ISSN2434-2688 Asian Journal of Dietetics

Vol.6 No.1.2, 2024

Contents

Page

Original Research
1-14

Title and authors

Impact of Utility Damage on Meals for Older Adults
after the Kumamoto Earthquake, Japan
Hiroka Sato1, Noriko Sudo2,*

Original Research
15-19

A Pragmatic Approach towards Healthcare Needs in
Malaysia through Student-led Dietetics Clinic
Yang Wai Yew1, Chee Winnie Siew Swee1 *, Arasu Kanimolli1,
Alphonso Augustin Ambrose Charmaine Lavinia1, Samingan Nur
Adila1, Sahathevan Sharmela1, Wong Ting Xuan1, Yap Zi Qian1,
Soh Pheh Huang1

Original Research
21-24

Replacement of Sea Salt with Aizuyamajio May
Reduce Salt Consumption in Japan
Shin Yamaoka1,

Original Research
25-30

A Comparison of Physical Activity Among 10-yearold Children Between Suburban Vietnam and Japan
Sumiko Kamoshita1, Phuong Mai Nguyen1*, Hitomi Takeichi2,
Shigeru Yamamoto1

Original Research
31-38

Effectiveness of Medical Nutrition Therapy in
Improving Prognostic Nutritional Index
Scoring among Dietitian Referred Chronic Kidney
Patients: A Retrospective Study at Hospital
Kuala Lumpur, Malaysia
Jayvikramjit Singh1, Basmawati Baharom1, Zamtira
Seman2, Lye Sing Ie1, Nor Fazlyn Zakaria1

Special Reports:
39-40

Introduction of AYDN activities: Participation at theThai Dietetic Association Conference
F.A.Z.Firouse1, Nur Ayu Ruhmayanti2,

Sumaya Islam3, Yen Ngoc Ma4

41-43

Report (Bangladesh) on the Asian Young Dietitians
Network Meeting in Thailand
Sumaya Islam1*, Tapati Saha2

44-44

Report (Bhutan) on the Asian Young Dietitians
Network Meeting in Thailand
Prem Kumar Neopanay1*, Chanda Dhungyel2,
Hari Prasad Pokhrel3

45-45

46-48

Report (India) on the Asian Young Dietitians
Network Meeting in Thailand
Naaznin Husein
Report (Indonesia) on the Asian Young Dietitians
Network Meeting in Thailand
Nur Ayu Ruhmayanti1, Achmed Forest Khan2,
Wita Rizki Amelia3, Ishak Halim Octawijaya 4*

49-50

Report (Japan) on the Asian Young Dietitians
Network Meeting in Thailand
Risako Okuyama1

51-52

Report (Malaysia) on the Asian Young Dietitians
Network Meeting in Thailand
Georgen Thye1*, Ng Kar Foo1

53-54

55-57

Report (Philippines) the Asian Young Dietitians
Network Meeting in Thailand
Mabelle Yna C. Aragon1, Marita V. De Guzman2*
Report (Sri Lanka) the Asian Young Dietitians
Network Meeting in Thailand
Firouse F.A.Z1*, Abeysinghe AAKS2

58-58

Report (Taiwan) the Asian Young Dietitians
Network Meeting in Thailand
Tzu-Yun Chu1, Zi-Xuan Lin2*

59-60

Report (Thailand) the Asian Young Dietitians
Network Meeting in Thailand
Samitti Chotsriluecha1,2,3*, Yupa Chanwikrai4

61-63

Report (Vietnam) the Asian Young Dietitians
Network Meeting in Thailand
Trang Thu Nguyen1* , Yen Ngoc Ma2,3

Special Report
64-68

Observation of Eating Habits between
Cambodian and Japanese
On Sothida, Ry Manydine

Asian Journal of Dietetics, 2024

Original
Impact of Utility Damage on Meals for Older Adults after
the Kumamoto Earthquake, Japan
Hiroka Sato1, Noriko Sudo2,*
1

Department of Food and Nutritional Science, Division of Life Sciences, Graduate School of
Humanities and Sciences, Ochanomizu University, Tokyo, Japan
2
Natural Science Division, Faculty of Core Research, Ochanomizu University, Tokyo, Japan
ABSTRACT In the post-disaster period, providing food especially for older adults is importantsince they require dietary care despite being in a lifeline disruption. In this study, we examinedfood service relating to utility disruption and explored the hardship of meals provision in older
adult-care facilities after a disaster. Out of 96 facilities which answered our first questionnaire
survey, we targeted 43 older adult-care facilities that were affected by the 2016 Kumamoto
Earthquake. We analyzed the records of six facilities from our second survey which reported
the changes in meals provision due to the earthquake. One facility without water, gas, andelectricity supply served only two meals per day mostly consisting of ready-to-eat foods. On
the contrary, facilities with lifeline supply could serve regular meals with just a few changes
in dishes. Food delivery was disrupted during emergency. A hospital lost contact with dealers
and could not get foods due to loss of communication tools. The number of staff was fewer
than usual, which resulted in increased pressure sore patients. Utility outage and difficulties ofdelivery or manpower led to skipping meals and were an obstacle to serve meals. This study
would contribute to preparation of meal provision in older adult-care facilities.
Keywords: disaster management; older adults; lifeline; meal provision, Kumamoto
Earthquake

INTRODUCTION
Japan is a disaster-prone country and has
experienced countless earthquakes, typhoons, andother disasters (1). The 2016 Kumamoto Earthquake,a recent large-scale disaster, damaged 198,000 homes
and disrupted electricity, gas, and water supply
infrastructure (2).
Lifeline outages after disasters are serious issues.
For instance, Ulak et al. demonstrated that areas withmany older adult residents were more susceptible toblackout in Hurricane Hermine occurred in 2016 (3).
Puerto Rico faced long-term power outage due toHurricane Maria in 2017 (4). In 2018 Hokkaido
Eastern Iburi Earthquake, elevator outages had anegative impact on residents in high-rise building (5).
Under these circumstances, providing adequate
food and nutrition is necessary in every phase of thedisaster, particularly for older adult (6). The shortageof foods in proper form and manpower to take care ofthem during disasters links to aspiration orundernutrition of individuals requiring special meal
attention (7). In fact, older adults complained that the
food at evacuation centers after 2016 Kumamoto
Earthquake was uncooked and hard to swallow (8).
After the 1999 Athens earthquake, nutritional intake
among older adults was insufficient (9). The residentsof older adult-care facilities depend on their facilities
for most of their life support, so facilities need tocontinue operations even during emergencies.Despite these facts, the meals provided in older
adult-care facilities following disasters remain
understudied. It is unclear as to what is served and how

staff change meal contents during emergencies.
Moreover, the relationship between available utilities
and meals which can be prepared under thoseconditions has not been verified. Therefore, this study
examines the relationship between utility disruption
and food service in the immediate aftermath ofearthquake and explores the actual situation of meal
provision in older adult-care facilities.
MATERIALS AND METHODS
Study setting and design
Kumamoto Prefecture is located in Southern partof Japan. In November 2020, the authors conducted
the first questionnaire survey on disaster preparedness
for food service to all older adult-care facilities inKumamoto, comprising 125 welfare facilities for theelderly requiring long-term care, 92 health carefacilities for the elderly requiring long-term care, 50
sanatorium type medical care facilities for the elderly
requiring care, and 6 integrated facilities for medical
and long-term care (10). Out of 96 facilities which
responded to the survey (response rate = 35.2%) (10),
we targeted 43 facilities affected by the 2016
Kumamoto Earthquake. The second questionnaire wasmailed in August 2021 to the food service managersof those facilities. Although some facilities presented
meal contents of several weeks, we focused on only 1–
3 days after the main shock that occurred at 1:25 a.m.
JST on April 16, 2016, during the acute phase of thedisaster (11).
Data sources and data collection methods
In the second survey, we inquired about (1) the
number of meals per day in normal times, and thefollowing for each meal occasion immediately after
the Kumamoto Earthquake: (2) type of tableware*To whom correspondence should be addressed:
sudo.noriko@ocha.ac.jp

1

Impact of utility damage on meals for older adults(daily use or disposable), (3) manpower, (4) whether
or not providing meals to non-residents, and (5) tostaff.
We also asked (6) whether meal contents werechanged due to the disaster, and if so, what changes
were made, (7) the state of utilities; water, gas,
electricity, and food delivery, (8) the frequency ofregular and disaster meals, and (9) the overall
impression about the disaster by free-text description.
Disaster meals are alternative menus for emergency,
which mainly consist of ready-to-eat foods.

extracted some free responses to describe thechallenges in emergency meal provisions in detail.
Ethical considerations
The following was explained in writing: thatparticipation in the questionnaire survey is voluntaryand even if they do not answer, they would not bedisadvantaged at all, that the respondent’s name andcontact information are used only for inquiries
regarding their answers, that responses would beanonymized and used only for research. By receiving
the completed questionnaire, we obtained the consent.
The Ochanomizu University Humanities and Social
Science Research Ethics Review Board (approval
number 2021-56) granted ethical approval for thisstudy.

Data analysis methods
Fifteen facilities responded to the second survey(response rate = 34.9%); among them, six facilities
reported the changes in meals due to the earthquake.
We thoroughly analyzed daily meal descriptions. The
location of each facility was available on the websiteof the Ministry of Health, Labour and Welfare (12),and the damage sustained was drawn from the websiteof the Cabinet Office (13). According to that
information, the seismic intensity of those six facilities
was above the upper range of 6. Data from the firstsurvey was used in determining the presence orabsence of a private generator, as well as the numberof electrical outlets from the generator in the kitchen(10). Supplements 1–3 show the contents of menus
categorized into food groups based on the Japanese
Food Guide Spinning Top (grain-based dish;vegetable-based dish; fish, eggs, and meat dish; milk;
fruits; and others) (14). In this manuscript, we only
summarized the changes in meal contents for threedays after the main shock and examined therelationship with lifeline usage. In addition, we

RESULTS
Faculty attributes
Table 1 lists the attributes of the six facilities.
Welfare facilities for the elderly requiring long-termcare and health care facilities for the elderly requiringlong-term care were represented as “Home”.
Sanatorium type medical care facilities for the elderly
requiring care were described as “Hospital”. Almost
all facilities, with the exception of Hospital F, hadprivate generators. However, only the kitchens ofHome C and Hospital D had outlets connected to
private generators. The tableware used in Homes A–C
and Hospitals D and E were disposable. Most facilities
had reduced the number of staff compared to usual.
Homes A–C distributed meals to non-residents aswell. Most facilities, except for Hospital D, prepared
meals for staff.

Table 1 Characteristics of six elder-care facilities (Days 1–3)
Home A
Home B
Home C
Facility type*abb

Hospital DcHospital EcHospital F
c

121
187
149

118
120
118

38
55
38

25
25
25

Yes

Yes

Yes

No

5

1

0

Not applicable

Disposable

Disposable
Day 1: Fewer
Days 2, 3: Same

Disposable

Unknown

Same

Same

Number of meals per day in normal times
52
120• Breakfast
76
170• Lunch52
120• Dinner
Possession of private
Yes
Yes
generator
Outlets in the kitchen
connected to the00private generator
Tableware
Disposable Disposable
Number of staff
Fewer
Fewer
(compared to usual)

Fewer

Providing meals to
Yes
Yes
Yes
No
No
No
non-residents**
Providing meals to
Yes
Yes
No
Yes
Yes
Yes
staff
* a: welfare facility for the elderly requiring long-term careb: health care facility for the elderly requiring long-term carec: sanatorium type medical care facility for the elderly requiring care** Neighbourhood residents who have evacuated to the facility, older adults at-home care, and older adults
living in other facilities, etc.

2Asian Journal of Dietetics, 2024

Relationship between lifeline utilities and meal
contents
Tables 2–4 summarize the status of lifeline
utilities and use of disaster meals for three days after
the earthquake (Days 1–3). Although Home B
described the meal contents on Day 1 only, otherfacilities provided descriptions of three days. On
Day 1, gas was fully available as usual only in HomeA (Table 2). That facility could serve three regularmeals, omitting one vegetable-based dish for supper.
Home B could not utilize most of the lifelines,
leading it to serve only instant rice with canned or
packaged foods as disaster meals. Hospital Dchanged the meal contents for lunch in response to
the disaster and used in-stock items for supper.
Hospital F had a disruption of water, gas, andelectricity compelling staff to use perishable foodsfrom refrigerator and freezer as priority. They served
only two disaster meals in a day, such as instant rice.
On Day 2, Home A, where only water was notavailable in perfect condition, could prepare three
regular meals omitting some dishes in each meal
(Table 3). Home C still had water outage. Staff
utilized food aid and foods that were close to their
expiry dates. That facility served only disaster meals
as alternative. Hospital D did not serve miso soup
due to elevator outage as it was too difficult to carryusing the stairs. Hospital E, which had water and gas
disruption, provided disaster foods such as canned
miso mackerel stew. Water, gas, and electricity in
Hospital F had still not recovered. The staff only
provided two disaster meals. On Day 3, neither water
nor gas was recovered in Hospitals E and F (Table4). Hospitals C, E, and F, where some lifeline
outages occurred, served disaster meals at least oncein a day. These three facilities utilized relief supply.

