Prevalence and incidence of overweight and obesity among Vietnamese preschool children: a longitudinal cohort study

Predicting higher child BMI z-score and obesity incidence in Malaysia: a longitudinal analysis of a dynamic cohort study

BACKGROUND

To target public health obesity prevention, we need to predict who might become obese i.e. predictors of increasing Body Mass Index (BMI) or obesity incidence. Predictors of incidence may be distinct from more well-studied predictors of prevalence, therefore we explored parent, child and sociodemographic predictors of child/adolescent BMI z-score and obesity incidence over 5 years in Malaysia.

METHODS

The South East Asia Community Observatory in Segamat, Malaysia, provided longitudinal data on children and their parents (n = 1767). Children were aged 6-14 years at baseline (2013-14) and followed up 5 years later. Linear multilevel models estimated associations with child BMI z-score at follow-up, adjusting for baseline BMI z-score and potential confounders. Predictors included parent cardiometabolic health (overweight/obesity, central obesity, hypertension, hyperglycaemia), and socio-demographics (ethnicity, employment, education). Logistic multilevel models explored predictors of obesity incidence.

RESULTS

Higher baseline BMI z-score predicted higher follow-up BMI z-score both in childhood to late adolescence (0.60; 95% CI: 0.55, 0.65) and early to late adolescence (0.76; 95% CI: 0.70, 0.82). There was inconsistent evidence of association between child BMI z-score at follow-up with parent cardiometabolic risk factors independent of baseline child BMI z-score. For example, maternal obesity, but not overweight, predicted a higher BMI z-score in childhood to early adolescence (overweight: 0.16; 95% CI: -0.03, 0.36, obesity: 0.41; 95% CI: 0.20, 0.61), and paternal overweight, but not obesity, predicted a higher BMI z-score in early to late adolescence (overweight: 0.22; 95% CI: 0.01, 0.43, obesity: 0.16; 95% CI: -0.10, 0.41). Parental obesity consistently predicted five-year obesity incidence in early to late adolescence, but not childhood to early adolescence. An adolescent without obesity at baseline with parents with obesity, had 3-4 times greater odds of developing obesity during follow-up (incidence OR = 3.38 (95% CI: 1.14-9.98, mother) and OR = 4.37 (95% CI 1.34-14.27, father) respectively).

CONCLUSIONS

Having a higher BMI z-score at baseline was a stronger predictor of a higher BMI z-score at follow-up than any parental or sociodemographic factor. Targeting prevention efforts based on parent or sociodemographic factors is unwarranted but early childhood remains a key period for universal obesity prevention.

Prevalence, determinants, intervention strategies and current gaps in addressing childhood malnutrition in Vietnam: a systematic review

BACKGROUND

Childhood malnutrition in all forms is a major public health issue worldwide. This review systematically examined the prevalence and determinants and identify the potential interventions and current gap in addressing malnutrition including undernutrition, overnutrition and micronutrient deficiencies (MNDs) in Vietnamese children aged 0-18 years old.

METHODS

Embase, Scopus, PubMed, and Web of Science were systematically searched through June 2022 to identify relevant articles published within the past 25 years. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Risk of publication bias was assessed using American Dietetic Association Quality Criteria Checklist.

RESULTS

Seventy-two studies that met the inclusion criteria were included. Undernutrition has decreased over time but still 22.4%, 5.2% and 12.2% of children under 5 were stunted, wasted and underweight, respectively. Anaemia, iron, zinc, and vitamin D deficiencies were the more common forms of MNDs, the prevalence varied by age, region, and socioeconomic group. Population-based surveys reported that 11% and 48% of children aged 0-11 years old were iron and vitamin D deficient, respectively. Zinc deficiency affected almost one-quarter of the children and adolescents. Retinol deficiency was of less concern (< 20%). However, more evidence on MNDs prevalence is needed. Overweight and obesity is now on the rise, affecting one-third of school-aged children. The key determinants of undernutrition included living in rural areas, children with low birth weight, and poor socio-economic status, whereas living in urban and affluent areas, having an inactive lifestyle and being a boy were associated with increased risk of overweight and obesity. Nutrition specific intervention studies including supplementation and food fortification consistently showed improvements in anthropometric indices and micronutrient biomarkers. National nutrition-sensitive programmes also provided nutritional benefits for children's growth and eating behaviours, but there is a lack of data on childhood obesity.

CONCLUSION

This finding highlights the need for effective double duty actions to simultaneously address different forms of childhood malnutrition in Vietnam. However, evidence on the potential intervention strategies, especially on MNDs and overnutrition are still limited to inform policy decision, thus future research is warranted.

