ISSN2434-2688 Asian Journal of Dietetics

Vol.3 No.4, 2021
Contents
Page T Title and authors
Special Report111-113

School Meal Program No. 4 in a Series:
The different between Japanese and Vietnamese school lunches
Nguyen Van Diep, Nguyen Huong Giang, Nguyen Mai Phuong

Original Research
115-119

Study of energy intake of children with or without school lunch in Hanoi,
VietnamNguyen Thi Thao, Nguyen Van Diep, Nguyen Thi Thuan, Nguyen Huong Giang,
Nguyen Mai Phuong, Shigeru Yamamoto

Original Research
121-127

The Stability of Vitamin K in The Diet of Patients Using Oral Anticoagulant
Vitamin K Antagonist (VKA) Drugs in Hanoi Medical University Hospital in
2021
Linh Nguyen Thuy, Yen Ngoc Ma, Chinh Pham Thi Tuyet, Nga Ta Thanh, Ninh
Tran Thi Khanh, Hoa Nguyen Quynh, Oanh Hoang Vu

Special Issue
129-135

Development and Acceptability of New Japanese Menus with Soy-based meat
substituteYoko Ozaki, Tamami Kawakami, Saori Kamiya, Hitoshi Iizuka

Asian Journal of Dietetics 2021

Special Report: School Meal Program

The different between Japanese and Vietnamese school lunches
No.4 in a Series
Nguyen Van Diep, Nguyen Huong Giang, Nguyen Mai Phuong
Jumonji University, Saitama, JapanAs the first generation of dietitians in Vietnam,
studying in a graduate program in Japan, we areworking hard to study every day in order to improve
our country's nutrition situation, especially schools'
nutrition. Through one year of working as a dietitianin a primary school in Vietnam, as well as one year ofinternship in Japanese school kitchens, I have seen the
difference in school meals between two countries.
In Japan, lunch is often the most enjoyable timeof the day for children. They eagerly await the lunchand eat with delight. Meals are meticulously plannedby the dietitian and carefully prepared by the cooking
staff. Hence school lunches are very attractive anddelicious. Moreover, the menus are different every day
in a school year, keeping children from getting bored.
For those reasons, almost all the students eat all thefood provided, and the amount of food leftover is verysmall.
In contrast, in Vietnam, children often do not likeschool meals. They often say that school meals are nottasty, the menu is repetitive. Many children do not eat
at school but choose to eat at home. Currently, publicschools in Vietnam do not have dietitians. Meals areprepared based on the experiences of the kitchen staff
members – who are not fully trained in nutrition. They
often make simple, quick-cooking menus. The dishes
are very monotonous and not eye-catching. For thatreason, children who eat school lunch often leave a lotof food, mainly vegetables, and rice.
So why there is such a difference in thedeliciousness and attractiveness of school meals
between the two countries?
During my internship, I discovered that in Japan,
they use a lot of materials, more than 10 kinds for eachmeal. On the first day of my internship, I was reallysurprised when I walked into the kitchen and saw
many types of vegetables with a variety of colors. With
such a variety of vegetables, they have created manydifferent food combinations, in all dishes: main dishes,side dishes or even stable food (Photo 1). When
combining vegetables together, vegetables withmeats/fish/eggs or with rice, it will give children newsensations in both flavor and texture. In addition, whenvegetables are part of a tasty mixture, even disliked
vegetables might become acceptable. Also, because of
these combinations, meals become colorfulstimulating children's appetite. On the other hand, in
Vietnam, a meal has only about 5-6 materials and isoften cooked separately, without any combination(Photo 2). Therefore, the colors are also quitemonotonous, not bringing excitement to children.
Because of that cooking method, children who alreadydo not like to eat vegetables will only eat meat andleave vegetables behind.

Photo 1: Japanese school meal

Photo 2: Vietnamese school meal

In addition to using a variety of food materials,
the cutting method between the two countries is also
different. In Japan, the Ministry of Education, Culture,
Sports, Science and Technology has recommended tochoose a cutting method that suits the nature of theingredients and the cooking method, and decide thethickness and size according to the dish to standardize.
They had made the guideline on how to cut the vegetable

for school lunch (photo 3) and also give examples of
the characteristics of different cutting methods (Photo4). Through my internship, I saw that the school reallyput it into practice. Each material has a different
cutting method depending on the combination and iscut very carefully so that the thickness of all pieces issimilar. With fish and meat, when delivered, thesupplier has already cut it according to therequirements of the dietitian. With vegetables, every
morning, the cooking staff cut them according to the
instruction which was carefully noted by the dietitian.

*Corresponding author: nvdiep.hmu@gmail.com
111

Japanese and Vietnamese school lunches
With the same vegetable but two different dishes, thecut is different. For example, carrots in a salad had thin
strips cut, but in a soup, they were cut into quarterslices (Photo 1). With that cutting method, theingredients will be mixed well together, and make thedish look better. In opposition, in Vietnam, thematerials are cut very rough, the size is uneven. As in
stir-fried chicken (Photo 2), there were both very large
pieces and very small pieces, so when cooking, small
pieces might become very tender while large pieces
still hard. Vegetables and eggs were also the same.
This made the overall dish look less appealing.

Photo 3: Guideline on how to cut the vegetable for school lunch

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Asian Journal of Dietetics 2021

Photo 4: Characteristics of different cutting methods.
[Those cut at right angles to the fibers (left) are characterized by their ease of chewing.
Those cut in parallel (right) retain elasticity and chewy texture]
While these findings may sound small, simply
increasing the number of food materials to make more
food combinations and more colorful meals andchanging the way of cutting can have a huge impact on
the palatability and appeal of a meal. In my opinion, if
Vietnamese school meals can improve those points, itwill make children able to eat with interest and theleftover will be reduced. In addition, I think that it
might work not only at school meals but also at homemeals. And not only Vietnam, but all countries can also
try the above points to improve children's meals.

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Asian Journal of Dietetics, 2021

Original
Study of Energy Intake of Children with or without School Lunch in Hanoi, Vietnam
Nguyen Thi Thao1, Nguyen Van Diep1*, Nguyen Thi Thuan1,
Nguyen Huong Giang1, Nguyen Mai Phuong1, and Shigeru Yamamoto1
1

Asian Nutrition and Food Culture Research Center at Hanoi Medical University

Abstract: Background: In the urban areas of Vietnam, the obesity rate of children isincreasing rapidly. Over the past few years, Vietnam has implemented a school meals
program to address this problem. However, students are free to decide whether to get school
lunch or not. Students who do not eat lunch at school tend to consume sweet drinks, sweet
confections, greasy snacks etc. that are energy rich, more often than other students do. The
objective of this study was to confirm the hypothesis that students without school lunch
consume higher energy, especially from snacks, when compare with students with school
lunch. Methods: We asked approximately 200 fifth grade students (10 years old) with orwithout school lunch for more than 3 years at a public elementary school to cooperate in our
research. From over 100 children who agreed, we randomly selected 50 children who ate
school lunch and 50 who didn’t eat school lunch. We rented smartphones for the students andasked them to send photos of all the food and beverages that they consumed for three days
(two weekdays, one weekend day or holiday). From those photos, we estimated the weightof the food and then calculated the energy intake. Results: The average energy intakes (kcal)of children who ate school lunch and those who did not eat it were respectively 1902 and2075 on weekday one, 1907 and 2108 on weekday two, 2107 and 2120 on the weekend day(p<0.05), and 1972 and 2101 on average for three days (p<0.01). The average energy intake(kcal) of three days from snacks was 235 for student with school lunch and 401 for student
without school lunch (p<0.01). The reason for the higher energy intake among children who
did not eat school lunch was the large influence of snacks during the day. The average BMI
of children with school lunch was 17.1, and of children without school lunch was 18.5
(p<0.05). Conclusion: In comparison with children with school lunch, children withoutschool lunch had higher energy intake from their snacks, resulting in higher total energy
intake.
Key Words: School lunch, energy intake, snack.