Hospital F still provided only two disaster meals in a
day.
Water
Table 5 shows the detailed usage status of
lifeline during emergency. Home B failed to makeuse of food aid due to water outage. That facility
covered the normal plate with plastic wrap to deal
with the water shortage. Hospital D could purify
cloudy water. The staff in that facility also indicatedthe necessity of having disposable dishes to prevent
infectious diseases. Those dishes were also reported
as a more convenient resource than a large water tankin Hospital F.
GasHome A was offered an electric rice cooker by
a local resident (Table 5). Portable stoves (Hospitals
E and F) and propane gas (Hospital F) were utilized
to provide meals and sterilize water by boiling.
Hospital E, where there was no outlet in the kitchen(Table 1), cooked and served meals in the staff
cafeteria (Table 5).
Electricity
As shown in Table 5, outage of steam
convection oven required alteration of meals.
Electricity outage forced staff to use foods stocked
in refrigerator and freezer. An elevator outage in
Hospital E forced staff to carry meals by bucket
brigade method.
Food delivery
Food delivery did not recover in Hospital D
even on Day 3 (Table 4). As the staff could notconnect with dealers, they experienced hardship in
procuring foods (Table 5). Hospital E did notindicate supply disruption (Tables 2–4); however,staff could not procure fresh vegetables in the usual
way. In Home A and Hospital E, special foods forolder adults were delivered.

Table 2 Status of utilities and meal frequency on the first day after the earthquake (Day 1)
Frequency of
Food
Facilities Water Gas Electricity
Changes made (free description)
RegularDisasterdelivery
meals
meals
l Supper: One vegetable-based
A
○
○
○
3
0
△
dish was omitted.
○
l All meals: Instant rice was served
B××
except for×
03
with canned or packaged food.
morning○
C××
except for
0
3
Not specified△
morningl Breakfast: Staff just provided
what they had available at thattime.
○ except○lLunch: Meal content wasD○forexcept for×
2
1changed according to themorning morning
situation.
l Supper: Food in stock were used.
E○cloudy

×

○

○

1

3

2

Not specified

Impact of utility damage on meals for older adults

F

×

×

×

○

0

2

l All meals: Food from refrigerator
and freezer were used as priority.
Instant rice was served.

○: available, △: partly available, ×: not available
Table 3 Status of utilities and meal frequency on the second day after the earthquake (Day 2)
Frequency of
Food
Facilities Water Gas Electricity
Changes made (free description)
RegularDisasterdeliverymeals mealsl Breakfast: The content of vegetable-baseddish was changed according to the situation.
A
○
○
○
3
0
l Lunch: Bread could not be provided.
△l Supper: One vegetable-based dish wasomitted.
l Breakfast: Rice was cooked on gas (notusing instant rice as previous day)
C
×
○
○
0
3
l Lunch: Food aids were served.
△
l Supper: Sauté was prepared using nearexpired food.
l Breakfast: Miso soup was not served whenthe elevators were not working due to○difficulty in carrying it on the stairs.
D
○
○
×
3
0
cloudyl Lunch/Supper: Stocked food was used toprepare regular meals.
l Breakfast: Disaster food, canned miso
mackerel stew was used.
E
×
×
○
○
2
1
l Snack: Instead of lunch, a snack wasserved.
l All meals: Food from refrigerator and
F
×
×
×
○
0
2
freezer were used as priority. Instant rice
was served.
○: available, △: partly available, ×: not available

Table 4 Status of utilities and meal frequency on the third day after the earthquake (Day 3)
Frequency of
Food
Facilities Water
Gas
Electricity
Changes made (free description)
RegularDisasterdeliverymeals mealsl Breakfast: One vegetable-based dishwas omitted.
○l Lunch: One vegetable-based dish was
A
○
○
3
0
△ except foromitted.
morningl Supper: One vegetable-based dish andclear soup were omitted.
l Supper: Milk and strawberries wereadded. Strawberries were provided by
C
×
○
○
2
1
△
a local farmer.
l Breakfast: The president provided
large amount of food from areas withminimal damage. Staff went shopping○in a nearby prefecture to overcome
D
○
○
×
3
0
cloudyfood shortage.
l Lunch: Meals were provided using
what they had in the facility (including
relief supply).
l Lunch/snack: Instead of lunch, snack
was served.
E
×
×
○
○
2
1
l Supper: “Protein jelly,” a relief food,
was provided.

4

Asian Journal of Dietetics, 2024

F

×

×

○

○

0

2

l All meals: Meals were prepared using
food aids.

○: available, △: partly available, ×: not available

Table 5 The lifeline situations of each nursing care facilityl B: Although we received food aid, the vegetables could not be washed due to the lack ofwater. The length of the water outage was unknown, so we decided to cover normal plateswith plastic wrap for several days after the disaster.
l D: As the water was cloudy, we used a water purifier and used purified water in cooking. On
Water
Day 5, norovirus-infected individuals entered our facility, infecting other residents. There
was insufficient disposable tableware from that day.
l F: The family of a staff member brought a large water tank to wash dishes. However,disposable ones were more convenient.
l A: An electric rice-cooker was provided by a local resident.
l E: Staff used some portable stoves in the cafeteria and provided hot meals.
Gasl F: We could serve meals and boil water to disinfect using portable stoves and propane gas
thanks to lifeline providers.
l E: The cooking methods were changed for the regular meals due to the outage of the steam
convection oven. All staff served meals by bucket brigade method because the elevator had
stopped due to an aftershock.
Electricityl F: On Days 1 and 2, food in refrigerator and freezer were used as priority. Because of theelevator outage, we carried cooked meals manually to a hospital ward and served them.
l A: Dealers provided us with food thickeners and some food.
l D: Despite calling contractors, they had no explanation for delivery failures. We worked hardto procure food.
Food delivery
l E: Fresh vegetables were difficult to get for a few days. We could get eternal feedingproducts and special food for vulnerable as usual.
A, B, and D–F refer to different facilities (Table 1).
We only chose comments describing difficulties and coping methods which would contribute to disaster
preparedness for the future.
ManpowerSome staff from Home A and Hospital D wereforced to stay in the gymnasium or their cars overnight(Table 6). Under these situations, volunteers or staff
from other facilities helped their works. Due to thelack of available care in Home B, the number ofresidents with bedsores increased.
Food
Local residents and farmers donated foods toHomes A and C. Hospital D reported that it was hard
to serve milk or fruit. Hospital F had difficulty inutilizing food aid because of the close to expiry dateand high-sodium content food (Table 6).
Nutrition
Home A, which was damaged the least of all six
facilities (Tables 2–4) provided meals considering
nutrition as usual (Table 6). In Home B, staff worried
about nutrient deficiencies among residents due tofood shortage. Although Hospital D tried to provide
balanced and delicious diets, the nutrients appeared to
be deficient.

Table 6 Situations other than lifelines of each eldercare facilityl A: Some of the staff slept in the
gymnasium or in their cars.
Volunteers came to help out with
our work.
l B: Because staff could not provide
Manpower
enough care for older adults, there
were more patients with bedsores.
l D: Some staff had difficulty incommuting and camped in theircars. Staff in charge of morning

Food

5

shift were unable to commute, so
those working in other facilities
helped us serve meals.
l A: Food was provided by local
residents.
l C: Farmers near the facility
provided asparagus andstrawberries.
l D: Milk and fruit were difficult toserve after the disaster.
l F: Food aid, such as instant rice,
noodles, and canned food wereImpact of utility damage on meals for older adults
followed by foods preserved in a freezer (21). Food
service facilities always have large refrigerators andfreezers. If food there can be stored in good condition,
it would ease food shortage in emergencies. Therefore,
above everything else, limited electricity from inhouse generation should be connected to cold storage
equipment. Electricity is also necessary for the
purpose of using cooking appliances; if electric
appliances such as blenders cannot be used, it isdifficult to make appropriate meals for older adults(22). This could cause aspiration pneumonia, a lifethreatening illness (7). Although five out of six
facilities had private generators, only two of them hadoutlets in the kitchen which connected to an in-house
generator (Table 1). Because the provision of meals
will be hindered without refrigerators and cooking
equipment, portable generators should also be
arranged in advance.
Hospital D struggled with procuring foods due tounavailability of communication tools to connect withdealers (Table 5). Even in a facility that provided
meals without missing any, staff was concerned about
malnutrition among older adults (Table 6) as they aresusceptible to infection7. Some food aid they received
were close to expiry date or had high sodium content(Table 6), as seen in a previous study (23,24). That
meal contents were inadequate for older adults, as
hypertension is a concern (7). To deal with this,contact with the outside world is essential because
meal scores during the Great East Japan Earthquake
were related to that (25). Because email or landline
telephone cannot be used during power outage,facilities should create emergency contact lists (17) or
utilize social networking services such as LINE tocommunicate with dealers (26).
Although our respondents did not clearly refer totransportation, its impairment could also cause limitedaccess to foods (19). Special foods are especiallyvulnerable to stagnation or deterioration (27) due totheir production on a small scale. Thus, having foodstockpile, not relying on food aid, is essential to ensure
consistent provision of special care meals for older
adults.
Manpower
As observed in previous studies (28) somefacilities accommodated outside evacuees, although
they had fewer staff than usual (Table 1). The
manpower shortage might cause increased number ofpressure sore patients (Table 6). Moreover, meal
provision for the staff (Table 1) is also inevitablebecause staff tend to suffer from health issues due tooverwork under a chaotic situation (290. Because meal
preparation under those emergency situation isdifficult, human resource planning that utilizes
external support is a crucial part of business continuity
plan. For example, inter-networks among meal
provision facilities are structured within thejurisdiction of the Okayama Bihoku Health
Department. This network allows disaster-stricken
facilities to request meal delivery from places inregular operation (30).
Limitations of this study
The first limitation is the small number offacilities analyzed. Our final number of respondents
was only six facilities, which is very small since thetarget of the analysis was narrowed down to facilities
in which the disaster affected the content of meals andthat described the content of meals for one day ormore. The second limitation is that some of theirdescription about changes in meals content weredelivered. However, some of themwere near their expiry dates and/or
were high in sodium, which made itdifficult to use them.
l A: Nutritional considerations were
given to older adults as usual.
l B: Staff were concerned that
residents took lower amounts ofnutrition than usual due to foodNutritionshortage.
l D: We made all the efforts to servebalanced and delicious diet as muchas possible, but the nutrition seemed
to be insufficient.
A-C, and F refer to different facilities (see Table 1).
We only chose comments describing difficulties andcoping methods which would contribute to disaster
preparedness for the future.
DISCUSSION
Lifeline disruption made food provision difficult.
Hospital F, where water, gas, and electricity had been
cut off on Days 1 and 2, served only two meals perday. Meals in this facility were all disaster foods asalternative of regular menus. On the contrary, threemeals were served as usual in Home A, where only thewater supply was partially disrupted. That home
simply omitted a few dishes without any otherdifficulty. This result shows that meal provisions had
a definite link to utilities. Older adults in disasterstricken areas require special dietary care (70), so thedisruption of lifelines precludes appropriate foodsupply and the use of cooking appliances which
require gas and electricity.
Disposable dishes were used in most facilities(Table 1), which are convenient resources undersuspension of water supply. However, garbagedisposal facilities might stop working due to themalfunctioning of incinerator after the disasters (15).
The excess garbage accumulation in health carefacilities and hospitals for long period could lead tosanitary and health problems (16). This might
particularly affect older adults, who are susceptible toinfection7. Although disposable dishes might be user
friendly for staff (Table 5), they are usually thin andfragile making it difficult for older adults to eat (17).
Therefore, normal dishes covered with plastic wrap
(Table 5), might be preferable in terms of reducing thevolume of waste and improve usability for older adults
unless there is no virus-infected individual.
Ensuring heat source is also essential because it
affects cooking well-balanced diet (18). In fact,
Hospital F, the only facility without a private
generator, could not serve regular meals at all for threedays (Tables 1–4). This presents the necessity to havegenerators and find other places for cooking, such as acafeteria as seen in Table 5.
Electricity lead vulnerability in facilities during
emergency (19). This study also revealed that power
outages limited the range of available foods. As in thecase of Hospital D, which refrained from serving easyto-spill soup for safety (Table 3), meals may need to
be transported by hand on a stairway if elevators areunavailable. For that case, facilities should consider
using transportable containers to deal with theunavailability of meal carts (20).
Like Hospital F, where foodstuffs in the
refrigerator were used first (Table 5), it isrecommended to utilize perishable foods as priority,
6

Asian Journal of Dietetics, 2024

ambiguous. They provided free responses describing
meals changes. At times, it was unclear how
ingredients and cooking methods were changed.
Therefore, we could not strictly divide betweenchanged and unchanged meals. However, this is thefirst study to describe the precise meal contents served
at senior care facilities in an acute phase of a disaster.
We were able to clarify the actual situation of meals
provided during disasters and evaluate the direct
impact of utilities by taking a descriptive approachrather than statistical analysis.

