Thai Adults Research Articles

Preparedness for Later Life and Associated Factors among Thai Adults

ABSTRACT This cross-sectional survey was aimed to explore the features of later life security and their related factors among Thais using the WHO Active Aging Framework. Data were collected from 1,129 adults aged 18–59 years in Nakhon Nayok, Thailand using a self-administered questionnaire consisting of three sections measuring demographic data, factors related to the active aging concept, and preparedness for later life. Logistic regression analyses were applied to determine the associated factors. The results showed that all the three later life preparedness variables were rated at medium levels; and setting aside funds for later life and managing inheritance were reported more frequently than having made funeral arrangements. Preparation for later life was strongly associated with community participation (odds ratio, 4.6; 95% CI 3.1–6.8) and financial security preparation (odds ratio,3.5; 95% CI 2.3–5.2). Further research is needed to promote later life preparation during the new normal period when community engagement and financial planning are more difficult and also to understand the features of later life preparation among aging population because lives of older persons are also more vulnerable and uncertain due to the pandemic.

Comparison of unweighted and item response theory-based weighted sum scoring for the Nine-Questions Depression-Rating Scale in the Northern Thai Dialect

BackgroundThe Nine-Questions Depression-Rating Scale (9Q) has been developed as an alternative assessment tool for assessing the severity of depressive symptoms in Thai adults. The traditional unweighted sum scoring approach does not account for differences in the loadings of the items on the actual severity. Therefore, we developed an Item Response Theory (IRT)-based weighted sum scoring approach to provide a scoring method that is more precise than the unweighted sum score.MethodsSecondary data from a study on the criterion-related validity of the 9Q in the northern Thai dialect was used in this study. All participants were interviewed to obtain demographic data and screened/evaluated for major depressive disorder and the severity of the associated depressive symptoms, followed by diagnosis by a psychiatrist for major depressive disorder. IRT models were used to estimate the discrimination and threshold parameters. Differential item functioning (DIF) of responses to each item between males and females was compared using likelihood-ratio tests. The IRT-based weighed sum scores of the individual items are defined as the linear combination of individual response weighted with the discrimination and threshold parameters divided by the plausible maximum score based on the graded-response model (GRM) for the 9Q score (9Q-GRM) or the nominal-response model (NRM) for categorical combinations of the intensity and frequency of symptoms from the 9Q responses (9QSF-NRM). The performances of the two scoring procedures were compared using relative precision.ResultsOf the 1,355 participants, 1,000 and 355 participants were randomly selected for the developmental and validation group for the IRT-based weighted scoring, respectively. the gender-related DIF were presented for items 2 and 5 for the 9Q-GRM, while most items (except for items 3 and 6) for the 9QSF-NRM, which could be used to separately estimate the parameters between genders. The 9Q-GRM model accounting for DIF had a higher precision (16.7%) than the unweighted sum-score approach.DiscussionOur findings suggest that weighted sum scoring with the IRT parameters can improve the scoring when using 9Q to measure the severity of the depressive symptoms in Thai adults. Accounting for DIF between the genders resulted in higher precision for IRT-based weighted scoring.

Risk Prediction Performance of the Thai Cardiovascular Risk Score for Mild Cognitive Impairment in Adults with Metabolic Risk Factors in Thailand.

Individuals with metabolic risks are at high risk of cognitive impairment. We aimed to investigate whether the Thai Cardiovascular Risk (TCVR) score can be used to predict mild cognitive impairment (MCI) in Thai adults with metabolic risks. The study was conducted using secondary data of patients with metabolic risks from Maharaj Nakorn Chiang Mai Hospital. MCI was indicated by an MoCA score of less than 25. Six different TCVR models were used with various combinations of ten different variables for predicting the risk of MCI. The area under the receiver operator characteristic curve (AuROC) and Hosmer–Lemeshow goodness of fit tests were used for determining discriminative performance and model calibration. The sensitivity of the discriminative performance was further evaluated by stratifying by age and gender. From a total of 421 participants, 348 participants had MCI. All six TCVR models showed a similar AuROC, varying between 0.58 and 0.61. The anthropometric-based model showed the best risk prediction performance in the older age group (AuROC 0.69). The laboratory-based model provided the highest discriminative performance for the younger age group (AuROC 0.60). There is potential for the development of an MCI risk model based on values from routine cardiovascular risk assessments among patients with metabolic risks.

