Thammathirat Open University, Thailand.
3Queensland Institute of Medical Health, Australia.
* Corresponding author. National Centre for Epidemiology and Population Health (NCEPH), Building 62, Australian National University ACTON ACT 0200. E-mail: cathy.banwell{at}anu.edu.au
Accepted 29 November 2006
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Background
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A restricted diet, if high in saturated fats, sugars, animal
products and processed carbohydrates, is associated with many
modern diseases
1 while diverse diets are considered to be healthy;
2 and an effective indicator of food security.
3 Dietary guidelines
recommend balanced consumption from a number of core food groups
to ensure adequate intake of essential nutrients to promote
good health
4 and prevent non-communicable chronic diseases.
The availability of a diverse diet reflects political and economic
factors, such as the global trade in foods and national GDP.
5
Industrialization has brought many Thais greater dietary diversity as well as more pre-processed foods and more dietary sugar, fat and animal products.6 These dietary changes are reflected in an epidemiological transition with increasing obesity, Type II diabetes, hypertension, stroke, hyperlipidaemia, coronary heart disease and cancer.7
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A photographic record of changes in dietary diversity in Khon Kaen, 1988–2006
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Khon Kaen is the capital of the north-east or Isaan region where
the 20 million residents have the lowest average household income
of any Thai region. Rice farming has declined recently but is
still the major activity for 85% of farming households,
8 as
Khon Kaen transitions from an agricultural to an industrial
and service economy. Almost 11% of 7–9 year old children
are obese, with those from higher income and educated parents
particularly at risk.
9
Bang Lum Poo (BLP) is the city's largest central wholesale market from 5 a.m. and local produce and retail market from 10 a.m. Photographs taken at the market in February 2006 were compared with 35 photos taken in February 1988. We also conducted individual and group interviews with stall holders and consumers. An assessment of the differences between the 1988 and 2006 photos provides the following conclusions. In 2006:
- Per stall, there is a greater volume and variety of foods.
- There is a greater volume and variety of fruit and orange vegetables like carrots and capsicum since the Free Trade Agreement between Thailand and China was signed.
- Fruit and vegetables appeared to be of good quality, but interviewees were concerned about inorganic fertilizer and pesticide residues.
- There was a larger range of ready-prepared foods (stir-fry pastes, herb ‘bouquets’, bags of cut-up vegetables, fermented foods), and of ready-to-eat snacks.
- Forest foods (like mushrooms that grow on trees) were not abundant, although insects (including the local delicacy of ant eggs) and water foods (like frogs) were available. Older Khon Kaen residents regretted that only farmed forms of previously wild foods (e.g. frogs, insects) are usually available. This may be a health risk if the nutritional significance of wild foods in the diets of older rural Vietnamese women applies to Thailand.10
- Food safety standards have been improved with metal or steel containers rather than plastic bowls used to hold wet foods and less food is in contact with the ground.
The following photos (1–11) attempt to visually capture the greater diversity in the food supply of this relatively poor region.
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Conclusion
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The increasing diversity of market foods, particularly green
vegetables and herbs, is health promoting as long as residents
have sufficient income to participate in the growing market
economy.
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Colour online-only version
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These images are available in full colour in the online version
of this article. Visit
IJE online at
www.ije.oxfordjournals.org.
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Acknowledgements
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We thank the Khon Kaen residents who agreed to be interviewed
for this study. The essay forms one part of a mini-project auspiced
by the Thai Health Risk Transition Study, which is funded by
the Wellcome Trust and the Australian National Health and Medical
Research Council. Dr Robert MacLennan provided the 1988 photos
while the first four authors undertook the fieldwork in 2005
and 2006.
Conflict of interest: None declared.
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References
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1 WHO/FAO. Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. In: Technical Report Series 916 (2003) Geneva: World Health Organisation.
2 Ruel M. Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr (2003) 39:11–26S.
3 Hoddinott J, Yohannes Y. Dietary diversity as a food security indicator. (2002) Washington, DC: International Food Policy Research Institute. Report No.: FCND Discussion Paper No.136.
4 WHO. Food based dietary guidelines in the WHO European Region. (2003) Copenhagen: Nutrition and Food Security Programme, WHO Regional Office for Europe.
5 Popkin BM. The nutrition transition in the developing world. Dev Policy Rev (2003) 21:581–97.[CrossRef]
6 FAO. Food Balance Sheets FAO (available at http://apps.fao.org) extracted. (2005) November. Rome: FAO.
7 Kosulwat V. The nutrition and health transition in Thailand. Public Health Nutr (2002) 5:183–89.[CrossRef][ISI][Medline]
8 National Statistics Office. Agricultural Census. (2003) Northeastern Region: Ministry of Information and Communication Technology; n.d.
9 Langendijk G, Wellings S, van Wyk M, Thompson S, McComb J, Chusilp K. The prevalence of childhood obesity in primary school children in urban Khon Kaen, Northeast Thailand. Asia Pac J Clin Nutr (2003) 12:66–72.[ISI][Medline]
10 Ogle B, Hung P, Tuyet H. Significance of wild vegetables in micronutrient intakes of women in Vietnam: an analysis of food variety. Asia Pac J Clin Nutr (2001) 10:21–30.[CrossRef][ISI][Medline]
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