8)

9)

10)

CONCLUSION
Utility outage leads to skipping meals andrepresents an obstacle to serving meals. On thecontrary, facilities with lifeline supply can serve
regular meals with a few changes in dishes. Moreover,food deliveries were disrupted by the earthquake. The
number of staff was fewer than usual in some facilities
resulting in increased pressure on staff and patients.
Human resource planning utilizing external support
thus appears to be crucial for business continuity.

11)
12)

ACKNOWLEDGMENTS
We would like to express our sincere gratitude to
everyone who participated in the questionnaire survey.
1)

2)

3)

4)

5)

6)

7)

13)

REFERENCES
Ministries of Foreign Affairs of Japan. Disastersanddisasterprevention
inJapan.
https://www.mofa.go.jp/policy/disaster/21st/2.ht
ml#:~:text=Japan%20is%20particularly%20vul
nerable%20to,of%20natural%20disasters%20in%20Japan. Accessed June 22, 2023.
Kumamoto Prefectural Government. Disasterarchives of Kumamoto. https://www.kumamotoarchive.jp/en/about. (in Japanese). Accessed
June 22, 2023.
Ulak MB, Kocatepe A, Sriram LMK, Ozguven
EE, Arghandeh R. Assessment of the hurricaneinduced power outages from a demographic,socioeconomic, and transportation perspective.
Nat Hazards 92: 1489–1508. 2018.
Keerthisinghe C, Ahumada-Paras M, Pozzo LD,
Kirschen DS, Pontes H, Tatum WK, Matos MA.
PV-battery systems for critical loads during
emergencies: a case study from Puerto Rico after
Hurricane Maria. IEEE Power Energy Mag 17:
82–92. 2019.
Shirai K, Matsumoto R, Horii J. Questionnaire
survey of the occupants of high-residentialbuildings in Sapporo after the 2018 Hokkaido
Eastern Iburi Earthquake. J Asian Archi Build
Eng 21: 884–899. 2022.
Tsuboyama-Kasaoka N, Ueda S, IshikawaTakata K. Food and nutrition assistanceactivities at emergency shelters and survivors’
homes after the great East Japan earthquake, andlongitudinal changes in vulnerable groups
needing special assistance. Int J Disaster Risk
Reduc 66: 1–6. 2021.
Sudo N. Health issues among the elderly indisasters. JATAFF 43–46. (in Japanese). 2017.

14)

15)

16)

17)

18)

19)

7

Saito K, Sudo N, Tsuboyama-Kasaoka N,
Shimoura Y. Dietary difficulties among
vulnerable people affected by the Kumamoto
earthquake. Jpn J Health Hum Ecol 87: 84–93.
(in Japanese). 2021.
Magkos F, Arvaniti F, Piperkou I, Katsigaraki S,
Stamatelopoulos K, Sitara M, Zampelas A.
Identifying nutritionally vulnerable groups incase of emergencies: experience from the Athens
1999 earthquake. Int J Food Sci Nutr 55: 527–
536. 2004.
Shibamura Y, Sudo N, Kubo A. A questionnaire
survey on business continuity for meal service ofnursing homes in Kumamoto Prefecture withexperiences of natural disasters and pandemic.
Jpn J Health Hum Ecol 88: 137–149. (inJapanese). 2022.
Harada M. Diet and nutrition in disasters. J
Cookery Sci Jpn 54: 197–200. (in Japanese).
2021.
Ministry of Health, Labour and Welfare. Nursing
care office and life-related information search:
nursing care service information publication
system.
http://www.kaigokensaku.mhlw.go.jp/43/. (inJapanese). Accessed July 18, 2023.
Cabinet Office, Government of Japan. The
damage situation and related information
concerning the earthquake with its epicenter inthe Kumamoto region of Kumamoto prefecture.
https://www.bousai.go.jp/updates/h280414jishin/. (in Japanese). Accessed August 16, 2023.
Yoshiike N, Hayashi F, Takemi Y, Mizoguchi K,
Seino F. A new food guide in Japan: the Japanesefood guide spinning top. Nutr Rev 65: 149–154.
2007.
Ministry of the Environment Government ofJapan. A guide to initial response for generalwaste management in times of disaster.
https://www.env.go.jp/content/900535402.pdf.
(in Japanese). Accessed August 28, 2023.
World Health Organization. Solid waste
managementinemergency.
https://cdn.who.int/media/docs/defaultsource/wash-documents/who-tn-07-solid-wastemanagement-inemergencies.pdf?sfvrsn=17d5009e_4. Accessed
August 28, 2023.
Sudo N, Shindo Y, Mizuno R, Mashiro G.
Guideline for Implementing Meal Provision
BCP (Business Continuity Plan). 2023.
Kenpakusha, Tokyo. (in Japanese).
Tsuboyama-Kasaoka N, Hoshi Y, Onodera K,
Mizuno S, Sako K. What factors were importantfor dietary improvement in emergency shelters
after the great East Japan earthquake? Asia Pac J
Clin Nutr 23: 159–166. 2014.
Toland JC, Wein AM, Wu AM, Spearing LA. A
conceptual framework for estimation of initialemergency
food
and
water
resource
requirements in disasters. Int J Disaster Risk
Reduc 90: 103661. 2023.

Impact of utility damage on meals for older adults20) Kamada Y. On nutritional management at the
medical institutions in Miyagi Prefecture
affected by the great East Japan earthquake. Ann
Rep Inst Living Environ Sci 44: 13–24. (inJapanese). 2012.
21) Bales CW, Tumosa N. Minimizing the impact ofcomplex emergencies on nutrition and geriatrichealth: planning for prevention is key. In:
Handbook of Clinical Nutrition and Aging(Bales CW, Ritchie CS, eds). p 635-654. 2009.
Humana Press, Totowa.
22) Harada M, Ishikawa-Takata K, TsuboyamaKasaoka N. Analysis of necessary support in the2011 Great East Japan Earthquake disaster area.
Int J Environ Res Public Health 17: 3475. 2020.
23) Ainehvand S, Raeissi P, Ravaghi H, Maleki M.
Natural disasters and challenges towardachieving food security response in Iran. J Educ
Health Promot 8: 51. 2019.
24) Nekouie Moghadam M, Amiresmaieli M,
Hassibi M, Doostan F, Khosravi S. Toward abetter nutritional aiding in disasters: relying on
lessons learned during the bam earthquake.
Prehosp Disaster Med 32: 382–386. 2017.
25) Nozue M, Ishikawa-Takata K, Sarukura N, Sako
K, Tsuboyama-Kasaoka N. Stockpiles and foodavailability in feeding facilities after the great
East Japan earthquake. Asia Pac J Clin Nutr 23:
321–330. 2014.

26) Sudo N, Urakawa M, Tsuboyama-Kasaoka N,
Yamada K, Shimoura Y, Yoshiike N. Local
governments’disasteremergency
communication and information collection for
nutrition assistance. Int J Environ Res Public
Health 16: 4617. 2019.
27) Ministry of Agriculture, Forestry and Fisheries.
Food stockpile guideline for vulnerable people.
https://www.maff.go.jp/j/zyukyu/foodstock/guidebook.html (in Japanese). Accessed August 16,
2023.
28) Peterson LJ, Dobbs D, June J, Dosa DM, Hyer
K. ‘You just forge ahead’: the continuingchallenges of disaster preparedness and response
in long-term care. Innov Aging 5: igab038. 2021.
29) Azuma T, Saito R, Ogawa Y, Hoshino E,
Nakamura E, Suzuki H. Effects on physicalhealth of the staff of local government byengaging in the work in the disaster—From thechange of examination for medical examination
data before and after the Mid-Niigata
Earthquake. Niigata J 124: 671–680. (inJapanese). 2010.
30) Okayama Prefecture. Internetwork among meal
provision facilities.https://www.pref.okayama.
jp/page/350264.html (in Japanese). Accessed
August 28, 2023.

8

Asian Journal of Dietetics, 2024

Supplement 1: Meal served on the first day after the earthquake (April 16, 2016: Day 1) Homes A-C
BreakfastGrain-based dish
Vegetable-based disheslllFish, eggs, and meat dishes

Home B

Regular meal
Rice
Vegetable dishes
Japanese pickles

Disaster meal
Instant rice

l
l

Lunch

l

-*
l

-

Milk
FruitsOthersHome A

Miso soup
Furikake†

Vegetable-based disheslllFish, eggs, and meat dishesl
Milk
FruitsOtherslSupperGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
Fruits
Other

l
l
l

Disaster meall Breadlcanned or poucheddishes-Regular meal
Grain-based dishHome C

Vegetable juice-lDisaster meal

Strawberry
pudding
Disaster meal

Rice
Root
vegetablesalad
Yuan-style grilledfish
Agedashi tofu
Clear soup
Regular meallInstant rice
-

l
l

Rice
Potato saladlCannedorpouched disheslMapo tofu‡

Rice
Spaghetti salad
Beef miso stewl-Disaster meallInstant rice
Cannedorpouched dishes-

Disaster meal
l
l
l

Rice
Kidney beans
Cannedmackerel-* not served† Furikake: Japanese seasoning sprinkled on the rice, which is made of some mixed ingredients such as sesame
seeds, dried fish flakes, seaweed, and so on‡ Mapo tofu: Stewed tofu and minced meats seasoned with red pepper, Sichuan peppercorns, doubanjiang (chilibean paste), fermented black beans, and so on (Chinese dish)9Impact of utility damage on meals for older adults
Supplement 2: Meal served on the first day after the earthquake (April 16, 2016: Day 1) Hospitals D-F
Hospital D
Disaster meal

BreakfastGrain-based dish
Vegetable-based dishes-

Fish, eggs, and meat dishes-

Milk
FruitsOthersl

Lunch
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk

l
l
l
l
l

Fruits

l
l

2
packs
of
Pempals†
Regular meal(changed)
Rice
Salad
with
vinegar and miso
Fish-ball stew
Soy milk tofu
Milk-

OthersllGrain-based dish
Vegetable-based dishesllFish, eggs, and meat dishes
Milk
Fruits
Other

Rice
Sweet
potatosalad
Japanese pickles
Grilled fish withplum sauce
Matcha agar

Rice balls
Crab-flavoredomeletMiso soup
Furikake‡-

Disaster meal

Disaster meal

Rice balls
Broccoli saladlStewed fish

l
l

Milk
Cannedtangerine
-

-

l
l

Hospital F-*llRegular meal(changed)

SupperHospital E
Disaster meal

-

l
l

l

Regular meallll

Rice balls
Egg-bound soup
with
wheat
glutenBeef and tofu
stew-

Instant rice
Vegetable sauté

Miso soupDisaster meallllInstant rice
Dressedsalad(carrots and green
beans)
StewedGanmodoki§ andvegetable soup-l
* not served† Pempal: Oral nutritional supplement produced by Nestle.
‡ Furikake: Japanese seasoning sprinkled on the rice, which is made of some mixed ingredients such as sesame
seeds, dried fish flakes, seaweed, and so on§ Ganmodoki: A fried tofu mixed with some sliced ingredients such as vegetables (Japanese dish).