up to 93% (5), but it is not required by law and children
can decide to eat lunch at school or return home to eat.
Many children prefer to go home because they don’t
like the taste of school meals. When they go home forlunch, on the way, they can easily buy junk food fromthe vendors – who are waiting for the hungry children– around the school. The children who have school
lunch are not able to go outside to buy snacks. So, we
thought that children without school lunch may havehigher energy intake, especially from snacks, whencompared with children with school lunch. Therefore,
we conducted this study to confirm this hypothesis inorder to show directly the effect of school lunch on
dietary behavior and obesity of children

INTRODUCTION
Since the Vietnam War ended in 1975, theVietnamese economy has entered a period of peacefuldevelopment. Along with the country's socioeconomic growth, Vietnam has achieved remarkable
results in improving nutritional status and child health.
However, in this period, eating habits have alsochanged. In particular, children's diet and lifestyle areaffected in various ways, such as the trend toward
consuming a lot of fast food and processed foods thatare less healthy, the trend toward drinking carbonatedsoft drinks and energy drinks, and the trend towardeating snacks and street food which do not guarantee
food safety. Consequently, childhood obesity has been
rapidly increasing. In 1995, the prevalence of obesity
among primary school children in Ho Chi Minh City
was 1.4% (1) and rose to 52.7% in 2016 (2). In Hanoi,
the prevalence also increased rapidly from 3.3% in1995 to 40.6% in 2013 (3, 4).
Over the past few years, Vietnam has implemented
a school meals program to address this problem. The
school lunch implementation rate in Vietnam is high,

METHODS
Study design. This was a cross-sectional study
conducted between January 2018 and March 2018 at a
public elementary school in Hanoi where all thechildren came from middle-income families. We
divided students into two groups: students who tookschool lunch and students who did not for more than 3
years, then asked them and their parents to cooperate
in the research. 63 out of 94 students who took school*Corresponding author: nvdiep.hmu@gmail.com

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Energy intake of children with or without school lunch

lunch and 89 out of 106 students who did not takeschool lunch agreed to participate. In each group, we
randomly selected 50 children (25 boys and 25 girls).
The protocol had been approved by the ethics
committee of primary school in January 2018. The
study complied with the ethical principles provided by
Declaration of Helsinki. Before we conducted theresearch, all the parents and children were introduced
to the nature of the project, signed a consent form andwere instructed on how to record dietary items andsend them to the researchers.

eating, then send the photos to the researchers everyday. The size of dishes and energy intake were
estimated and calculated using Calorie Smile Vietnam
version software.
Calorie Smile Vietnam version (7) is a nutrition
support software which was made for Vietnamese
people. The basic method is that subjects take photosof their food, send them to the Calorie Smile software
with/without some notes, and then the dietitians
evaluate their dietary pattern. Calorie Smile Vietnam
Version software has been integrated with the Vietnam
food composition table (8), the nutrition value of 500
popular dishes from Hanoi area (9) and the nutrition
value of 400 popular street foods from the Ho Chi
Minh City area (10). When subjects’ meals aredifferent or they eat items other than those in the database, adjustments can be made according to the "Photobook to estimate the weight of food" (11), so the
dietitians can analyze users’ meals easily and quickly.
It has been reported that the Calorie Smile Vietnam
version software was able to accurately estimate theweights of food portions and to give resultscomparable to the actually consumed amounts (12, 13).

Anthropometric measurement. Weight and height
were measured at baseline, in light clothing andwithout shoes. Body mass index (BMI) was computed
as the ratio of weight (kg) per height squared (m2). The
nutritional status was determined based on BMI
reported in WHO 2007 (6): obesity >+2SD;
overweight >+1SD; normal -2SD≤ Z-score ≥ +1SD;
thinness <-2SD; severe thinness <-3SD.
Nutrition survey. Three-consecutive-day nutrition
surveys which included two weekdays and one
weekend day were conducted by the photographmethod. We rented smartphones, gave one to eachchild before the survey and took it back after thesurvey. We asked the children to take pictures of all
the foods and drinks they consumed, before and after

Statistical analysis. Microsoft Excel was used toanalyze the data. The variables were compared byunpaired Student t-test. P-values of less than 0.05 wereconsidered statistically significant for all the analyses.

RESULTS

Fig. 1. The average BMI of students with or without school lunch for more than 3 years(25 boys and 25 girls in each groups)(*p<0.05, unpaired student t-test)
The average BMI of subjects is shown in Fig.1.
Most children had normal nutrition status; however,students without school lunch had higher BMI thanstudents with school lunch (p<0.05).
Fig.2 shows the average energy consumption ofsubjects by days and group. The average energy

consumption of the group without school lunch whencompared with the group with school lunch was higher
on weekdays (p<0.05) but was similar on the weekend.
On average for the 3 days, students without school
lunch consumed 2101 kcal, higher than students withschool lunch, who consumed 1972 kcal (p<0.01)

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Asian Journal of Dietetics, 2021

Fig. 2. Average energy consumption of subjects by days and group(Significantly different by unpaired Student t-test, *p<0.05, **p<0.01)

Fig. 3.

Average energy intake of subjects by meals and group for 3 days.
(Significantly different by unpaired Student t-test, **p<0.01)

Fig.3 presents the average energy intake of subjects
by meals and group. The energy intake of both groups
was similar at breakfast and dinner but was different
at lunch and snack. Children with school lunch had
higher energy intake at lunch and lower energy intake
at snack, when compared with children without school
lunch (p<0.01)

Fig.4 shows the average energy intake from snacks
by time and group. On weekdays, children tended toeat more snacks from 11am-1pm and 5-7pm and on
weekends, children ate more snacks in the afternoon,
especially from 5-7pm. Children with school lunch ate
fewer snacks than children without school lunch on
weekdays.

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Energy intake of children with or without school lunch

Fig. 4. Average energy intake from snacks by time and group.

DISCUSSION
The present study found that children withoutschool lunch had higher BMI, higher total energy
intake, and higher energy intake from snacks whencompared with children with school lunch.
Subjects' conditions in our two research groups
were quite similar: They are the fifth-grade students atthe same primary school, have similar economic
conditions, which helped reduce confounding factors.
In addition, the student ate or did not ate school lunch
for more than 3 years and the BMI data is the result of
several years, hence, we could point out that the school
lunch is a factor that influences the nutrition status ofchildren.
All subjects were fifth graders, so they were able todo the nutrition survey on their own. Self-reported
food records are common methods of obtaining dietaryintake data however, those methods are riddled withlimitations including the time-consuming, and errors
in estimates of portion size (14-16). Our study used thephotography method which was reported could
improve accuracy over standard self-report methods
and reduce the burden on children (17). Children only
took pictures of their food, send it to the researchers
and researchers estimated and analyzed those portions.
Therefore, the nutrition survey results in this study
were accurate.
According to the nutrition survey results, we foundthat while children with school lunch had energy
consumption on weekdays lower than on the weekend
day, children without school lunch had almost thesame energy consumption every day. In Vietnam,
people usually like their children to be chubby; they
think a chubby child is healthy and beautiful (18), so
when their children are at home, they give them a lotof food. This explains why the energy intake on
weekdays and on the weekend was different. In
addition, children without school lunch had an averageenergy intake throughout the week higher than thosewith school lunch. It seems that school meals can help
control children's total energy consumption and keep
it in moderation.
In terms of snacks, in this study, we considered asnack as everything children ate or drank between themain meals. Snacks, which are rich in fat and addedsugar, such as potato chips, fast food, candy, ice cream,and sweetened beverages, were often consumed.
Student tended to eat snack at the times that schoolends for the morning and afternoon. Therefore, thereason for snacking may be that after a long time inschool, children feel hungry and want to eat something
tasty and rich in calories. Along with that, there aremany shops and local vendors outside school selling
many unhealthy snacks that look very attractive andare also very cheap, so children have ample
opportunity to purchase them with their pocket moneyor to ask a family member to purchase them. For
children with school lunch, at lunch (11am-1pm) theycannot leave the school to buy snacks, which is whyenergy from snacks was low. But for children withoutschool lunch, they ate a lot of snacks during this break
and as a result, they could not eat much at lunch, so the118Asian Journal of Dietetics, 2021