Sexuality in Older Adults in A Primary Care Unit of Thailand during the COVID-19 Pandemic: A Cross-sectional Survey

ABSTRACT Objectives To investigate sexuality in older Thai adults during the coronavirus disease (COVID-19) pandemic and the associated factors. Methods This cross-sectional survey was conducted on older adults visiting a primary care unit (PCU) in Thailand. A hundred and ninety older adults were enrolled by convenience sampling. Multiple logistic regression analysis with a backward stepwise algorithm was used to analyze factors associated with sexual desire and activity in older Thai adults. Results The median age of participants was 67.99 (60.01–88.57) years, and 63.2% were women. Overall, 37.4% of participants had sexual desires, and 54.2% were sexually active during the COVID-19 pandemic; however, more than half reported a decrease in sexual activity, fearing COVID-19 transmission as the most common reason. Men had more sexual desire and activity than women (adjusted OR [95% CI] = 13.92 [4.76, 40.73] and 6.63 [2.59, 16.94], respectively). Conclusions Older Thai adults in the PCU displayed decreased sexual desire and activity during the COVID-19 pandemic. Sexual health is a lifestyle aspect that required investigation and care during the pandemic. Clinical Implications Older Thai adults should be educated in that sexual activities can be broader than sexual intercourse, and sexual health should be cared for during an eventual new pandemic disease.

The reliability of neurobehavioral tests in a thai adult population.

The purpose of this study was to investigate the test-retest reliability of NB tests in a Thai adult population and examine the impact of demographic data on NB tests. The aspects of the tests chosen were memory, attention, hand-eye coordination, motor speed, and dexterity. The three NB tests used were digit span, Purdue Pegboard, and visual-motor integration. All three were administered to a population of 30 Thai adults. The outcomes of all Pearson's correlation coefficient tests (r) were positive and greater than 0.60, and subtest-retest reliability correlation coefficients ranged from 0.63 (p<0.001) to 0.81 (p<0.001). Interestingly, the outcomes of all of these tests were not affected by demographic data, with the exception of the Purdue Pegboard test, in which performance on the preferred hand and both hands assessment was weakly associated with age (β=-0.09, p<0.001 and β=-0.08, p<0.05, respectively). NB tests have adequate reliability and are useful for the evaluation of clinical memory, attention, hand-eye coordination, motor speed, and dexterity in Thai adults. These tests were not affected by demographic data. However, further studies to measure the validity of the digit span, Purdue Pegboard, and visual-motor integration tests are needed.

How do cohabitation and marital status affect mortality risk? Results from a cohort study in Thailand

ObjectiveTo examine the relationship between baseline union status (ie, including marriage and cohabitation) and mortality, paying attention to gender differentials, through an 11-year follow-up of a large cohort in Thailand.DesignCohort...

Refining index to measure physical activity inequality: which group of the population is the most vulnerable?

BackgroundThe existing body of research mostly discusses inequality in physical activity (PA) based on the difference in the level of moderate-to-vigorous physical activity (MVPA). Evidence is lacking on the quantified inequality measures (e.g., how big the inequality is, and the distribution) in order to identify the most vulnerable groups of a population. This study measured PA inequality among Thai adults by using three parameters to construct an inequality index: (1) Proportion of the population with sufficient MVPA; (2) Cumulative minutes of MVPA; and (3) The Gini coefficient.MethodsThis study employed three rounds of data from Thailand’s Surveillance on Physical Activity (SPA) 2019–2021. In each round, over 6,000 individuals age 18–64 years were selected as nationally-representative samples, and were included in the analysis. PA inequality was constructed by using three parameters, with a combination of the three as the final measure, to identify the sub-groups of the Thai adults who are most vulnerable: groups with the least MVPA, highest insufficiency, and highest inequality index (Gini).ResultsCovid-19 containment measures have widened the gap in PA inequality, as shown by a declining proportion of the population meeting the recommended guidelines, from 74.3% in 2019 to 56.7% in 2020 and 65.5% in 2021. PA inequality existed in all sub-populations. However, by combining three parameters, the most vulnerable groups during the Covid-19 epidemic were identified as follows: (1) Those with no income; (2) The unemployed; (3) Those who have no access to PA facilities; (4) Older adults aged 60 + years; and (5) Those earning < 3,500 baht per month. Further, residents of Bangkok, young adults aged 18–24, individuals who attained primary level education or less, those who had no exposure to a PA awareness campaign and those who have a debilitating chronic disease also had elevated risk of PA insufficiency.ConclusionA concerning level of PA inequality existed in all sub-populations. The use of combined indicators in measuring PA inequality should aid in determining the most vulnerable groups of the population with a refined procedure. This method can be applied in many settings since the baseline data used to measure inequality (i.e., percent sufficient and cumulative minutes of MVPA) are widely available.