Use of artificial sweeteners and caffeine in a population of Hanoi: An assessment by wastewater-based epidemiology

Monitoring the consumption of artificial sweeteners in the population is essential to help public health authorities understand the level of sugar consumption. There is a gap in knowledge of patterns and levels of artificial sweetener consumption in Vietnam. Using wastewater-based epidemiology (WBE), this study aims to evaluate the use of artificial sweeteners in an urban population in Hanoi, Vietnam. A total of 184 wastewater samples were collected at two sampling sites in an urban canal, receiving sewage from over 400,000 people in three different periods between 2018 and 2020. The population normalized per capita consumption of the five detected artificial sweeteners varied from 0.87 mg d^-1 p^-1 (sucralose) to 5.2 mg d^-1 p^-1 (aspartame). The daily consumption of artificial sweeteners was found to be stable throughout the week, however the consumption of artificial sweeteners was influenced by season with higher consumption in summer. Significant correlations (p < 0.01) were found among levels of artificial sweeteners and caffeine in urban canal samples, suggesting these chemicals had common sources. Population-weighted consumption load of artificial sweeteners and caffeine was compared in Vietnam, China and Australia, and the per capita consumption load mainly depended on the habitual of tea/coffee drinking in different countries. This was the first study that provided information on the artificial sweetener consumption by wastewater analysis in Vietnam. However, several sources of uncertainty (sample collection, population estimation, other sources of artificial sweeteners in wastewater, etc.) were acknowledged in this study. Further investigations on the spatial-temporal variation of artificial sweetener consumption with more intensive sampling scheme in Vietnam are recommended.

The Association of Maternal BMI with Overweight among Children Aged 0-59 Months in Kenya: A Nationwide Cross-Sectional Study

Childhood overweight is a growing global public health challenge and is prevalent in many countries. We aimed at exploring the prevalence of childhood overweight and the association of maternal body mass index (BMI), maternal demographic factors, and child-related factors with childhood overweight among Kenyan children aged 0-59 months. This study utilized Kenya's 2014 demographic and health survey, which was based on national representative cross-sectional data. A total of 8316 children and their mothers' data were analyzed. Overweight in children and maternal BMI were defined using WHO standard criteria. Multivariate logistics regression models were used to study the association of maternal BMI and childhood overweight. Nationally 5% of Kenyan children aged 0-59 months are overweight (5.5% male vs. 3.8% female). The highest prevalence in overweight among children was found in Central region (6.9%) and lowest in North Eastern (3.1%) which could be explained by the various economic disparities. Maternal BMI with underweight was associated with lower odds (OR 0.30, 95% CI 0.14-0.64) whereas, overweight and obesity were associated with higher odds of overweight (OR for overweight 1.64, 95% CI 1.28-2.11 and OR for obesity 1.74, 95% CI 1.22-2.47) among their children compared to normal weight mothers. Overweight among children is of great concern and therefore initiatives to tackle both child and maternal health are urgently needed.

Key Informants' Perspectives on Childhood Obesity in Vietnam: A Qualitative Study

Objectives

Vietnam’s post-war globalization, economic development, and urbanization have contributed to a nutrition transition from traditional diets to highly-processed diets, and increased prevalence of childhood overweight and obesity. Our study aims to explore the attitudes and behaviors driving this epidemic.

Methods

This qualitative study focused on the perspectives and practices of Vietnamese parents, schoolteachers and doctors. Semi-structured interviews were conducted with a convenience sample of 12 regarding the historical, social, and cultural influences contributing to childhood overweight and obesity. Audio-recorded interviews were translated and transcribed, then analyzed using modified ground theory to identify themes and representative quotes.

Results

Five themes were identified: (1) Change in diet between generations, (2) Preference for rounder children, (3) Unhealthy feeding practices, (4) Reduced physical activity, and (5) Increasing awareness of childhood obesity. A conceptual map detailed the shift from war-time to post-war economic environment and psycho-social context for raising children to be large, safe and academically-successful.

Conclusions for Practice

We found that globalization, urbanization and economic development—in the context of historical, social and cultural attitudes—may contribute to increasing child obesity in Vietnam. Obesity prevention through public health and educational institutions should involve policies and programs for healthy eating and exercise, tailored to address parental figures’ concerns.

Initial investigation of associations between feeding practices, eating behaviours, and weight status in Vietnamese children using modified questionnaires

AIMS

This cross-sectional study aims to extend the preliminary validation of the Feeding Practices and Structure Questionnaire (FPSQ) and Children's Eating Behaviour Questionnaire (CEBQ) in the Vietnamese context by examining associations between maternal feeding practices, child eating behaviours, and child weight status.