energy intake at lunch for them was lower than for thechildren with school lunch. Thus, we could said that
school meals and school environment also helped
prevent snacking in children.
From those results, we considered whether it ispreferable for children to have school lunch. School
lunch has been considered as a factor in controllingobesity rates in children in Japan; however there has
been no evidence yet. This study may be the first study
to show the effect of school lunch on the energy intake
of children. School lunch not only provides lunch forchildren but also conveys an understanding of portion
size, meal balance and gratitude for the food and forthe people who make it (19–21). Therefore, school
lunch may be important in controlling overweight.
Especially important is the role of the dietitian in theschool, not only to develop menus for children, butalso to develop educational programs to teach children(21). Coordination with the education from the familyis also necessary. Parents can restrict junk food orabsolutely not allow children buy it when they go toschool.
However, the number of dietitians in Vietnam is still
very limited, so menus are drawn up by the cooks, who
often lack knowledge about nutrition (5). Therefore,
the school lunch menu is repeated, and the price isconsidered more than the nutritional aspect. Thismeans that students do not really like the school lunch.
That is the main reason why many children do not eat
at school, not because of other factors such as price orfamily environment.
As a limitation of this study, any difference inphysical activity between children who ate school
lunch and those who do not, which is thought to affectmeal intake, could not be assessed in this study, so it
was not possible to examine this. The other limitationof this study was that the results are from only one
school, and it will be necessary to analyze how
accurately this school represents Vietnam as a whole.
It is desirable to spread school lunches and establish aschool dietitian system in Vietnam so that children canenjoy a nutritious school lunch.
In conclusion, this study showed that in comparison
with children with school lunch, children withoutschool lunch had higher energy intake from theirsnacks, resulting in higher total energy intake.

3) Ministry of Health, National Institute of
Nutrition. Overweight and obesity in children
aged 7-12 in Hanoi and evaluation of someinterventions. State-Level Branch Report
KC.10.05, 2004 (in Vietnamese).
4) Hanh HD, Huong LDT. Situation of overweight,
obesity of elementary school students in Hanoi
in 2013. J Prev Med 25: 4-164, 2015
5) Son NTLD. School meal program in Ho Chi
Minh city, Vietnam: reality and future plan.
Asia Pac J Clin Nutr 21(1): 139-43, 2012
6) De Onis M, Onyango AW, Borghi E.
Development of a WHO growth reference forschool-aged children and adolescents. Bull
World Health Organ 85(9): 660-667, 2007
7) Tho PA, Hanh TTM, Hien VTT, Iizuka H,
Yamamoto S. Calorie smile Vietnam. 20188) Ministry of Health, National Institute of
Nutrition. Vietnam food composition table.
Medical Publishing House, 2007
9) Ministry of Heath, National Institute of
Nutrition. Nutrition Value of 500 Common
Dishes. Medical Publishing House, Hanoi, 201610) Ho Chi Minh Nutrition Center, Ho Chi Minh
Food Nutrition Association. Nutrition Value ofCommon Street Food. Medical Publishing
House, Ho chi minh, 201711) Ministry of Heath, National Institute of
Nutrition. Photo book to estimate the weight offood. Medical Publishing House, Hanoi, 201412) Giang NH, Ngoc TT, Phuong NM. Validationof calorie smile Vietnam software formeasuring food intake. Asian J Diet 2(2): 79-82,
202013) Giang NH, Hung NT, Hien VTT. Fiber-focused
nutrition counseling through nutrition software
improved HbA1c of Vietnamese type 2 diabetes
mellitus patients. Asian J Diet 2(2): 65-70, 2020
14) Dwyer JT, Krall EA, Coleman KA. The
problem of memory in nutritional epidemiology
research. J Am Diet Assoc 87(11): 1509-12,
198715) Medlin C, Skinner JD. Individual dietary intake
methodology: a 50-year review of progress. J
Am Diet Assoc 88(10): 1250-1257, 1988
16) Thompson FE, Byers T. Dietary assessment
resource manual. J Nutr 124(11 Suppl): 2245S2317S, 199417) Higgins J, LaSalle A, Zhaoxing P. Validation ofphotographic food records in children: are
pictures really worth a thousand words? Eur J
Clin Nutr 63, 1025–1033, 200918) Nhung BT, Anh NT, Danh Tuyen L.
Establishment of child body image and study on
mother’s perception for child body weight.
Asian J Diet 2(4): 155-164, 202019) Tanaka N, Miyoshi M. School lunch programfor health promotion among children in Japan.
Asia Pac J Clin Nutr 21(1):155-158, 201220) Ishida H. Role of school meal service innutrition. J Nutr Sci Vitaminol 61: 20-22, 201521) Ministry of Education, Culture, Sports, Scienceand Technology Japan. School lunch program
act, 2009 (in Japanese)

ACKNOWLEDGMENTS
We would like to extend our great appreciation to
the primary school where we conducted this study aswell as all the participants of the study; US-Japan
Medical Science Program, Jumonji University forgiving the best condition to complete the study; and to
Prof. Andrew Durkin, emeritus professor at Indiana
University, for careful proofreading of the paper.
REFERENCES
1) Viet CQ. Childhood obesity, causes, treatment
and prevention. Childhood overweight andobesity Conference. Hanoi, Vietnam, 1995
2) To QG, Gallegos D, Do DV. The level andpattern of physical activity among fifth-gradestudents in Ho Chi Minh City, Vietnam. Public
Health 160: 18-25, 2018

119Asian Journal of Dietetics, 2021

Original
The Stability of Vitamin K in The Diet of Patients Using Oral Anticoagulant Vitamin K
Antagonist (VKA) Drugs in Hanoi Medical University Hospital in 2021
Linh Nguyen Thuy1,2, Yen Ngoc Ma1*, Chinh Pham Thi Tuyet1, Nga Ta Thanh1,
Ninh Tran Thi Khanh2, Hoa Nguyen Quynh2, Oanh Hoang Vu2
2

1
Department of Nutrition and Dietetics, Hanoi Medical University Hospital, Hanoi, Vietnam.
School for Preventative Medicine and Public Health – Hanoi Medical University, Hanoi, Vietnam.

ABSTRACT: The amount of vitamin K in the daily diet plays a pivotal role in thetherapeutic effects of oral anticoagulant vitamin K antagonist (VKA) medicines. The study
aims to describe the dietary and the stability of vitamin K in daily meals of patients who
use oral anticoagulant VKA medicines. A longitudinal study was carried out on 26 patients,
which shows that the average amount of vitamin K in the participant’s diet was 237.8 µg,
and 58.6% of the patient's diet did not meet the recommendation for vitamin K. The surveys
had been conducted among two groups: patients who knew and patients who did not know
about the nutritional knowledge when using oral anticoagulant VKA drugs. The results
showed that the average amounts of vitamin K of the two groups were 183.4 µg and 292.2µg, respectively. The variation in the amount of vitamin K in knowledgeable patients’groups was less than the figure for the non-knowledgeable patients’ groups with thecoefficient of variation (CV) being 1.01 and 1.19, respectively.
Key words: Vitamin K, oral anticoagulant vitamin K antagonist (VKA) drugs, Hanoi Medical University Hospital.

