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Objectives Since the 1990s, programs for the control of micronutrient deficiencies became a public health priority for many governments, including the countries partnering the project "Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia" (SMILING): Cambodia, Indonesia, Laos-PDR, Thailand and Vietnam. The aim of this study was to map which micronutrient deficiencies have been addressed and which interventions were in place in the SMILING countries. Methods The mapping covered the period up to 2012. Updated information from relevant surveys after 2012 is included in this paper after the completion of the SMILING project. The mapping of micronutrient status was limited to either national or at least large-scale surveys. Information on nutrition interventions obtained through a systematic mapping of national programs combined with a snowball collection from various sources. Results Among the five SMILING countries, Thailand differed historically by an early implementation of a nationwide community-based nutrition program, contributing to reductions in undernutrition and micronutrient deficiencies. For Cambodia, Indonesia, Laos PDR, and Vietnam, some national programs addressing micronutrients have been implemented following adjusted international recommendations. National surveys on micronutrient status were scattered and inconsistent across the countries in design and frequency. Conclusion for practice In conclusion, some micronutrient deficiencies were addressed in national interventions but the evidence of effects was generally lacking because of limited nationally representative data collected. Improvement of intervention programs to efficiently reduce or eliminate micronutrient deficiencies requires more systematic monitoring and evaluation of effects of interventions in order to identify best practices.

Objectives Food composition data are key for many nutrition related activities in research, planning and policy. Combatting micronutrient malnutrition among women and young children using sustainable food based approaches, as aimed at in the SMILING project, requires high quality food composition data. Methods In order to develop capacity and to align procedures for establishing, updating and assessing the quality of key nutrient data in the food composition tables in Southeast Asia, a detailed roadmap was developed to identify and propose steps for this. This included a training workshop to build capacity in the field of food composition data, and alignment of procedures for selecting foods and nutrients to be included for quality assessment, and update of country specific food composition tables. The SEA partners in the SMILING project finalised a country specific food composition table (FCT) with updated compositional data on selected foods and nutrients considered key for designing nutrient dense and optimal diets for the target groups. Results Between 140 and 175 foods were selected for inclusion in the country specific FCTs. Key-nutrients were: energy, protein, total fat, carbohydrates, iron, zinc, (pro-)-vitamin A, folate, calcium, vitamin D, vitamin B1, vitamin B2, vitamin B3, vitamin B6, vitamin B12 and vitamin C. A detailed quality assessment on 13 key-foods per nutrient was performed using international guidelines. Nutrient data for specific local food items were often unavailable and data on folate, vitamin B12 and vitamin B6 contents were mostly missing. For many foods, documentation was not available, thereby complicating an in-depth quality assessment. Despite these limitations, the SMILING project offered a unique opportunity to increase awareness of the importance of high quality well documented food composition data. Conclusion for Practise The self-reported data quality demonstrated that there is considerable room for improvement of the nutrient data quality in some countries. In addition, investment in sustainable capacity development and an urgent need to produce and document high quality data on the micronutrient composition of especially local foods is required.

Targeted fortification programs for infants and young children are an effective strategy to prevent micronutrient deficiencies in developing countries, but the role of large-scale fortification of staple foods and condiments is less clear. Dietary modeling in children aged 6–60 months was undertaken, based on food consumption patterns described in the 2009 national food consumption survey, using a 24-h recall method. Consumption data showed that the median intake of a child for iron, vitamin A and zinc, as a proportion of the Vietnamese Recommended Dietary Allowance (VRDA), is respectively 16%–48%, 14%–49% and 36%–46%, (depending on the age group). Potential fortification vehicles, such as rice, fish/soy sauces and vegetable oil are consumed daily in significant amounts (median: 170 g/capita/day, 4 g/capita/day and 6 g/capita/day, respectively) by over 40% of the children. Vegetable oil fortification could contribute to an additional vitamin A intake of 21%–24% of VRDA recommended nutrient intake, while fortified rice could support the intakes of all the other micronutrients (14%–61% for iron, 4%–11% for zinc and 33%–49% of folate requirements). Other food vehicles, such as wheat flour, which is consumed by 16% of children, could also contribute to efforts to increase micronutrient intakes, although little impact on the prevalence of micronutrient deficiencies can be expected if used alone. The modeling suggests that fortification of vegetable oil, rice and sauces would be an effective strategy to address micronutrient gaps and deficiencies in young children.

