ISSN2434-2688 Asian Journal of Dietetics

Vol.3 No.3, 2021
Contents
Page T Title and authors

Special Report
63-66

School Meal Program No. 3 in a Series:
Cultural Flavors Spice Up Japanese School Meals: A Perspective from
Vietnamese Dietitians
Giang Nguyen Huong, Noriko Sumida,, Hitomi Takeichi, Phuong Nguyen Mai,
Diep Nguyen Van, Yoko Ozaki, Tamami Kawakami , Mayu Funahashi,
Hitoshi Iizuka

Special Issue: AFDA
30th Anniversary
67-77

History of Asian Federation of Dietetic Associations:Celebrating the 30th Anniversary, 1991-2021
Chwang Leh-Chii

79-80

NDAP Hosts the 4th ICD in Manila, Philippines
Zenaida F. Velasco

81-85

Thai Dietetic Association:
Celebrating the AFDA 30th Anniversary
Sunard Taechangam, Chanida Pachotikarn

87

Original Research
89-93

Development of Asian dietetics and the further solidarity of dietitians
Teiji Nakamura
Effectiveness of Medical Nutrition Therapy with Technology-Assisted
Intervention on Cardiometabolic Parameters in Thai Participants with
Prediabetes and Obesity
Pornthip Yoonaisil, Nipa Rojroongwasinkul, Weerachai Srivanichakorn,
Theeravet Pattayanant, Wantanee Kriengsinyos

95-103

Energy and Nutrient Intakes and Recommendations from a Survey of Children
in a Coastal City in Central Japan
Nguyen Huong Giang, Nguyen Mai Phuong, Nguyen Van Diep,
Nobuko Sarukura, Hitomi Takeichi, Ayami Sano, Sumiko Kamoshita, Yoko Ozaki,
Saori Okushima, Hitoshi Iizuka, Masayo Kaneda,
Shigeru Yamamoto

105-110The Employment Status and the Need for Issuing Practising Certificates to
Bachelors of Nutrition in Vietnam in 2021
Yen Ngoc Ma, Ninh Thi Khanh Tran, Thao Phuong Tran, Huong Thi Le,
Linh Thuy Nguyen

Asian Journal of Dietetics 2021

Special Report: School Meal Program
Cultural Flavors Spice Up Japanese School Meals: A Perspective from Vietnamese Dietitians
No. 3 in a Series
Giang Nguyen Huong1, Noriko Sumida2 , Hitomi Takeichi2, Phuong Nguyen Mai1,
Diep Nguyen Van1, Yoko Ozaki3, Tamami Kawakami3, Mayu Funahashi3, Hitoshi Iizuka2,3
1
Jumonji University, Saitama, Japan
Asian Nutrition and Food Culture Research Center, Jumonji University
3
Quest Computer, Tokyo, Japan

2

Cultural features create a unique identity for eachcountry and one of the ways it expressed is throughthe foods we eat. We learn about our culture frommany sources and school meals are no exception.
In Japan, school meals designed not only toprovide children with healthy and delicious meals
but also to teach children about cultural traditions.
This broad perspective on food and nutrition helps
instill in children a sense of gratitude for the foodthey are eating and an appreciation for and interest
in its origins. In addition, it is likely responsible forthe remarkably low levels of food waste.
Japan places a high value on food and nutrition
education in schools, and correspondingly also on
the professionals who provide this instruction to
students. Food culture is one of the aspects of foodand nutrition education conducted by nutrition
teachers/school dietitians working in tandem withteachers of other subjects. For seasonal events, theyplan special meals to celebrate, which are called“Gyouji shoku” in Japanese. Along with the meal
for the event, they also tell some story or draw somecartoons to explain drop the meaning of that day andthe reason for eating that particular food.
As an example, Ms. Sumida, a co-author of thisarticle who is a nutrition teacher in a city in thewestern part of Japan, used the school lunch for the
study of the Japanese traditional observance of
Setsubun - Midwinter Day and Tanabata – The Star
Festival. She developed menus and the kitchen staff
prepared appropriate meals. She explained thecultural history of those days through the cartoons
shown below.
“As a society with long traditions, Japan enjoys
many traditional festivals and observations in thecourse of the year. As in other countries, these days
are marked by the preparation of special foods andthe school lunch program often incorporates thesedishes into its menus on these days, both for theirtraditional cultural significance and to acquaintstudents with foods that they might not otherwise
eat often” Ms. Sumida says’
Setsubun - Midwinter Day
Setsubun is the day before the beginning ofspring in Japan. It is also New Year’s Eve by the
lunar calendar, which begins the year with the firstday of spring. On this day, the Japanese perform aritual to cleanse away all the evil of the previous
year and drive it away.

Photo 1: Lunch on Setsubun at Ms. Sumida’s school.
*Corresponding author: giang3900@gmail.com
63Food culture

Conversation between teacher and students at Setsubun lunch time

Photo 2: Holly and sardine heads (Drawings by K. Nagao and N. Sumida)
64

Asian Journal of Dietetics 2021

Tanabata - the Star Festival
Tanabata is one of Japan’s five traditional seasonal
festivals. Tanabata originated from a Chineselegend, was brought to Japan in the 8th century andis held on July 7th every year. The cartoon below
was prepared to tell a story of two lovers which was
the origin of this day and also to explain the special
food for Tanabata.

Photo 2: Tanabata story
65

Food culture

Photo 3: Special food for Tanabata
When we heard this story, we found it very
interesting. In Vietnam, we also have this holiday
but the story about it is a little different and there isno special food like Somen. These stories andillustrations make the meals more attractive.
Children will enjoy the food more and not let it go
to waste. Learning about the legends of the holidays
in this way helps children to associate the stories
and the food and to remember them more easily. At

the same time, it is also a fascinating topic forfamily conversation at home.
Integrating culture into school meals is a really
good way to educate children. Meals with stories
not only nourish children’s bodies but also enrichtheir minds. Through cultural inclusion andnutritious choices, schools will pave the way for ahealthier next generation.

66

Asian Journal of Dietetics 2021

Special Issue: AFDA 30th Anniversary
History of Asian Federation of Dietetic Associations:Celebrating the 30th Anniversary, 1991-2021
Chwang Leh-Chii
Honorary President, Asian Federation of Dietetic Associations
President, Chinese Dietetic Society (Taiwan)
The Birth and Founding of AFDA:
The birth of Asian Federation of Dietetic
Associations (AFDA) fell on September 1991, in
Kuala Lumpur, Malaysia. The original name of
AFDA was Asian Forum of Dietetic Professionals(AFDP).AFDA serves to enhance the level ofprofessionalism of dietetic practitioners and facilitate
the regional collaboration of dietetics in Asia. This
year of 2021 marks AFDA's 30th anniversary. The
purpose of this article is to document the founding anddevelopment of AFDA during 1991- 2021.
The science and practice of modern dietetics began
evolving in early 20th century. Dietetic Associations in
Asia have been formed in various countries since1945(1). The idea for forming Asian Federation of
Dietetic Associations (AFDA) was inspired by thevery first meeting of Asian dietitians who were invited
to Taipei for the 1990 Asian Symposium on Rice andNutrition held by Taipei Dietitians Association (2).

Representatives (in alphabetical order ofOrganization) were Connie Chan (President, Hong
Kong Nutrition
Association), Murni
Prakaso(Indonesian Nutrition Association), Mitsutoyo
Hanamura (Delegate, Japan Dietetic Association),
Cho JS (President, Korean Dietetic Association), Uma
Thevendran (Nutrition Society of Malaysia), Verona
Corpus, President, Nutritionist-Dietitians' Associationof the Philippines), Susani Karta (Singapore
Dietitians' Association), Viboonyanont S, Vichai
Tanphaichitr (Delegates, Dietitian Club of Thailand)
and Chwang Leh-chii (President, Taipei Dietitians
Association)(3). The most existing session was
representatives from 9 Asian countries briefed theirdietetic practice and activities outlining the dietetic
status. In the plenary session of "where do we gofrom here", we concluded to form an Asian Dietetic
Network for further collaboration (Photo 1).

Photo 1: Asian Symposium on Rice and Nutrition, Taipei, Taiwan, 1990
In the following year, a group of dietitians
attended the 6th Asian Congress of Nutrition during
September 16-19, 1991 (Photo 2), and held thePreparatory Meeting for establishing AFDP (4) on
September 17, 1991 (Tuesday), 1.30-2.30 pm, at Putra
World Trade Center, 3rd level.

The meeting was chaired by Chwang Leh-chii.
Participants were: Hong Kong Nutrition AssociationVeronica Ho, Indonesian Nutrition Association Murni I.D. Prakaso, Susirah Sutardjo, Japan Dietetic
Association - Teiji Nakamura, Korean Dietetic
Association- Kim Eul-Sang, Lee Young-Na,
Nutrition Society of Malaysia- Uma Rani Thevendran,Singapore Nutrition and Dietetics Association- Evelyn
Fong, Lynn Alexander, Taipei Dietitians AssociationChwang Leh-chii, Chiu Ching-hwa*Corresponding author: lcchwang@gmail.com

67

History of AFDA

Photo 2: AFDP established in Kuala Lumpur, Malaysia, 1991
Uma Rani Thevendran (2nd, L), Murni I.D. Prakaso (3rd, L), Chwang Leh-chii (4th, L),
Lee Young-Na (5th, L), Susirah Sutardjo (6th, L), Teiji Nakamura (1st, R)

The Resolution Adopted by AFDP
In order to improve nutrition status for the
population, to promote the development of the dietetic
profession,andtoestablish
international
cooperation for dietetic education and research
activities in Asia, it is agreed to set up a Forum, named
as the Asian Forum of Dietetic Professionals (AFDP).
The following resolutions were made:1. The Forum is open to Asian national dietetic
associations that represent their countries / areas.
When a national dietetic association is not available,
a leading association of dietitians will take its
position instead.
2. The definition of Dietitian is based upon that ofrespective country/area.
3. The President-Elect for the Forum is Dr. Chwang
Leh-chii, President of the Taipei Dietitians
Association and Secretary-General is Ms. Murni
Prakaso of Indonesian Nutrition Association.
4. A Symposium on Dietetics is to be held on a 4 year
interval. The first one will be held in Indonesia in
1994 and the second one in Korea in 1998.
5. The followings are the founding members of AFDP:
Hong Kong Nutrition Association,Indonesian
Nutrition
Association(now
Indonesian
Dietetic Association), Japan Dietetic Association,
Korean Dietetic Association, Nutrition Society of
Malaysia (now Malaysian Dietitians' Association),
Singapore Nutrition and Dietetics Association,
Taipei Dietitians Association (now Chinese DieteticSociety (Taiwan)), Thailand Dietitians Club (nowThai Dietetic Association), Nutritionist-Dietitians's
Association of the Philippines
In the beginning, it is expected that theForum develops to a Federation when time is mature
for conducting Asian Congress of Dietetics, as wehave minimal experience in organizing a Dietetic
Congress of a large international scale.
Our wish rapidly became materialized in 1994,
the Asian Congress of Dietetics (ACD) was held inJakarta, Indonesia. Vice President Try Sutrisno andMinister of Health Sujudi inaugurated theCongress. The first Congress laid an excellent
example for the following ACDs. AFDP was renamed
as Asian Federation of Dietetics Associations (AFDA),
and Murni Prakaso of Indonesian was the President
elected.