INTRODUCTION
Vitamin K antagonists (VKA) are a group of
substances that reduce blood clotting by reducing theaction of vitamin K. However, the risks ofcomplications related to the usage of these substances
are significant. According to some studies, the rate ofhemorrhage is approximately 1% to 3% each year
(1,2). World-wide, “Vitamin K antagonist medicines
related to about 6.000 deaths in which about 4.000
cases can be avoided as well as 17.300 hospitalization
cases can be avoided each year” (3). Recently, manypieces of evidence showed that uncontrolled-vitamin
K diets are one of the most prevalence factors whichhave direct influences on these treatments (4,5). If theamount of vitamin K intake is too much, this canincrease clotting factors and decrease the effect ofthese drugs. Whereas, if the amount of vitamin K
intake is not enough, it will lead to clotting factor
deficiency and the risks of hemorrhage. According toprevious opinions, patients who use oral anticoagulant
VKA medicines need to limit food containing a highamount of vitamin K. However, recent researches
show that it is not necessary to constrain these foodand more important thing is that patients have tomaintain their daily diets with a stable amount ofvitamin K (6,7).
In Vietnam, there are many common food, which
are used in everyday meals that containing a highamount of vitamin K such as cruciferous vegetables,
seasoning vegetables, amaranths, and morning glory
water (8). In fact, vitamin K dietary intake is unstablebecause of seasonal vegetables and therefore making

it difficult to control the INR. In many Western andNorth American countries, patients are instructed topractice nutrition under the supervision of doctors, theproportion of patients who achieved the INR target
was from 60% to 75% (9,10). In Vietnam, it is only
30% to 45% of patients using oral anticoagulant VKA
drugs meet the INR target (11,12).
In the world, there are researches about the effectof diets relating to the result of INR (6,7). By contrast,
in Vietnam, researches about nutrition for patients
who used oral anticoagulant VKA drugs are extremely
rare. Therefore, we conducted this study to describe
the dietary vitamin K intake and the stability ofvitamin K intake in diets of patients who used these
medicines.
METHODS
Study setting and subjects
This longitudinal study involved 26 inpatients in
the Cardiovascular Center at Hanoi Medical
University Hospital from January to May 2021. We
used a non-probabilistic and purposive sampling
method in this study and collected all inpatients who
had the required criteria during the study period.
Patients were chosen based on the criteria: people who
were above 18 years, were treated with oral
anticoagulant VKA drugs, and had agreed for the
researcher to keep in contact to ask for 24-hour recall
dietary meals after discharging from the hospital. The
study excluded patients who were in serious
conditions, had disabilities such as dumbness ordeafness, or refused to take part in this study (figure 1).

*To whom correspondence should be addressed:mangocyenyly@gmail.com

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The stability of dietary Vitamin K intake

Patients use oral VKA drugs (n = 85)

Meeting inclusion criteria (n=26)

Conducting data about characteristics, 24hour dietary record, FFQ (food frequency
questionare) about food enrich Vitamin K

59 Excluded
06 Refused to participate because of the scaryof strangers medical staff during the COVID19 pandemic.
10 Due to too stress of health issues
20 Not enough patience to continue answering
after discharging from the hospital
15 Suffering from ventilator, coma, trauma, orloss of conscious
8 Mute, deaf or psychotic

Figure 1. Diagram of study participants

Data collection
Demographic characteristics (gender, age,academic levels (primary/secondary/high school/college /university/postgraduate) and address (rural or
urban areas)).
The average amount of vitamin K and the
proportion of patients which achieve recommended
vitamin K allowances of subjects.
The variation of vitamin K intake in groups withknowledge and without knowledge during the study
period.
Knowledge of patients: Knowledgeable patients
when they have been consulted directly by medical
staff/ received nutritional leaflets/ self – educate
information through media and then answering thecorrect answer about the name and the principle ofusing enriched vitamin K vegetables. Non-knowledge
patients when they have not been consulted by medical
staff or they have not learned by themself about
nutrition while using oral anticoagulant VKA drugs orhave been consulted by medical staff but answered
wrongly about the name and the principle of using
enriched vitamin K vegetables.
The amount of vitamin K had been evaluated by
the 24-hour recording method in three consecutive
weeks. Each week, 24-hour dietary record in three inconsecutive days. The patient's dietary intake
information was taken by face-to-face questionnaires
during the hospital stay and by telephone interviews
during the patient's discharge period from the hospital.
General information of patients and the frequency ofusing food containing a high level of vitamin K in thepast 12 months were gathered by using questionnaires.
Food that contains a high level of vitamin K is divided
into 3 main groups: the cruciferous vegetable group,
the seasoning vegetable group, and other vegetables
group. The cruciferous vegetable group includes:
green cruciferous vegetables, watercress, spinaches;
the seasoning vegetable group includes: cilantro, saw
leaf, basil. Others include Morning glory, amaranth,and lettuces. Patients would be asked about thefrequency of using these food in a week in its season
and out of season. The frequency of food was
calculated by the total number of consumption in aweek multiplied by the number of weeks in a season.
Biases were controlled by using a single equipment
tool and one researcher to collect the data for all
subjects.
The assessing criteria about the amount of vitamin
K in dietary
Based on the recommended vitamin K allowancefor Vietnamese adults: Recommended vitamin K
allowance for male and female: 150µg/day (13).
Currently, we have not referred to any
recommendation in the amount of vitamin K daily forpatients who use oral VKA drugs. The most important
thing is that patients should keep on stability regularly.
Statistical analysis
The data were entered by using Microsoft Excel
Workbook 2019 (Microsoft Corporation) and Stata
15.1 statistical software (StataCorp LLC) foranalysing. The intergroup comparisons were
performed using the Mann-Whitney test. Categoricaland quantitative variables were expressed as thenumber of subjects (percentage), and mean (standard
deviation), respectively. Statistical differences wereconsidered significant at p<0.05.
Ethics approval
The study has been approved by the researchreview board of Hanoi Medical University Hospital.
All participants are fully informed about the purposesof the study.
RESULTS
The study was conducted on 26 patients who
were treated with oral anticoagulant VKA drugs, theproportions of males and females were 26.9% and73.1% respectively. The percentage of patients who
had knowledge and patients did not know were thesame, at 50%.

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Asian Journal of Dietetics, 2021

Table 1: The amount of vitamin K in 24 - hour recall dietary of participants

Mean ± SD

Nutrients
Recommendation(µg)

19-65 (n=16)

255.9 ± 317.5> 65 (n=10)GroupsAge
GenderAddress

Academiclevel

Percentage (%)

150

Meet
RDA
45.1

Did not
meet RDA
54.9

227.4 ± 316.4

150

33.3

66.7

Male (n=7)

176.1 ± 254.1

150

33.3

66.7

Female (n=19)272.8 ± 333.4

150

43.8

56.2

Rural areas (n=15)

240.5 ± 301.9

150

40

60

Urban areas (n=11)

253.7 ± 337.4

150

42.4

57.6

Before high school (n=7)

215.1 ± 267.4

150

41.6

58.4

High school (n=8)

258.9 ± 327.2

150

41.6

58.4

260.6 ± 345.1

150

40

60

Knowledge (n=13)

183.4 ± 209.4

150

37.6

62.4

Non - knowledge (n=13)292.2 ± 349.7

150

46.2

53.8

237.8±292.7

150

41.4

58.6

College/university/
postgraduate (n=11)
Knowledge

Total (n=26)

Table 1 showed that the average amount ofvitamin K intake of participants was 237.8 µg per day,and the percentage of patients who meet recommended
vitamin K allowance was 41.4%. The average amountsof vitamin K in dietary in groups of knowledgeable
and non-knowledgeable groups were 183.4 ± 209.4µg
and 292.2 ± 349.7µg respectively. The proportions ofmale and older people who meet the recommended
vitamin K allowance were the lowest, atapproximately 33.3%. The percentage of patients whomeet the recommended vitamin K allowance was thehighest in non- knowledgeable patients (46.2%). The
average amount of vitamin K and the percentage ofpatients who meet the recommended allowance ofvitamin K , which were classified by living areas andthe education levels of subjects, showed no significant
difference.
Figure 2 illustrated that the differences in theamount of vitamin K in the diet between two

consecutive investigation days of non-knowledgeable
patients were mostly higher than that ofknowledgeable patients. In terms of the nonknowledgeable group, the orange line was dramaticfluctuated between investigation days. To be specific,
the amount of vitamin K was highest on the third
investigation day at 513.3 µg while the lowest figureon the sixth day was at 114.1 µg. The coefficient ofvariation (CV) of vitamin K between investigation
days in the group was 1.19. When it came to theknowledgeable group, the blue line slightly fluctuatedbetween investigation days. To be specific, the amountof vitamin K was highest on the eighth investigation
day at 269.3 µg while the lowest figure on the sixth
day was at 87.4 µg. The coefficient of variation (CV)of vitamin K between investigation days in the groupwas 1.01. Therefore, the amount of vitamin K in thediet of knowledgeable patients was more stable than
the figure for non-knowledgeable patients.