The ankle kinematic reference of normal gait pattern in Thai adults.

ObjectiveThis study was aimed to establish the reference values of ankle kinematics and factors associated with ankle kinematics of healthy Thai adults.MethodsA prospective cohort was conducted among healthy volunteers aged between 18 and 40 years and evaluated gait analysis between 2016 and 2020. After applying the modified Halen Hayes marker set, participants were assigned to walk 8–10 rounds with their preferred speed. Demographic data i.e., age, gender and body mass index (BMI) and ankle kinematics (varus-valgus, dorsiflexion-plantar flexion, foot progression, and ankle rotation) using motion analysis software were recorded and analyzed.Results98 volunteers (60 females and 38 males) aged 28.6 ± 5.4 years with body mass index 21.2 ± 2.0 kg/m2 were included. The average ranges of ankle kinematics entire gait cycle were varus-valgus −1.62 to 3.17 degrees, dorsiflexion-plantar flexion 0.67 to 14.52 degrees, foot progression −21.73 to −8.47 degrees, and ankle rotation 5.22 to 9.74 degrees. The ankle kinematic data in this study population was significantly different from the normal values supplied by OrthoTrak software of the motion analysis program, especially more ankle internal rotation at mid-stance (5.22 vs. −12.10 degrees) and terminal stance (5.48 vs. −10.74 degrees) with P < 0.001. Foot progression significantly exhibited more external rotation for 1.5 degrees on the right compared to the left side, and for 5 degrees more in males than females. One increment in age was significantly correlated with ankle internal rotation at mid-swing (coefficient 0.21 degrees, P = 0.039). BMI had no statistical association with ankle kinematics. Statistical parametric mapping for full-time series of angle assessments showed significantly different foot progression at initial contact and terminal stance between sides, and our ankle kinematics significantly differed from the reference values of the motion analysis program in all planes (P < 0.05).ConclusionThe reference of ankle kinematics of Thai adults was established and differences between sides and the normal values of the motion analysis program were identified. Advanced age was associated with ankle internal rotation, and male gender was related to external foot progression. Further studies are needed to define all-age group reference values.

Childhood encephalitis in the Greater Mekong region: critical to public health policy

Childhood encephalitis in the Greater Mekong region: critical to public health policy

Well-being in Thailand: A Culturally Driven Grounded Inquiry Exploration of a Complex Construct

BackgroundWell-being has long been recognized as a key construct in human history. Quantitative studies have been limited in their ability to uncover contextual and cultural nuances that can be leveraged to inform the promotion of well-being. The present study employed a qualitative approach informed by narrative inquiry to understand how individuals in a rapidly developing Asian country experience what it means to be well and what contributes to or detracts from their well-being.MethodsA purposeful sample of 50 Thai adults living in Bangkok shared their personal stories of times when they experienced high and low levels of well-being. Data were inductively coded and analysed to identify key domains of participants’ well-being and their inter-connections.ResultsThe results reflect three layers of well-being. Social relationships (i.e., family, friends and acquaintances, and relationships at work or education) are at the center of well-being in Thailand, connecting and supporting a second layer of eight constituent domains of well-being (experience of emotions, sense of self, finances, self-care, demands and responsibilities, thoughts and feelings about the future, personal health, spirituality). The third layer is composed of the societal and physical contexts that are formative for well-being.ConclusionsOur findings suggest both universal and culturally unique components of well-being among Thai adults. Implications for the promotion of well-being in Thailand are discussed.

Perception of Older Thai Adults in a Do-Not-Attempt Resuscitation Order during the COVID-19 Era If Infected with COVID-19.