10

Asian Journal of Dietetics, 2024

Supplement 3: Meal served on the second day after the earthquake (April 17, 2016: Day 2) Homes A, C
Home A
BreakfastGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthers

l
l
l

l

Lunch
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthersSupperlllGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
FruitslllOthersll

Regular meal
Rice
Japanese pickles
Fried tofu stew
Miso soup
Regular meal
Rice balls
Stewed vegetables
Cream stew
Regular meal
Rice
Sesame-dressed salad
Fish with tomato sauce
Miso soup
JellyHome C
l
l

l
l
l

l
l
l
l
l

Disaster meal
Rice
Dried daikon strips-*
Miso soup
Furikake†
Disaster meal
Bread
Strawberries
PotageDisaster meal
Rice
Sauté
Curry
-

* not served† Furikake: Japanese seasoning sprinkled on the rice, which is made of some mixed ingredients such as sesame
seeds, dried fish flakes, seaweed, and so on

11Impact of utility damage on meals for older adults
Supplement 4: Meal served on the second day after the earthquake (April 17, 2016: Day 2) Hospitals D-F
Hospital D
Regular meal(changed)

BreakfastGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes

l

Rice

l

Tofu stewl

FurikakelllRegular meal(changed)
Rice
Stewed hijiki‡Cream stew

Milk
FruitsOthersLunch
Grain-based dish
Vegetable-based dishes

Hospital E
Combination ofregular & disasterfoods
l Ricel Grated daikonl Misomackerelstew
l Miso soupl Furikake†

Hospital F-

Disaster meal-

Vegetable-based dishes

Fish, eggs, and meat dishes

l

l
l
l

Apple jelly-

Regular meal(changed)

Combination ofregular & disaster
foods

Rice
Vegetable omelet
Cauliflower salad

-

l

l
l

l

Stew with meatstuffed inari
Pork miso soupDisaster meall

Clear soup-

Others

-

l

Milk

l

Castella manju or
Isocal jellyHC ||Rice
StewedGanmodoki§
and vegetable
Miso soupDisaster meal

Rice balls
Steamed eggplant
Pickled cucumber-

Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
Fruitslllll
FruitsOthersSnack--

SupperGrain-based dish-lFish, eggs, and meat dishes
Milk
FruitsOthers-*Rice
Stir-friedsalmon flakes
and cabbage
Chinese-style
shrimp stew-

* not served† Furikake: Japanese seasoning sprinkled on the rice, which is made of some mixed ingredients such as sesame
seeds, dried fish flakes, seaweed, and so on‡ Hijiki: One of the seaweeds which is usually used in stewed dishes§ Ganmodoki: A fried tofu mixed with some sliced ingredients such as vegetables (Japanese dish)|| Isocal jelly HC: Oral nutritional supplement produced by Nestle

12Asian Journal of Dietetics, 2024

Supplement 5: Meal served on the third day after the earthquake (April 18, 2016: Day 3) Homes A, C
BreakfastGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthers

l
l
l

l

Lunch
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthersSupperHome A

Home C

Regular meal

Regular meal

Rice
Tsukudani*
Japanese pickles-‡
Miso soup

l
l
l

l

Regular meal
l
l
l

l

Rice
Sesame-dressed salad
Chicken stew
Clear souplllRegular meal

Grain-based dish l Rice
Vegetable-based dishes l Plum vinegar-dressed saladFish, eggs, and meat dishes l Boiled fish with grated radish
Milk
FruitsOthers* Tsukudani: Shellfishes boiled in soy sauce and sugar† Hijiki: One of the seaweeds which is usually used in stewed dishes‡ not served§ Soboro: Minced and cooked fishes or meats

13

Rice
Hijiki†Japanese pickles
Miso soupDisaster meal
Mixed rice
Canned saury
Stew
Regular meal

l
l
l
l
l

Rice
Dressed salad
Stir-fried soboro§
Milk
Strawberries-Impact of utility damage on meals for older adults
Supplement 6: Meal served on the third day after the earthquake (April 18, 2016: Day 3)
Hospitals D-F
Hospital D
Breakfast

Regular meal (changed)
Grain-based dish

Vegetable-based dishes
Fish, eggs, and meat dishes

l
l

Rice
Tsukudani†lSimmered pumpkin
and deep-fried tofu-

Milk
FruitsOthersLunch
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthersSupperll

Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthersSnack
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsHospital F-llDisaster meal
Rice
Vegetable sautélMiso soup

Regular meal (changed)
Ricel Vegetable saladl Stew with dried
daikon strips
Grilled fish
Tangerine jelly
Regular meal (changed)

Grain-based dishHospital E
Combination ofregular & disasterfoods
l Rice ballsl Saladwithgrated daikonl Teriyaki‡ fishstew
l Miso soupl

Rice
Dressed daikon
Yogurt-dressed
salad
Chicken and egg
stew
-

-

Combination ofregular & disaster
foodslWakame rice

Disaster meal
l
l

Rice
Salad

l

Simmeredmackerel in miso
-

l
l

l

Babaocai§
Egg soup
Protein jelly-

Disaster meal

-

-

-

-

l
l

Others-*l

Milk
Citrusmadeleine
Protein jelly-* not served† Tsukudani: Shellfishes boiled in soy sauce and sugar‡ Teriyaki: Fishes or meats grilled or boiled with soy sauce, mirin, and sugar§ Babaocai: Thickened stew made of various foods including meat, shellfishes, vegetables, eggs and so on(Chinese dish)14

Original
A Pragmatic Approach towards Healthcare Needs in Malaysia
through Student-led Dietetics Clinic
Yang Wai Yew1, Chee Winnie Siew Swee1 *, Arasu Kanimolli1, Alphonso Augustin Ambrose Charmaine
Lavinia1, Samingan Nur Adila1, Sahathevan Sharmela1, Wong Ting Xuan1, Yap Zi Qian1, Soh Pheh Huang1
1

Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil,
Kuala Lumpur, 57000, Malaysia
ABSTRACT Background and purpose While the concept of student-led clinics is well-established,
the available evidence has been limited to multidisciplinary teams, and in North America. There is anotable gap in researching and implementing this model within dietetics, especially in resource-scarceand high disease-burden developing countries. Methods. The student-led dietetics clinic began withthe formation of a project management team, a 2-tier team in December 2022. The implementation of
SDC was carefully considered by multiple factors including operation, finance, and public outreach.
The academic team consist of faculty members providing guidance and oversight on the setting up
and operations of the clinic to meet students' learning outcomes. The students’ team planned the daily
operations of the clinic and developed resources for its operations including rotation of students on
duty to manage the clinic, and strategies to obtain referrals for the clinic. Result. The student-led
dietetics clinic presents valuable opportunities for early clinical exposure, leadership development,interprofessional skills, and practising empathy. Its accessibility to address underserved community
needs should be explored more effectively. Conclusion. Therefore, this pragmatic approach not only
benefits the student dietitians’ professional development but contributes to the overall improvementof public health through specialised dietary services.
Keywords: Community dietetics, student-led clinic, education, dietary services, Malaysia

INTRODUCTION
The rise of non-communicable diseases (NCDs) indeveloping nations (1), highlights the urgency for aparadigm shift in dietetics education to meet the
population's health needs. Integrating competencybased education can optimally train dietitians as
healthcare professionals by bridging theory andpractice while developing core clinical skills (2).
Therefore, the dietetics programmes offered byhigher education institutions must evolve to meetcontemporary healthcare demands. Malaysia, an
Asian developing country, faces a significant burdenof NCDs linked to major nutrition transitions. The
latest national health survey shows the population’shigh dependency on public healthcare (3). However,there exist opportunities to address the issue throughaccessible and affordable healthcare services. In
addition, specific health-seeking behaviours such as
the willingness to seek advice from healthcare

Professionals and paying out of pocket could be
advantageous for dietetics services offered privately.
Global shortages of clinical placement for allied
health professionals including student dietitians,
necessitate innovative solutions. The international
competency standards for dietitians stipulated theminimum competencies to be met at the point ofentry. In Malaysia, student dietitians must fulfil 1200
hours of dietetics practicum, mostly in hospitals andprimary care facilities. While the concept of a
student-led clinic is underexplored in dietetics indeveloping countries (4), a student-led dietetics clinic
emerges as a pragmatic approach to address thedemand effectively (5). The student-led clinicpresents valuable opportunities for early clinicalexposure, leadership development, interprofessional
skills, and practising empathy. Additionally, thestudent-led clinics can be more accessible andaffordable, addressing underserved community needs
more effectively---------------------------------------------------------* Correspondence author: Winnie Chee
winnie_chee@imu.edu.my

15

Student-led dietetics clinic in Malaysia
MATERIALS AND METHODS
The setting up of a student-led dietetics clinic(SDC) in a local private university began with theformation of a project management team, a 2-tier
team in December 2022 (Figure 1). The
implementation of SDC was carefully considered bymultiple factors including operation, finance, andpublic outreach. The academic team consist of faculty
members providing guidance and oversight on thesetting up and operations of the clinic to meet
students' learning outcomes. The students’ teamplanned the daily perations of the clinic anddeveloped resources for its operations including
rotation of students on duty to manage the clinic, andstrategies to obtain referrals for the clinic. The
specific activities include public announcements onsocial media, booking of appointments, managing thepatient flow, patient consent and confidentiality
process, patient documentation and collecting patient
feedback on the services provided.

Project teamAdvisory committee

Project Owner

Project Manager

Operations
Coordinator(Dietetics Practicum)

Public Outreach /Community
RelationsOperations
Coordinator(Project andResources)

Public Outreach /Community
RelationsOperations
Coordinator(Project andResources)

Finance

Student project teamOperations
Coordinator(Dietetics Practicum)

Figure 1: Student-led dietetics clinic project management team

16

FinanceAsian Journal of Dietetics, 2024
RESULTS
Launched in August 2023, the SDC served as a freeclinic and a clinical training site for the final-year
dietetics programme, supervised by clinicaleducators. The Nutrition Care Process was fully
implemented in managing patients supported bymulti-frequency body impedance analysis (Figure 3),anthropometry kits, real food models, and householdmeasurement tools. Physical copies of patient
documentation using ADIME, and medical
documents were stored confidentially. Since its
inception, a total of 138 patients received individual
consultations (Figure 2), and 90 individuals haveundergone nutrition screening which mainly consistsof students and working professionals in theuniversity. The student dietitians were able to provide
medical nutrition therapy primarily for obesity,
diabetes, and hyperlipidaemia. All patients seen
expressed their satisfaction with the services provided
including the quality of nutrition care provided
especially on personalised advice and new
information acquired, activities conducted, ease of
making appointments, minimal waiting times, andoverall benefits.
Figure 3: Body composition analysis using a multifrequency body impedance analyser

The activities created the learning opportunity to
conduct nutrition screening, manage adult-related
NCDs through individual diet consultation, andimplement a thematic-based group education project(Figure 4 and Figure 5) for the community in the formof live talks, webinars, or recorded videos (Figure 6
and Figure 7). The free dietetics services by SDC
were promoted to increase public awareness throughparticipation in health events and fairs (Figure 8).

Figure 2: Individual diet consultation by a student
dietitian as part of their daily activities

17

Student-led dietetics clinic in Malaysia

Figure 5: Healthy meal preparation workshop during aweight management campaign

Figure 4: Group education session on malnutrition among
the elderly conducted by student dietitians

Figure 6: Educational videos on various nutrition-related topics for different target populations

Figure 7: Live webinars to educate on medical
nutrition therapy for non-communicable diseases

Figure 8: Name

18

Asian Journal of Dietetics, 2024
DISCUSSIONACKNOWLEDGEMENT

A key advantage of SDC is the student-led approach
while maintaining skills development throughcontinuous feedback and guidance from theregistered dietitians to the student dietitians. The
student board plays a pivotal role in overseeing allclinic aspects, including delivering diet consultations,programme development, and daily operations
management. This structure fosters transparency andallows younger students to volunteer and participate
in clinic activities, gaining valuable insights into
clinical settings. The hands-on experience not only
allows all stakeholders to be involved inmanagement, planning, and implementation but also
provides beneficial exposure into the diverse andevolving needs of patients.

We thanked the student committees from twocohorts (DN119 and DN120) who took charge of
operations coordination in dietetic practicum, public
outreach and community relations, operations
coordination in project and resources, and finance.
We would also like to thank the International Medical
University for their support in the establishment of
the student-led clinic in the setting.

REFERENCES
1.

For student dietitians, the advantages of the SDC are
multifaceted. Firstly, it offers a unique opportunity toapply and refine the skills acquired during their final
year academic journey, providing practicalexperiences to work with real patients in an authentic
clinical environment. Secondly, it provides a platform
to develop effective communication strategies,
fostering connections with patients from diverse
backgrounds and age groups. Thirdly, students will
receive invaluable feedback from supervisingprofessionals, enhancing their documentation,practical skills, and decision-making abilities. This
mentorship is recognized as a critical component in
the dietetics workforce preparation and at the earlystages of one's professional career (6). In addition, theSDC plays a pivotal role in nurturing professionalism
and altruism, contributing to their growth ascompassionate healthcare practitioners.

2.

3.

4.

In conclusion, the SDC has the potential to address
the gap in dietetics training in Malaysia by providing
timely and cost-free dietetics services. Establishing
the SDC elevated the experience of dietetics students
by offering a unique platform to foster
entrepreneurship, leadership, teamwork and problemsolving
skillsbesidesenhancingclinicalcompetencies and improving client interactions.
These are real-world experiences to prepare workready graduates for the country in combating NCDs.
Ensuring the sustainability of SDC requires securing
funding, expanding partnerships, integrating it into
healthcare systems, and leveraging telehealthopportunities.

5.

6.