123

The stability of dietary Vitamin K intake

Figure 2. Diagram of the variation of the average amount of vitamin K in patients dietary over theinvestigation days in the two groups
600
513.3
500
404.1

390.3
400

305.7

279

300
193.7

134.5

261.4
269.3

193.6

178

200

264.4

155.4

237.9
93.7

87.4

100

114.1

135.4

0
1

2

3

4

5

Subjects had knowledge

6

7

8

9

Subjects had no knowledge

Figure 2. Diagram of the variation of the average amount of vitamin K in patients dietary over the investigation daysin the two groups

Subjects had
knowledge

The amountof vitamin K
intake (µg)

Min (Actual):0

1st Quartile:

16.1

Median:

55.4

Mean

183.4

3rd Quartile:

260.4

Max (Actual):

615.6

Subjects had
no knowledge

The amountof vitamin K
intake (µg)

Min (Actual):0

1st Quartile:
Median:

28.3
112.9

Mean
3rd Quartile:

292.2
447.8

Max (Actual):

1037.5Figure 3. The variation of the amount of the dietary vitamin K intake during nine investigation days on each group124

Asian Journal of Dietetics, 2021
vitamin K in patients’ diets in both groups. But, theswing of the amount of vitamin K in the nonknowledgeable group was worse than the figure for theknowledgeable group.
Figure 4 showed that the frequency of using foodthat contains a high amount of vitamin K increased
significantly in two seasons (winter and spring),
especially in the cruciferous vegetable group (higher
than that of summer and autumn for about six times).
The frequency of using vegetable seasoning group
showed little difference between seasons. Some typesof vegetables that contain a high amount of vitamin K
such as morning glory water or lettuce, wereconsumed much higher in summer and autumn. The
consumption of these vegetables in winter and spring
was only one-third.

Figure 3 provided data on the variation of theamount of vitamin K between nine investigation dayson two groups. In terms of the knowledgeable group,
the average amount of vitamin K consumption and the
median were 183.4 µg and 55.4 µg respectively. The
data tended to toward the above of the mean. Theinterquartile rage IQR = Q3 – Q1 = 244.3 µg. The
difference between the highest and the lowest amountof vitamin K in the patients’ diet was 866 µg.
Regarding the non-knowledgeable group, the averageamount of vitamin K consumption and the medianwere 292.2 µg and 112.9 µg respectively. The data had
a tendency toward the above of the mean. Theinterquartile rage IQR = Q3 – Q1 = 419.3 µg. The
difference between the highest and the lowest amountof vitamin K in the patients’ diet was 1171.6 µg.
Thereby, there was a large variation in the amount of

Figure 4. The frequency of using food that contains a very high amount of vitamin K
6000
5000

1440

1419

4000
3000

833

1716

608

1906

2939

1197
2000

2812

1432

1000

489

469

SummerAutumn0

Spring

Cruciferous vegetables group

Vegetable seasoning group

WinterOther vegetables

Figure 4. The frequency of using food that contains a very high amount of vitamin K in four seasons(58.6%). The result shows that the amount of vitamin
K intake in the patients’ diet was unstable. Patients
may much food enriched with a high amount ofvitamin K on some days to make up for the other days,
which could lead to a high average amount of vitamin
K in general. The study also showed that the
proportion of people who meet the recommended
vitamin K in knowledgeable patients was lower than
the figure for non-knowledgeable patients. This showsthat instructing patients to eat limited foods containing
vitamin K leads to unnecessary abstinence. And there
should be more specific instructions to help patients
maintain a diet with a stable vitamin K content.
To assess the stability of the amount of vitamin K
in the patients’ diet, we used the coefficient ofvariation (CV) and the interquartile range (IQR). TheDISCUSSION
In terms of the average amount of vitamin K, theresult in the study was 237.8 µg per day, lower than
the study of Pham Van Bac in Bac Ninh General
hospital ( 346.6(µg) ) and higher than the result of Kim
K.H et at., 2010 in Korean (161.3µg), Lubetsky A in
Israel (176 µg/day) or Custodio das Dores SM in
Brazil (76-120 µg/day) (5,14,15,16). The result can be
explained by eating habits and the availability ofvitamin K-rich food in different countries. Other
studies about the vitamin K diet in Vietnamese people
showed that the average amount of vitamin K in thediet was higher than the recommended allowance.
However, based on our study, the percentage ofpatients who did not achieve the recommended
allowance as normal adults was still significantly high125

The stability of dietary Vitamin K intake
CV of knowledgeable patients about nutrition relating
to vitamin K was 1.01 while the figure for nonknowledgeable patients was 1.19. The coefficient ofvariation of knowledgeable patients was lower, which
proved that the amount of vitamin K of theknowledgeable patient’s diet was more stable than the
figure for non-knowledgeable subjects. The result
showed that it is important to consult nutritional
information carefully for patients who use oral
anticoagulant VKA drugs. However, this effect was
not high enough and had not led to a significant
difference in controlling the stability of vitamin K
dietary intake of patients. This could show that
consultation for these patients about the diet patterns
was effective. The amount number of Vitamin K in
knowledgeable patients’ diets was less changing than
the figure for non-knowledgeable patients’ diets.
However, this effect on these patients was not high andwas not leading to many differences in controlling thestability of the amount of vitamin K in patients’s diets.
So it is necessary to establish an intensive intervention
strategy, which could help patients to have a deep
understanding of their diets and its importance. The
limitation of our research is the basic in studying
design, which only accessed patients’ knowledge
while using oral VKA drugs. Change in attitudes andpractices is extremely hard. Therefore, there is a needfor more new nutritional intervention patterns, which
are not only focussing on knowledge but also on how
to do the right practice.
Moreover, vitamin K dietary intake was also
affected by the frequency of consumption and theavailability of foods. With the development oftechnology and farming techniques, most of these food
was available all year round. However, some types offood are not usually consumed because Vietnamese
people have the tendency to eat a particular kind offood in its main season. Therefore, vitamin K dietaryintake was undirectly affected by the seasonal natureof these food, especially in the group of vegetables andfruits. In addition, this group has the highest amountof vitamin K compared with other food groups. This
was the main reason why we decided to survey thefrequency of using types of vegetable which contains
the highest amount of vitamin K in a year. The results
showed that the frequency of using foods containing ahigh amount of vitamin K increased remarkably in thetwo seasons: winter and spring, especially in the groupof cruciferous vegetables. The frequency of using
cruciferous vegetables in winter and spring was about
six times as many as in other seasons. The frequency
of using seasoning vegetables had a little variation
between each season of the year. Other foodcontaining a very high level of vitamin K such as water
spinaches, amaranths, lettuces, which had a frequency
of use in summer and autumn was about three times as
many as other seasons. The frequency of vegetableconsumption with a very high amount of vitamin K
was closely related to the patients’ vitamin K intake
mainly because even a small amount of these foods
can contribute a significant part to the amount ofvitamin K intake. It is clear that not every vegetablehas vitamin K, so it is easy to point out the differencein the amount of vitamin K in the patients’ diet.