METHODS

Modified versions of the FPSQ and CEBQ were used to measure maternal feeding practices and child eating behaviours, respectively, in a sample of Vietnamese mothers of children within the age range of two to five years (n = 100). Children's weight-for-height z-scores (WHZs) were calculated using weight and height measurements obtained by clinicians. Pearson's correlation coefficients were used to examine bivariate associations between maternal feeding practices, child eating behaviours, and child WHZs. Significant variables were then entered into a multivariable regression model.

RESULTS

Child WHZs were associated with maternal persuasive feeding, and child slowness in eating, enjoyment of food/food responsiveness, and emotional undereating, but in multivariable regression analysis, only persuasive feeding (β = -0.44, p = 0.027) and slowness in eating (β = -0.39, p = 0.036) contributed significantly to the model.

CONCLUSIONS

The findings provide some evidence of construct validity for the modified questionnaires. Potential implications of dietary-related behaviours on weight status in preschool-aged children in Viet Nam are evident. However, further validation and analysis in larger datasets must be undertaken in order to examine these associations with increased certainty.

A survey of parabens in aquatic environments in Hanoi, Vietnam and its implications for human exposure and ecological risk

Seven parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), iso-propylparaben (iPrP), butylparaben (BuP), benzylparaben (BzP), and heptylparaben (HepP) were determined in bottled water, tap water, river water, lake water, and wastewater samples collected from Hanoi, Vietnam, using solid phase extraction (SPE) followed by ultrahigh performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The highest total concentration of parabens were measured in wastewater (range, 27.3-1050 ng/L; mean/median, 268/175 ng/L), followed by lake water (range, 18.0-254 ng/L; mean/median, 51.7/58.5 ng/L), river water (range, 16.5-52.1 ng/L; mean/median, 32.1/42.6 ng/L), tap water (range, 5.01-54.3 ng/L; mean/median, 28.6/41.1 ng/L), and bottled water (range, 1.56-39.9 ng/L; mean/median, 6.92/9.19 ng/L). Methylparaben and propylparaben were the predominant compounds found in all samples. The mean estimated human exposure dose of parabens through drinking bottled water was 0.27 ng/kg-bw/day, which is 6 orders of magnitude below the safety threshold recommended by the Joint FAO/WHO Expert Committee on Food Additive in 1974 (10 mg/kg-bw/day). Concentrations of parabens measured in river water, lake water, and wastewater samples were assessed to pose low to moderate ecological risks to aquatic organisms (0.1 < RQ < 1). Methyl, ethyl, and propyl parabens exhibited significant correlations in water samples.

Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6–23 months in the Tamale Metropolis of Ghana

The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother–child pairs aged 6–23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery.

Trends of overweight and obesity among preschool children from 2013 to 2018: a cross-sectional study in Rhine-Neckar County and the City of Heidelberg, Germany

BACKGROUND

Early childhood overweight and obesity is a growing public health concern worldwide. Few recent studies have addressed how time trends varied by sociodemographic characteristics at the regional level using large and high-quality data. This study determines how time trends vary in the prevalence of early childhood overweight and obesity by age, gender, and migration background at the regional level.

METHODS

We used a Kernel-density curve to describe the BMI distribution, and evaluated the trends of overweight and obesity by age, gender, and migration background using logistic regression.

RESULTS

Mean BMI and the overall prevalence of overweight and obesity increased among preschool children aged 4-6 years in the Rhine-Neckar County and the City of Heidelberg. After adjusting for age, sex, and migration background, trends of overweight significantly increased only among male children in the age 5 year group with migration background (P < 0.05), and an upward trend of obesity was observed only among male children in the age 5 year group and female children in the age 6 year group with migration background (P < 0.05).

CONCLUSIONS

BMI distribution as well as general prevalence of overweight and obesity are still increasing among preschool children. Children with migration backgrounds, particularly male children in the age 5 year groups and female children in the age 6 year group should be prioritized. Health promotion strategies for children with migration backgrounds will help address this challenge.