19

Mozaffarian D, Rosenberg I, Uauy R. History ofmodern nutrition science-implications for
current research, dietary guidelines, and foodpolicy.
BMJ.
2018;361:1–6.
https://doi.10.1136/bmj.k2392
Imanipour M, Ebadi A, Monadi Ziarat H,
Mohammadi MM. The effect of competencybased education on clinical performance of
health care providers: A systematic review andmeta-analysis. Int J Nurs Pract. 2021;28(1):1–
18. https://doi.org/10.1111/ijn.13003
Institute for Health Systems Research (IHSR),
National Institute of Health, Ministry of Health
Malaysia. 2020. National Health and Morbidity
Survey (NHMS) 2019: Vol. II: Healthcare
Demand.
Wilson OW, Broman P, Tokolahi E, Andersen
P, Brownie S. Learning Outcomes from
Participation in Student-Run Health Clinics: A
Systematic Review. J Multidiscip Healthc.
2023;16:143–57.
https://doi.org/10.2147/JMDH.S385709
Taylor C, Angel L, Nyanga L, Dickson C. The
process and challenges of obtaining andsustaining clinical placements for nursing andallied health students. J Clin Nurs. 2017;26(19–20):3099–110.
https://doi.org/10.1111/jocn.13658
Morgan K, Kelly JT, Campbell KL, Hughes R,
Reidlinger DP. Dietetics workforce preparationand preparedness in Australia: a systematic
mapping review to inform future dietetics
education research. Nutrition & Dietetics.
2019;76(1):47-56.
https://doi.org/10.1111/1747-0080.1245

Asian Journal of Dietetics, 2024

Original
Replacement of Sea Salt with Aizuyamajio may Reduce Salt Consumption in Japan
Shin Yamaoka1, *1

Department of Food and Nutrition, Junior College Division, University of Aizu, Fukushima Japan
ABSTRACT Background and purpose. Excessive salt intake is a global health concern. In the
Aizu region of Fukushima Prefecture in Japan, Aizuyamajio is made from hot spring water andhas a lower salt content than sea salt. In this study conducted a sensory evaluation of
Aizuyamajio and sea salt, and compared the differences. Methods. Fourteen students fromdifferent prefectures consented to participate in this study. For the sensory evaluation method,
participants rated sea salt and Aizuyamajio on their sweetness, saltiness, bitterness, sourness,and umami which were further evaluated using the four-point method. Additionally,
respondents freely answered questions regarding the use of Aizuyamajio for cooking. Results.
On comparing the sweet, salty, bitter, sour, and umami tastes between Aizuyamajio and sea
salt, a significant difference was noted in the saltiness, however, no other significant
differences were observed. Thirty-five methods have been suggested for using Aizuyamajio
for cooking. Conclusion. The results of this study suggest that sea salt and Aizuyamajio havedifferent tastes and lower salt equivalents. Furthermore, Aizuyamajio has a different taste fromsea salt and may be used as a low-salt seasoning.
Keywords: Aizuyamajio, sea salt, low-salt, salty, tastes

INTRODUCTION
Excessive salt intake is associated with lifestylerelated diseases, such as hypertension (1).
Hypertension, in turn, is associated withcerebrovascular diseases including arteriosclerosis(1). World Health Organization (2) recommends a
sodium intake of less than 2000 mg/day (equivalent toless than 5 g/day of salt) for adults to maintain good
health. However, the global average sodium intake for
adults is reported to be 4310 mg/day (equivalent to10.78 g/day of salt) (3).
In Japan, Dietary Reference Intakes for Japanese(2020) has set the daily salt intake for men and women(for those 18 years of age or older) at less than 7.5 g
and less than 6.5 g, respectively (4). However,according to the 2019 Japanese National Health andNutrition Survey, the average salt intake was 10.1g
and 9.3 g for men and women, respectively (5). Hence,
efforts to reduce salt consumption are required, which
may serve as a role model and contribute significantly
to improving health worldwide.
When the body ingests excessive amounts of salt,
it increases the salt concentration in the plasma
volume, resulting in an increase in water content in the
blood and a subsequent increase in plasma volume (6).
As a result, contribute to the cause of hypertension
develops when the pressure on the plasma volume
vessels increases to circulate more plasma (6).
In Japan, sea salt is commonly consumed and ismainly prepared from seawater. There is salt madefrom hot spring water in the Aizu region of Fukushima
Prefecture (7). That salt termed Aizuyamajio (7). The
Aizuyamajio content in hot spring water in the Aizu
region is 16.5 g/L, lower than the 23 g/L of seawater,
the source of sea salt (7). The nutritional value of sea
salt (A co. anonymised for commercial purposes) per
100 g is 0 kcal of energy, 0 g of protein, 0 g of fat, 0 gof carbohydrates, 95.0 g of salt equivalent, 350
mg of potassium, 200 mg of calcium, and 570 mg ofmagnesium. The nutritional value of Aizuyamajio per
100 g is 0 kcal of energy, 0 g of protein, 0 g of fat, 0 gof carbohydrates, 77.8 g of salt equivalent, 400 mg ofpotassium, 2200 mg of calcium, and 400 mg ofmagnesium. Therefore, Aizuyamajio has less saltcontent compared to sea salt of the same amount.
Using Aizuyamajio instead of sea salt as a seasoning
may help reduce excessive salt intake. However, very
few studies have between Aizuyamajio and sea salt
and their preparation methods. In this study conducteda sensory evaluation of Aizuyamajio and sea salt,
compared differences in taste, and examined cooking
methods using Aizuyamajio to improve the use of
Aizuyamajio in cooking.
MATERIALS AND METHODS
Participants and methods
All study participants provided informed consent,
and this study was approved by the University of Aizu
Research Ethics Committee (2023 University of Aizu
Plan No. 77). In this study verbally explained to theparticipants that their privacy would be protected andthat there would be no disadvantages based on whether
they responded. Also, participants were given an
explanation of the study design and aim of theexperiment. Those subject to ethical considerations
were informed and consented to participate by signinga consent form. A prepaid card worth 1,500 JPY(approximately $9.9) was provided to the respondents
after survey completion as compensation for theirtime. Those who were unwell were excluded from thestudy participant. This study was conducted on 14
students from A junior college in A prefecture who
consented to be the research participants of this study.
The study was performed in only one day. Study
participants conducted a sensory evaluation of
Aizuyamajio and cooking methods by eating
Aizuyamajio.
The sensory evaluation method was as follows.
First, 1 cup (approximately 0.1 g) of sea salt (A co.

*To whom correspondence should be addressed:
s_yama@jc.u-aizu.ac.jp

21

Aizuyamajio may reduce salt consumption
anonymised for commercial purposes) was placed ona cocktail steer (Muddler Spoon Ivory 100 Pieces
Artnap). Participants drank one glass of water to get
rid of the sea salt left in them mouth. Subsequently,
they consumed one cup (approximately 0.1 g) of
Aizuyamajio (Purchased from: AizuYamajio Kigyo
Kumiai, All Rights Reserved Aizu Yamajio Kigyo
Kumiai) different from the one that they had
consumed earlier. Then filled out a self-administeredquestionnaire (Questionnaire) about the five tastes ofsweetness, saltiness, bitterness, sourness, and umami
as well as how to use Aizuyamajio. The study design

is shown in Fig 1. The sweet, salty, bitter, sour, andumami tastes of Aizuyamajio and sea salts were
evaluated using the four-point scale, and theappropriate answers were marked with a circle.
Statistical analyses
The Student's t-test was performed on the results
using Excel statistical software to compare
Aizuyamajio and sea salt. In all cases, a p-value of<0.05 was considered statistically significant.
Additionally, respondents were free to answer
questions regarding the use of Aizuyamajio for
cooking.

Fig 1. Study design
Questionnaire: Sex
AgePlease circle the one you think is most appropriate for each category of sea salt and Aizuyamajio.
Sea salt
Aizuyamajio
Sweetness
Sweet・Somewhat sweet ・Sweet・Somewhat sweet ・Somewhat not sweet・Not sweet
Somewhat not sweet・Not sweet
Salty
Salty・Somewhat salty・Salty・Somewhat salty・
Somewhat not salty・Not salty
Somewhat not salty・Not salty
BitterBitter・Somewhat bitter・Bitter・Somewhat bitter・taste
Somewhat not bitter・Not bitter
Somewhat not bitter・Not bitter
Acidity
Sour・Somewhat sour・
Sour・Somewhat sour・Somewhat not sour・Not sour
Somewhat not sour・Not sourUmami
Has umami・Somewhat umami・Has umami・Somewhat umami・Somewhat no umami・No umami
Somewhat no umami・No umami*If you use Aizuyamajio, please describe what kind of dishes you would use it for.
RESULTSAll the 14 participants were females aged
19.07±1.64 years (mean±SD). The results ofcomparing Aizuyamajio and sea salt in sweetness,saltiness, bitterness, sourness, and umami arepresented in Table 1. A significant difference wasobserved in the ‘saltiness’ of the taste, however, noother significant differences were noted.
Thirty-five methods have been proposed for theuse of Aizuyamajio in cooking which are listed inTable 2. As a result, dishes that are used with sea salt
in Japan were proposed.

Table 1 Comparison of the taste of sea salt and Aizuyamajio (same respondents, n=14)＊
There is a significant difference between sea salt and Aizuyamajio (p<0.05).

Sweetness
Salty
Bittertaste
Acidity
Umami

Sweet
0
Salty
9
Bitter
0
Sour
1
Has
umami
1

Sea salt
Number of respondents n=14
Somewhat
Somewhat not
sweet
sweet
4
2
Somewhat
Somewhat not
salty
salty
5
0
Somewhat
Somewhat not
bitterbitter4
0
Somewhat
Somewhat Not
sour
sour
5
1
Somewhat
Somewhat no
umami
umami
9
0

p-value
Not
Sweet
sweet
8
0.15
2
Not
Salty
salty
0
<0.01＊ 1
Not
Bitterbitter
10
0.15
3
Not
Sour
sour
7
0.24
0
No
Has
umami
umami
4
0.18
4

Table 2 Suggestion on how to cook Aizuyamajio

22

Aizuyamajio
Number of respondents n=14
Somewhat
Somewhat not
sweet
sweet
4
4
Somewhat
Somewhat not
salty
salty
9
2
Somewhat
Somewhat not
bitterbitter3
2
Somewhat Somewhat Not
sour
sour
3
1
Somewhat
Somewhat no
umami
umami
7
2

Not
sweet
4
Not
salty
2
Not
bitter
6
Not
sour
10
No
umami
1

Asian Journal of Dietetics, 2024

Suggested dishes
Ramen
Salt rice ballNigiri meshi
Salt soft serve ice cream
Sweets (Ice cream, etc.)
Ice cream
Salted chocolate pie
Daifuku (Japanese sweets)
Clear soup
Soup
Miso soup
Put on tempura
Sprinkle over tempura
TempuraSprinkle on grilled foods (such as shiitake mushrooms)
Grilled fish
Fish (cooked with plenty of salt)
Salt-grilled fish
Yakitori salty
SashimiFried vegetables
Cucumber
PicklesAjilloBoiledBoiled dishes
Japanese food
Chinese cuisine
The true taste of Aizuyamajio
Put on meat
Tamagoyaki
Egg dishes
Unless the answers were identical, they were written exactly as they were.
DISCUSSION AND CONCLUSION
In this study observed that the salty taste wasperceived to be significantly different among thesurvey participants at Junior College A in Prefecture
A on sensory evaluation of Aizuyamajio and sea salt,
and usage of Aizuyamajio in cooking. Additionally,
many foods that use sea salt are listed and can besubstituted with Aizuyamajio for cooking purposes.
The difference in the amount of salt equivalents is
considered to be the main reason for the differencein saltiness. The salt equivalent amount of
Aizuyamajio used in this study was 77.8 g per 100 g,
while that of sea salt was 95.0 g per 100 g. As aresult, the ratio of salt equivalent to Aizuyamajio/sea
salt was 18% lower at 77.8/95.0; therefore, many
participants felt that Aizuyamajio was saltier,whereas others felt that Aizuyamajio was less saltierthan sea salt.
For example, in a previous study, sensory tests
showed that healthy tasters, who were young
Japanese women in their late teens and 20s, wereunable to distinguish between salty tastes (sodium
chloride concentrations of 0.3%, 1.25%, 5%, 10%,and 20%). Therefore, a difference in the salt
equivalent amounting to 18% in this study wasrecognized (8). These results suggest that on
consuming an identical amount of Aizuyamajio as
sea salt, one may find it less salty.

Number of responses
3
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

Based on the results of the sensory evaluations
other than salty taste, there were no significant
differences; however, the results for sweetness,
bitterness, sourness, and umami, and taste perception
differed. This is attributed to the fact that the amountof mineral components is generally different in
Aizuyamajio than in sea salt. For example, studies
involving mineral water revealed that taste
sensations differed depending on the mineral (9).
Therefore, although there was no significant
difference between the Aizuyamajio and sea salt, theresults were not the same.
Many dishes that use sea salt as a seasoning or
dishes that are already made using Aizuyamajio havebeen cited (10,11). Regarding cooking methods for
Aizuyamajio, most of the foods mentioned include
those that use sea salt as a seasoning in Japan or thosethat are already prepared using Aizuyamajio. For
example, sea salt is used in Japanese food culture(12,13). Furthermore, sea salt is used in products
including ice cream. Aizuyamajio is used in cheese,rice balls, and ice cream, and has already beencommercialised. Similar foods were proposed in thisstudy, suggesting the possibility of using
Aizuyamajio in foods that already use sea salt.
The limitation of this study is that, although
Aizuyamajio use is popular in one region of Japan, it
is unclear whether they are widespread throughout

23

Aizuyamajio may reduce salt consumption
Japan. Additionally, the number of participants was
small and the results were limited to one area. If salt
is reduced by using Aizuyamajio, there is no known
data regarding its effect on the blood pressure ofindividuals, creating a need for further investigationof the effects of intake of Aizuyamajio.
In Japan, efforts are being made to reduce saltcontent by adding glutamic acid, monosodium
glutamate, calcium diglutamate, inosinic acid, andguanylic acid to umami substances which has beencommercialised (14). The equivalent amount of saltin Aizuyamajio is low, and it is thought that wild saltwith a different flavour may be added to the low-saltseasonings used in Japan and used as low-salt foods.
However, though Aizuyamajio consumption ispractised, is not with the intent of salt reduction.
Patients with mild essential hypertension had lower
blood pressure when they changed their diet from sea
salt to mineral-rich salt (15). Therefore, Aizuyamajio
may have the potential to improve hypertension.
Furthermore, Aizuyamajio may also be possible touse it as a low-salt food with a different taste thansea salt.
In conclusion, the results of this study revealed
that Aizuyamajio can be used as a low-salt food witha different taste from sea salt.

