The malnutrition prevalence among under-5 children has trend to be reduced but still at high level. The first published figure on underweight prevalence announced by the Institute of Nutrition in 1985 was 51.5 percent as classification of WHO. After about 10 years, the survey on malnutrition and xerophthalmia jointly carried out by the Institute and UNICEF in 1994 showed that the prevalence was 44.9 percent. Since 1994 up to now, the State has approved a National Program to control malnutrition among children implemented by the Committee for Protection and Care of Children (CPCC) and since 1998 by the Ministry of Health. The most recent figure (in 2000) showed that the prevalence of malnutrition nationwide was 33.8 percent. So during some recent years, the rate of malnutrition reduction was about 2 percent per year, classified by WHO as a high rate. The actual prevalence of malnutrition among our children is still high because our initial situation was too bad rather than because our nutrition program did not get good progress.
The Institute has also paid attention on malnutrition situation among women in productive age, juvenile and other subjects.
Among the prioritized issues, the Institute should further study stunting situation and its consequences, low birth weight situation and maternal malnutrition situation.
Among the nutritional surveillance indicators, height/age indicator should be noted because of its value on monitoring the changes of socio-economic condition
The program of micronutrient deficiency control, especially vitamin A deficiency and iodine deficiency has achieved the remarkable progress but needs to be sustained by an appropriate strategy. Despite xerophthalmia due to vitamin A deficiency causing irreversible blindness is no more a significant public health problem, the prevalence of pre-clinical vitamin A deficiency is still high, in particular among lactating mothers. The State’s policy to fortify all kinds of salt in market with iodine made the elimination of iodine defiance by 2000 and elimination of IDD by 2005 become feasible.
If the last two decades were a period for vitamin A and iodine, the coming decade will be for iron deficiency anemia (IDA); this fact was confirmed by the epidemiological survey in large scale in 1995 and the actual program of IDA control with cooperative strategies guided by the Ministry of Health.
Concerning the solutions, despite the Institute’s experience on supplementation of high dosed vitamin A, supplementation of iron, etc. the strategy on food fortification with micronutrients (vitamin A, iron) should be paid attention with participation of industry, commerce and marketing.
In addition to malnutrition situation needed to be solved, overweight and obesity prevalence among children has been worriedly increasing, especially in urban areas. For examples in schooling ages, a survey on 3,434 pupils aged 6-12 years in Hanoi downtown showed that overweight prevalence was 4.1 percent (while underweight prevalence was 4.5 percent) and in a district in Ho Chi Minh city was 12.2 percent. Among adult aged 50-59 years, the overweight prevalence in male was 15.5 percent and in female was 19 percent in 2 central wards of Hanoi.
That was an alarming sign for another relevant public health problem: over-nutrition related nutrition and health issue leading to other severe chronic diseases. The importance of diet was approved in some diseases: obesity, cardio-vascular diseases, hypertension and stroke, diabetes mellitus type 2 (insulin-independent type), dental caries, some kinds of cancer, some hepatic and gastro-intestinal diseases. In general, these diseases attribute to more than 70 percent of mortality in developed countries.
That is nutritional situation in transition period with both two parallel burden: malnutrition and over-nutrition (more precisely, that is unbalance and inappropriate diet)
The initial result of the General survey on nutrition in 2000 showed that:
Concerning food consumption: in comparison with 10-15 years ago, rice consumption is reduced, meat, fat and oil, fruit and sugar consumption is increased. There is little change on total energy consumption but the energy proportion in diet has been changed: protein and lipid energy has been increased, glucid energy has been reduced. Especially, fat energy has been increased from 8 to 14 percent in comparison with 10 years ago.
Many nutrition deficiency disorders among children have been reduced. Prevalence of chronic energy deficiency (CED) among women in productive age has been reduced from 40 percent (1989) to 28 percent (2000).
These changes are more clear in urban areas than in rural and mountainous areas.
The market economy made food hygiene and safety become more urgent. The products become more diversified but some of them also are of bed quality. Because of profit, several companies and producers use hygienically forbidden plant protective chemicals and preservative products. Insufficient understanding and knowledge of both producers and consumers also lead the situation become more serious problem. Prevention and reduction of food poisoning need to be more prioritized.