Background:During the coronavirus disease 2019 (COVID-19) pandemic, older adults experienced high mortality rates, and their deaths were often preceded by sudden health deterioration and acute respiratory failure. This prompted older adults and their families to make rapid goals-of-care decisions.Objective:This study aimed at determining the prevalence of and factors associated with COVID-19-related do-not-attempt resuscitation (DNR) decisions among older adults.Design:This was a cross-sectional population-based survey.Setting:Well-looking active (mobile) community-dwelling adults aged ≥60 years and residing in the Bangkok district, Thailand, between April and May 2020, were included in this study. We excluded older adults who (1) were unable to speak Thai, (2) had severe cognitive impairment, or (3) were blind or deaf. We interviewed participants about their perceptions regarding end-of-life decisions in case they got infected with COVID-19 and experienced respiratory arrest.Results:We recruited 848 participants with a mean age of 70.5 (±6.74) years. When asked about their choice, 49.8% chose a DNR status, 44.5% chose full life support, and 5.8% were undecided. The three most common reasons provided by the DNR group for their choice were old age (54.9%), acceptance of death (15.6%), and fear of pain (8.5%).Conclusion:Almost half of the older Thai adults chose a DNR status for scenarios in which they were infected with COVID-19 and suffered from cardiac arrest during the pandemic period. Future studies should include an in-depth examination of participants' lifestyles, family life expectancy, and religious faith to understand their end-of-life decisions.

Reference equations of the impulse oscillatory in healthy Thai adults.

BackgroundThe ethnicity is significantly under-reported and this may limit the applicability of current impulse oscillometry (IOS) equations to heterogeneous patient populations. Establishing predictive equations for the IOS in the Thai adult population is still required. Therefore, this study aimed to establish reference equations for the IOS in the Thai adult population.MethodsThis retrospective cross-sectional study of IOS parameters in healthy adults aged greater than 20 years old with normal spirometry and who had no chronic respiratory diseases. Pre-bronchodilator (BD) IOS was performed in all subjects. Reference equations were calculated separately for men and women using multivariable linear regression analysis.ResultsA total of 127 subjects (87 men and 40 women) with a mean age of 48.7±17.2 (range, 22–92) years were included. The resistance at 5 Hz (R5), resistance at 20 Hz (R20), and area under reactance curve between 5 Hz and resonant frequency (AX) were significantly higher in women compared to men. The reference equations of the IOS parameters were established for men and women. Age, height, and bodyweight were shown to be the influential predictor as they contributed to the most of IOS indices except for the R5–R20 in men equations. Bodyweight was shown to be the influential predictor as it contributed to the most IOS indices except for the X5 in women’s equations.ConclusionsWe provided the reference equations for the IOS indices in Thai adults. IOS indices including R5, R20, and AX were significantly higher in women compared to men.

Seroprevalence of anti-SARS-CoV-2 antibodies in Thai adults during the first three epidemic waves.

This study determined the presence of anti-SARS-CoV-2 antibodies in 4964 individuals, comprising 300 coronavirus disease-19 (COVID-19) prepandemic serum samples, 142 COVID-19 patients, 2113 individuals at risk due to their occupations, 1856 individuals at risk due to sharing workplaces or communities with COVID-19 patients, and 553 Thai citizens returning after spending extended periods of time in countries with a high disease prevalence. We recruited participants between May 2020 and May 2021, which spanned the first two epidemic waves and part of the third wave of the COVID-19 outbreaks in Thailand. Their sera were tested in a microneutralization and a chemiluminescence immunoassay for IgG against the N protein. Furthermore, we performed an immunofluorescence assay to resolve discordant results between the two assays. None of the prepandemic sera contained anti-SARS-CoV-2 antibodies, while antibodies developed in 88% (15 of 17) of the COVID-19 patients at 8-14 days and in 94-100% of the patients between 15 and 60 days after disease onset. Neutralizing antibodies persisted for at least 8 months, longer than IgG antibodies. Of the 2113 individuals at risk due to their occupation, none of the health providers, airport officers, or public transport drivers were seropositive, while antibodies were present in 0.44% of entertainment workers. Among the 1856 individuals at risk due to sharing workplaces or communities with COVID-19 patients, seropositivity was present in 1.9, 1.5, and 7.5% of the Bangkok residents during the three epidemic waves, respectively, and in 1.3% of the Chiang Mai people during the first epidemic wave. The antibody prevalence varied between 6.5 and 47.0% in 553 Thai people returning from high-risk countries. This serosurveillance study found a low infection rate of SARS-CoV-2 in Thailand before the emergence of the Delta variant in late May 2021. The findings support the Ministry of Public Health's data, which are based on numbers of patients and contact tracing.