Profiles of phthalic acid esters (PAEs) in bottled water, tap water, lake water, and wastewater samples collected from Hanoi, Vietnam

Contamination levels and distribution patterns of ten typical phthalic acid esters (PAEs) were investigated in various types of water samples collected from Hanoi metropolitan area in Vietnam. Concentrations of 10 PAEs in bottled water, tap water, lake water, and wastewater samples were measured in the ranges of 1640-15,700 ng/L (mean/median: 6400/5820 ng/L), 2100-18,000 ng/L (mean/median: 11,200/9270 ng/L), 19,600-127,000 ng/L (mean/median: 51,800/49,300 ng/L), and 20,700-405,000 ng/L (mean/median: 121,000/115,000 ng/L), respectively. Among PAEs, di-(2-ethylhexyl) phthalate (DEHP) accounted for a major proportion of total concentrations (45%) in wastewater, followed by diisobutyl phthalate (DiBP, 10.3%), and dibutyl phthalate (DBP, 9.53%). Concentrations of PAEs in wastewater decreased significantly with distance from the wastewater treatment plants (WWTPs). Concentrations of PAEs in surface water samples did not vary greatly between locations. PAEs were found in bottled water in the following order: DBP (22.4%), DiBP (22.3%), benzylbutyl phthalate (BzBP, 20.1%), and DEHP (15.5%). The estimated mean exposure doses of 10 PAEs through consumption of drinking water for adults and children in Vietnam were 254 and 256 ng/kg-bw/day, respectively. Capsule: Highest concentrations of PAEs were measured in wastewater, followed by lake water, tap water, and bottled water.

Distribution of cyclic volatile methylsiloxanes in drinking water, tap water, surface water, and wastewater in Hanoi, Vietnam

In this study, four cyclic volatile methylsiloxanes (cVMSs) were determined in drinking water, tap water, surface water, and wastewater samples collected from Hanoi metropolitan area, Vietnam, during August to December 2020 (dry season) by using solid phase extraction combined with gas chromatography tandem mass spectrometry. Highest concentrations of cVMSs in the range of 63-7400 ng/L (mean/median: 1840/1310 ng/L) were found in wastewater samples. A significant difference existed in the concentrations of cVMSs between influent and effluent of a wastewater treatment plant. The sum concentrations of four cVMSs in lake water, tap water, and bottled water samples were in the ranges of 67.0-1100 ng/L (mean/median: 350/282 ng/L), 19.8-350 ng/L (12.6/12.3 ng/L), and 2.31-28.1 ng/L (10.3/8.23 ng/L), respectively. Among the four cVMSs, decamethylcyclopentasiloxane (D5) was found at the highest concentrations in all water samples analyzed. The mean exposure doses of cVMSs calculated for adults and children through the consumption of drinking were 0.409 and 0.412 ng/kg-bw/day, respectively. Human exposure to cVMSs calculated through drinking water consumption was significantly lower than that reported for inhalation.

Childhood obesity prevention policies in Iran: a policy analysis of agenda-setting using Kingdon's multiple streams

BACKGROUND

Pediatric obesity is one of the most important health challenges of the twenty-first century. Primary prevention of childhood obesity, can lessen its consequences. This study aims to assess childhood obesity prevention policies in Iran through a policy analysis of agenda-setting using Kingdon's multiple streams.

METHODS

A qualitative study was conducted using in-depth interviews with 39 key informants and document review from different stages of the policymaking process of childhood and adolescent obesity prevention programs in Iran. The analysis of documents and interviews were guided based on Kingdon's multiple streams (problem, policy and political streams).

RESULTS

The important factors of the problem stream were the high prevalence of childhood and adolescent obesity and its risk factors in Iran. In the policy stream, a focus on preventing non-communicable diseases in the health system, increasing the workforce in health centers, promoting health school programs, and creating healthy eating buffets in schools was identified. Under the political stream, the impact of the WHO ECHO program in 2015 and the implementation of the health system transformation plan in Iran in the new government took place after 2013, caused the Iran ECHO program entered the agenda and implemented from 2016.

CONCLUSIONS

Now that a window of opportunity for childhood and adolescent obesity prevention policymaking has been created, the problems such as the therapeutic approach in the health system, the existence of sanctions against Iran and outbreak of coronavirus disease-19 (COVID-19), have hindered the successful implementation of this policy and the opportunity window has not been well used. However, actors need political support from the high levels of government to keep this policy on the agenda.

Annual incidence and prevalence of obesity in childhood and young adulthood based on a 30-year longitudinal population-based cohort study in Korea: the Kangwha study

PURPOSE

Childhood obesity is a major global issue that causes a variety of health problems and high social costs. Many previous studies have investigated childhood obesity using cross-sectional data, but few longitudinal cohort studies have been performed, especially in the Korean population.

METHODS

We analyzed the incidence and prevalence of obesity and overweight in a Korean prospective cohort study of children that were followed-up from age 7 to age 36. The study eventually recruited a total of 1216 participants, with 16 follow-up surveys over 30 years (1986-2017).