This study estimates the dietary exposure to cadmium (Cd), and associated potential health risks, for individuals living and working in a metal recycling community (n=132) in Vietnam in comparison to an agricultural (reference) community (n=130). Individual-level exposure to Cd was estimated through analysis of staple foodstuffs combined with information from a food frequency questionnaire. Individual-level exposure estimates were compared with published 'safe' doses to derive a Hazard Quotient (HQ) for each member of the study population. Looking at the populations as a whole, there were no significant differences in the diets of the two villages. However, significantly more rice was consumed by working age adults (18-60 years) in the recycling village compared to the reference village (p0.001). Rice was the main staple food with individuals consuming 461±162g/d, followed by water spinach (103±51kg/d). Concentrations of Cd in the studied foodstuffs were elevated in the metal recycling village. Values of HQ exceeded unity for 87% of adult participants of the metal recycling community (39% had a HQ3), while 20% of adult participants from the reference village had an HQ1. We found an elevated health risk from dietary exposure to Cd in the metal recycling village compared to the reference community. WHO standard of 0.4mg Cd/kg rice may not be protective where people consume large amounts of rice/have relatively low body weight.

Although environmental factors are important, there is considerable evidence that genes also have a significant role in the pathogenesis of obesity. We conducted a population-based study to investigate the relationship between candidate genes for obesity (UCP1, UCP2, ADRA2B, ADRB3, LEPR, VDR and ESR1) and adiposity measures (body mass index, body fat percentage, weight, waist circumference and waist-hip ratio) in terms of individual gene and gene x gene interaction in models unadjusted and adjusted for covariates (age, years since menopause, educational level and total energy intake). Postmenopausal women with TC genotype of ESR1 gene had higher body fat percentage than those with TT genotype in the models unadjusted and adjusted for the covariates (P = 0.006 in adjusted model). In multiple logistic regression analysis, BsmI and ApaI SNPs of VDR genes were significantly associated with overweight and obesity. The UCP2-VDR ApaI interaction to susceptibility of overweight and obesity was first observed from logistic regression analysis, and then confirmed in the multifactor dimensionality reduction method unadjusted and adjusted for the covariates. This interaction had 69.09% prediction accuracy for overweight and obesity (P = 0.001, sign test). In conclusion, the study suggests the significant association of ESR1 and VDR genes with adiposity measures and the UCP2-VDR ApaI interaction to susceptibility to being overweight and obesity in postmenopausal Vietnamese women.

In order to assess secular trends in growth of the Vietnamese population following a period of rapid economic growth, a follow-up study on physical growth and nutritional status of adults was carried out in a rural section of the Red River delta, Vietnam 30 years after the original study. The initial study in 1976 found that average height and weight of Vietnamese adults was similar to data collected by French experts Huard and Bigot in 1938. Hence, no noticeable secular trends were observed in almost 40 years. However, the 2006 follow-up study revealed a positive secular trend in growth of adults, aged 16-60 years. The average increased rate in height of males was up to 1.1 cm/decade in the age group 26-40 years and up to 2.7 cm/decade in the age group 16-25 years. Nutritional status, as indicated by body mass index, increased in both sexes and in all age groups between 1976 and 2006.were observed. In 2006, average dietary intake of fat and animal protein was higher than that found in 1976. The percentage of energy from fat in the diet increased from 6% in 1976 to 16% in 2006. This study shows that Vietnam is entering the nutrition transition period.

Objective : To assess the prevalence of undernutrition, incidence of infectious diseases and the situation of feeding practices to determine the risk factors for undernutri- tion among children aged 6 to 18 months in rural Vietnam. Design : A cross-sectional study was conducted among one hundred eighty-eight mother-child pairs in Bac Giang, Viet- nam. Weight and height of the children were measured and referred to data from the WHO/CDC/NCHS. Incidence of infectious diseases was diagnosed based on the WHO Rec- ommended Surveillance Standards. Data on socio-demographic variables and feeding practices were obtained through a structured questionnaire. Result : The prevalence of underweight, stunting and wasting was 19.7% 23.4% nd 5.3% respectively. The incidence of diarrhea and acute respiratory infections (ARIs) during the last 14 days of the inter- view was 12.2% and 20.2% respectively. Although 99% of the children were breastfed, the prevalence of exclusive breastfeeding in the first 4 mo was 21.3% Non-exclusive breast- feeding in the first 4 month (OR 3.95, p=0.025) and low birth weight (OR 4.38, p=0.009) were associated with underweight in the children, while incidence of infectious disease was not (OR 1.16, p=0.734). Conclusion : Undernutrition is highly prevalent in the study site and non-exclusive breast feeding is one of the risk factors. J. Med. Invest. 57 : 45-53, February, 2010