The Effect of Traditional Thai Massage on Quality of Sleep in Adults with Sleep Problem

Sleep problem or insomnia is one of the most common causes of health problems, affecting around 10 - 20 % of the world population. Traditional Thai massage (TTM) is a popular alternative treatment in Thailand for reducing fatigue and improving sleep quality. This study aimed to examine the effect of traditional Thai massage on sleep quality in adults. Twenty-eight adults with poor sleep quality (based on Verran and Snyder-Halpern sleep scale) participated. They were randomly allocated into a control group (n = 14) and a TTM group (n = 14). Participants in the TTM group received three 90-min whole body traditional Thai massage sessions within one week, whereas the control group participants maintained their daily lives. Quality of sleep was assessed before and a day after the massage sessions. The outcome measure was the Verran and Snyder-Halpern sleep scale. The within-group data was analyzed by Paired t-test, whereas ANCOVA did the between-group data. &#x0D; The results showed that the participants in the TTM group had significantly decreased score of sleep disturbance (31.63 ± 2.95 vs 45.47 ± 3.24, p &lt; 0.001) and increased the effectiveness score (70.73 ± 7.33 vs 53.47 ± 4.23, p &lt; 0.001) after the last session of massage as compared to those of the control group. We conclude that TTM could significantly improve sleep quality without any adverse effects.&#x0D; HIGHLIGHTS&#x0D; &#x0D; The overall prevalence of insomnia in Thai adults was 40.8 % and is commonly found in the Thai population&#x0D; Sleep quality was associated with all the academic performance in adolescents and cognitive function in adults&#x0D; Traditional Thai massage could significantly improve sleep quality without any adverse effects&#x0D; Since this treatment is generally safe and comfortable, it could be used as an alternative therapy to treat people with sleep problems&#x0D; &#x0D; GRAPHICAL ABSTRACT

Applying the PDSA cycle to a group activity promoting lifestyle change for the active ageing of older Thai adults \u2013 a focused ethnography

BackgroundThe proportion of the older Thai population is increasing rapidly. Lifestyle may impact active ageing in later life. Interventions that empower older Thai adults to initiate and carry out lifestyle changes are needed. This study applied the Plan-Do-Study-Act (PDSA) cycle, a tool for improving lifestyle changes, with the aim of exploring interactions among older Thai adults when participating in group activities.MethodFocused ethnography was used based on participant observations, field notes and video recordings of 15 older Thai adults aged 62–78 years.ResultsOlder Thai adults faced difficulties at the beginning since they were unfamiliar with initiating and carrying out lifestyle changes according to the PDSA concept. This provided a learning opportunity enabling older Thai adults to reach their individual goals of lifestyle change.ConclusionsThe PDSA cycle has the potential to empower older adults in group contexts to promote lifestyle changes related to active ageing.

Sociocultural reflexivity study of the development of social participation among Thai adults with depression

ABSTRACT Reflexivity is essential for a grounded theory study to systematically collect and analyze data and develop rigour and credibility. This study aimed to provide reflexivity in a Thai sociocultural context that influences the social participation of the Thai adults suffering from depression, employing Alvesson and Skolberg’s reflexivity through constant comparative methodology. The study used reflexive notes from the reflexive stance of the primary researcher in her doctoral study for assisting the construction of a substantial theory in the development of social participation among Thai adults with depression. Krengjai, or mutual dependence in social life and coexistence, revealed a linkage reciprocating support and challenged rebounding social participation. The reflexivity of krengjai showed limitations and appropriateness for social participation among Thai adults with depression. In conclusion, krengjai’s reflexivity encouraged the researcher’s and grounded theory study’s moral and theoretical sensitivity.