RESULTS

The annual incidence of obesity showed a small peak (2.1%) at age 13 when the cohort entered middle school, but a rapid increase (6.4%) when participants reached the age of 20. The prevalence of obesity and overweight at age 8 was 0.8% and 0.9%, respectively, and increased rapidly from age 12 (obesity 2.2%, overweight 4.6%), reaching 9.5% and 15.9%, respectively, at age 20. The prevalence of obesity and overweight was consistently higher in girls than in boys during the childhood period, but this trend reversed in adulthood.

CONCLUSIONS

Incidence and prevalence of obesity and overweight increased markedly after the final grades of elementary school in females, but after adolescence in males.

Parabens in personal care products and indoor dust from Hanoi, Vietnam: Temporal trends, emission sources, and non-dietary exposure through dust ingestion

The occurrence of seven typical parabens was investigated in several types of personal care products (PCPs) sold at supermarkets and in indoor dust samples collected from houses, laboratories, and medical stores in Hanoi, Vietnam. Parabens were frequently detected in PCPs regardless of the paraben indication in their ingredient labels. However, concentrations of parabens in labeled products (median 3280; range 1370-5610 μg/g) were much higher than those found in non-labeled products (69.4; not detected - 356 μg/g). Parabens were also measured in indoor dust samples of this study at elevated concentrations, ranging from not detected to 1650 (median 286 ng/g). Levels of parabens in the indoor dust samples collected in 2019 decreased in the order: house > medical store > laboratory dust, however, the difference was not statistically significant. Interestingly, levels of parabens in Vietnamese house dust exhibited an increasing trend over time, for example, mean/median concentrations of parabens in house dust samples collected in 2014, 2017, and 2019 were 245/205, 310/264, and 505/379 ng/g, respectively. Methylparaben was found at the highest frequency and concentrations in both PCPs and indoor dust samples. Mean exposure doses of total parabens through dust ingestion were estimated to be 2.02, 1.61, 0.968, 0.504, and 0.192 ng/kg-bw/d for infants, toddlers, children, teenagers, and adults, respectively. Further studies on the distribution, emission behavior, potential sources, and negative impacts of parabens in different environmental media in Vietnam are needed.

Early childhood factors associated with obesity at age 8 in Vietnamese children: The Young Lives Cohort Study

Background

Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transition from the traditional diet to highly-processed and calorie-dense foods and beverages, and an increasing prevalence of childhood overweight/obesity (ow/ob). The goal of this study is to describe the patterns of ow/ob in a longitudinal sample of Vietnamese children from ages 1 to 8, and the sociodemographic and behavioral factors associated with ow/ob at age 8.

Methods

This study is a secondary data analysis of a geographically-representative, longitudinal cohort of 1961 Vietnamese children from the Young Lives Cohort Study from 2002 to 2009. Thirty-one communities were selected with oversampling in rural communities, and children age 1 were recruited from each community using simple random sampling. Surveys of families and measurements of children were collected at child ages 1, 5, and 8. Our specified outcome measure was childhood ow/ob at age 8, defined by the World Health Organization’s thresholds for body-mass-index (BMI) for age Z-scores. Associations between early and concurrent socio-behavioral factors, childhood nutrition and physical activity variables were analyzed using STATA 15. Bivariate and multivariable analyses were completed utilizing logistic regression models.

Results

The prevalence of ow/ob increased from 1.1% in both sexes at age 1 to 7% in females and 13% in males at age 8. Bivariate analyses show greater likelihood of ow/ob at age 8 was significantly associated with early life sociodemographic factors (at age 1), male sex (OR = 2.2, 1.6–3.1), higher wealth (OR = 1.1–1.4), and urban residence (OR = 4.3, 3–6). In adjusted analyses, ow/ob at age 8 was associated with early nutrition practices at age 5, including frequent consumption of powdered milk (OR = 2.8, 1.6–4.6), honey/sugar (OR = 2.7, 1.8–4.1), prepared restaurant/fast foods (OR = 4.6, 2.6–8.2), and packaged sweets (OR = 3.4, 2.3–4.9). In addition, breastfeeding for 6 months or longer was protective against obesity at age 8 (OR = 0.3, 0.1–0.9).

Conclusions

We found that increased consumption of powdered milk, honey/sugar, packaged sweets, and prepared restaurants/fast foods are associated with childhood ow/ob. In contrast, breastfeeding for 6 months or longer was protective against childhood ow/ob. These findings suggest that public health programs and campaigns aimed to prevent childhood ow/ob in Vietnam should target early feeding practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10292-z.