5) Ministry of Health, Labour and Welfare. 2019Japanese National Health and Nutrition Survey.
2019.
https://www.mhlw.go.jp/content/10900000/000
687163.pdf (Accessed date: October 14, 20 22)
6) Pavlov TS, and Staruschenko A. Involvement of
ENaC in the development of salt-sensitive
hypertension. Am J Physiol Renal Physiol
313(2): F135-F140. 2017.
7) AizuYamajio Kigyo Kumiai, All Rights
Reserved Aizu Yamajio Kigyo Kumiai.
AizuYamajio
Top.
2021.
https://aizuyamajio.com (Accessed date: October 1, 2023)
8) Okayama T, and Watanabe H. Association
between taste perception, nutrient intake, andmental health in young Japanese women. Nutr
Res Pract 13(1): 41-46. 2019.
9) Honig V, Procházka P, Obergruber M, et al.
Nutrient Effect on the Taste of Mineral Waters:
Evidence from Europe. Foods 9(12): 1875.
2020.
10) AizuYamajio Kigyo Kumiai, All Rights
Reserved Aizu Yamajio Kigyo Kumiai.
Aizuyamajio shop-list. 2023. https://aizuyamajio.com/shop-list (Accessed date: October
14, 2023)
11) Imamoto M, Takada T, Sasaki S, et al. Salt
intake per dish in the Japanese diet: a clue tohelp establish dietary goals at home. J Nutr Sci
10: e107. 2021.
12) Matsuzono K, Mieno M, and Fujimoto S.
Ramen restaurant prevalence is associated withstroke mortality in Japan: an ecological study.
Nutr J 18(1): 53. 2019.
13) Hasegawa T, and Sakai N Comparing mealsatisfaction based on different types oftableware: an experimental study of japanesecuisine culture. Foods. 10(7):1546. 2021.
14) Tanaka S, Yoneoka D, Ishizuka A, et al.
Modelling of salt intake reduction byincorporation of umami substances into
Japanese foods: a cross-sectional study. BMC
Public Health 23(1): 516. 2023
15) Kawasaki T, Itoh K, and Kawasaki M.
Reduction in blood pressure with a sodiumreduced, potassium- and magnesium-enriched
mineral salt in subjects with mild essential
hypertension. Hypertens Res 21(4): 235-243.
1998.

ACKNOWLEDGMENTS
Author would like to thank the research
participants. This study was supported by an internal
competitive research funding from the University of
Aizu. The author declared no conflicts of interest.
REFERENCES
1) He FJ, Tan M, Ma Y, et al. Salt Reduction toPrevent Hypertension and Cardiovascular
Disease: JACC State-of-the-Art Review. J Am
Coll Cardiol 75(6): 632-647. 2020.
2) World Health Organization. Sodium reduction.
2022.
https://www.who.int/news-room/factsheets/detail/salt-reduction (Accessed date:
October 14, 2023)
3) Noncommunicable Diseases Data Portal.
Geneva: World Health Organization; 2022.
2022. https://ncdportal.org (Accessed date:
October 14, 2023)
4) Ministry of Health, Labour and Welfare.
Dietary Reference Intakes for Japanese (2020).
2019.
https://www.mhlw.go.jp/content/10904750/000
586553.pdf (Accessed date: October 14, 2022)

24

Asian Journal of Dietetics, 2024

Original
A Comparison of Physical Activity Among 10-year-old Children
Between Suburban Vietnam and Japan
Sumiko Kamoshita1, Phuong Mai Nguyen1*, Hitomi Takeichi2, Shigeru Yamamoto1
1

Nutrition and Food Culture Research Center, Jumonji University, Saitama, Japan
2
Faculty of Home Economics, Kobe Women’s University, Hyogo, Japan
ABSTRACT Background: The prevalence of overweight and obesity among Vietnamesechildren is increasing. Meanwhile, Japan is one of the few developed countries with the lowest
prevalence of childhood obesity in the world. The Japanese government has many policies toencourage children to be more active. Therefore, Japanese children had higher levels ofphysical activity compared to other countries. Purpose Evaluation and comparison of physicalactivity of Vietnamese and Japanese children. Methods: The 7-day and 3-day minute-byminute activity records were used to assess the physical activity of children aged 10 years old
in Hanoi suburban (Vietnam) and Tokyo suburban (Japan), respectively. Results: The physicalactivity level (PAL) was higher for Japanese children (1.54) than for Vietnamese children(1.42) (p<0.001). Time spent in moderate to vigorous physical activity in Japanese children
was about 2 times longer than for Vietnamese children (p<0.001). Conclusion: Japanesechildren had higher levels of physical activity than Vietnamese children. The Government ofVietnam needs to have appropriate policies to increase the level of physical activity ofVietnamese children in order to prevent and solve the problem of obesity.
Keywords: physical activity, children, suburban, Vietnam, JapanINTRODUCTION
In recent years, the increase in childhood obesity
has been remarkable in Vietnam. According to theresults of the National Nutrition Survey, Vietnam, inthe decade from 2010 to 2020, the prevalence ofoverweight and obesity among 5-19 year olds almost
doubled from 15.4% to 26.8% in urban areas and from
8.5% to 19% in rural areas (1). Meanwhile, theprevalence of overweight and obesity in Japanesechildren was about 11%, one of the lowest in thedeveloped countries (2). Therefore, many countries
have taken Japan as a model to compare and findsolutions to overcome overweight and obesity.
The low prevalence of obesity in Japan can be
explained through healthy lifestyle habits that theJapanese population have continued over time (3). The
Japan Sports Association published a guideline
entitled “Active Child 60 min” (4). The main target
were pre-school and primary school children (JapanSports Association 2010). Moreover, Japan has highrates (98.3%) of active transport to school amongchildren in public school compared with other similarincome countries (5). Japan has a highly established“walking to school practice” (5).
Meanwhile, in Vietnam, the sedentary lifestyle isincreasing in children (6). In addition, at present, mostof the studies focus on over intake, but not manystudies focus on assessing the physical activity ofchildren. Therefore, this study was conducted with theaim of assessing and comparing the physical activityof Vietnamese and Japanese children.

MATERIALS AND METHODS
Participants
A total of 134 children (73 boys and 61 girls) aged
10 years old at a public primary school in suburban
Hanoi participated in this study. The school was
selected by convenience sampling. All data werecollected in October of 2020. Informed consent was
obtained from the children, their guardians andteachers according to the Declaration of Helsinki, andthe study protocol was approved by the Biomedical
Research Ethics Committee of Hanoi Medical
University (no. 355/HMUIRB).
A total of 78 children (35 boys and 43 girls) aged
10 years old at an elementary school in Tokyo
suburban participated in this study. All data werecollected in November of 2022. Informed consent was
obtained from the children, their guardians andteachers according to the Declaration of Helsinki.
Physical activity assessments
The 7-day and 3-day minute-by-minute activity
records were used in suburban Hanoi and Tokyo,
respectively to assess the physical activity level. The
activity record form is designed based on the templatedeveloped by Koebnick et.al. The same recording
form was used in both the Vietnam and Japan surveys.
Numbers 1 to 24 contain general activities, but
activities that do not fit into these categories are
written in numbers 25 to 28. The "Other'' columns
prevent bias due to the recording form. Children were
instructed to record the activity by number shown inrecording form and mark the start and end times foreach activity (Fig 1). The recording method was
explained to teachers, children and their guardianswith an example of a completed physical activity
form. We asked teachers and guardians to help thechildren to complete the activity record. Whencollecting the activity record form, we interviewed
children to improve the accuracy of the activity record*To whom correspondence should be addressed:
nguyenmaiphuong2102@gmail.com

25

Physical Activity of Vietnamese and Japanese Children
by adding and correcting the content regarding
omissions and unclear points.
Statistical analysis
The physical activity level (PAL) was calculated
based on the following formula:
PAL = ∑24h｛MET value of physical activity xtime (min)｝/1440 (minutes of 24 hours)
In which the MET value of physical activity wasreferenced from the compendium of physical activities
of Ainsworth et al (7).
The time spent in each physical acitivity intensity
each day was calculated using METs for eachparticipant: average minutes spent in sedentary andlight physical activity (METs< 3), moderate tovigorous physical activity (METs ≥3.0) (8), (9).
All statistical analyses were performed using
SPSS software (version 26; IBM Corporation,
Armonk, New York). The data were expressed as
mean±SD or %. The study analyses involved
comparisons between Tokyo suburban and Hanoi
suburban. Differences between groups were assessedusing independent t-tests and dependent t-tests forcontinuous data and chi-squared tests for categorical
data. P values less than 0.05 were defined as astatistical difference.

Fig 1. Physical activity recording form
RESULTS
Figure 2 shows the comparison of PAL between
Vietnamese and Japanese girls. In total, the PAL ofgirls in Tokyo suburban was significantly higher thanthose of Hanoi suburban at 1.45±0.10 and 1.40±0.12(p<0.05), respectively. The PAL of girls on weekdays
and weekends in Tokyo suburban was significantly
higher than those of Hanoi suburban were 1.45±0.11
vs 1.41±0.09 (p<0.05) and 1.46±0.18 vs 1.38 ±0.15(p<0.05), respectively. In overall, there was no
significant differences between PAL on weekdays andweekends in both Tokyo and Hanoi suburban(p>0.05).
Figure 3 shows the comparison of PAL between
Vietnamese and Japanese boys. In total, the PAL ofboys in Tokyo suburban was significantly higher thanthose of Hanoi suburban at 1.69±0.15 and 1.45±0.13,
respectively (p<0.001). The PAL of boys on weekdays
and weekends in Tokyo suburban was significantly
higher than those of Hanoi suburban were 1.67±0.14
vs 1.47±0.14 (p<0.001) and 1.74±0.29 vs 1.41±0.23(p<0.001), respectively. In overall, there was no
significant differences between PAL on weekdays andweekends in both Tokyo and Hanoi suburban(p>0.05).

Figure 4 shows the comparison of time spent on
moderate and vigorous physical activity between
Vietnamese and Japanese girls. In total, time spent formoderate to vigorous physical activity of girls inTokyo suburban was significantly higher than those of
Hanoi suburban at 153±59 and 85±37 min/d(p<0.001), respectively. Average time spent on
moderate to vigorous physical activity of girls on
weekdays and weekends in Tokyo suburban was
significantly higher than those of Hanoi suburban
were 145±62 vs 80±46 min/d (p<0.001) and 171±103
vs 95±62 min/d (p<0.001), respectively. In overall,there was no significant differences between averagetime spent on moderate to vigorous physical activity
on weekdays and weekends in both Tokyo and Hanoi
suburban (p>0.05).
Figure 5 shows the comparison of time spent on
moderate and vigorous physical activity between
Vietnamese and Japanese boys. In total, time spent formoderate to vigorous physical activity of boys inTokyo suburban was significantly higher than those of
Hanoi suburban at 175±93 and 97±43 min/d(p<0.001), respectively. Average time spent on
moderate to vigorous physical activity of boys on
weekdays and weekends in Tokyo suburban was26

Asian Journal of Dietetics, 2024
significantly higher than those of Hanoi suburban
were 157±74 vs 99±45 min/d (p<0.001) and 212±192
vs 92±67 min/d (p<0.001), respectively. In overall,there was no significant differences in average timespent on moderate to vigorous physical activity
between weekdays and weekends in both Hanoi andTokyo suburban (p>0.05)

Figure 2. Comparison of PAL between
Vietnamese (n=61) and Japanese girls (n=43)

Figure 3. Comparison of PAL between Vietnamese(n=73) and Japanese boys (n=35)

Figure 4. Comparison of time spent on moderate tovigorous physical activity between Vietnamese(n=61) and Japanese girls (n=43)

Figure 5. Comparison of time spent on moderate andvigorous physical activity between Vietnamese(n=73) and Japanese boys (n=35)

All values are mean±SD.
P-values were computed using an independent t-test between groups and a dependent t-test within group.
NS: non-significant differences and ***: significant differences at p<0.001.
PAL was calculated by ∑24h｛MET value of physical activity x time (min)｝/1440 min. It is the same as theaverage METs.
Table 1 compares some factors of physicalactivity in children aged 10 years old between Hanoi

suburban and Tokyo suburban. The sleeping time ofgirls and boys in Hanoi suburban was significantly

27

Physical Activity of Vietnamese and Japanese Children
longer than that in Tokyo suburban, with a differenceof 67 minutes and 39 minutes, respectively(p<0.001). Time spent for moderate to vigorous
physical activity of girls and boys in Tokyo suburban
was significantly higher than those of Hanoi
suburban at 153±59 vs 85±37 min/d (p<0.001) and

175±93 vs 97±43 min/d (p<0.001), respectively.
100% of children in the Tokyo suburban walked toschool while about 50% of children in the Hanoi
suburban walked or biked to school. The commutetime from school for children in Tokyo was about 3
times longer than that of Hanoi suburban (p<0.001).

