The population and recruitment of the Thai Cohort Study (TCS) was previously described in detail (Seubsman et al., 2011, 2012; Sleigh et al., 2008). Briefly, the Thai Health-Risk Transition Project began in 2004 with the aim of studying changes in the health status of the Thai population associated with rapid modernization and industrialization. Part of this study project has involved assembling a cohort of adult community dwelling Thais whose health status could be followed through time along with their risk behavior and socio-demographic and economic profiles. The target population was persons studying by correspondence via Sukhothai Thammathirat Open University (STOU). This group was chosen because STOU students lived throughout the country and display considerable variation in lifestyle, family structure, socio-economic status, domestic and occupational environment and personal behavior.

The cohort population is similar to the general Thai population in terms of median age, geographic residence and median income (Sleigh et al., 2008). They are however, overall, more highly educated than the Thai population. This means this study population is able to represent potential future health transitions in Thailand, as education levels in the general population increase. In 2005 a health questionnaire was mailed out to all students currently enrolled at STOU; 87,151 participants responded and formed the baseline cohort population. Two follow-ups were conducted in 2008/2009 (n = 60,569) and 2012/2013 (n = 42,785). Our study period was from 2005, the start of the cohort, until 2013 when the last survey was completed.

As shown in Fig. 1, we extracted the data of 25,532 subjects in TCS who lived in BMR, including Bangkok, Nonthaburi, Samutprakarn, Samut sakhon, Nakhon pathom, and Pathum thani in 2005. We excluded 3,683 subjects who moved from their baseline address and 6,404 subjects who were lost to follow-up. In addition, those who had developed diabetes (n = 155), high blood pressure (n = 418), and high cholesterol (n = 856) before 2005 were also excluded.

Flowchart of participant selection.

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