The AFDA Constitution
To guide the activities of AFDA and its members,
the AFDA constitution was initially drafted by Dr.
Chiu Ching-hwa from Taipei during the first ACD in
1994. The AFDA board held meeting in Beijing 1995,
when they attended the 7th ACN, discussed the draft
and invited Dr. Susan Lui of Hong Kong Nutrition
Association to join drafting. The preliminary editionof AFDA Constitution with 12 articles was set forth
during the 1996 International Congress of Dietetics(lCD) in Manila. The Constitution draft went throughcontinuous edition and discussion during 2002 and68

Asian Journal of Dietetics 2021

2006 ACD. The final version of Constitution with 11
articles was adopted at AFDA General Assembly,
chaired by Dr. Demetria Bongga of NDAP, 2007, the10th ACN in Taipei (5).
The Federation respects the autonomy of its
member associations and will not pursue any political,
religious, racial or commercial ends. The managementof AFDA affairs is vested in the Executive Council.
The member hosting the current AsianCongress of Dietetics (ACD) designates a
representative to serve as the President of theFederation for the next term of office. The Honorary
President is the founder of AFDA with apermanent appointment.
The objectives of AFDA are to: promote thedevelopment of the dietetic profession bykeeping members abreast of new knowledge in thearea of nutrition and dietetics, establish international
collaboration and linkages for dietetic research andeducational activities in Asia, promote a network ofscientific information exchange in nutrition anddietetics through sharing of expertise and otherresources, organize meetings, workshops, conferences
and congresses, and link with international dietetic,
nutrition and health-related organizations.

Association. It was completed and adopted during
AFDA General Assembly, chaired by Dr. Sunard
Taechangam (TDA) during the 5th ACD in 2010,
Bangkok (5).
The AFDA Website:
Facing digital era, a resolution was made to createa website for AFDA at the General Assembly meeting
during the 4th ACD held in Bangkok in 2010,
and Camila Lee of Hong Kong Nutrition Association
served as webmaster. The website www.afdadietitians.org was launched in 2016. It features
milestones and updated activities linking dietitians in
Asia and worldwide.
Asian Dietitian’s Day:
Asian Dietitian Day is to recognize dietitian’scontributions in providing nutrition care to thenation! All members celebrate Asian Dietitians Day
annually in their countries throughout Asia andaccolade fellow peers in their important roles.
September 19 is chosen to commemorate thefounding date of AFDA in 1991. It was approved by
Executive Council meeting of AFDA in 2015,
at Yokohama, Japan, during the 12th Asian Congressof Nutrition (5). For instance, Thai Dietetic
Association celebrates this day by sponsoring morethan 30 hospitals nationwide to conduct community
nutrition activities each year.

The Logo of AFDA:
The Development and Progress of AFDA:
Asian Congress of Dietetics (ACD)
Since the first ACD was held in Indonesia (1994),
it was consecutively held in Korea (1998), Malaysia(2002), Philippines (2006), Thailand (2010), Taiwan(2014) and Hong Kong (2018). The forthcoming
congresses will be in Japan (2022), and India (2026).
Each has a theme aiming at contemporary
directions and challenges. Gathering of dietetic
professionals, nutritionists, researchers and scholars
every four years provides a unique venue for sharing
new findings in dietetics and innovative evidencebased dietetic practices.
Among all ACD programs, the training andeducation of dietitians is always the essential
subject. It originated from the first ACD 1994, thevery first workshop on Education and Training ofProfessionals
inDietetics andFood Service
System Management (DFSSM), chaired by Dr. Sunita
Almatsier (INA) and Professor Corazon Barba(NDAP). It was agreed to set up an institutional
network to strengthen the education and training
program in Asia-Pacific region in order to produce
quality dietitians to provide quality nutrition care (6).
Highlight of ACD is the Declaration named after
each host city and signed by representatives from
AFDA members at the closing ceremony. The
declaration is based on discussions at the conference,
recognizing urgent issues, striving to promote quality
dietetic practices and education, and pledging toenhance health and well-being in Asia (Photo 4-11).

Photo 3: AFDA logo

The AFDA logo profiling the geographic territoryof AFDA members in shades of blue (Photo 3) was
jointly
designedbyNutritionistDietitians's Association of the Philippines, Dietitians
Association of Australia, and Hong Kong Nutrition

69

History of AFDA

Photo 4: Signing of Taipei Declaration, at 6th ACD, 2014.
Left to right: HKNA, IDA, AsDI, JDA, KDA (behind), MDA, PNDS, NDAP, SNDA, CDS (Taiwan),
TDA, DAA.

Photo 5: The 1st ACD, Organizing Chair of INA (now AsDI), 1994, Jakarta, Indonesia

70Asian Journal of Dietetics 2021

Photo 6: The 2nd ACD, Organizing Chair and President of KDA, 1998, Seoul, Korea

Photo 7: The 3rd ACD, Organizing Chair and President of MDA, 2002, Kuala Lumpur, Malaysia

71

History of AFDA

Photo 8: The 4th ACD, Organizing Chair and President of NDAP, 2006, Manila, Philippines

Photo 9: The 5th ACD, Organizing Chair and President of TDA, 2010, Bangkok, Thailand

72

Asian Journal of Dietetics 2021

Photo 10: The 6th ACD, Organizing Chair and President of CDS (Taiwan), 2014, Taipei, Taiwan

Photo 11: The 7th ACD, Organizing Chair and President of HKNA, 2018, Hong Kong

73

History of AFDA
Asian Dietetics Forum (ADF)
The purpose of the Asian Dietetics Forum is toallow AFDA to have interim meeting and activity
prior to every 4 years ACD conference.
The first ADF was held in Kuala Lumpur on May
25, 2016, sponsored by Chinese Dietetics Society(Taiwan) and Malaysian Dietitians' Association(Photo 12).
The theme of the forum is "Asian Dietetics
Education". The aim is to work out a benchmark

statement for AFDA member countries on
curriculum, practicum programs and competency
standards for dietetic education program. The goal
is to facilitate the free flow of dietetic professionals
in this region, and to uplift the competency
standards of dietitians to meet career requirements
and to explore more job opportunities.
The second one planned to be hosted by Hong
Kong Nutrition Association in 2020, however,postponed due to Covid-19 pandemic.

Photo 12: ADF in Kuala Lumpur, Malaysia, 2016
Left to right: PNDS, HKNA, JDA, SNDA, DAA, IDA (front), KDA, CDS (Taiwan), AND (USA),
MDA, NDAP, AsDI

Photo 13: Asian Journal of Dietetics, the official journal of AFDA

74

Asian Journal of Dietetics 2021
Asian Journal of Dietetics (AJD)
The 2002 Kuala Lumpur Declaration and 2006
Manila Declaration indicated the urgent need ofresearch and information exchange.
Publishing an academic international periodical in
Asia is a formidable task, as writers and readers arefrom diversified social cultural backgrounds,
and topics cover a wide range of preventive andclinical dietetics, dietary culture and behavior,institutional food service management, nutrition
policy, education, epidemiology, etc. It was until
2018, Council Meeting of AFDA held in Hong
Kong approved the web publishing and peerreviewed journal. Editorial board members arefrom eleven AFDA members. Owing to the inititiveof Editor-in-Chief, Professor Shigeru Yamamoto
from Japan Dietetic Association, the Asian Journalof Dietetics (AJD) with 4 issues a year has beensuccessfully published since January 2019, which
provides various subjects of interests to dietitians
and benefits their professional development (Photo13).

fulfill their duty well.
All health care
professionals require
education,internship,certifications and licensures. Dietitian being healthprofessional has no exception.
At present, certification of dietitians in Japan,
Philippines, Korea, Taiwan and Malaysia isregulated by government. qualification examinationis required to obtain the title of Dietitian.
In other
AFDA member countries, it is self-regulated by
NDAs, however, not all legally binding. Mandatory
registration from a governing body requires law
enactment to better safeguard the qualification andcredentials of dietitians. We shall also support andenhance professionalism in countries lacking
qualified dietetic workforce.
Honoring the devoted and committed pioneers
Many colleagues have been untiringly devoted
themselves during the past 3 decades to upgrade
dietetic profession and network linkages for AFDA.
In addition to the organizing chair of each ACD(Table 1), who is the President of host NAD andserves as the President of AFDA for the next
term; acknowledgment also extends to SecretaryGeneral, Dr. Susan Lui (HKNA), Dr. Adela
Jamorabo Ruiz (NDAP) and Dr. Winnie Chee
(MDA) for assisting AFDA affairs. In recognitionof prominent dietetic professionals making
significant contribution domestically andinternationally toward enhancing dietetic profession,
Dr. Chwang Leh-chii Asian Dietetics Award has
been conferred at ACDs since 1998 (Table 2).
Asian Outstanding Young Dietitian Award funded
by Dr. Chiu Ching-hwa since 2018 recognizes
young devoted dietetic professionals aged below 45
making contributions to nutrition and dietetics
through active participation, extensive services,
domestically and internationally (Table 3).
During the course of the past 30 years, there
have been inspiring collaborative events of dietetics
through active participation of all AFDA members.
The unprecedented Covid-19 pandemic has
drastically changed our life since 2020, we shalllearn to cope with it and turn crisis into
opportunities. Looking to the future, 2021 is an
inflection point as we move toward the next decade.
We shall continue to build a powerful support ofdietetic profession on a broader prospective and torealize the aim of better nutrition status for the
population in Asia.

Achievement and Prospective of AFDA
Expanding AFDA membership
Three more national dietetic associations(NDAs) joined AFDA since its founding in
1991: Dietitians Association of Australia (DAA) as
an affiliated member in 1998, Pakistan Nutrition
and Dietetic Society (PNDS) in 2006 and Indian
Dietetic Association (IDA) in 2014 as full members.
Among the founding members, three wereoriginallynutrition
associations.
AFDA
encouraged the transformation of dietetic
associations to join AFDA: Indonesian Dietetic
Association(AsDI),
MalaysianDietitians'
Association(MDA) and Thai Dietetic Association(TDA).
There are now in total 11 regular members and
1 affiliated member in AFDA, the population ofthese countries are more than 2 billion. The
geographic location of AFDA members therefore
expands from East and Southeast Asia to South Asia
and South Pacific. We shall continue to support
and assist establishing more NDAs to join AFDA.
Encouraging policy formation to advanceprofessionalism
Professionalism is manifested by accountablepersons acquiring knowledge and competency to75History of AFDA
Table 1. ACD during 1994-2022 (5)ACD

Venue & Date

Theme

Organizing Chair

1 ACD

Jakarta,Indonesia
October 2-5, 1994

Beyond Nutrition Challenges
andOpportunities
forProfessionals in Dietetics

Murni Prakaso,
President,
Indonesia Nutrition Association

2nd ACD

Seoul,
Korea
August 9-12, 1998

Networks & New Ventures
for Asian Dietetics

Suh Eun Kyung,President,
Korean Dietetic Association

3rd ACD

Kuala
Lumpur,Malaysia
August 18-21, 2002

Harmonization
Dietetics

Fatimah Arshad,President,
Malaysian Dietitian Association

4th ACD

Manila, Philippines
April 23-26, 2006

Nutrition in a BorderlessSociety

5th ACD

Bangkok, Thailand
November 10-12, 2010

6th ACD

Taipei,TaiwanAugust 21-24, 2014

The Art of Well-Being
through
Asian
Dietetic
Practice
Advancing Health throughInnovating Dietetic Practiceacross Asia

7th ACD

Hong Kong
July 6-8,
2018

The Rise of Nutrition andDietetics in Asia

Gordon Cheung,President,
Hong Kong Nutrition Association

8th ACD

Yokohama, Japan
August 19-21, 2022
(scheduled)