Characterization of triclosan and triclocarban in indoor dust from home micro-environments in Vietnam and relevance of non-dietary exposure

Contamination status, spatial variability, and exposure risk of triclosan (TCS) and triclocarban (TCC) in indoor dusts from different micro-environments were evaluated for the first time in Vietnam as well as in Southeast Asian region. TCS and TCC were measured in 89 dust samples collected from bedrooms, living rooms, and kitchens of private houses in four northern cities including Hanoi, Bac Ninh, Hung Yen, and Nam Dinh, by means of liquid chromatography-tandem mass spectrometry. Concentrations of TCS and TCC ranged from <5 to 1090 (median 33.2) and from <3 to 531 (median 19.3) ng g^-1, respectively. Concentrations of TCS and TCC in the kitchen and bedroom dusts were markedly higher than levels found in the living room samples, probably due to their applications in kitchen utensils, household cleaning reagents, and personal care products. A strong positive correlation between TCS and TCC concentrations was detected in the whole dataset (R² = 0.810, p < 0.001). For samples in which both TCS and TCC were quantified, TCS/TCC ratios ranged from 0.3 to 12 with a median value of 1.8, and did not show big differences between micro-environments. Human exposures to TCS and TCC through dust ingestion were estimated for various age groups with 95% CI daily intake doses ranging from (0.032-0.070) to (0.340-0.740) and from (0.017-0.033) to (0.175-0.345) ng kg-bw^-1 d^-1 for adults and infants respectively. Although our derived values were much lower than reference doses, more comprehensive risk assessment considering multiple exposure pathways of TCS and TCC is needed.

Understanding food westernisation and other contemporary drivers of adult, adolescent and child nutrition quality in urban Vietnam

OBJECTIVE

To examine the association between consumption of western foods purchased and consumed away from home and measures of nutrition quality: average daily caloric intake and macronutrient (carbohydrates, fat and protein) shares, for urban consumers in Vietnam, a country undergoing economic transition.

DESIGN

Cross-sectional observational data were collected using household surveys and 24-h food diaries. Outcome variables were individual average daily caloric intake and shares of calories from macronutrients: carbohydrates, fat and protein. The key explanatory variable was individual daily share of calories from western food purchased and consumed away from home. Ordinary least squares and multivariate regression analyses were used to examine the association between the outcome variables: caloric intake and macronutrient shares and the share of calories from western food consumed away from home.

SETTING

Hanoi and Ho Chi Minh City in Vietnam.

PARTICIPANTS

In total, 1685 households and 4997 individuals, including adults (aged $$ \ge $$ 18 years), adolescents (aged 10-17 years) and children (aged 0-9 years).

RESULTS

The share of calories from western food away from home was significantly associated with higher caloric intake among male and female adults (P < 0·01), adolescents (P < 0·01) and male children (P < 0·10) and was associated with higher shares of fat for male and female adults (P < 0·01), adolescents (P < 0·01) and male children (P < 0·01).

CONCLUSIONS

Policymakers must be conscious of the numerous factors associated with poor nutrition quality, especially in younger Vietnamese individuals. Relevant interventions targeting at risk groups are required if nutrition improvement is a long-term goal.

Maternal and Child Nutrition and Oral Health in Urban Vietnam

The global nutrition transition has contributed to child obesity and dental caries in developing countries, including Vietnam. Few studies have described the nutrition and oral health of mothers and children. This a descriptive study of the nutrition and oral health characteristics of a convenience sample of 571 children aged 2 to 5 years and their mothers from 5 urban preschools in Central and South Vietnam. The mothers completed a written survey, and the children received dental exams and weight/height measurements. High rates of bottle-feeding and the consumption of sweets were reported. One in 4 children were overweight/obese. Dental caries increased in prevalence and severity by age-at 5 years, 86.7% of children had tooth decay in an average of 8.5 teeth, and 70.9% experienced mouth pain. Most mothers and children suffered from untreated dental disease. Public health programs should focus on nutrition and oral health promotion, as well as dental treatment from pregnancy and birth onward.

Transition Patterns of Weight Status and Their Associated Factors among Elementary School Children: A Longitudinal Cohort Study Using Multistate Markov Model

Background: Childhood obesity is a recognized public health concern worldwide. It is essential to study the natural progression of obesity in the interest of prevention. This study aimed to describe the dynamic changes in weight status among elementary school children and identify the significant factors influencing the progression or regression of weight status. Methods: This study involved 928 elementary school children who were followed up annually during their elementary school years. Heights, weights, and vital capacity (VC) were measured each school year. A multistate Markov model containing three weight states was fit to longitudinal weight status data. Results: Children with healthy weight and obesity tended to stay in their preceding weight state. Children with overweight, in contrast, were more likely to move to the other two states. The mean sojourn time in obesity and in overweight states was 5.15 years (95% confidence interval [CI]: 4.22-6.3) and 2 years (95% CI: 1.76-2.28), respectively. Children in lower grades, those with a lower VC index, those with a higher initial BMI, those with a higher annual weight increment, and boys were at increased risk of progression to overweight or obesity, with a decreased probability of regression. Conclusions: Children with obesity were more resistant to recovery than those with overweight. Prevention and intervention measures should be adopted early when abnormal weight onset occurs. The multistate Markov model was an advanced tool to analyze dynamic changes in status and identify significant factors for progression and regression and helped to develop prevention and intervention targeting strategies.