CONCLUSION
The average amount of vitamin K intake of all
patients was higher than the recommendation forvitamin K but there were 58.6% of patients’ dietary
did not meet the recommendation as normal adults.
The study showed that the instability of vitamin K inpatient’s diets who used oral anticoagulant VKA drugs,
and the amount of vitamin K in the diet ofknowledgeable patients was more stable than the
figure for non-knowledgeable patients. The amount ofvitamin K in diet of the knowledgeable patientscompared with non-knowledgeable patients showedthat the intervention in order to raise the awareness ofpatients using oral anticoagulant VKA drugs was
effective. The frequency of using vitamin K enrichedfood in winter and spring was significantly higher thanin summer and autumn, which indirectly showed theinstability of vitamin K in the patient's diet in different
seasons.
GREATFUL THANKS
We would like to express our sincere thanks to
Hanoi Medical University Hospital because ofcreating suitable conditions during the research
process. We would also like to thank the patients who
participated in the study for their tireless efforts to help
us complete this study.
1.

2.

3.
4.

5.

6.

7.

126

REFERENCES
Olesen JB, Lip GYH, Lane DA, et al. Vascular
Disease and Stroke Risk in Atrial Fibrillation: A
Nationwide Cohort Study. Am J Med 125(8):826.e13-826.e23. 2012.
Albertsen IE, Rasmussen LH, Overvad TF,
Graungaard T, Larsen TB, Lip GYH. Risk of
Stroke or Systemic Embolism in Atrial
Fibrillation Patients Treated With Warfarin.
Stroke 44(5): 1329-1336. 2013.
Complications of Oral Anticoagulant Therapy:
Bleeding and Nonbleeding, Rates and Risk
Factors. Semin Vasc Med 03(3): 271-278. 2003.
Shinohara M, Wada R, Yano K, et al.
Relationship between the nutritional status andsafety and efficacy outcomes in atrial
fibrillation patients aged 80 years and overreceiving oral anticoagulants. J Cardiol 77(2):147-153. 2021.
Kim KH, Choi WS, Lee JH, Lee H, Yang DH,
Chae SC. Relationship between dietary vitamin
K intake and the stability of anticoagulation
effect in patients taking long-term warfarin.
Thromb Haemost 104(4): 755-759. 2010.
Violi F, Lip GY, Pignatelli P, Pastori D.
Interaction Between Dietary Vitamin K Intake
and Anticoagulation by Vitamin K Antagonists:
Is It Really True? Medicine (Baltimore) 95(10).
2016.
Dentali F, Crowther M, Galli M, et al. Effect ofVitamin K Intake on the Stability of Treatment
with Vitamin K Antagonists: A Systematic
Review of the Literature. Semin Thromb
Hemost 42(6): 671-681. 2016.

Asian Journal of Dietetics, 2021
8.
9.

10.

11.

Ministry of Health, The National Institute of
Nutrition. Vietnamese food composition table.
Medical publishing House. 2007.
Koertke H, Zittermann A, Tenderich G, et al.
Low-dose oral anticoagulation in patients withmechanical heart valve prostheses: final reportfrom the early self-management anticoagulation
trial II. Eur Heart J 28(20): 2479-2484. 2007.
Arbring K, Uppugunduri S, Lindahl TL.
Comparison of prothrombin time (INR) results
and main characteristics of patients on warfarin
treatment in primary health care centers andanticoagulation clinics. BMC Health Serv
Res13: 85. 2013.
Nguyen Quoc Kinh TMC. The evaluation of theeffectiveness off treatment wwith VKAs inpatients after mechanical heart valve
replacement. Published online 2011:44-46.

12.

13.
14.

15.

16.

127

Hung QD et al. The comparison of the usage off
anticoalulant: acenocoumarol and warfarin inpatients with mechanical prosthetic heart valves.
Published online 2011.
Ministry of health, Nutritional institue.
Recommended nutritional needs for vietnamese
people. Medical publising house: 96. 2016.
Bac PV. Nutritional status, actual dietary intake
and eating habits of patients at the departmentof Cardiology at Bac Ninh General Hospital.
Published online 2016.
Lubetsky A, Dekel-Stern E, Chetrit A, Lubin F,
Halkin H. Vitamin K intake and sensitivity to
warfarin in patients consuming regular diets.
Thromb Haemost 81(3): 396-399. 1999.
Custódio das Dôres SM, Booth SL, Aújo
Martini L, et al. Relationship between diet andanticoagulant response to warfarin. Eur J Nutr
46(3):147-154. 2007.

Asian Journal of Dietetics, 2021

Original
Development and Acceptability of New Japanese Menus
with Soy-based meat substitute. Yoko Ozaki. Tamami Kawakami. Saori Kamiya, Hitoshi Iizuka*
Quest Computer Co., Ohno-Bilding, 2-5-6 Irifune, Chuou-ku,Tokyo 104-042 Japan

ABSTRACT Background and purpose.
Textured Soybean Protein (soy-based meat
substitute: hereafter called SOY MEAT) , is rich in fiber (13.6g/100g) and a good protein source(about 56g/100g). Substituting SOY MEAT for meat in the diet may have beneficial effects inpreventing lifestyle-related diseases as well as in preserving the Earth. Purpose. To establish
a new food culture with Textured Soybean Protein and to assess the palatability of TSP dishes.
Method. There were two phases in the study.
The research group created 30 new menus
using SOY MEAT. From the traditional recipes, meat was replaced with about 6g SOY
MEAT/dish. The acceptability of new dishes using SOY MEAT was assessed by a Hedonic
5-point scale in 6 subjects. The points were; extremely like 5, like 4, neither like nor dislike
3, dislike 2 and extremely dislike 1. There were 11 dishes with the score higher than4 and only
one dish was scored less than 3. Results. The average score of overall taste of SOY MEAT
was 3.8 and 11 dishes scored higher than 4.0,. Conclusion. We found that most of the SOY
MEAT dishes are well accepted by Japanese
KEY WORDS: Textured Soybean Protein, meat analog, livestock, environment.
INTRODUCTION

It has become a problem for the survival of
humankind. Raising livestock for meat is responsible
for about 14.5% of total anthropogenic greenhouse gas(GHG) emissions, including methane gas ( a gas which
has an effect on global warming 28 times higher thancarbon dioxide) and nitrous oxide (a molecule with a
global warming potential 265 times higher than carbon
dioxide) (1). Animal agriculture is also a sector which
requires a significant amount of natural resources likewater and landmass when compared with other foods as
a protein source (2).
Based on this idea, textured soy protein has been
considered as a meat-like food from vegetable foods(soy-based meat substitute. Hereafter we called it SOY
MEAT). Based on this idea, the commercialization of
SOY MEAT has recently become active.
SOY MEAT is a meat analog which is produced
through an extrusion process. The defatted
thermoplastic protein is heated to 150–200°C, which
denatures it into a fibrous, insoluble, porous networkthat can soak up as much as three times its weight inliquids. As the pressurized molten protein mixture exits
the extruder, the sudden in pressure causes rapid
expansion into a puffy solid that is then dried. It is richin fiber (13.6g/100g) and plant protein (about
56g/100g).
Our expectation is its high fiber concentration. The
role of fiber in controlling metabolic disease in Asian
countries has been reported (3-5).
In order to realize the expected effects of soybean
meat as described above, it is necessary to develop

There are many vegetarians in the world. One of theimportant reasons seems to be the moral idea that weshould avoid eating creatures that think and act like wehumans do. A good example would be the idea that theact of killing and eating animals is not morally
permissible in some Buddhist denominations. I think thenext reason for advancing vegetarian diet is to think of it
as a healthy diet. Animal fat is a cause of heart disease,so the idea is to refrain from eating meat for the sake ofhealth. The idea of avoiding carnivorous food that has
recently arisen is probably due to the idea of preventing
global warming. Cows, goats, sheep, etc. used as
carnivorous animals are called ruminants. These animals
live on grass and the like. To digest the grass, theseanimals have four stomachs, reciprocating between them
many times. In the process, the bacteria that live in thestomach help digest the plants. It was known that thisbacterium produced methane gas, but we didn't feel thatit had any adverse effect on us. In recent years, humanlife has produced a large amount of carbon dioxide,
which has increased in the atmosphere surrounding theearth, causing global warming, abnormal weatherchanges, and changes in the ecosystem.
*To whom correspondence should be addressed:
iizuka@questcom.co.jp