The present work aimed to provide a basis for examination of intake of selected food items determined with a semi-quantitative food frequency questionnaire (SQFFQ) and planned-food selection (PFS). From February to July of 2003, ninety one cancer patients and 90 matched (same sex and age within 5 years) non-cancer patients were directly interviewed by trained interviewers using the designed questionnaire at the inpatient-department of Viet Duc hospital, Ha Noi City, Viet Nam. Study subjects consumed more SQFFQ-food items than PFS-food items, so that the latter method might not accurately reflect dietary habits regarding estimation of nutrient intake, especially vitamins. Because these are beneficial factors acting against cancer development at many sites, the absence of food items selected by SQFFQ may result in a poor database regarding possible confounding factors. For futher clarification we then focused on vitamin C contributions of Vietnamese food and analyzed data of the National Nutritional Household Survey in 2000: 7,686 households throughout the country (vitamin C intake status) and 158 households with 741 persons of the population of Hanoi city (individual food items contributing to vitamin C). Direct interview using a validated questionnaire with an album of current Vietnamese food items-recipes and weighing checks was conducted to obtain information regarding all types of food intake over the last 24-hours. Contribution analysis using the Nutritive Composition Table of Vietnamese Foods, revision 2000, and stepwise regression analysis was applied. Average intake adjusted by ages of vitamin C per person per day was estimated. In total, the study subjects were found to currently consume 184 food items. Average intake of vitamin C was 72.5 mg per person per day at the national level: 57.9% from leafy vegetables, 33.4% from fresh fruits, and 6.4% from non-leafy vegetables. For vitamin C contribution, the highest 25 food items contributed to a cumulative 95.3% of vitamin C intake with a cumulative R2=0.99.

The International Collaborative Epidemiological Study of Host and Environmental Factors for Stomach and Colorectal Cancers in Southeast Asian Countries (SEACs) has been conducted in Viet Nam from 2003 to 2008 on a case-control basis. For further effective primary prevention, we examined gastric and colorectal cancer mortality nationwide in eight regions of Viet Nam in 2005-06.Both demographic data and lists of all deaths in 2005-06 were obtained from all 10,769 commune health stations in Viet Nam. Five indicators included name, age, sex, date of death and cause of death was collected for each case. We selected only communes having the list of deaths with clear cause for each case and crude mortality rate for all causes from 300-600/100,000 as published by the Ministry of Health for a reasonable accuracy and completeness. Obtained data for all causes, all cancers, stomach and colorectal cancer deaths as well as demographic information were processed using Excel software and exported to STATA 8.0 for estimation of world age-standardized cancer mortality rates per 100,000.Data were available for 1,246 gastric cases, (819 male and 427 female) with age-standardized mortality rates from 12.7 to 31.3 per 100,000 in males and from 5.9 to 10.3 per 100,000 in females in the 8 regions of the country. For colorectal cancers, 542 cases (268 male and 274 female) gave mortality rates from 4.0 to 11.3 per 100,000 in males and from 3.0 to 7.8 per 100,000 in females.Stomach cancer mortality in males in the region of North East in the North Viet Nam (2005-06) was higher than that in Japan (2002) (31.3 versus 28.7 per 100,000) while colorectal cancer in Viet Nam was lower. While prevalence of Helicobacter pyloris infection in Viet Nam was from 70-75% in both males and females, the stomach cancer rate in males was significantly higher than in females, 31.3 versus 6.8 per 100,000, suggesting an influence of other environmental risk factors. Whether protective factors are operating against colorectal cancer in Viet Nam now needs to be explored.