Overweight, stunting, and concurrent overweight and stunting observed over 3 years in Vietnamese children

Background: Malnutrition, both stunting and overweight/obesity, present a public health concern in many countries in the world.

Objective: This study aims to examine: (1) longitudinal changes in prevalence of overweight, stunting, and concurrent overweight and stunting among preschool children during 3 years and (2) secular changes in these prevalences of a specific age group of children aged 5.5–6.5 year over a period of 3 years.

Methods: A cohort of 2,602 children initially aged 3–6 years old, 1,311 in an urban area and 1,291 in a rural area, was followed for 3 years. Of them, children aged 5.5–6.5 years old were identified to be included in three repeated cross-sectional surveys. The World Health Organization standard was used to classify children with overweight or stunting.

Results: Findings from the cohort study indicate that between 2013 and 2016, the estimated prevalence of overweight including obesity (OWOB) increased with age, particularly in the urban setting (14.2%–29.9% in boys and 9.0%–21.6% in girls). The estimated prevalence of stunting decreased from 8.2% to 3.4% in boys and 9.5% to 3.5% in girls with a considerably greater decrease among rural children. There was a similar pattern of an age-related decrease of concurrent OWOB and stunting from 2.4% in 2013 to 1.4% in 2016 in boys and from 2.9% to 1.3% in girls with significant decreases in rural children. Secular trends in the group of children 5.5 to 6.5 show the same pattern as the longitudinal results: decreasing prevalence of stunting as well as concurrent OWOB and stunting. OWOB prevalence increased significantly in urban girls and rural boys.

Conclusions: The pattern of increasing overweight, decreasing stunting and concurrent overweight and stunting both with increasing age and over chronological time is observed among Vietnamese preschool children.

Nutritional Status of Children Aged 12 to 36 Months in a Rural District of Hungyen Province, Vietnam

Objective

To evaluate the nutritional status of children from 12 to 36 months of age in Kimdong, a rural district in Hungyen Province, Northern Vietnam, in 2017.

Subjects and Methods

A cross-sectional study was carried out on 327 children aged 12-36 months. The data collected included anthropometric measurement, serum hemoglobin (Hb), and vitamin D concentration. Blood analysis was done at the Center Laboratory of Hungyen Obstetrics and Pediatrics Hospital. Underweight, stunted, and wasted children were classified based on z-scores cut-off less than -2 SD of weight for age (WAZ), height for age (HAZ), and weight for height (WHZ), respectively. Overweight and obese children were defined if WHZ was more than + 2SD. Anemic child was applied when Hb concentration was less than 110 g/L while vitamin D deficiency was termed for level less than 20 ng/L.

Results

The prevalence of underweight, stunted, wasted, and overweight/obese children was 7.6%, 23.5%, 6.7%, and 1.2%, respectively. The prevalence of anemia and vitamin D deficiency was 33.3% and 47.7%, respectively. Malnutrition, anemia, and vitamin D deficiency were not statistically different by sex. Malnutrition and vitamin D deficiency were not statistically different by age group but anemia by age groups was significantly different.

Conclusions

Stunting is still prevalent in children aged 12-36 months in Kimdong. Moreover, anemia and vitamin D deficiency also affected children in this area. Some interventions should be conducted to improve the nutritional status of children in Kimdong district.

Stunting and Overweight among 12-24-Month-Old Children Receiving Vaccination in Ho Chi Minh City, Vietnam

Introduction

Malnutrition and obesity are a double burden on children in developing countries and could induce higher risks of noncommunicable diseases in the long term. In the big cities of Vietnam, both issues are present and share the issue of nutrition problems; the prevalence of malnutrition in children is gradually decreasing while the prevalence of obesity is increasing rapidly. The paper aims to identify the prevalence of stunting and overweight/obesity in apparently healthy young children in Ho Chi Minh City (HCMC).

Methods

A prospective cross-sectional study recruited 12-24-month-old children receiving national vaccination in community health centers in HCMC from February 2016 to July 2017. Sixteen healthcare centers were randomly selected among 8 districts of HCMC. Stunting and overweight were defined by height-for-age z-score <-2 SD and BMI z-score ≥+2 SD.