Realizing a Sustainable
Healthy Society for a Bright
Future in Asia

Teiji Nakamura,President,
Japan Dietetic Association

st

of

Asian

Demetria Bongga,
President,
Nutritionist-Dietitians' Associationof the Philippines
Sunard Taechangam,
President,
Thai Dietetic Society
Chwang Leh-chii,
President,
Chinese Dietetic Society (Taiwan)

Table 2: Dr. Leh-Chii Chwang Asian Dietetics Award
AwardeeDr. Fatimah Arshad,
Malaysian Dietitians’ Association

Venue, Year conferredat the 2nd ACD,
1998, Seoul, Korea

Ms. Murni Muhilal,
Indonesian Dietetic Association

at the 3rd ACD,
2002, Kuala Lumpur, Malaysia

Ms. Velona Corpus,
Nutritionist-Dietitians’ Association of the Philippines

at the 4th ACD,
2006, Manila, Philippines

Dr. Hyun Kyung Moon,
Korean Dietetic Association

at the 5th ACD,
2010, Bangkok, Thailand

Dr. Sunrad Taechangam,
Thai Dietetic Association

at the 6th ACD,
2014, Taipei, Taiwan

Dr. Susan Lui,
Hong Kong Nutrition Association

at the 7th ACD,
2018, Hong Kong

Dr. Salma Halai Badrudin,
Pakistan Nutrition and Dietetic Society

at the 7th ACD,
2018, Hong Kong
76

Asian Journal of Dietetics 2021
Table 3: Dr. Ching-Hwa Chiu Asian Outstanding Young Dietitian Award
Awardee
Mr. Gordon Cheung,Hong Kong Nutrition Association
Ms. Fayza Khan,
Pakistan Nutrition and Dietetic Society

ACKNOWLEDGEMENTS
The author greatly appreciate Mr. Ta-te Yuan formaking photo PowerPoint of this manuscript.
REFERENCES
1) Japan Dietetic Association.
About JDA,
Outline of the Japan Dietetic Association.
https://www.dietitian.or.jp/english/
2) Chwang LC: The Rise of Nutrition and Dietetics
in Asia. 2019. Asian J Dietetics 1: 1-3.
http://jnl.calorie-smile.jp
3) Program Book of Asian Symposium on Rice andNutrition, 1990. Taipei

Venue, Year conferredat the 7th 7th ACD,
2018, Hong Kongat the 7th 7th ACD,
2018, Hong Kong

4) Tai YF: Asia Symposium on Rice and Nutrition.
1990. The Singapore Dietitian 5: 15-17.
5) AFDA: AFDA Constitution Final, http://www.
afda-dietitians.org/constitution.php
6) Almatsier S: Term of Reference, Workshop on
Education and Training Professionals in
Dietetics and Food Service System.1998.
APINET-EDFS Newsletter, 2: 1.
7) Chwang LC: It is Time to Publish! Editorial for
the First Issue of Asian Journal of Dietet ics.
2019.
Asian J Dietetics 1: Forward. Htt
p://jnl.calorie-smile.jp77Asian Journal of Dietetics, 2021

NDAP Hosts the 4th ICD in Manila, Philippines
Zenaida F. Velasco
President of the Nutritionist-Dietitians' Association of the Philippines

It is with great pride that the NutritionistDietitians’ Association of the Philippines (NDAP)
hosted the 4th Asian Congress of Dietetics (ACD) from
April 23 to 26, 2006. The Philippine International

Convention Center (PICC) in Manila became theconvergence zone of 853 nutrition professionals fromdifferent cultures in the Asia Pacific region.

Country Representatives to the 4th ACD in Manila, 2006.
L-R: Dr. Demetria Bongga (Congress Chair), Dr. Chwang Leh-chii (Taiwan),Susan Lui (Hong Kong), Murni Prakoso(Indonesia), Dr. Teiji Nakamura (Japan), Kwak Dong-Kyung (Korea), Velona Corpus (Asian Dietetic awardee), Nilofer Safdar(Pakistan), Sunard Taechangam (Thailand) and Dr. Corazon Barba (Philippines)

The theme of the 4th ACD is “Nutrition andDietetics in a Borderless Society” which opened thelimitless possibilities of the profession to a society
without borders. The Congress aimed to provide theparticipants from Thailand, Taiwan, Singapore,
Pakistan, Malaysia, Korea, Indonesia, Hong Kong,
Australia and the Philippines with: 1) an advanced
awareness of the scientific advances and issues innutrition and dietetics; 2) an experience of
camaraderie among fellow dietitians and strengthen
bonds with old and new friends; and 3) the chance tochart new directions for Asian dietitians in an
increasingly borderless region.

would be a catalyzer for the Asian ND professionals to
respond to nutritional challenges and issues through aregional,
strengthened
collaborationusing
technological advancements in the knowledge
management area.
The 4th ICD focused on nutrition and dietetic
issues towards a realistic convergence in the practiceof the profession in the Asian region. Topics such as
harmonization of growth and nutrition standards; thedietetics curriculum; healthy lifestyles and foodchoices in the light of the increasing borderlessness offood production and consumption, and the integrationof cultures; food and national security in Asia; updates
on the dietary management of non-communicablediseases; developments on Nutrigenomics and health;and other recent trends in the profession.

Leading the Congress was Dr. Demetria C.
Bongga (Congress Chair) and Dr. Corazon VC. Barba(NDAP President), who believed that the Congress*Corresponding author: mszhenie@yahoo.com
79Message from Philippines

4th ACD Overall Chair Dr. Demetria Bongga (seated extreme left) with country representatives of the AFDA

A host of international speakers, including
respected dietitians and researchers shared their recent
work and best practices in the advancement ofdietetics during the plenary sessions, concurrent
symposia and workshops, free communication
sessions and exhibits. Aside from the technicalsessions, participants, particularly the first-timers in
Manila were offered tours at cost which they can enjoy
such as city tour, shopping and food tour, spa
experience, hospital tour, and out of Manila
destinations.

The successful hosting of the ACD in Manila has
shown that the ND profession has attained higher
professional relevance both in Asia and in theinternational arena. Filipino dietitians including
physicians and other food and nutrition professionals
presented 38 papers and 28 posters in the technicalprogram. In the closing ceremony, the ACD flag was
handed to next ACD host country Thailand by NDAP
President Dr. Barba. After chairing the Congress in2006 Dr. Bongga will assume the Presidency of AFDA
until the conclusion of the 5th ACD in 2010.

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Asian Journal of Dietetics 2021

Thai Dietetic Association:
Celebrating the AFDA 30th Anniversary
Sunard Taechangam1, Chanida Pachotikarn2
1

Former President of AFDA and Advisory Committee of Thai Dietetic Association
2
President of Thai Dietetic Association

To celebrate the AFDA's 30th anniversary, TDA
would like to congratulate to AFDA for achieving
AFDA's objectives, promoting the development of thedietetic profession, striving to promote quality dietetic
practices and education, and pledging to enhance
health and well-being in Asian population. Sincere
thanks to the twelve National Dietetic Association
members for our great collaboration that have madeAFDA widely recognized as the Asian Organization
for Dietetics Professionals. The purpose of this article
is to document what activities TDA organized tosupport the objectives of AFDA and TDA.

The Aims and Activities of TDA
Vision of TDA:
Achieving healthy Thais through the excellenceof dietetic practices
Mission of TDA:
1. Maintain dietetic education and professional
standards and continually quality improvement ofdietetic practices.
2. To be a center for information regarding all aspectsof nutrition and dietetics to dietitians, health care
professionals and general public.
3. Exchange knowledge and experience in nutritionand dietetics with corporate networks domesticallyand internationally, to improve the quality of life of the
population.

About Thai Dietetic Association (TDA)
TDA was first established as The Thai Dietetic
Club in 1974 and became the Association on March
18, 2005. It is a non-profit private organization and is a
professional member organization. The seven key
contributors as shown below (Photo 1) supported theestablishment and participation of TDA. TDA wasformed to support and advance the dietetic profession,
to promote quality improvement of dietetic practices
and education in Thailand. The activities conducted by
TDA including studies related to the education andwork of dietitians, and developing the standards ofeducation and practice of dietitians in the regions.
Currently, TDA has 4,028 members from all over thecountry.

Registration/Licensing of Dietitians in Thailand
Dietitians received a royal order to enact a royal
decree and King Rama the 10 th approved on June 20,
2020 and published in the Government Gazette, given
on June 23, 2020 (Photo 2-3). There are 2550 dietitians
passed the first registration examination out of 2577
eligible members applying for the registration andtaking the examination. Currently, there are 2923
registered dietitians obtained a dietitian license.

Photo 1: The Seven Key Contributors Supported the Establishment and Participation of TDA*Corresponding author: s.taechangam@gmail.com

81Message from Thailand

Photo 2: Dietitians Received a Royal Order to Enacta Royal Decree on 2020

Photo 3: The First Meeting of theProfessional Committee

The Activities for TDA
TDA organizes the Annual Conference for 3 daysin April. There are approximately 700-800 dietitians
from various hospitals of the country attending theconference. The E-posters are presented during theConference. (Photo: 4-6) In addition, to promote Asian
Food Culture, to encourage dietitians to conduct
research on nutrition and nutrition therapy and also

develop the recipes to patients and general population
using soy products for the study, TDA provides the
Soybean and Soymilk Study Awards annually. The
food demonstration of the modified soy recipes withnutrient composition, ingredients, cooking method arepresented via video and E-poster. (Photo: 7-9)

Photo 4-6: Organize the TDA Annual Conference

Photo 7-9: TDA provides the Soybean and Soymilk Study Awards annually

Photo 10-11: Organize Regional Meeting, Short Courses Training for Professional Development

Photo 12-14: Establish a Network of Dietetic Professionals in 13 Health Districts
82

Asian Journal of Dietetics 2021

Photo 15-16: Support the TDA Research Award to Promote the Research Activities

Photo 17-18: Set the Standards of Dietitian Education and Training
Certified Dietitian of Thailand (CDT)
To standardize the knowledge and practice ofdietitians, TDA organized the examination forcertified dietitian of Thailand (CDT.) since the year
2010. There are 2173 dietitians passed the CDT
examination out of 4028 members. The CDT
certificate is valid for 5 years and should be renewed(Photo 19-20)

Asian Dietitian’s Day
TDA and the members organize the activities for
Asian Dietitian’s Day during September annually in
Thailand to recognize dietitian’s contributions inproviding nutrition care and dietitian’s roles. TDA also
provides the fund to the members for support theactivities. (Photo 21-26)

Photo 19-20: Organize the Examination for Certified Dietitian of Thailand (CDT)

Photo 21-26: Asian Dietitian 's Day
83

Message from Thailand

Photo 27-29: Participate the Activities During Disaster and Covid-19

Photo 30-35: The Educational Tool Box Providing Diet Counseling According to Stage of Change

Photo 36-37: The Educational Tools : Food-Based Dietary Guideline & Food Model
The Activities with AFDA

Photo 38-40: TDA Organized the 5th Asian Congress of Dietetics (ACD) 2010, Bangkok, Thailand
84

Asian Journal of Dietetics 2021

Photo 41-43: The 5th ACD 2010, Opening Ceremony and Invited Speakers

Photo 44-46: The 5th ACD 2010, AFDA Committees, Food Demonstration and Asian Night

Photo 47-49: AFDA COUNCIL AND BUSINESS MEETING
Photo 47-48: The 5th ACD 2010, Bangkok, Thailand
Photo 49: The 6th ACD 2014, Taipei, Taiwan
The Asian Dietetics Forum (ADF)

Photo 50-51: TDA joined the First Asian Dietetic Education Forum (ADF) 2016, Kuala Lumpur, Malaysia
Conclusion
In celebration of the AFDA 30th Anniversary, give
us a chance to reflect on our Dietetic Associations’history and events, our founders who have contributed
to our success along the way and also to look at thechallenges and future directions to come. The National
Dietetic Associations in Asia have to join our hands
together to enhance health and well-being in Asian
population. There are many more career opportunities
available for dietitians, not only in the hospitals but
today we are entrepreneurial. Dietitians are in private
practices, in specialties, as well as personalized
dietitians and so on.