129New Japanese Menus with Soy-based meat substitutecooking methods for the 30 Soy Meat dishes are listed
in Figure 1. Each dish contained about 6g Soy Meat.
Assessing the palatability of new dishes using Soy
Meat: We asked to score for each dish in terms ofappearance, aroma, taste, texture, overall was recordedby using the Hedonic 5-point scale (1-point. Dislike
very much, 2-point. Dislike moderately, 3-point.
Neither like nor dislike, 4-point. Like moderately, and5-point. Like very much).

delicious dishes. We have been developing Vietnameseand Indonesian food (6,7). This research was conducted
to develop delicious Japanese food.
METHODS
Creating new menus using SOY MEAT: We made 30
types of traditional dishes with Soy Meat replacing themeat ingredient. The dishes were made for lunch on
different days. The subjects were 6 (female 5, averageage 31±6 years, male 1, age 55 years). Details of the

1.Extremely dislike

2.Dislike 3.Neither like nor dislike 4. Like

Fig. 1

5. Extremely like

Hedonic 5-point scale of the sensory test

DM omelet
Omlet

Froed purse
Deep-fried soy meat,asatsuki, and shiitake
mushrooms are stuffed
and boiled in soup stock,soy sauce, salt, sake, andpotato starch.

Fry the minced onion in afrying pan, put it in a bowl
and remove the heat. Add
soy meat beef, eggs andmayonnaise and mix well.
Add oil to the frying pan
again, bake the mixed
ingredients, put the finishedomelet in a bowl, andsprinkle with ketchup andparsley.

Paprika stuffedwith cheese

Dry curry

Fry chopped onions, carrots,
peppers and soy meat
rehydrated in hot water in afrying pan. Add water andcurry roux, heat and serve on
rice.

130

Put minced meat and soymeat chicken together in abowl and knead by hand, cut
paprika in half, remove seeds
and cotton, put a pinch ofcheese in the bottom, and add
plenty of meat from above.
Place the paprika in an oiled
frying pan. When it gets alittle browned, add water,
cover and steam. 5- minutes
Put the tomato soup in afrying pan, put it on low heat
for about 10 minutes, put thelettuce in a bowl and sprinkle
with parsley.

Asian Journal of Dietetics, 2020

Dumplings

apao ice

Wrap chopped
garlic, garlic, andsoy meatrehydrated in hot
water indumpling skin,and steam in afrying pan withsesame oil.

Add chopped garlicand onions,
rehydrated soy meat,soy sauce, nam pla
and sugar and fry in afrying pan. Add
shredded peppers, redpaprika and basil, fry
and serve on rice.

Chinese Yam withsta chyFried rice

Sprinkle Japanesestyle ankake madefrom soy meat andsoup stock on the longpotatoes.

n a frying pan withsesame oil, add soymeat, rice, eggs, green
onions, soy sauce, salt,
and pepper in thatorder, and fry.

Cabbage roll

Taco ricecooked cabbage leaves
wrapped around a variety
of fillings .

Fry the chopped garlic, onions
and soy meat rehydrated in hot
water in a frying pan. Season
with ketchup, worcestershiresauce, and soy sauce. Serve on
rice in the order of shredded
lettuce, diced tomatoes, andsoy meat.

eef soboro

Soboro bowl
Cut the trumpet mushrooms inhalf and stir-fry them in a frying
pan with sesame oil over medium
heat. When it gets brown, add soymeat pork and all -purpose onion,
add sake, sugar, soy sauce, water,chicken gala, and oyster sauce,
simmer for 3 minutes on medium
heat, add ginger, mix, and reduce
to low heat to add water-soluble
potato starch. Put it in a bowl andput it in a bowl.

131

Put the soy meat beef,water, and soup in a frying
pan, soak the soy meat
beef for about 30 seconds,
turn on the heat, add theginger tube, and fry until
the water is removed.

New Japanese Menus with Soy-based meat substituteWestern-style Nanakusagayu

Fried rice with ankake

Western-style seven herbs cut
to a si e that is easy to eat tothe porridge and warm it.
ehydrate the soy meat with
hot water, add soy sauce,sugar and ginger and fry.
Serve soy meat on Nanakusagayu.

Add starch to the broth,heat it, thicken it, andsprinkle it on fried noodles
to eat.

Corn soup

dumplings

Warm corn cream, chicken
sardines, sake, ginger, soymeat (beef), corn, add beaten
egg and water-soluble potato
starch, and season with salt.

Put cabbage, minced chives,
minced pork soy meat beef,
soy meat pork, lard soy sauce,and pepper in a bowl, kneadwell, wrap in skin, grind oil ina frying pan, and heat for 1
minute. Add water and cookover medium heat for 5 to 8
minutes to complete thedumplings. Put water andnoodle soup in a pot and add
green onions before boiling.

DM soybean meatand tofu suki yaki-stylebow
oil soy meat, tofu, andgreen onions rehydrated
in hot water with ginger,
sugar, sake, soy sauce,and granulated potato
starch. Add shichimi toyour liking.

Cro uette
oil the potato carrots sothat the bamboo skewers
stick to them, fry theminced soy meat beef andchopped onions, peel theboiled potatoes in a bowl,
and mash them whilewarm.

Soy meat miso rice ball

eef soboro sprinkle

Add soy meat, shiso, miso,
sugar, sesame, driedbonito, and sesame oilthat have been rehydrated
with hot water. Serve withrice balls.

Add oil to the pan, add
soy meat pork andminced pork, and when
it s cooked a little, add
all theand simmer
on low heat for 15
minutes.

132

Asian Journal of Dietetics, 2020

Mabo tofu

Omurice

Fry chopped garlic andsoy meat rehydrated in
hot water, and season
with miso, tianmiansauce, doubanjiang, andsoy sauce. Add
sliced green onions anddiced tofu and heat.

Western-influenced
Japanese cuisine consisting ofan omelette made with friedrice and thin, fried scrambled
eggs, usually topped
with ketchup

Curry udonJapanese meal.

Soboro Ankake

Add Japanese noodles to thesoup curry with Japanesestyle dashi stock.

oiled and loosenedsoybean meat, beaten egg,etc., as it is or seasoned
and roasted until the soupis gone and it becomesdry. t can be placed onrice as it is, or used as amaterial for certain typesof sushi and bento.

Hachis Parmentier

SoboroJapanesefood,soybean meat boiled andloosened, beaten eggs, etc.,
as it is or seasoned, androasted until the soup isgone and it becomes fluffy.
Eat it on rice

French dish of finely
chopped meat baked in theoven with potatoes.

Japanese noodle

TsukuneSprinkle warm soup on
boiled udon noodles, andserve soy meat rehydrated
with hot water andsliced green onions.

Soy meatballs

Meatball most often cookedcovered in a sweet soysouce.

Japanese style oiled
pumpkinCut the pumpkin into
bite-si ed pieces, mix
water, mirin, sugar, soysauce, and book sauce ina bakeware, add the
pumpkin, mix uickly,
wrap and heat in a
microwave for 8 minutes
at 600W. t s done.

Mix soy meat, eggs, breadcrumbs, flour, onions,ginger, salt and pepper thathave been rehydrated in
hot water, roll into bite si ed pieces, bake in afrying pan, and season
with ketchup, soy sauce,and potato starch.

Picture 1.