Table 1 Comparison of some factors of physical activity in children aged 10 years old between Hanoi suburban(N=134) and Tokyo suburban (N=78) by gender
Girls
Boys
Hanoi
(n=61)
621±38Tokyo(n=43)
554±37p-value†Hanoi(n=73)
611±49Tokyo(n=35)
572±56p-value†Sleeping time (min/d)<0.001<0.001Moderate to vigorous
85±37
153±59<0.00197±43
175±93<0.001
physical activity (min/d)No. of children walking or
50.8
100<0.00152.1
100<0.001
biking to school (%)
Time of walking or biking
7±9
26±11
<0.0017±8
24±9<0.001to school (min/d)
Values are mean±SD and %.
†Independent t-test except Chi-squared test for walking or biking to school (%). Significant difference: p<0.05.
DISCUSSION
The purposes of the present study was to assessand compare the physical activiy in Vietnamese andJapanese children. The physical activity level inJapanese children was higher than that of Vietnames
children. The sleep time of Vietnamese children islonger than that of Japanese children. 100% ofJapanese children walked to school that was 2 times
higher than Vietnamese children. In particular, thetime spent on moderate and vigorous physicalactivities of Japanese children was about 2 times
higher than that of Vietnamese children.
The research period for this study was 7 days in
Vietnam and 3 days in Japan. In terms of physicalactivity assessment, previous research has shownthat with the minute-by-minute activity record
method, the 7-day study period gives reliable results(10). However, in Japan, the Japanese Ministry of
Education applied the physical activity record
method for three non-consecutive days (11).
Therefore, most of the studies on physical activity ofJapanese children were conducted over a nonconsecutive 3-day period and were found to bereliable. In other words, the difference in study
period does not affect the results of this study. The
two studies in Vietnam and Japan were all conductedaround October-November of the year and insuburban area to reduce spatial and temporal errors.
This allowed us to rule out differences in exercisethat might be caused by season.
Regarding physical activity, the present study
indicates that the level of physical activity of Tokyo
children is higher than that of Hanoi children of both
sexes, with a big difference especially among boys.
The sleep duration of Japanese children was about
554 min/d in girls and about 572 min/d in boys.
Sleeping time of girls and boys in Tokyo suburban
were significantly shorter than those of Hanoi
suburban at 67 and 39 min, respectively. Thisdifference may be due to the nap habits ofVietnamese. In Vietnam, after lunch, children haveabout 45-60 minutes to take a nap before theafternoon class starts. In the present study, 100% ofchildren in Tokyo suburban walked to school while
the percentage of children in Hanoi suburban walked
or cycled to school only about 50%. A crosssectional study in 2020 reported that 53% of school
children (aged 5-15 years) used active transport toand from school in Hanoi city (12). Promotion ofactive school travel (e.g., walking and cycling
to/from school) may be a way to improve children’s
health due to its association with levels of physicalactivity (13). In Japan, more than 90% of children
travel to school on foot, which may partly contributeto the relatively low prevalence of childhood obesityand being overweight (14). According to the 2018
Report Cards on Physical Activity for Children andYouth from 49 countries (also known as the Global
Matrix 3.0) (15), Japan was highly rated as “A-” (i.e.,
80–86% prevalence) for active transportation (16).
Previous research has shown that active school travel
was positively associated with neighborhood
physical and social environments, safety,
walkability, and neighborhood social interactions,and negatively associated with travel distance andcar ownership (17), (18). In particular, safety has
been identified as the core concept of school travel
policies (19), (20), most studies have focused on
traffic safety (21), (22). In the present study, theaverage time children walked to school about 30
minutes was an appropriate time because normally,
the walking distance to school ranges between 2 and4 kilometers for elementary school (3). In Vietnam,
to increase the rate of children walking to school, it
is necessary to improve the level of traffic safety as
well as social security.
The difference in physical activity levels
between children in Tokyo and Hanoi is mainly due
to the difference in time spent on moderate tovigorous physical activities. A survey conducted in
2021 in Japan revealed that almost 55% of girls andclose to 62% of boys aged between 4 and 11 years
28Asian Journal of Dietetics, 2024
participated in sports teams and clubs (23). Besides
sports clubs, schools often also offer clubs for
cultural activities, such as playing music instruments(23). In Vietnam, percentage of students who were
physically active for a total of at least 60 minutes per
day on all seven days during the past seven days was
13.6% (6). Additionally, for female students aged
10-11 years old showed that in 2012 only 11.9% of
the grade 5 students in Ho Chi Minh City
participated in active play after school (6). Timespent for moderate to vigorous physical activity ofgirls and boys in Tokyo suburban was significantly
higher than those of Hanoi suburban at 68 min/d and78 min/d, respectively. Consistently, the previous
studies indicated that more than half of the children
participated in organized sports for at least 60
minutes per day (4).
The evidence suggests that Vietnamese children
had low levels of physical activity. Physical activity
initiatives in Vietnamese children are largely
focused on enhancing physical education in schools(24). Public health policy initiatives should focus
more on community-based programs and promoting
physical activity environments for children outsideschool settings (6). As recommended by the WHO
ACTIVE toolkit, countries should focus on four
policy action areas: changing the population's
perception of the importance of physical activity;
providing safe and well-maintained facilities andgreen areas for physical activity; encouraging peopleof all age groups to engage in regular physicalactivity, and to build a strong leadership andgovernance system to support successful policy
implementation (6).
The present study has several limitations tonote. In terms of physical activity, the present study
was conducted in suburban areas of two big cities inVietnam and Japan at the same time of year.
However, the effects of the covid-19 pandemic may
affect children's physical activity in both countries.
A study to be conducted after the covid-19 pandemic
is needed. In addition, the cross-sectional designused in the present study could not determine
causality. Therefore, cohort studies should be
conducted among Vietnamese and Japanese children
in the future.

2)

3)
4)
5)
6)

7)

8)

9)

10)

11)

12)
13)

ACKNOWLEDGMENTS
The authors are grateful to the all participants
for their cooperation and the staffs of Asian
Nutrition and Food Culture Research Center for theirassistance. We would like to thank Andrew Durkin,
Prof. Emeritus of Indiana University, for editing ourEnglish.

14)

15)

CONFLICT OF INTEREST
The authors has no conflicts of interest to
disclose.

1)

16)

REFERENCES
Ministries of Foreign Affairs of Japan.
Disasters and disaster prevention in Japan.
https://www.mofa.go.jp/policy/disaster/21st/2.
html#:~:text=Japan%20is%20particularly%20

17)

29

vulnerable%20to,of%20natural%20disasters%
20in%20Japan. Accessed June 22, 2023.
Baek Y, Owen AJ, Fisher J, Tran T, et al.
Lifetime impact of being underweight or
overweight/obese during childhood in
Vietnam. BMC Public Health 22(1):645. 2022.
Wang Y, Lobstein T. Worldwide trends inchildhood overweight and obesity. Int J Pediatr
Obes 1(1):11-25.2006.
Senauer B, Gemma M. Why Is the Obesity
Rate So Low in Japan and High in the U.S.?
Some Possible Economic Explanations.; 2006.
Tanaka S. Status of physical activity inJapanese adults and children. Ann Hum Biol
46(4):305-310. 2019.
Mori N, Armada F, Willcox DC. Walking to
School in Japan and Childhood Obesity
Prevention: New Lessons From an Old Policy.
Am J Public Health,102(11):2068. 2012.
Nguyen P, Nguyen DX, Khanh-Dao Le L, etal. Results from Viet Nam’s 2022 report cardon physical activity for children and youth. J
Exerc Sci Fit, 21(1):52-57. 2022.
Ainsworth B.E., Haskell W.L., Leon A.S., etal. Compendium of physical activities:classification of energy costs of humanphysical activities. Med Sci Sports Exerc
25(1): 71–80. 1993.
Haskell W.L., Lee I.M., Pate R.R., et al.
Physical Activity and Public Health: Updated
Recommendation for Adults from theAmerican College of Sports Medicine and theAmerican Heart Assocoation. Med Sci Sports
Exerc 39(8): 1423–1434. 2007.
Elliott S.A., Baxter K.A., et al. Accuracy of
Self-Reported Physical Activity Levels in
Obese Adolescents. J Nutrition andMetabolism. 2014.
Strath S.J., Kaminsky L.A., Ainsworth B.E., etal. Guide to the Assessment of Physical
Activity: Clinical and Research Applications.
Circulation, 128(20), 2259–2279. 2013.
Bouchard Three-Day Physical Activity
Record. Med Sci Sports Exerc 29(6):1924.1997.
Nguyen MH, Pojani D, Nguyen TC, et al. The
impact of Covid-19 on children’s active travelto school in Vietnam. J Transp Geogr,
96:103191. 2021.
Yoshinaga M, Miyazaki A, Aoki M, et al.
Promoting physical activity through walking totreat childhood obesity, mainly for mild tomoderate obesity. Pediatr Int, 62(8):976-984.
2020.
Ikeda N, Nishi N. First incidence andassociated factors of overweight and obesityfrom preschool to primary school: longitudinal
analysis of a national cohort in Japan. Int J
Obes (Lond), 43(4):751-760. 2019.
Coppinger T, Milton K, Murtagh E, et al.
Global Matrix 3.0 physical activity report cardfor children and youth: a comparison acrossEurope. Public Health, 187:150-156. 2020.
Tanaka C, Tanaka S, Inoue S, et al. Resultsfrom the Japan’s 2018 report card on physicalactivity for children and youth. J Exerc Sci Fit,
17(1):20-25. 2019.

Physical Activity of Vietnamese and Japanese Children18) Smith M, Ikeda E, Hawley G, et al. An
integrated conceptual model of environmental
needs for New Zealand children’s active travelto school. J. Transport Health, 16:100814.
2020.
19) Ikeda E, Hinckson E, Witten K, et al.
Associations of children’s active school travelwith perceptions of the physical environmentand characteristics of the social environment:
A systematic review. Health Place, 54:118131. 2018.
20) Aranda-Balboa MJ, Huertas-Delgado FJ,
Herrador-Colmenero M, et al. Parental barriers
to active transport to school: a systematic
review. Int J Public Health, 65(1):87-98. 2020.
21) Ikeda E, Mavoa S, Cavadino A, et al. Keeping
kids safe for active travel to school: A mixed
method examination of school policies andpractices and children’s school travel
behaviour. Travel Behav Soc, 21:57-68. 2020.
22) Rothman L, Buliung R, To T, et al.
Associations between parents ‫ ׳‬perception of

traffic danger, the built environment andwalking to school. J. Transport Health,2(3):327-335. 2015.
23) Giles-Corti B, Wood G, Pikora T, et al. Schoolsite and the potential to walk to school: theimpact of street connectivity and traffic
exposure in school neighborhoods. HealthPlace, 17(2):545-550. 2011.
24) Japan: children’s participation rate in sports
teams or clubs by gender 2021. Retrieved on
November
28,
2022
from
<https://www.statista.com/statistics/922647/japan-children-participation-ratesports-team-clubs-by-gender/>.
25) To QG, Wharton L, Gallegos D, et al. Schoolbased physical education: Physical activity andimplementation barriers in Vietnameseelementary schools. Eur Phy Educ Rev,
26(2):587-606. 2020.