Our dietetic professions have come a long way
with many challenges in the last three decades but yet
a unique opportunity for innovation and collaboration
among us to promote the value of the dietetic
professions that we can make a difference in health andwell-being through food, nutrition and dietetics.
Lastly, TDA would like to thank AFDA that brings
us to work together toward our mutual vision, moving
forward together to accomplish our common goal “To
be the best as we can as the Asian dietitians”

85Message from Japan

Development of Asian dietetics and the further solidarity of dietitians
Teiji Nakamura
President of the Japan Dietetic Association

In 1991, when the 6th Asian Congress of Nutrition(ACN) was held in Kuala Lumpur, the current AsianFederation of Dietetic Association (AFDA)’s
predecessor, the Asian Forum of Dietetic Professionals(AFDP) was born, and Dr. Leh- Chii Chwang waselected as the first president. I still remember thatHong Kong, Indonesia, South Korea 、 Malaysia,
Philippines, Singapore, Taipei, Thailand and Japansigned the Declaration. 3We would like to express our
sincere gratitude to the many stakeholders who havecontributed to the development of AFDA over the last
30 years.
Now, there are three issues that were
enthusiastically discussed during the founding periodof AFDA and have not changed even today.
One is to activate research on dietetics as well as
nutrition in order to make nutrition useful to society.
In general, as medicine advances, medical caredevelops, and people can greatly benefit from it.
However, even if basic research in nutrition progresses,
it does not lead directly to a solution for malnutrition.
Despite significant advances in nutritional research inrecent years, the world is still suffering from the
double burden of malnutrition, a mixture of hunger
and obesity, and the situation is getting worse rather
than being resolved. This is because research indietetics with a focus on practical nutrition has notprogressed.
The reason why dietetics has not progressed isthat physiology and biochemical research centered onenergy and nutrients are easy to tackle because
research methods are established and the results areclear, but dietetics is a complicated matter. In orderto optimize energy and nutrient intake, it is necessary
to adjust the content of foods, the combinations offoods, and the menus, which involve the households,
as well as the agriculture, industries, and economies,
customs, and even culture in which people live. In
other words, actual nutritional improvement requires
these modifications, taking into account a wide varietyof vector (direction and force) effects. It is notpossible through the efforts of individuals, one region,or one nation alone.
The second is the issue of Asia. At present, Asia

world, with remarkable economic development, andis the most ethnically diverse and populous area in thethe changes and problems of the whole world are
currently concentrated in Asia and the Middle East.
Moreover, each Asian country has a long cultural
tradition and has a unique diet. Moreover, many
countries have been influenced by the developed
countries of Europe and by the United States and havesought rapid economic growth in order to reducepoverty and attain affluence. Western foods with highenergy and a high content of various nutrients,
temporarily solve a country’s undernutrition, but
eventually become an inducer of obesity and noncommunicable diseases (lifestyle-related diseases).
If left unchecked, this will lead to an increase in
medical expenses and will have an adverse effect onnational finances with the advent of an aging society.
Third is the immaturity of the dietitian system.
It is necessary that the education and training systemfor dietitians which is conducted independent fromnutritionists and medical doctors for nutrition, thatthey have their own social roles, and that they becertified as officially recognized professions, but there
are still variations in each country.
Despite these three issues, the westernization,
simplification, and modernization of meals will
progress in Asian countries in the future. Furthermore,
we need to contribute to the creation of a sustainable
society where no one is left behind. It is nutrition in
Asia that can play a role in such a difficult situation.
The reason for this is that Asians respect nature andhave a farming culture that has been nurtured in nature.
If Asian dietetics, which should fuse this food culture
and scientific rationality, is developed, it can betransmitted as a model for the world.
To that end, it is necessary to further develop the
AFDA through further cooperation of the dietetic
associations of each country.
Fortunately, Asia Congress of Dietetics (ACD)
will be held in Yokohama in Japan from August 19th
(Friday) to 21st (Sunday), 2022. We look forward to
the participation of many people and a great deal of
discussion about Asian dietetics and nutrition.

*Corresponding author: nakamura-t@kuhs.ac.jp87Asian Journal of Dietetics, 2021

Original
Effectiveness of Medical Nutrition Therapy with Technology-Assisted Intervention on
Cardiometabolic Parameters in Thai Participants with Prediabetes and Obesity
Pornthip Yoonaisil1*, Nipa Rojroongwasinkul1, Weerachai Srivanichakorn2,
Theeravet Pattayanant3, Wantanee Kriengsinyos1
2

1
Institute of Nutrition, Mahidol University, Thailand
Faculty of Medicine, Siriraj hospital, Mahidol University, Thailand
3
Faculty of Medicine, Bhumibol Adulyadej hospital, Thailand

ABSTRACT: Prior studies proved that intensive behavioral lifestyle intervention can preventor delay development of type 2 diabetes mellitus (T2DM). However, few studies regarding
diabetes prevention were as effective programs for Thai participants. The objective of this study
was to investigate the effects of developed behavioral lifestyle intervention program comparedwith usual care on cardiometabolic parameters in Thai participants with prediabetes and obesity
after 12 weeks. The study design was randomized controlled trial and block allocationaccording to gender and age. Experimental group received individual Medical nutrition therapy(MNT) counseling and developed technology-assisted intervention. The technology-assisted
intervention had 3 activities via LINE application including sending message 3 days/week
according to their stages of change, asking question and self-report. Control group was the usual
care at check-up center that received general health advice. Per-protocol analysis was
performed in participants who completed 12-week intervention; experimental group (n=22) andcontrol group (n=21). Experimental group had a greater percentage of weight loss -3.1% withmedian difference -4.4% compared control group. Twenty-seven percent of experimental groupreturn prediabetes status to normoglycemia after 12 weeks without T2DM development.
Moreover, waist circumference, percentage of body fat, fasting plasma glucose, blood pressure,Thai CVD risk and DM risk score were significantly changed to better outcomes over control
group. In conclusion, the results demonstrated that this program is effective in weight reduction,
remission of prediabetes status and improving other cardiometabolic parameters. Change ofbetter outcomes was according to healthier diet pattern and more active physical activity.
Keywords: Medical nutrition therapy (MNT), prediabetes, obesity, diabetes prevention
INTRODUCTION
Type 2 diabetes mellitus (T2DM) is a common
health problem effected disability and global healthexpenditure. International Diabetes Federation (IDF)2019 reported the global prevalence of diabetes wasapproximately 9.3% or 463 million adults (20-79
years) with more than half undiagnosed (1). In
Thailand, there were 8.9% of Thai people withdiabetes, 14.2% with impaired fasting glucose (IFG)
and 37.5% with obesity (2). Therefore, early detection
and prevention in high risk of diabetes such asprediabetes and obesity are important for reducing theincidence of disease, other NCDs and consequentdisability. The American Diabetes Association(ADA) 2019, the standards of medical care in diabetes
recommends that people with prediabetes or high risk
for T2DM should be referred to intensive behavioral
lifestyle intervention for diabetes prevention. The
lifestyle intervention should be composed ofindividual approach and goal setting to highly
effective in T2DM prevention and also improve othercardiometabolic parameters such as blood pressure,lipid profile and inflammation. Combined
technology-assisted intervention based on patient
preference also could increase effectiveness ofoutcome. Long-term management should promote
diabetes self-management education and support tomaintain behaviours (3).
The Diabetes Prevention Program (DPP)
recommended by the ADA demonstrated that
intensive lifestyle intervention by initial weight loss
and active physical activity can reduce the incidence*To whom correspondence should be addressed:
o-jinny-o@hotmail.com

of type 2 diabetes by 58% over 3 years (4). Moreover,a randomized controlled trial study in prediabetes
with overweight or obesity who received
individualized medical nutrition therapy by aregistered dietitian was confirmed that HbA1C anddiabetes risk score in 3 months were significant after
this intervention compared with usual care group who
received brief advice from a physician (5).
However, few lifestyle intervention program andstudy regarding diabetes prevention were as effective
program for Thai participants with prediabetes. The
usual care of prediabetes setting usually provides brief
advice from a physician and no role of dietitian
obviously. So the researcher wanted to develop
diabetes prevention program that suitable for Thai
people with high risk as prediabetes and obesity, andevaluate the effectiveness of the program for 12
weeks.
METHODS
The study design was a randomized controlled
trial and block allocation. Recruited participants wererandomly allocated according to gender and age (3044, 45-60 years old) then divided into experimental orcontrol group. This study was proceeded at check-up
center of private hospital in Bangkok, Thailand.
Participants were selected after blood test within 3months. Inclusion criteria was Thai adults aged
between 30-60 years old with IFG (100-125 mg/dL)
and obesity (BMI ≥25 kg/m2) diagnosed who could
daily use of LINE application. Exclusion criteria waspeople with chronic disease such as related
metabolism disturbance (chronic kidney disease,89Medical Nutrition Therapy with Technology-Assisted Intervention

cancer, thyroid disease), eating disorder, who taking
medication effected on weight, or ongoing otherweight loss program within 3 months.
Experimental group received behavioural lifestyleintervention composed of individual MNT
counselling and technology-assisted intervention via
LINE application. Individual MNT counselling wasprovided by face-to-face at week 1 around 15-20
minutes, then via LINE call follow-up 5-10 minutes
at week 3, 6, and 9. At the end of each MNT session,
participants were specified “goal setting” (ex. weight,
waist circumference or other health outcomes) and“action planning” (diet and exercise) together with theresearch and record in personal LINE Note.
Technology-assisted intervention composed ofmotivational and educational text messages reviewed
by 2 experts (diabetes with certified diabetes
educator). There were four types of massages (diet,exercise, health problem and empowerment). Sending
text messages depended on the stages of change, goal
setting and action planning. Participants werereceived it via LINE chat 3 days/week. Moreover,they could send messages to asking questions related
intervention or reporting behaviour change to theresearcher anytime along 12 weeks.
Control group was similar to usual care in checkup center. Participants received general health advice
from the researcher around 5 minutes. The advice
followed by check-up report from the hospital and
ADA recommendations. Contents of advice included
lab result interpretation, diagnosis with IFG andobesity and generalize recommendations. The
recommendations were long term losing weight 7%
from baseline, diet control, regular exercise at least
150 minutes/week, monitoring and follow up withphysician next 3 months.