Thirty types of t aditional dishes with Soy Meat eplacing the meat ing edient.
133

New Japanese Menus with Soy-based meat substitute

Table 1. Acceptability for new Soy Meat dishes
No

Name of dishes

Aroma

Basic taste

Apperance

TextureOveralltaste

1Fried purse

3.7±0.8

3.7±0.8

4.5±0.7

4.5±0.5

4.3±0.52

Omelette

4.2±0.4

4.0±0.9

3.8±0.8

3.7±0.5

4.3±0.8

3

Dry curry

4.0±0.6

4.3±0.5

4.2±0.4

4.3±0.5

4.3±0.5

4

Paprika cheese

3.8±1.0

4.3±1.0

4.5±0.8

4.2±0.8

4.3±0.8

5

Boiled dumpling

3.7±0.8

4.2±0.8

4.3±0.7

4.0±0.6

4.3±1.0

6Gapao Rice

3.5±0.5

3.7±0.8

4.0±0.7

4.2±1.0

4.2±0.8

7

Chinese Yam with starchy
sauce

3.3±0.5

4.2±0.8

4.5±0.5

3.8±1.0

4.0±0.6

8

Fried-rice

3.8±0.8

4.0±0.6

4.0±0.5

3.5±0.5

4.0±0.6

9

Cabbage Rolls

4.2±0.8

3.7±0.8

4.5±0.9

4.3±0.8

4.0±0.6

10

Taco rice

4.0±1.1

4.2±1.0

4.0±0.5

3.8±0.8

4.0±0.6

11

Soboro bowl

3.3±0.5

3.5±0.5

4.5±0.

3.8±0.8

4.0±0.6

12

Sticky meat soboro sprinkle

4.0±0.0

3.7±0.5

3.7±0.8

3.7±0.5

3.8±1.013Fried Noodles with Starchy
Sauce

4.3±0.5

3.8±0.8

4.5±1.3

2.8±0.4

3.8±0.4

14

Westerngayu

4.0±0.6

4.0±0.9

3.8±0.8

4.0±0.6

3.8±0.8

15

Corn soup

4.0±0.6

4.2±1.0

3.8±0.5

3.8±0.8

3.8±0.816

Dumpling

3.8±1.0

3.8±0.8

4.8±0.8

3.8±0.8

3.8±0.8

17

Croquette

4.3±0.8

3.8±0.8

3.8±0.8

3.5±0.8

3.7±0.8

18

Soy meat and tofu sukiyaki
donburi rice bowl

4.0±0.9

4.3±0.5

4.2±0.8

3.8±0.4

3.7±0.8

19

Soy meat miso rice ball

2.8±0.8

3.3±1.0

3.7±0.9

4.0±0.6

3.7±1.4

20

Beef soboro

3.7±0.8

3.0±0.6

3.8±0.5

3.5±0.5

3.7±1.021

Mabo tofu

3.2±0.8

3.5±0.5

3.8±0.7

3.7±0.5

3.7±0.5

22

Omelette rice

3.0±0.6

3.2±0.8

3.5±1.2

3.2±0.4

3.5±0.5

23

Curry udon

3.5±0.5

3.7±0.8

3.2±0.8

3.2±0.4

3.5±0.524

Udon

3.7±0.8

3.2±0.8

3.7±0.6

3.5±0.8

3.5±0.5

25

Hachis Parmentier3.8±1.0

3.8±1.0

3.3±0.7

3.5±0.5

3.5±0.8

26

spinach miso soboro

3.3±0.5

3.8±0.8

3.5±0.7

3.7±0.5

3.5±0.5

27

Meet udon

3.2±0.4

3.2±0.8

3.7±1.0

3.3±1.0

3.3±0.5

28

Chicken meatball

3.7±0.5

3.5±0.5

3.8±0.8

3.0±0.6

3.3±0.5

29

Soy meatball

2.8±1.2

3.3±1.4

3.7±0.9

3.0±0.6

3.2±0.830

Pumpkin stew

3.2±1.2

3.2±0.8

3.7±0.9

2.7±0.5

2.8±0.8

style

Nanakusa

134

Asian Journal of Dietetics, 2020

Fig. 3 Ave age sco e of the senso y test

RESULTS
Table 1 shows 30 dishes in descending order ofscore. Fig. 3 shows the average score of each items.
The average score of overall taste of SOY MEAT was
3.8 and 11 dishes scored higher than 4.0,. The score of
only a dish was less than 3. The results suggest thegood acceptability of Soy Meat dishes. It can be said
that the deeply seasoned dishes were highly evaluated as
the cause of such a difference.

Prof. Andrew Durkin, Emeritus Professor of Indiana
University, for editing our English.

1)

2)

DISCUSSION
In this study, 30 kinds of dishes were made and asensory test was performed by the 5-point method. As aresult, 11 kinds were very delicious, 18 kinds weredelicious, the remaining one was normal, and most of thedishes were highly evaluated. I was able to get it.
For fried purse, omelet, dry curry, Paprika cheese,and dumplings, which had the highest sensory test valueof 4.3, simmered pumpkin, which had the lowest 2.8
points, and soybean meatballs. The possible cause ofsuch a difference is that if the tissues are similar, it isdifficult to tell the difference between meat andsoybeans due to the strong seasoning. In other words, it
can be said that it is important to erase the characteristics
of soybeans and how the characteristics resemble meat
in determining the taste. With this in mind, soy meat may
be quite close to cooking close to minced meat, but it
may not be suitable for cooking as chunks of meat, suchas beefsteak and pork cutlet.
In other words, this also leads to how to eliminate
the characteristics of soybeans. However, this idea is aneffort similar to how to bring pork closer to beef or tofu
taste closer to beef taste, and does not try to make thebest use of the good taste of soybean itself. Comparing
milk and soy milk, the question of which one is moredelicious is close to nonsense. For example, in hot pot
dishes, soy milk will be better than milk. The effort weshould make in the future will be the pursuit of dishes
that should express the deliciousness of soybean meat
itself.

3)

4)

5)

6)

7)

ACKNOWLEDGEMENT
The authors would like to thank to Jumonji
University and Fuji Oil Company for supplying the TSP
materials. Finally, we would like to express thanks to

135

REFERENCES
Grossi G, Goglio P, Vitali A, Williams AG.
Livestock and climate change: Impact of livestock
on climate and mitigation strategies. Anim Front.
2019;9:69–76.
Godfray HCJ, Aveyard P, Garnett T, Hall JW, Key
TJ, Lorimer J, Pierrehumbert RT, Scarborough P,
Springmann M, Jebb SA. Meat consumption,
health, and the environment. Science. 2018;361.
Nguyen LT, Nguyen TH, Nguyen LT, Kamoshita
S, Tran TP, Le HT, Shimura F, Yamamoto S.
Okara improved blood glucose level in vietnamesewith type 2 diabetes mellitus. J Nutr Sci Vitaminol(Tokyo). 2019;65:60–5.
Analysis of fiber intake and its sources in a year
school lunches at a school in Japan Noriko Sumida,
Saiko Shikanai, Nobuko Sarukura, Hitomi Takeich,
Miho Nunokawa, Nguyen Mai Phuong
Asian Journal of Dietetics 2 (1) 97-103, 2020
Indri Kartiko Sari, Diah Mulyawati Utari,
Mitsutaka Kohno, Ryuji Yamaguchi, Shigeru
Yamamoto Acceptance of Textured Soybean
Protein in Indonesian Dishes and Its Effects on
Energy in Overweight Women, Asian Journal of
Dietetics. Asian Journal of Dietetics 2(4),171177,2020.
Ta Thi Ngoc, Ngo Thi Thu Hien, Nguyen Mai
Phuong, Truong Thi Thu, Nguyen Huong
Giang,Dinh Thi Dieu Hang, Nguyen Thuy Linh, Le
Thi Huong, Nguyen Cong Khan, Shigeru
Yamamotom, Vietnam’s New Food Culture with
Textured Soybean Protein Can Save the Earth.
Asian Journal of Dietetics 3, 97-103, 2020
Indri Kartiko Sari, Diah Mulyawati Utari, Sumiko
Kamoshita, Dwi Oktaviana, Seigo Sakai, Hiroshi
Nishiyama, Yasunobu Masuda, Shigeru
Yamamoto. Increasing vegetable intake 400
g/day to control body weight and lipid profile inoverweight hyperlipidemia menopausal women,
Journal of Public Health Research, 9, 264-270,
2020