Psychometric properties of the apraxia of speech rating scale Thai version

Background: Thai speech-language pathologists lack appropriate tools to describe apraxia of speech (AOS) characteristics in Thai patients. Objectives: This study aimed to translate and adapt the most recent version of the Apraxia of Speech Rating Scale (ASRS) 3.3, the ASRS 3.3, into a Thai version and evaluate the psychometric properties of the Thai version (ASRS-Thai). Materials and methods: The original ASRS 3.3 has been translated into Thai using the backward-translation approach. The original developer was also included in the translation process to improve the translation accuracy. The resulting tool, ASRS-Thai, was administered to 28 adults with neurological speech or language disorders, along with another AOS test available in Thai, Apraxia Test for Thai Adults (ATTA). The recordings were rated independently by 5 experienced speech-language pathologists at different hospitals. The clinical assessment of patients’ performance on the ATTA was used as the reference standard to measure the sensitivity and specificity of ASRS-Thai for AOS diagnosis. Concurrent validity and reliability measures were also examined. Reliability was examined by evaluating intra-rater and inter-rater reliability. Results: Moderate-to-strong negative correlations were found between the ATTA and the ASRS-Thai (-0.575 to -0.900). Additionally, the sensitivity and specificity of the ASRS-Thai at a cut-off score of 16 were 100% and 86.7%, respectively. Reliability was computed by measuring the intraclass correlation (ICC) values. The intra-rater ICCs were 0.96, 0.968, and 0.976, and the inter-rater ICC was 0.927 for the total score. Conclusion: The ASRS-Thai is a reliable, valid instrument to describe the presence and severity of AOS characteristics in clinical settings and research. Additional data collection by testing a larger sample size with diverse severities, including cases of pure AOS, is warranted in future studies

Can Muscle Mass Be Maintained with A Simple Resistance Intervention in the Older People? A Cluster Randomized Controlled Trial in Thailand.

The aging population is rapidly increasing worldwide. Sarcopenia is a common and important health problem among older people. The prevalence of sarcopenia among older Thai adults is increasing. Exercise intervention for sarcopenia prevention may significantly improve muscle strength, body balance, and muscle mass. Therefore, this study aimed to investigate the effects of a simple resistance intervention (SRI) program in preventing sarcopenia on physiological outcomes among community-dwelling older Thai adults. This study was a 12-week randomized controlled trial, which included 80 community-dwelling older adults in Chiang Mai, Thailand, who were randomly assigned into control (40 participants who performed usual exercise) and intervention (40 participants who performed the SRI program) groups. The SRI program was a home-based program consisting of 30 min of resistance exercise three times/week for 12 weeks, health education on sarcopenia. After 12 weeks, all physiological outcomes were measured and were significantly improved in the intervention group compared with baseline; hand grip, skeletal muscle mass index, and walking speed were significantly improved in the intervention group compared with the control group. Based on our results, the SRI program may prevent muscle weakness in community-dwelling older people in Thailand.

Developing and Validating the Narcissistic Personality Scale (NPS) among Older Thai Adults Using Rasch Analysis.

Background: Being older could be stressful, especially among people with narcissistic personality disorders. Nevertheless, the tool is yet to be available among older Thai individuals. The study aimed to develop a tool to detect symptoms of narcissistic personality, and to validate its psychometric properties among older Thai adults. Methods: The Narcissistic Personality Scale (NPS) was developed based on nine domain symptoms of narcissistic personality disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), consisting of 80 items. The original scale was field-tested using Rasch analysis for item reduction, rendering a final 43 items. NPS was further investigated among 296 seniors aged 60 years old. Rasch analysis was used to assess its construct validity. Result: Of 43 items, 17 were further removed as infit or outfit mean square >1.5. The final 26-item NPS met all necessary criteria of unidimensionality and local independence without differential item functioning due to age and sex, and good targeting with subjects. Person and item reliability were 0.88 and 0.95, respectively. No disordered threshold or category was found. Conclusions: The NPS is a promising tool with a proven construct validity based on the Rasch measurement model among Thai seniors. This new questionnaire can be used as outcome measures in clinical practice.

Association Between Diet and Acne Severity: A Cross-sectional Study in Thai Adolescents and Adults.

The association between diet and acne is of growing concern. Every country has its own food culture; however, only a few studies have surveyed the influence of Asian cuisine on acne. This study investigated the association between acne severity and diet/lifestyle factors in 2,467 Thai adolescents and adults. Data were collected via a validated semi-quantitative food frequency questionnaire. In Thai adolescents and adults, the prevalence of mild acne was 52%, moderate acne 22%, and severe acne 8%. No acne was found in 18% of participants. The dietary factors associated with increased severity of acne were consumption of chocolate >100 g/week (adjusted odds ratio (aOR) 1.29; 95% CI 1.07–1.56), oily and fried food >3 times/week (aOR 1.84; 95% CI 1.07–3.16) and white rice (aOR 1.80; 95% CI 1.24–2.63). Conversely, the factors associated with decreased severity of acne were consumption of sugar-free milk-free tea (aOR 0.61; 95% CI 0.43–0.87) and vegetables (aOR 0.74; 95% CI 0.62–0.89).