Results

A total of 768 children had mean age of 16.8±4.2 months old, 51.7% boys. The prevalence of stunting and overweight/obesity was 8.2% and 10.7%, respectively. Stunting was associated with older age, boys, and low birth weight of children and occupation of mothers (P <0.05). No associated risk factor was observed for overweight/ obesity status.

Conclusion

The prevalence of overweight/obesity was higher than the prevalence of stunting in 12-24-month-old children in HCMC. Overweight/obesity would be a public health problem for children in big cities.

Food safety and nutrition for low-income urbanites: exploring a social justice dilemma in consumption policy

Equitable access to healthy food is a critical challenge in urban Asia. Food safety governance promotes modern supermarkets over more traditional markets, but supermarkets are associated with unequal access to food. This study investigates how retail policies driven by food safety impact the diets of the urban poor in Hanoi, Vietnam. We do this by linking food retail infrastructures with the food shopping practices and measured dietary intake of 400 women. Our results reveal sub-optimal dietary diversity and reliance on foods sourced through traditional markets, which do not provide formal food safety guarantees. Modern channels supply formal food safety guarantees, but are mainly frequented for purchasing ultra-processed foods. The paper uncovers a conflicting duality governing food security and suggests that the public responsibility for ensuring access of the poor to nutritious and safe foods requires a more diverse retail policy approach.

Factors related to dental caries in 10-year-old Vietnamese schoolchildren

BACKGROUND

In Vietnam, research is required to provide a clearer understanding of the factors associated with dental caries. This will allow paediatric dentists and physicians to provide appropriate care to children.

AIM

To determine the factors related to dental caries and to evaluate the association between dental caries and nutritional status in 10-year-old schoolchildren.

METHOD

In 2015, 1,079 10-year-old children were randomly selected from 16 public schools in Ho Chi Minh City. Information on self-reported oral health, dental habits, eating, drinking and physical activity behaviours was obtained via a questionnaire. Anthropometric measurements (height and weight) were also taken. Body mass index (BMI) was calculated, and nutritional classification of children was conducted using the BMI-for-age percentile. Dental plaque and dental caries (decayed and filled teeth) were recorded for both primary and permanent teeth.

RESULTS

Dental caries was experienced on primary and permanent teeth by 60.7% and 39.6%, respectively, of subjects. The factors significantly related to primary tooth decay were school location [odds ratio (OR) = 1.78], self-reported dental caries (OR = 1.36), frequency of tooth self-checking (OR = 1.32), toothbrushing habits (OR = 1.31) and nutritional status (OR = 1.77); however, the factors associated with permanent tooth decay were school location (OR = 2.66), self-reported dental caries (OR = 1.34), frequency of tooth self-checking (OR = 1.37), frequency of dental check-ups (OR = 1.35), toothbrushing habits (OR = 1.31) and nutritional status (OR = 1.39 and 1.74) (P < 0.05).

CONCLUSION

Dental caries was associated with school location, dental-related behaviours and nutritional status in 10-year-old schoolchildren in Ho Chi Minh City, Vietnam.

Socio-Economic Disparities in Attitude and Preference for Menu Labels among Vietnamese Restaurant Customers

Calories and nutrition labeling on restaurant menus are powerful policy interventions to reduce the burden of obesity epidemic. However, the success of this policy requires an assurance of equal benefits among customers with different characteristics, especially people at a higher risk of poor health outcomes and eating habits. This study examined the sociodemographic disparities in the attitude and preference for calories and nutrition labeling on menus among customers in various food facilities. A cross-sectional study was conducted with 1746 customers of food facilities in Hanoi, Vietnam, who were recruited by using a multistage sampling method. Socio-economic characteristics, attitudes regarding the necessity and preferences for calories, and nutrition labeling on menus were analyzed. Multivariate logistic regression was employed to determine the associated factors with attitudes and preferences. Results show that most of the sample understood the necessity to have calories and nutrition labeling (59.8%), and 71.8% preferred to have calories and nutrition labeling. People who often visited food facilities (Odd Ratio (OR) = 1.36; 95% confident interval (CI) = 1.06–1.74) and had higher education and were more likely to understand the necessity of calories and nutrition labeling. Factors such as being homemakers, often going to dine-in restaurants, and perceiving that labeling was unnecessary were negatively associated with preferences for calories and nutrition labeling. The results of this study encourage policymakers to implement calories and nutrition labeling in the future. Health education interventions to improve knowledge and attitude as regards calories and nutrition labeling on menus are important, particularly for males, less-educated individuals, and high-income people.