ObjectiveTo examine the effect of community-based nutrition education intervention on calcium intake and bone mass in Vietnamese postmenopausal women.DesignA controlled trial was conducted in two groups as intervention and control. The intervention group was given nutrition education during 18 months to improve calcium intake, while the control subjects had the usual diet. Calcium intake and bone mass were evaluated every 6 months. Bone mass was assessed by speed of sound (SOS) at calcaneus, referred to as quantitative ultrasound measurement. Anthropometric indices and serum parathyroid hormone (PTH) were determined at baseline and at the end of intervention.SettingTwo rural communes of Hai Duong province located in the Red River Delta in Vietnam.SubjectsA total of 140 women aged 55–65 years, who were more than 5 years postmenopausal and with low calcium intake (ResultsCalcium intake in the intervention group had increased significantly (P < 0·01) while it had no significant changes in controls. SOS values were not changed significantly in the intervention subjects while it decreased significantly by 0·5 % in the controls (P < 0·01). The intervention led to a decrease in serum PTH by 12 % (P < 0·01). In the controls, there was an increase in serum PTH by 32 % (P < 0·001).ConclusionNutrition education intervention was effective in improving calcium intake and retarding bone loss in the studied subjects.

This study was done to develop a Food Frequency Questionnaire (FFQ) for assessing calcium intake in Vietnamese based on data from the National Nutrition Survey in 2000. From the data, a total of 36 calcium-rich food items were selected for the FFQ by ranking food items according to their contribution to the population intake of nutrients. The FFQ was validated in 140 postmenopausal women by comparing estimates of calcium intake from the FFQ with those from multi-pass 24 h recalls. The results showed that the Pearson correlation coefficient between the 2 methods was 0.84 (p0.001), and that the weighted kappa value was 0.44. Cross-classification analysis indicated that 82.1% of subjects were classified into the same or adjacent quartile by both methods. No subject was grossly misclassified by the FFQ. There is no significant difference of calcium intake between the 2 methods (by paired t test, p0.05). A reproducibility study also presented good correlation between 2 administrations of the FFQ, with Pearson correlation coefficient being 0.93 (p0.001) and weighted kappa value being 0.67. In conclusion, this FFQ is useful and reliable for estimating calcium intake in population-based epidemiological studies in postmenopausal Vietnamese women.

Objective: To describe the household intakes of retinol and carotenoids and social economic factors determining their intakes. Subjects: Data on a total of 1001 households (771 in rural areas and 230 in urban areas) were used in the analyses. Interviewed person was household food preparer. Results: Mean (s.d.) intake of carotenoids was 4178 (3154) mu g/capita/day in rural and 4208 (3408) mu g/capita/day in urban areas and intake of retinol was 101 (275) mu g/capita/day in rural and 201 (470) mu g/capita/day in urban areas. Multivariate analyses show that the subjects in households with four or more members consume about 700 mu g carotenoids less compared to households with less than three members. Households with a higher expenditure (fourth quartile) consumed about 100 mg retinol/day more than those with a lower expenditure (first quartile). Conclusion: Carotenoids from plant food sources is the main source of vitamin A intake of the population and its main determinants are household expenditure and size of household. Food fortification and dietary diversification with special emphasis on promotion of consumption of animal foods should be key strategies for overcoming vitamin A deficiency in Vietnam.

In 2003, the authors conducted a population-based, cross-sectional survey to determine the prevalence of osteoporosis and related factors in Vietnamese adult women by using quantitative ultrasound at the heel bone (calcaneus). A total of 2,232 adult women agedor =20 years, living in Hanoi City, and free of illnesses affecting bone metabolism were randomly selected to participate in the study. Subjects' bone mass was assessed by speed of sound at the calcaneus, referred to as quantitative ultrasound measurement. The T-score threshold, defined asor =-1.8, was used to identify subjects with osteoporosis. The crude prevalence of osteoporosis in Hanoi City was 15.4%; after adjustment for age, it was 9.0%. Among premenopausal women, the crude prevalence of osteoporosis was higher in the urban areas compared with the rural areas. By contrast, postmenopausal women in the rural areas had a higher prevalence of osteoporosis. Multiple logistic regression analysis revealed that factors associated with low speed of sound were age, menopause, educational level, lifelong occupation, recreational weight-bearing exercise, number of births, and height. Results suggest that osteoporosis is a noteworthy problem in Vietnam, and intervention strategies should be considered to control it, especially in high-risk populations.