Primary outcome was percentage of weightchange between baseline and week 12. Secondary
outcomes were cardiometabolic parameter changes
including BMI, fat mass, blood glucose, bloodpressure, Thai CVD and DM risk score. Other
outcomes were observed diet pattern and active
physical activities.
Statistical analysis was analysed with IBM SPSS
Statistics for Windows version 19.0 (IBM Corp.,
Armonk, NY, USA). Analyses were performed using
data available by per-protocol analysis fromindividuals who completed 12-week intervention.
Independent T-test or Pearson Chi-square were used
to compare intergroup differences of baselinecharacteristic in experimental and control group.
Mann-Whitney U tests applied to skewed distribution
data. Paired T-test was used to determine within groupdifference of outcome changes. P values < 0.05
considered statistically significant.
This study approved by the committee on humanrights related to research involving human volunteers,
Mahidol University.
RESULTS
Eligible 64 people enrolled between July andOctober 2019 from check-up center shown in Figure
1. Fourteen people were excluded before
randomization. Total 50 participants wererandomized and allocated into 4 categories by sex(female and male) and age (30-44 and 45-60 years
old) then transferred to experimental group (n=25) orcontrol group (n=25). There were 43 participants(84%) who completed 12-week intervention period;
experimental group (n=22) and control group (n=21).
Seven participants lost to follow-up or could not meet
appointment. Per-protocol analysis was performed todetermine the difference of outcomes after 12 weeks.

Fig 1. Participant flow diagram from screening to final analysis
90

Asian Journal of Dietetics, 2021

Table 1 Baseline characteristic and cardiometabolic parameters in the experimental and control groups

Age (year)
Gender: Male, n (%)
Education level: Low/ High, n (%)
Smoking: Yes, n (%)
Alcohol drinking: Yes, n (%)
Hypertension: Yes, n (%)
Dyslipidemia: Yes, n (%)
Weight (kg)BMI (kg/cm2)
Waist (cm)
Lean mass (%)
Body fat mass (%)
Fasting plasma glucose (mg/dL)
Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
Thai CVD risk (%)
Thai DM risk score
Energy (kcal/day)% Carbohydrate% Protein% Fat
Fiber (g/day)
Sugar (g/day)Saturated fat (g/day)
Sodium (mg/day)
Water (ml/day)
Vegetable (serving/day)
Fruit (serving/day)
Whole gain (serving/day)
Legume (serving/day)
MVPA (minutes/week)

Experimental group(n=22)
45.1 ± 7.2
8 (36.4%)
9 (40.9%) / 13 (59.1%)
2 (9.1%)7 (31.8%)
4 (18.2%)
17 (77.3%)
77.2 ± 11.2
29.2 ± 3.3
97.0 ± 6.1
60.0 ± 8.4
36.4 ± 8.65
112 ± 8128 ± 1981 ± 11
3.57 [-1.47, -5.71]
10.3 ± 2.6
1713 [1561, 2148]
55.0 ± 4.7
15.6 ± 3.0
29.4 ± 3.7
10.0 [7.5, 14.5]
50.5 [40.3, 63.0]
16.0 [9.8, 20.0]3106 [2090, 3649]
1500 [1150, 2000]
1.75 [0.69, 2.25]
0.93 [0.29, 1.5]
0.43 [0.07, 1.78]
0.36 [0.15, 0.93]
55.0 [0.0, 76.3]

Control group(n=21)
44.3 ± 8.05
6 (28.6%)
10 (47.6%) / 11 (52.4%)
0 (0.0%)5 (23.8%)
5 (23.8%)
17 (81.0%)
76.2 ± 10.8
30.1 ± 3.1
99.9 ± 7.2
58.4 ± 7.6
38.2 ± 7.71
109 ± 6128 ± 1182 ± 102.88 [-1.7, -5.57]
10.8 ± 2.7
1724 [1516, 1940]
57.6 ± 6.9
15.2 ± 2.7
27.1 ± 5.5
10.0 [7.0, 12.0]
63.0 [46.5, 87.5]
14.0 [9.5, 16.5]
2587 [2316, 4928]
1500 [1100, 2000]
1.50 [1.00, 1.50]
1.43 [0.50, 2.00]
0.29 [0.03, 0.50]
0.13 [0.00, 0.75]
40.0 [0.0, 90.0]

P value
0.75 a0.59 b
0.66 b0.16 b0.56 b0.65 b0.77 b
0.76 a0.38 a0.15 a0.52 a0.49 a0.16 a0.97 a0.82 a0.83 c0.54 a0.63 c0.22 a0.69 a0.13 a0.49 c0.08 c0.62 c0.66 c0.56 c0.20 c0.36 c0.14 c0.15 c0.96 cData are presented as the frequency, mean ± sd (normally distributed data) and median [P25, P75] (non-normally distributeddata). a Independent T-test, b Pearson Chi-Square, c Mann-Whitney U-test.
Low = high school or below, High = bachelor Degrees/ diploma or above; BMI, body index mass; Thai CVD risk, Thai
cardiovascular risk; Thai DM risk score, Thai diabetic risk score.

There was no statistically significant difference
in baseline characteristics among 43 participants inexperimental group (n=22) and control group (n=21)
that shown in Table 1. Participants in experimentalgroup significantly lost a greater percentage of bodyweight (median [P25, P75]) with -3.11% [-4.16%, 0.95%] whereas those in the control group
significantly gained their weight +1.30% [-0.45%,+3.05%].
There were 59% of participants who lost weight≥ 3%, other cardiometabolic parameter changes
were shown in Table 2. Percentage of lean mass inexperimental group significantly increased and mean
percentage of body fat significantly decreased, while
those in control group did not. Fasting capillary
blood glucose in experimental group significantly
decreased (-5.0 mg/dL, P <0.01). Moreover,glycemic status after intervention was regressedfrom IFG to normoglycemia about 27% without
newly diagnosed diabetes during 12-weekintervention. Fasting plasma glucose in control
group significantly increased and did not change inglycemic status. Thai DM risk score in experimentalgroup was significantly decreased within andbetween groups. Statistically significant differencesamong both groups were observed in Thai CVD risk,
systolic and diastolic blood pressure.
Nutrient data from 3-day food record and semiFFQ were shown in Table 2. Experimental groupreduced daily energy intake 334 kcal (p <0.001)
while control group was little increasing. Significant
food group and nutrient consumption difference
between groups were found in protein distribution(p<0.05), saturated fat (p<0.05), water intake(p<0.05) and vegetable (p<0.01). Distribution ofmacronutrient (Carbohydrate: Protein: Fat %) at
week 12 were (50: 20: 30 %) in experimental groupand (57: 17: 26 %) in control group. Diet pattern
within experimental group had a significant
increasing in protein distribution, fiber, vegetable,
and decreasing in carbohydrate distribution, sugar,
saturated fat at 12-week compared baseline. Minuteof weekly moderate to vigorous intensity physicalactivity (MVPA) at baseline and week 12 wereshown in Table 2 Participants in experimental group
significantly increased the minute of weekly MVPAat week 12 compared baseline above control group(p<0.05).

91

Medical Nutrition Therapy with Technology-Assisted Intervention

Table 2 Changes of cardiometabolic parameters, food groups, energy and nutrient intakes
within the group and between the groups
Cardiometabolic parameters
Weight (kg)BMI (kg/cm2)
Waist (cm)
Lean mass (%)
Body fat mass (%)
Fasting plasma glucose (mg/dL)
Systolic BP (mmHg)
Diastolic BP (mmHg)
Thai CVD risk (%)
Thai DM risk score
Energy (kcal/day)% Carbohydrate% Protein% Fat
Fiber (g/day)
Sugar (g/day)Saturated fat (g/day)
Sodium (mg/day)
Water (ml/day)
Vegetable (serving/day)
Fruit (serving/day)
Whole gain (serving/day)
Legume (serving/day)
MVPA (minutes/week)

Experimental group-2.2 [-3.1, -0.9] ***-0.8 [-1.2, -0.3] ***-2.3 [-5.0, -1.0] ***+0.8 [-0.2, +1.8] *-0.8 [-1.8, +0.2] *-5.0 [-10.5, +1.0] *-2.5 [-10.5, +1.0]-2.0 [-7.5, +1.8]-0.25 [-0.43, +0.13]
0.0 [-2.0, 0.0] *-334 [-574, -128] ***-4.0 [-9.3, +2.0] *5.0 [+3.0, +7.3] ***0.0 [-6.25, 5.5]
+2.0 [-1.3, +6.3] *-24.8 [-10.5, +0.5] *-4.5 [-12.3, +3.5] *+39 [-1197, +1027]+350 [0, +625] **+0.47 [0.00, +1.31] **+0.07 [-0.27, +0.52]
0.00 [-0.40, +0.34]
0.00 [-1.7, +0.28]+55 [+8, +90] *Control group+1.0 [-0.4, +2.1] *+0.4 [-1.5, +0.85] *+1.0 [-0.3, +2.0] **-0.3 [-0.8, +0.3]+0.5 [-0.3, +0.8]+3.0 [-1.5, +12.0] *+3.0 [-2.5, +9.5]+4.0 [-0.5, +11.5] *+0.10 [-0.10, +0.70]
0.0 [0.0, 0.0]+77 [-134, 288]
0.0 [-4.5, +2.5]
1.0 [-1.0, +2.5] *0.0 [-3.5, +2.5]+2.0 [-1.0, +4.0]+11.0 [-14.4, +22.0]
0.0 [-4.5, +6.5]+492 [-796, +1529]
0 [0, 0]0.00 [0.00, 0.00]
0.00 [0.00, +0.13]
0.00 [0.00, +0.09]
0.00 [-0.2, 0.00]
0 [0, 0]P value a<0.001<0.001<0.001
<0.01
<0.01
<0.01
0.04
0.01
0.02
0.02
<0.001
0.20
<0.01
0.87
0.53
0.07
0.11
0.17
<0.01
<0.01
0.70
0.98
0.60
<0.001

Data are shown as median [P25, P75].
a = metabolic outcome change between group, non-parametric test, Mann-Whitney U-test.
*** = P<0.001; ** = P<0.01; * = P<0.05, outcome changes within group with Paired T-test.
BMI, body index mass; BP, blood pressure, Thai CVD risk, Thai cardiovascular risk; Thai DM risk score, Thai diabetic risk
score; MVPA, Moderate to vigorous intensity physical activity.

DISCUSSION
To maximize the effectiveness of the program,
this intervention was emphasized individual approachby the stages of change in face-to-face counselling
and technology-assisted via LINE application. The
program demonstrated that participants in theexperimental group had greater percentage of weightloss and better cardiometabolic parameters than theusual care. These results accorded to large
randomized controlled trials including the US DPP (6),Thai DPP (7) and the Da Qing study (8) that could
prevent T2DM in long term. Systematic reviews in2017 reported MNT and weight loss are the strongest
evidence altered clinical parameters (9).
This
program had percentage weight loss 3.11%. At least
3–5% of initial weight loss is clinically meaningful
reductions in cardiovascular risk factors (10). Long
term lifestyle modification program had average
weight loss 5.6 kg in 3 years from the US DPP (6) and1.5 kg in 2 years from the Thai DPP (7). The reductionin blood glucose and DM risk score was similar to 3month prediabetes program with individualized MNT
by dietitian in the US (5).
Energy balance with a reasonable meal plan bydietitian is the key to achieve weight goal. Energy
requirement was calculated by individual withpredictive equation. There is no ideal macronutrient
distribution for people with prediabetes. Provided
MNT was based on individual preferences andmetabolic goals. In addition, quality of food patterns
should be focused on dense nutrient-rich foods morethan specific nutrients. Evidence suggests healthy
food such as whole grains, legumes, nuts, fruits andvegetables, and minimal refined and processed foods(11). The nutrient consumption in experimental group
was changed by increasing fiber, and decreasing sugar
and saturated fat. Increasing water intake waspromoted by replacing sugary drink strategy andwhen exercise (12). Experimental group increased
minutes of moderate-intensity physical activity above
control group. Active physical activity improves
insulin sensitivity and reduces abdominal fat. At least
150 min/week of moderate-intensity physical activity
has beneficial effects in prediabetes (13).
CONCLUSION
This study proved that 12-week individual
approach with MNT and technology-assisted
intervention could reduce percentage of weightchange. Proportion of IFG status and othercardiometabolic parameters also improved inexperimental group over control group. Change ofbetter outcomes was according to healthier dietpattern, more active physical activity. So intensive
lifestyle intervention should be started after diagnosis
of prediabetes to prevent or delay diabetes andupcoming complication.
CONFLICT OF INTEREST
There is no conflict of interest in this study.
ACKNOWLEDGEMENTS
We would like to thank Thai Dietetic Association
and Diabetes Association of Thailand for supporting
research funding and DM preventing program award.
92

Asian Journal of Dietetics, 2021

REFERENCES
1) International Diabetes Federation. IDF Diabetes
Atlas, 9th ed. Brussels, Belgium: International
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5) Parker AR, Byham-Gray L, Denmark R, Winkle
PJ. The effect of medical nutrition therapy by aregistered dietitian nutritionist in patients withprediabetes participating in a randomized
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2002;25:2165–2171.
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Tatsato N, Luckanajantachote P, Himathongkam
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8) Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An
ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang
XG, Jiang YY, Wang JP, Zheng H, Zhang H,
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9) Raynor HA, Davidson PG, Burns H, Nadelson
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Nutrition Therapy and Weight Loss Questions for
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NEJMoa012512. PMID: 11832527; PMCID: PM
C1370926.