It is possible to say that we are in transition period with the following issues:
- Transition from centralized planning economy into market oriented economy, from “rationed” diet to “budget and choice” diet.
- Moving from control of severe malnutrition to moderate and mild malnutrition as well as facing with nutrition related chronic diseases: that is a double burden. It is more clear that infant malnutrition leading to later over-nutrition that is risky to developing countries.
- Urbanization is also a specific characteristic of the transition period.
- Concerning diet, in the beginning of the transition period, foodstuff consumption such as meat, milk, sugar, fat and oil, fruit in general will be increased parallel with increasing income. It is noted that the proportion of animal protein and fat is increasing, proportion of glucid is decreasing and it should be careful when proportion of animal protein is more than 50 percent of total protein and proportion of lipid is more than 20 percent of total energy consumed. The relation between vegetable and animal lipid is also a relevant issue.
In this context, how will development trend of the Institute of Nutrition be in the coming years?
Concerning scientific research, the Institute is required and also has opportunity to solve the following learning issues:
- Causes of malnutrition and strategy for control of malnutrition among children, especially moderate and mild forms. Actually, it is focused on stunting, low birth weight, relation between maternal and child malnutrition. In addition to that, obesity among children is becoming relevant, in particular in urban areas. There are several researches on relation between obesity and stunting among children, how is this situation in our country? It is also urgently necessary to study on acceleration of growth and its relation with diet.
- Strategies for control of micronutrient deficiency, especially iron deficiency. Research on strategy for food fortification and diet diversification.
- There is a heavy task for nutritional epidemiology in the coming years. In addition to the classical nutrition diseases carefully studied such as protein-energy malnutrition, iodine deficiency, vitamin A deficiency, iron deficiency anemia, it is necessary to further study other elements like zinc, selenium, calcium, etc. Epidemiology of nutrition related chronic diseases is not much studied. In Vietnamese population, which are the most important dietary factors for the subjects suffering from hypertension, diabetes mellitus and cancers? It is necessary to study the relation between diet and osteoporosis that is commonly seen in elderly.
Epidemiology of food poisoning needs to be cared but not yet monitored by the Institute’s insufficient monitoring system on both number of outbreak of food poisoning and its causes. That is a shortcoming that needs to be solved.
Comparative nutrition is a convenient issue in transition period. Several important findings in nutrition is based on comparison of dietary patterns between different population groups because of difficulty on experiment in human being. The existence of different dietary patterns of the same Vietnamese people living in Vietnam territory will help the Institute to search many interesting and useful findings.
An increasing social demand in transition period is development different appropriate diet rations for people suffering from nutrition related chronic diseases. Our ancient has found the pharmacological benefits of the foods. “Food is medicine and medicine is food”. To search the food’s functions is also an important approach of the modern nutrition and became a classical in our country.
Food science also needs to be further studied. Improved economy and life quality made people more care food hygiene and nutritional quality. The table of nutritive value of Vietnamese foods needs to be continuously updated and becomes an useful tool for everyone. The other issues on foods like the roles of anti-oxidant elements, anti-nutrition elements and poisons also need to be cared.
In some recent years, the Institute has made a great effort to develop and to get approved “the Table of nutritional requirement for Vietnamese people”. But that is only the first step. Together with development and complishment of the table of nutritive value of Vietnamese foods, the Table of nutritional requirement for Vietnamese people also needs to be updated and more widely and lively used. Firstly, it requires the researches to assess the appropriateness of the actual table of nutritional requirement based on the anthropometric, bio-physiological, bio-chemical indicators of different subjects.
Because of different difficulties, especially budgetary and personal difficulties, there are still very few number of researches on nutrition among the different subjects rather than women and children. There are also few number of researches on nutrition in profession like sport people, heavily working people and in different ages such as elderly.
The Institute also needs to speed up researches on food hygiene and safety. There is requirement on systemic researches on food contamination from different sources (natural toxic agents, plant protective chemicals, preservative agents, soil and water contaminated agents, etc.). Safe foods are the essential factor of life in the coming era.
Urbanization also created a lot of serious nutrition problems. Because of increasing number of investment projects and market economy mechanism, shortage of job in rural areas, the urban areas are attracting many laborers. The poor people, especially the recently settled people with unhygienic and temporary living facility are high risk group for disease and inappropriate nutrition.