93Asian Journal of Dietetics, 2021

Original
Energy and Nutrient Intakes and Recommendations from a Survey of Children
in a Coastal City in Central Japan
Nguyen Huong Giang1, Nguyen Mai Phuong1, Nguyen Van Diep1, Nobuko Sarukura2,
Hitomi Takeichi2, Ayami Sano2, Sumiko Kamoshita2, Yoko Ozaki3, Saori Okushima3,
Hitoshi Iizuka3, Masayo Kaneda5, Shigeru Yamamoto1,2*2

1Jumonji University, Saitama, Japan
Asian Nutrition and Food Culture Research Center, Saitama, Japan
3
Quest Computer, Tokyo Japan
4
Tokoha University, Hamamtsu City, Japan
5

Japan Society of Nutrition Teachers, Tokyo, Japan

ABSTRACT: Background: Childhood’ obesity is a world-wide problem but Japan is an
exception. We tried to find the dietary factors for this through a nutrition survey in Japan.
Methods: A cross-sectional dietary survey was conducted in Okazaki City, a mid-size city, inthe central part of Japan and facing the Pacific Ocean. The subjects were 10 year old children(35 boys, 30 girls) and 13 year old children (39 boys, 33 girls). Height and weight were
measured. Energy and nutrient intakes were measured by the photograph method using
Calorie Smile software on 2 non-consecutive days including 1 school day and 1 weekend day.
Results: Weight for height was mostly within the normal range (within 0.8-1.2 mean).
However, the average energy intake was lower than the recommended level, especially forthe older children. Protein intake was adequate if compared with the recommendation ingrams but was deficient when compared with the recommended value as percentage of energy(13-20%). Average lipid intake was close to the upper limit of lipid recommendation (30% ofenergy), indicating that about half of the students took more than the upper limit. Dietaryfiber intake did not reach the recommended values. Ca intake was close to the recommended
amount on the school day, but significantly lower on the weekend day. Energy and nutrient
intakes were lower on the weekend day than on the weekday. Conclusion: Despite the lower
energy intake than recommendation, the weight for height of the children were mostly in thenormal range, suggesting the energy requirements was too high. If the protein requirement
is defined as 13-20% of energy recommendation, about 30% of children took lower than theminimum level, suggesting this method is improper. Results of energy and nutrients intakes
and the recommendations were inconsistent and further studies are necessary to find theproper direction of child nutrition.
Key words: school children, energy, nutrients, intake, recommendation

INTRODUCTION
Childhood obesity is a world-wide problem but
Japan is an exception. Among the 38 OECD member
countries in 2018, the obesity rate of Japanesechildren was 17.5%, which was the second lowest(median 31.4%) (1). Obese children are at greater riskof developing hypertension and metabolic disorders.
Psychologically, obesity can lead to poor self-esteem,
eating disorders and depression. Childhood obesity isparticularly concerning as it is a strong predictor ofobesity in adulthood, which is linked to diabetes,
heart disease and certain types of cancer (2). It is
worth considering the factors in the low prevalence ofobesity in Japanese children. From our previous studyof 7-, 10-, and 13-year-old children in an area ofwestern Japan, energy intake was lower than therecommendation, especially in older children (3). It isnecessary to confirm these results in other parts ofJapan and we conducted this study in a central part ofJapan. We tried to evaluate the new method for DRI
of protein in Japan. It is expressed as 13-20% ofenergy (4). The reason why percentage of energy for*Corresponding author:shigeruy@jumonji-u.ac.jp

protein is difficult to understand because among thevarious nutrients, the protein requirement has been
most thoroughly studied mainly by nitrogen balance.
This was never expressed as a percentage of energy.
We should consider the fact that the protein
requirement does not change in proportion to energy
intake. According to the US/Canadian Dietary
Reference Intakes, the recommendation for protein of
0·8 g protein/kg/d is “the average daily intake levelthat is sufficient to meet the nutrient requirement ofnearly all (98%) healthy individuals (5). The panel
also states that “no additional dietary protein issuggested for healthy adults undertaking resistance orendurance exercise According to the national
nutrition survey in Japan, average protein intake ofJapanese is about 1.2g/kg body weight, about 50%
higher than the recommendation (6). In this study
we tried to evaluate the energy and nutrient
recommendations by comparing with the actual
intakes ..

95

Energy and Nutrient Intakes and Recommendations

METHODSThis was a cross-sectional dietary survey
conducted in November 2018 at all elementary schooland junior high schools in Okazaki City. Of theapproximately 200 children who agreed to participate,
65 10-years old children (35 boys, 30 girls) and 72
13-years old children (39 boys, 33 girls) completed
the survey. Children were asked to take photos of all
food items and beverages consumed on two nonconsecutive days (1 school day and 1 weekend day)and to send them using the Calorie Smile software
with/without some notes (7) (Photo 1). Calorie Smilesoftware was introduced to the children and theirfamilies before the data collection took place. The
dietary survey was completed by the children
themselves or with the help of an adult. To estimate
size and weight of foods, foods were placed onsquared paper and sized (Photo 2).
Using these photos, researchers estimated theweight of food, entered this into the software to
calculate energy and nutrient intakes, and thencompared them to the recommendations for Japanese.
Typical dishes, with ingredients and weights areintegrated into the software. When children’s meals
are different or they eat items other than those in thedata base, adjustments can be made. SPSS was used
to analyze the data. Ethical approval was obtained
from the City Board of Education.
Photo 1. Calorie Smile software

Photo 2: Photos of meals sent by children

96Asian Journal of Dietetics, 2021

RESULTSIn 10 years old children only 4 boys and no girls
were overweight and no boy and only 1 girl wasunderweight (Figure 1). The results indicate thatweight for height of most of the children were normal.
In 13 years old children only 1boy and 1 girl were
overweight and 1 boy and no girl was underweight(Figure 2). The results indicate that weight for heightof most of the children were normal.
These results indicate that most of the children inthis city, their weight for height was within a normal
range.

Figure 1 and 2 show the weight for height of 10 and
13 years old children, respectively. Obesity andthinness in Japanese children are defined as more than
20% or less than 20% of the standard weight for height,
respectively. The red line is ± 20% of standard bodyweight for height. In other words, the point between
the two red lines is a normal weight child.

Boys (n=35)

Girls (n=33)

Figure 1: Weight for height of 10-year-old boys (left) and girls (right)

Girls (n=33)

Boys (n=35)

Figure 2: Weight for height of 13-year-old boys (left) and girls (right)

97

Energy and Nutrient Intakes and Recommendations

Figure 3: Energy intake of 10-year-old children

Figure 4: Energy intake of 13-year-old children

Figure 3 shows energy intake of 10-year-old
children, the energy intake was lower than therecommendation about 200 kcal on school day, andabout 300 kcal on weekend day. Figure 4 presentsboys, energy intake was about 300 kcal lower than therecommendation in both days. For 13-year-old girls,
energy intake was about 200 kcal and 350 kcal lower
than the standard on school day and weekend day,respectively.

energy intake of 13-year-old children. For 13-year-old

98Asian Journal of Dietetics, 2021

Figure 5: Protein intake of 10-year-old children

Figure 6: Protein intake of 13-year-old children
Figure 5 and 6 shows the protein intake of 10-yearold and 13-year-old children, respectively. Comparing
Okazaki's data of protein intake with a target amountof 13-20% energy recommendation, many children
were deficient. On the other hand, as before the revise,
when expressed the recommendation in absolute gram(black bar), most children were sufficient. For
example, for 10-year-old boy, the actual protein intake
in weekend day was 68.5g, higher than therequirement in gram (60g), but lower than therequirement in percentage of energy (13-20%E = 73113g).

99

Energy and Nutrient Intakes and Recommendations

Figure 7: Lipid intake of 10-year-old children

Figure 8: Lipid intake of 13-year-old children
Figure 7 and 8 presents the lipid intake of 10year-old and 13-year-old children, respectively.
Lipid intake was shown to be widespread on bothsides of the black frame (dietary intake

recommendation criteria), with some being higher
and some being lower than recommended. However,
if we see the average intakes, the intakes of children
were close to the upper limit of the recommendation.

100

Asian Journal of Dietetics, 2021

Figure 9: Dietary fiber intake of 10-year-old children
Figure 9 shows dietary fiber intake of 10-year-old
children. The mean dietary fiber intake in fifth grade
was close to the recommended amount. However, if

we look at the figure, about half of the children
consumed less than requirement.

Figure 10: Dietary fiber intake of 13-year-old children
Figure 10 shows dietary fiber intake of 13-year-old
children. Unlike fifth graders, dietary fiber intake in

13-year-old children was very low, especially, on
the day without school lunch.

101

Energy and Nutrient Intakes and Recommendations

Figure 13: Calcium intake of 10-year-old children

Figure 14: Calcium intake of 13-year-old children
Figure 13 and 14 show the Calcium intake of 10year-old and 13-year-old children, respectively.
Calcium intake was close to the recommended

amount on school day. However,significantly lower on weekend day.

s

102

it

was

Asian Journal of Dietetics, 2021

DISCUSSION
Our study showed that despite a low energy intake
relative to the recommendation, the height and weightof the children were mostly in the normal range.
Only 4 out of 68 children aged 10 years and 4 out of
76 children aged 13 years were not within the normal
range (Figure 1 and 2).
Energy intakes of 10- and 13-year-old children
were about 200 kcal and 300 kcal lower than therecommendations, respectively (Figure 3 and 4).
About 70% of the children had an energy intake thatwas lower than the recommendation. We observed
similar results in a 7-day nutrition survey of 200
children in a city in western Japan (2). These results
indicate that the current energy recommendation does
not fit well with the actual energy intake. In fact, thecurrent energy requirement is based primarily on the
results of studies done more than 50 years ago when
the level of physical activity was much higher thannow. In Japan, the estimated energy requirement
has been revised every 5 years, but the basic data are
old and only their expression has been changed,
sometimes per body surface area, sometimes per bodyweight, etc. If children can maintain their healthwith a lower energy intake than the recommendation,
the professionals must reconsider that children do
more physical activity or decreased therecommendation.
The New protein recommendation was announced
as 13 – 20% of energy. If we use these values, morethan 30% of children consume less protein than therecommendation (Figure 4 and 5).
However, if we
use the traditional method (g protein), most of thechildren satisfied the requirements. There have beenvery few studies of protein requirements over the last
50 years and they were never estimated using energy
intake.
Lipids and carbohydrate are usually
recommended as percentages of energy, perhaps
because their main role is the supply of energy.
However, protein is not the same as these nutrients.
It is very difficult to estimate the protein requirement
using percentages of energy requirements
andrecommendations.
Lipid intake is recommended as 20-30% ofenergy. The average lipid intake of children wasclose to the upper limit of lipid recommendation(Figure 7and 8). It means that about half of thechildren took high lipid foods.
As we discussed
above, there is a possibility that the energy
recommendation is too high, which means that if theproper energy recommendation is lower than thepresent recommendation, more than 50% of children
take the upper limit of lipids.
Both fiber (Figure 9 ad 10) and Ca (Figure 11 and
12) intakes was lower than the recommendation,
especially week end days when they did not haveschool lunch. It means that school lunch helps toincrease fiber and Ca intakes.

In conclusion, there have been poor studies about
the dietary recommendations, mostly more than halfa century. During the time, life-style of Japanese
has changed a lot. New studies and reconsiderationof the present recommendations must be studied.

ACKNOWLEGEMENT
The author would like to thank staff of Okazaki
City Department of Education for their hard effort toarrange the meetings for schools and teachers. The
authors are grateful to all the study participants andtheir family.
Acknowledgement is gratefully
addressed to US-Medical Science Program forsupport of this study and Professor Andrew Durkinof Indiana Bloomington University for his careful
proof-reading of this article.

REFERENCES
1. WHO Global Health, Overweight and obesity
among children, https://www.who.int/newsroom/fact-sheets/detail/obesity-and-overweight(accessed on Aug 1, 2021)
2. Atsuko Yamaguchi, Nobuko Tanaka, Yoko
Eguchi, Kazue Kuno, Noriko,
Wakikawa, Nobuko Sarukura, Mina
Fukinbara, Shigeru Yamamoto, Study on thenecessary survey days for energy intake inschool children assessed by 7 day survey, J Med
Investigation, 59, 111-115, 2012
3. Japanese Ministry of Health, Dietary
Reference Intakes for Japanese 2020,
www.mhlw.go.jp/content/10904750/000586553(
in Japanese). Accessed on Aug, 7, 2021
4. Stuart M. Phillips, Dietary protein requirements
and adaptive advantages in athletes, British
Journal of Nutrition, 108, S158–S167, 2012
5. Alexandra Caspero , Protein and the Athlete —How Much Do You Need? Academy of
Nutrition and Dietetics, July 2020,
https://www.eatright.org/fitness/sports-andperformance/fueling-your-workout/protein-andthe-athlete, (accessed on Aug 1, 2021)
6. Japanese Ministry of Health, National Nutrition
Survey 2019,https://www.mhlw.go.jp/bunya/kenkou/kenkoue
iyou_chousa.html , accessed on Aug 10, 2021

103

Asian Journal of Dietetics, 2021
ORIGINAL
The Employment Status and the Need for Issuing Practising Certificates to
Bachelors of Nutrition in Vietnam in 2021
Yen Ngoc Ma1,2*, Ninh Thi Khanh Tran2,
Thao Phuong Tran2,3, Huong Thi Le1,2, Linh Thuy Nguyen1,2
1

Department of Nutrition and Dietetics, Hanoi Medical University Hospital, Hanoi, Vietnam.
2
Hanoi Medical University, Hanoi, Vietnam
3
Jumonji University, Saitama 352-8510, Japan.
(received August 8th, 2021)
ABSTRACT: The objectives of this research were to study the occupational situation and thedemand for a practising certificate to dietitians at Hanoi Medical University (HMU) in Vietnam
in 2021. The cross-sectional study by an online survey was conducted on 239 subjects (23.3 ±1.9 years old, 88.3% female) of 6 Bachelor of Nutrition (BN) courses. In terms of the survey on
workplaces for graduates of the first 4 years surveyed, the results showed that hospital dietitians
account for one-third of the total number of dietitians (55/165). And this rate is a significant
downward trend from 52.3% (the first class from 2013) to 15.8% (the fourth class from 2016).
The percentages of dietitians working in food companies or in postgraduate studies were 13.9%(23/165) and 10.3% (17/165). No dietitians were working in the fields of School Nutrition andFood Hygiene and Safety. The percentage of dietitians working outside the field or unemployed
was increasing, from 6.8% (the first BN from 2013) to 26.3% (the fourth BN from 2016). For
the survey on issues related to the demand for practising certificates for 6 BN classes, some ofthe difficulties they faced when working without a practising certificate included the fact thatover 80% of dietitians claimed that they were not allowed to participate in consultation andassessment of the nutritional status of patients. More than half of the dietitians (55.8%) felt that
it was difficult to give nutritional advice to patients. About the degree of necessity for apractising certificate, nearly 90% of BNs thought that a practising certificate was necessary for
positions that employ dietitians as part of their human resources, such as specialized/general
hospitals; Community nutrition care and support facilities; School nutrition; management
agencies/Ministry of Health/Department of Health; Center for Disease Control (CDC);
Universities/colleges; food companies, canteens, and fitness centers/gymnasiums. In conclusion,
the trend of dietitians who work in a clinical nutrition field is decreasing; almost no dietitians are
employed in the school nutrition and food hygiene and safety fields. The rate of unemployment
and side jobs is increasing significantly. Almost all BNs find it difficult to work without apractising certificate. The results show the high level of necessity of granting a license for BN
in all fields of nutrition, especially in clinical nutrition.
Key words Bachelor of Nutrition, Practising certificate, Vietnam.

INTRODUCTION
Nutrition is a career related to food and human health,subdivided into many areas such as clinical nutrition,community nutrition, school nutrition, food hygiene andsafety, and nutritional science research (1,2). The
demand for dietitians increases every year due toawareness of the key role of nutrition in supporting
treatment in hospitals and health areas in the community.
In the healthcare system, human nutrition training began
in the 19th century in the United Kingdom andcontinued to expand to the United States throughout the20th century. World-wide, the system of accreditationand certification of dietitians' practice has existed for along time. The first registered dietitian qualification
examination in Japan was administered in 1987, and it
became a regular exam given once a year. At present,
Japan has 25 dietitians per 100,000 residents. After
decades of development, human nutrition has become athriving system that is widely recognized byprofessionals and the public. In Vietnam, in 2006, Hai*To whom correspondence should be addressed:mangocyenyly@gmail.com

105

Duong Medical Technical College, now part of Hai
Duong Medical Technology University, began to train
Nutrition Technicians, but the training program did not
gain acceptance by society, so the school stopped thisprogram after only 3 classes of students. By 2013,
because of being aware of the role, necessity, andurgency of dietetics, the Ministry of Education andTraining permitted the enrollment and specialized
training of Bachelor of Nutrition (BN) students at HMU,
with the job code 7720401 (3,4). According to Joint
Circular No. 28/2015/TTLT-BYT-BNV, a BN is aperson who is trained with the ability to work in many
positions related to nutrition in society (1). However,unlike some countries in the region and the world,
Vietnamese dietitians have not currently been granted apractising certificate. This has caused some difficulties
in the job, especially in positions that require specialized
knowledge and outstanding skills in nutrition diagnosis
and intervention. As a leading institution in the trainingof BN, by 2021 Hanoi Medical University has trained 8

Practising Certificates for Vietnamese Dietitians
classes of BN students in Vietnam, of which 4 courses
graduated at least 165 dietitians. Therefore, what are thedifficulties faced by dietitians who have not been issued
a practising certificate during their work. We conductedsurveys on the demand for granting a registereddietitian’s license from the first 6 BN classes in Vietnam
and the employment situation of those dietitians who
have been graduated for at least one year.

RESULTS
There were 239 subjects (23.3 ± 1.9 years old, 88.3%
female) who participated in this study in total, 278
current and graduated students from 6 BN courses.
The number of dietitians from four classes working
in nutrition departments/centers in hospitals accounts
for the highest number of total BN graduates (55/165).
However, this trend was gradually decreasing,specifically: the number of the first class of dietitians
working in hospitals accounts for the highest percentage(52.3%), but it decreases to 32.4% (the second course),
30.6% (the third course), and finally only 15.8%,
equivalent to 6 dietitians for the fourth class. Currently,
there are no detitians from any of the 4 classes working
in the field of School Nutrition. The percentage of BNs
working in Food Companies from the first class to thefourth class was 9.1%, 20.6%, 4.1%, 26.3%,
respectively. The percentage of dietitians working in
nutrition clinics was highest for the third class at 14.3%.
The figure for dietitians who continued in postgraduate
training programs (Master, Ph.D.) was highest for the
fourth class at 18.4%, equivalent to 7 dietitians. The
proportion of BNs working in other field/unemployment
for the first class and the second class is 6.8% and 8.7%,
respectively, and then this trend rises significantly forthe third class and the fourth class at 26.5% and 26.3 %,respectively.

METHODS
Study setting and subjects
The study was designed to be a cross-sectional study
and was conducted during one month from May 2021 toJune 2021. The study collected data only with theconsent of the research subjects to participate. All
information is for research purposes only. We used a
non-probabilistic and purposive sampling method in thisstudy. The study included participants who are BNs of
the full-time nutrition course of HMU from the firstcourse (2013 – 2017) to the sixth course (2018 – 2022)(278 subjects) and who have fully understood the
explanation of the survey and agreed to take part in the
online survey.
Data collection
We collected data by using online questionnairesthat included an explanation of the meaning andobjectives of the study. These questionnaires were sent
to class monitors and group leaders of each class. They
had responsibility for announcements, supervising, andencouraging the members to complete these surveys.
For the occupational situation objectives of BN, wecollected the information on subjects who were BN fromthe full-time nutrition course of HMU from the first(2013 - 2017) to the fourth course (2016 - 2020). They
had been graduated from HMU for at least one year andhad the opportunity to work in various institutions. The
information includes (1) General information aboutage/gender/year of graduation; (2) workplaces atpresent: Hospitals / Universities / Colleges (lecturers or
researchers) / School nutrition (school lunch) / Nutrition
clinics / food’s companies / Management agencies of the
Ministry of Health/ Department of health / Sport
Nutrition/ The Gymnastic Center / Center for Disease
Control (CDC) / Postgraduate courses/ unemployment/side jobs/ no response.
With regard to the demand for issuing a practisingcertificate to BN, we collected the information on
subjects who are BN from the full-time nutrition courseof HMU from the first (2013 - 2017) to the sixth course(2018 - 2022), of which the fifth class is newly graduated students from HMU (2021), and the sixth areseniors. The information includes: (1) General
information about age/gender/year of graduation (2)Dietitians' opinions on which workplaces they thinkshould issue the practising certificate (3) Dietitians’
opinion on the basis/bases on which a certificate should
be issued (Using a Likert scale).
Statistical analysis
Categorical and quantitative variables wereexpressed as the number of subjects (percentage), andmean (standard deviation), respectively.

Figure 2 shows that 97.8% of BN believe that apractising certificate is necessary for working positions
in general and in specialized hospitals; 93.1% of BN
believe that a practising certificate is necessary forworking in health care and nutrition support facilities in
the community. The percentage of BNs who think that apractising certificate is necessary to work in the field of
School Nutrition; the management agencies of the
Ministry of Health, the Department of Health; CDC;
universities and colleges (research, teaching) is 83.5%,
83.5%, 77.9% respectively. 73.6% of BN think that apractising certificate is necessary for positions in foodcompanies and 66.2% of BN think that it is necessary to
be granted a practising certificate for working in acollective kitchen.
The results of figure 3 show that 86.6% of BN foundit difficult when they could not participate in nutrition
consultations in health facilities; 82.3% had difficultywhen they could not examine and assess the nutritional
status of patients. The percentages of BN who haddifficulties when they were not allowed to give nutrition
advice and were not permitted to communicate nutrition
education to patients were 55.8% and 43.7%,
respectively. There were only 1.7% of BN who had
other difficulties such as not being licensed to launch a
nutrition clinic, being equated with those selling
functional foods, not being respected when working in
healthcare facilities and so on.
A major proportion of BN believe that a practisingcertificate is would provide a legal basis to protect
dietitians in professional activities in the field of
nutrition; 87.1% of BN think that this is necessary andvery necessary, and only 11.7% think that this is notnecessary. The percentage of BN who think that apractising certificate as the basis for certifying that
health workers are qualified to participate in106

Asian Journal of Dietetics, 2021
professional activities is necessary and very necessary
accounts for 87.5%; only 11.7% think it is not necessary.
The practice certificate is the basis for the state
management agency to manage the profession and to
define the scope of the practice of the practitioner.
86.6% of BN think that this is necessary and very

necessary, while only 13.1% of them are considered
normal and unnecessary. The practice certificate shouldbe the basis for the authorities to recognize the job
position and function of the BN, is assessed by 87.5% of
BN as necessary and very necessary, and only 11.7% of
BN think this is not really necessary.

Figure 1. The employment status of the first four classes of Bachelor of Nutrition (The first class to the fourth class)107

Practising Certificates for Vietnamese Dietitians
226 (97.8%)
General/specialized hospitals

215 (93.1%)

Support in the local comunity such as Nursing home, Private nutrition
clinic and Welfare (elderly, children)
School lunch

193 (83.5%)

Management agencies of the Ministry of health/ Department of Health

193 (83.5%)
180 (77.9%)

Universities/Colleges (researchers, lecturers)
Food's companies (salers, marketing, conducting studies,experiments
and doing research in developing new products)

170 73.6%)

Sport nutrition/ The Gymnastics Center

169 (73.2%)

Cafeterias (offices, universities, company accomodations anddormitory)

153 (66.2%)
1 (0.4%)

Others

0

50

100

150

200

250

Figure 2. The percentage of workplaces for which a Bachelor of Nutrition believes that apractising certificate is required (n=231)

Dietitian cannot participate to a nutritional
consultation
Dietitian cannot participate to examine and assess
nutritional status for patients200 (86.6%)
190 (82.3%)

Dietitian cannot provide nutritional advice to patients

129 (55.8%)

Dietitian cannot give public presentations on nutrition
matters for patients
Others101 (43.7%)
4 (1.7%)

0
50
100
150
200
250
Figure 3. The main difficulties that Bachelor of Nutrition faces when they work without apractising certificate (n=231)

Strongly Disagree

Disagree

Neither

Agree

Strongly Agree

The legal basis to protect people who take part in nutritional
11.7%
fields.

39.0%

48.1%

The basis of certifying medical staffs who have enough
11.7%
ability to participate in professtional activities

40.3%

47.2%

The basis of the appropriate authorities managing
professional knowledge and a range of activities of 11.7%
practitioners

39.0%

47.6%

It is foundational to the appropriate authorities admitting the
11.7%
job positions and the functions of Bachelor of Nutrition

39.4%

48.1%

0.0%
20.0%
40.0%
60.0%
80.0%
Figure 4. The level of necessary of the foundations and the bases to issue a practisingcertificate that follow the opinions from the first course to the sixth course Bachelor of
Nutrition (Likert Scale)108

100.0%

Asian Journal of Dietetics, 2021
DISCUSSION

increasing compared to the previous decades. But the
unemployment rate is still quite high, which shows thelimitations and inadequate attention paid to the positionof dietitians in society. These findings show that theauthorities should introduce more focused policies on
the development of nutritional human resources andexpand the development of clinical nutrition in district
and provincial areas. The government also should
improve the quality of school nutrition in order to set
the goal of building awareness and knowledge about theimportance of nutrition in the primary students and at
the same time offer working opportunities for school
dietitians. One of the greatest contributions to thedevelopment of the nutrition major worldwide was theintroduction of the certificate of practice for "dietitians''
in 1923 in the United States, so nutrition was officiallyrecognized as a career (9). A registered dietitian musthave a minimum of a bachelor's degree or higher degree
in nutrition and food science. These standards wereadopted by The International Confederation of Dietetic
Associations (ICDA) and many countries such as theUnited States, the United Kingdom, Japan, and China.
In China, the education of dietitians (not registered)majoring in home economics was established in the
1920s (10). However, there was a lack of a registereddietitian accreditation system for dietitians, whichcaused inadequate government management some typesof nutritional training agencies. As a result, there werea large number of nutritionists or dietitians who aretrained in informal programs such as a short training
period (3 to 6 months of class training), unqualified
nutrition instructors, and no internship practice in the
nutritional institutes. These “dietitians” with minimal
training in nutrition and no practice, negatively
impacted the reputation of dietitians among the publicand hampered the development of nutrition anddietetics in China. Therefore, after many years of huge
effort, in 2016, China's government organized the firstregistered dietitian qualification examination (11). The
exam was successfully carried out in 2016, in theexamination center of Shanghai Jiao Tong University
School of Medicine (12).

In Vietnam, the system the of training for a bachelor's
degree in nutrition began in 2013 at Hanoi Medical
University (HMU). The survey of workplace
distribution of students from 4 BN classes (the 1st to the
4th year graduates from the BN course at HMU) who
have been graduated at least one year showed thepercentage of dietitians working in the field of clinicalnutrition in hospitals has tended to gradually decrease.
This trend shows that the number of dietitians withregular training struggle to meet the requirements forthe number of dietitians per each sick-bed as requiredby circular No.18 of November 2020 on hospitalnutrition (5). There are several reasons associated withthis trend such as low income, lack of supportive
policies and an insufficient attention from the board ofmanagers in hospitals. In Japan, according to astatistical report in 2018, there were about 40.000
hospital dietitians, which accounted for the highest
figure among all nutritional fields (6). However,according to a survey conducted by the National
Institute of Nutrition in 2018, in Vietnam, nearly half ofprovincial hospitals do not have a department or teamof Nutrition, and there are almost no Nutrition
Departments in district health centers. More than 3/5 of
the Departments of Nutrition do not have employeeswith a university degree, and the number of nutrition
staff is from 6 to 10 people, but the number of the staff
members with university degrees accounts for less than
50%. In addition, there are very few dietitians who laborin other areas such as community nutrition and foodhygiene. Notably no dietitians from any of the fourclasses are working in the field of school lunches. In
contrast, in 2014, 12.143 dietitians were working in thefield of school lunch and among them there wereapproximately 4.703 employees who worked as
nutrition teachers in Japan (7). In terms of school
nutrition, school dietitians have a key role in monitoring
food safety, making balanced diets, and conducting
nutrition education. They also cooperate with otherteachers and students’ families to encourage enhanced
dietary guidance in order to create solutions for
improving insufficient vitamin and mineral conditions,and controlling overweight and obesity in school-age
children. This is the case for Vietnam at present,
according to the national nutrition survey 2019 - 2020,
the prevalence of overweight and obesity increased
from 8.5% in 2010 to 19% in 2020 in which theprevalence is 26.8% in urban areas, 18.3% in rural and
6.9% in mountainous areas (8). The prevalence ishighest in the large metropolises, particularly in Ho Chi
Minh City (above 50%) and Hanoi (above 41%).
Therefore, the government should have policies toencourage school nutrition development. In addition,
the proportion of dietitians who work in foodcompanies slightly increased during the period from2017 to 2020. There are around 10% (equivalent to 17
dietitians) of the dietitians who are continuing to study
in postgraduate programs, which could lead to a rise inhigh-quality human resources in the nutritional fields in
Vietnam. It is clear that the figure for unemployment
and side jobs dramatically increased from 6.8% for the
first class to 26.3% for the fourth class. Currently, thedemand for nutritional resources in Vietnam is

In Vietnam, there are 7 universities which have
nutritional training programs to date of which 4
universities have graduated students who take part in
the labor market. Among these 4 universities, HMU
also has the highest number of dietitians with 4
graduated classes who have at least 1 year of experience
working, and 1 class has just graduated in 2021. The
results from our survey show that most BNs paid a lotof attention to licensing practising certificates for theircareer. In terms of working without a practisingcertificate, more than 80% of BN find it difficult toparticipate in nutritional consultations and assessmentof nutritional status for patients. There areapproximately 50% of BN who could not make publicpresentations on healthcare matters or counsel nutrition
for patients. These facts point out that the number of
dietitians working professionally in Vietnam is not high,and formal nutrition care for patients has not beendeveloped. Furthermore, a small proportion of BN havebeen misunderstood by society and consider untruthfulor a functional food businessperson, have not been109

Practising Certificates for Vietnamese Dietitians
respected, have been thought to not have an obvious
career title and so on. In terms of the four main aspectsof the needs need for a practising certificate for BN:“The legal basis to protect people who take part innutritional fields”, “The basis of certifying medical staff
who have enough ability to participate in professional
activities”, “The basis for the appropriate authorities
managing professional knowledge and a range ofactivities of practitioners”, “It is foundational to theappropriate authorities admitting the job positions andthe functions of BN”, this survey revealed that there arenearly 90% of BN who believe that it is necessary andvery necessary to issue a practising certificate innutrition career. Only about 10% of BN think that it isunnecessary and very unnecessary to issue a practisingcertificate; most of these BNs are working outside ofnutrition fields or unemployed. This makes clear the
expectation to be granted a practising certificate for BN
to protect and to confirm its functions while working.
With the positions in general or specialized hospitals,
healthcare facilities, and the nutrition community, over
93% of BN agree with the opinion that “a practisingcertificate should be provided to BN”. Over 84% of BN
believe that a practising certificate is needed for job
positions such as school nutrition, management
agencies of the Ministry of Health/Department of
Health, and the Center for Disease Control (CDC). The
figure for Universities/Colleges (researchers, lecturers)
and the food companies was above 70%. The lowest
figure for working at at canteens and Gymnastics
Centers is around 62%. However, no dietitians were
working in the field of food hygiene and safety or at
gymnastics centers and therefore these areas could
receive less attention from BN compared to other areas.
In general, almost all BN agree that a practisingcertificate should be issued for most fields of nutrition.
This is completely aligned with the trend of the leading
countries in nutrition development. In Japan, practisingcertificates are not only issued to employees working ina medical field but also in other fields if they pass thenational examination for registered dietitians (13). With
the innovation in the “Dietitians Act” in Japan, this was
the basic foundation for establishing the “Registered
Dietitian system” in 1962, which contributed todeveloping nutrition services for each Japaneseindividual. Therefore, Japan is one of nations which has
the highest life expectancy in the world. Thus practisingcertificates are not only a document for confirming thecompetences and professional qualifications of BN, but
it is also a great motivation to help the nutrition industry
grow and ensure greater future prosperity.
In conclusion, as a consequence of the employment
status of BN, the number of dietitians who work in aclinical nutrition field is decreasing, almost no dietitians
are employed in the school nutrition and food hygiene
and safety fields. The rate of unemployment and sidejobs is significantly increasing. Almost all BNs find it
difficult to work without a practising certificate. The
results show the very high necessity of granting the alicense for BN in all fields of nutrition, especially inclinical nutrition.

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