30

Nutrition Therapy in Chronic Kidney Patients
Original
Effectiveness of Medical Nutrition Therapy in Improving Prognostic Nutritional Index
Scoring among Dietitian Referred Chronic Kidney Patients: A Retrospective Study at
Hospital Kuala Lumpur, Malaysia
Jayvikramjit Singh1, Basmawati Baharom1, Zamtira Seman2, Lye Sing Ie1, Nor Fazlyn Zakaria1
1

Department of Dietetics and Food Service, Hospital Kuala Lumpur, Malaysia
2
National Institutes of Health, Selangor, Malaysia

ABSTRACT
Background and purpose: The prognostic nutritional index (PNI) is a simple assessment
tool to determine the nutritional status of patients. The purpose of this study was to assess
the effectiveness of MNT in improving PNI scoring among chronic kidney patients.
Methods: This retrospective study used data of patients seen by Dietitians in 2022.
Descriptive analysis was used to describe patient characteristics, prevalence of CKD
patients and PNI scoring. Analysis of PNI towards factor and parameter associated was doneusing Generalized Estimating Equation (GEE). A p-value of < 0.05 was set as the cutoff forstatistical significance.
Results: There were significant association (p<0.05) for variables such as PNI,
hemoglobin, total protein, albumin and urea. There was also positive improvement for PNI
scoring, hemoglobin, total protein, albumin. There was also reduction in urea, potassium,
phosphate, uric acid, fasting blood sugar and total cholesterol among referred patients todietitian. Significant association of PNI with hypercholesterolemia (p=0.017), albumin(p=0.003), total protein (p=0.003), creatinine (p=0.01), phosphate (p<0.001), uric acid
(p=0.043) and eGFR (p=0.013) among patients referred to dietitian. No significant
association was noted between BMI and PNI.
Conclusion: Results of current study suggests that medical nutrition therapy is an
important aspect of management for chronic kidney patients. Patients with improved PNIscoring which were seen by dietitian showed better nutritional status compared to thosepatients who did not receive dietary consultations from dietitians. Further study with large
coverage may give a concrete or better results in future
Keywords: Prognostic Nutritional Index, Chronic Kidney Disease, End Stage Kidney
Disease, Low Protein Diet, Medical Nutrition Therapy
INTRODUCTION
The prognostic nutritional index (PNI) is a simple
assessment tool to determine the nutritional status ofpatients (1). It is calculated by combining serum
albumin levels and total lymphocyte counts, which
are two indicators of nutritional status or malnutrition
and immune function (2). PNI has been shown to bea useful tool in predicting mortality among many
populations, including end stage renal patients on
dialysis (3).
A study published in the Journal of Renal Nutritionin 2021 investigated the prognostic value of PNI in
predicting mortality in 671 hemodialysis patientswith CKD (4). The study found that lower PNI
values were associated with higher mortality rates,
even after adjusting for other factors such as age,sex, and comorbidities (4). Similarly, a study
published in the Journal of Cachexia, Sarcopenia
and Muscle in 2020 found that PNI was asignificant predictor of mortality among Chronic
Kidney Disease (CKD) patients undergoinghemodialysis (5). The study also found that PNI
was more accurate than other nutritional indicessuch as the geriatric nutritional risk index and thecontrolling nutritional status score (5).
PNI has also been also researched among
peritoneal dialysis patients. A study conducted by
Sijia et al concluded that low PNI levels wereindependently associated with the first occurrenceof pneumonia in PD patients (6-8). PNI was anindependent predictor of new-onset pneumonia in
PD patients (6-8).

*To whom correspondence should be addressed:jayvikramjit@yahoo.co.uk

PNI has been also used as a prognostic tool among
diabetic nephropathy patients. This study aimed at
the long-term effects of prognostic nutritional index(PNI) on renal outcomes in patients with diabetic
nephropathy (DN) and type 2 diabetes mellitus (9-10).

31

Asian Journal of Dietetics, 2024
Results from this study proved that PNI correlatedwith eGFR and glomerular injury and was anindependent predictor for DN progression in patientswith T2DM (9-10).

Specific Objectives
To determine the effectiveness of Medical
Nutrition Therapy (MNT) in improving patients’nutritional status
To determine the association between Prognostic
Nutritional Index (PNI) and clinical outcomes(nutritional status and renal function) in patientswith Chronic Kidney Disease (CKD) receiving
dietary counselling.
MATERIALS AND METHODSThis study might help to strengthen the PNI as tool
to determine as a strong prognostic tool for CKD
patients. PNI is a simple tool that can be used todetermine nutritional status of CKD patients. Since
it is easy to use and only requires two variables(albumin and lymphocytes level) to calculatemalnutrition status of CKD patients, it will enableclinicians to better diagnose malnutrition among
CKD patients.

Study Type and Design
This was a retrospective study that was conductedat Hospital Kuala Lumpur. This study used
Malaysian Dietetics Care Notes (DCN) which isthe standard documentation form used by
Dietitians. Sample size targeted for this study was
352 patients. Chronic Kidney Disease patients at
Nephrology outpatient clinic referred to Dietitianand patients not referred to Dietitian from 1st
January 2022 until 31st December 2022 were
included in this study. A minimum of at least two
follow up by dietitian was required for analysis
purposes. The end point of the study was theaccuracy of PNI in determining nutritional statusof CKD patients. Flow chart of this study is
explained as below.

Medical nutrition therapy (MNT) has been provenin effectively improving CKD patients’ nutritional
status (11). However, research on effectiveness of
MNT improving patients PNI scoring among CKD
patients has not done before in Malaysia. We hope
the results of this study will help dietitians andother healthcare personnel to use PNI as adiagnostic tool for better patient outcome in termsof improving nutritional status and patient care.
Objective
General Objective
To assess the effectiveness of MNT in improving
PNI scoring among CKD patients

Identify patientsin inclusion
criteria from DCN

Extraction of data

Data entry into
SPSS

Publication offindings

Presentation ofresearch output

Data cleaning anddata analysis

Figure 1: Flow chart for data collection
Study Tool

from DCN. Laboratory test results was obtained fromLab Information System (LIS) at Nephrology Clinic,
Hospital Kuala Lumpur, Malaysia. All information
included demographic data such as age, gender,
ethnicity, medical history such as hypertension,
diabetes, heart disease, examination data such as

This study used PNI scoring as a nutritional tool. The
PNI was calculated by 5×lymphocyte count (109 /L)+serum albumin (g/L) in this study. Scoring for PNI
was determined by low (<40), moderate (40-45), high>45. Clinical information of patients was collected32

Nutrition Therapy in Chronic Kidney Patientsweight, height, blood pressure, laboratory data suchas serum creatinine, blood urea nitrogen, total serum
uric acid, total cholesterol, HbA1c, fasting blood
sugar, proteinuria.

•

Study Visits and Procedures
The data of concern involved outpatient patients seen
by Dietitian and not seen by Dietitian at Outpatient
Nephrology Clinic from 1st January 2022 until 31st
December 2022. These data were retrieved fromcopies of Dietetic Care Notes (DCN) which wasstored at Dietetic Clinical Store Office. The days ofreferral and follow ups were within the stipulated
time of 1st January 2022 until 31st December 2022.
Dietitians of Hospital Kuala Lumpur retrieved thedata from Dietetic Clinical Store Office and Lab
Information System (LIS) and entered the variablesof concern into SPSS for further analysis. These datacollection period commenced from 1st January 2024
until 31st January 2024.

Medical nutrition therapy based on The National
Kidney Foundation’s Kidney Disease Outcomes
Quality Initiative (KDOQI) Guidelines 2020 was
given to patients that were referred to dietitian (12).
Patients were given a diet comprised of 1) dietary
protein intake of 0.6 to 0.8 g/kg/day from 50% plantbased sources, 2) fiber intake of 25 g/day, 3) lowsodium intake of less than 5 g/d and 4) adequate
caloric intake of 30 to 35 kcal/kg/day. If patient has a
co-morbidity of diabetes and other form of noncommunicable diseases, the MNT shall be
individualized according to the patient’s diseases.
Study Population & Sampling Method

Statistical Analysis

This was a simple random sampling that referred toeligible patients (chronic kidney disease patients)
referred and seen by Dietitian as well as patients notreferred to Dietitians from 1st January 2022 until 31st
December 2022.

The Statistical Package for the Social Sciences (SPSS,
IBM, Chicago, IL) version 26 was utilized for data
analysis. Continuous variables were assessed fornormality using the Kolmogorov-Smirnov test.
Normally distributed variables were presented asmean ± standard deviation and compared using t-tests
or one-way analysis of variance (ANOVA). Nonparametric variables were presented as median(interquartile range) and compared using the MannWhitney or Kruskal-Wallis test. In cases where
significant differences were observed in ANOVA or
Kruskal-Wallis test, post-hoc Tukey comparison or
Bonferroni correction was employed.

Inclusion Criteriaa)All patients referred to dietitian by medical
officers/nephrologistsb) Aged 18 years and abovec) Available PNI values (albumin andlymphocytes count)d) Complete medical recordse) Patients with follow up at least 1 year

Categorical variables were presented as counts andpercentages and analyzed using Pearson's chisquared test or Fisher's exact test. The strength of therelationship between variables was assessed using
Pearson's bi variate correlation. Kaplan-Meier andCox-regression was used to estimate diseaseprogression. A significance level of p < 0.05 was used
to determine statistical significance.

Exclusion Criteriaa)Patients with a history of cancer, autoimmune
diseases, or chronic infections.
b) Missing datac) Patients with end stage renal disease at baselined) Deaths
Withdrawal Criteria

Risk and benefit to study participants

Not applicable

There were no risk and benefit to the participants as
this was a retrospective study which did not involve
direct contact with any patient.

Sample Size
We used G*Power version 3.1.9.4 to determine therequired sample size for detecting an improvement in
PNI scoring with a medium effect size of 0.3, asignificance level of 5%, and a power of 80%, thisstudy required sample 176 per arm. The two arms
were referring to patients referred to dietitians andpatients not referred to dietitians. Total patients forboth required arms were 352 patients. As no
information on effect size was available for thisparticular factor, we chose to use Cohen's guidelines
for effect size interpretation to determine the target
effect size.

Risk Benefit Assessment
Assessment using PNI should be considered to treat
malnutrition which might lead to significant
improvement in relation to treating and improving
nutritional status of CKD patients. The results of thisstudy may help clinicians identify patients with low
PNI scores and improve their clinical outcome.
Clinicians will be able to accurately identify the
impact of PNI scoring on patient nutritional outcome.
Results from this study will enable Dietitians tofurther strengthen the usage of PNI as a prognostic
tool for treating malnutrition.

Study Duration and Timeline••

Stage 3, presentation and publication - 2 months

Stage 1, proposal development - 1 monthStage 2, data collection and data analysis - 2
months

Ethics of Study

33

Asian Journal of Dietetics, 2024
Ethical approval was needed from the Medical
Research and Ethics Committee, Ministry of Health
Malaysia. This research was registered with National
Medical Research Register (NMRR), Malaysia under
the registration identification number of NMRR ID23-03077-3ZW.

Privacy and Confidentiality
Subject’s names were kept on a password-protected
database and were linked only with a study
identification number for this research. The
identification number instead of patient identifiers
was used on subject data sheets. All data were enteredinto a computer that was password protected. On
completion of study, data in the computer was copied
to thumb drives and the data in the computer erased.
Thumb drives and any hard copy data were stored ina locked office of the investigators and maintained fora minimum of three years after the completion of thestudy. The thumb drives and data will be destroyed
after that period of storage. Study will not be sharedwith any third party.

Ethical approval was obtained from other relevant
approvals prior to the start of any study related
activities. The study was performed in compliancewith the principles of the Declaration of Helsinki, in
accordance with the International Conference ofHarmonization Guideline for Good Clinical Practice,and in accordance with applicable regulatory
requirements.
Informed Consent/Assent Process

Termination of Study

Waiver of consent was requested and was granted by
Medical Research and Ethics Committee (MREC) inview of retrospective study and no patient/participant
contacts.

Not applicable

RESULTS
Table 1: Patient characteristics stratified by Dietitian Referred (N=300)
Dietitian Referred
Variable
Yes
No
Total

p-value

GenderEthnicity

FemaleMale

Malay
ChineseIndianOthersDiabetes mellitus
Yes
No
Hypertension
Yes
No
Hypercholesterolemia
Yes
No
Heart DiseaseYes
No
BMI category
Underweight
NormalOverweight
ObeseaChi Square, bExacts

73 (50)77 (50)73 (50)77 (50)146
154>0.999a93 (48.7)
34 (51.5)
21 (51.2)
2 (100)98 (51.3)
32 (48.5)
20 (48.8)
0 (0)

191
66
41
2

0.393b108 (56.5)
42 (38.5)

83 (43.5)
67 (61.5)191
109

0.003a131 (51.6)
19 (41.3)

123 (48.4)
27 (58.7)254
460.200a81 (48.5)
69 (51.9)

86 (51.5)
64 (48.1)

167
133

0.561a25 (52.1)
125 (49.6)

23 (47.9)
127 (50.4)

48252

0.753a7 (70)
41 (53.2)
47 (50.5)
46 (68.7)

3 (30)
36 (46.8)
46 (49.5)
21 (31.3)

10
77
93
67

0.092a34

Nutrition Therapy in Chronic Kidney Patients
Table 2: Parameter changes for overall patients and stratified by dietitian referred.

Table 3: Analysis of PNI towards factor and parameter associated using Generalized Estimating Equation(GEE)
Overall
Referred
Not-Referred
Variableβ (95%CI)
p-valueβ (95%CI)
p-valueβ (95%CI)
p-value
Dietitian0.52 (-0.54,
Referred
0.336
1.58)
Not referred
1
Gender
-1.01 (-2.07,-0.74 (-2.24,-1.28 (-2.77,
Female
0.061
0.334
0.090
0.05)
0.76)
0.20)
Male
1
1
1
Ethnicity
0.53 (-0.70,-0.47 (-2.31,
1.11 (-2.30,
Malay
0.398
0.620
0.523
1.75)
1.38)
4.52)
0.59 (-1.39,
0.10 (-1.93,
Indian
0.561
0.924
2.57)
2.13)
1.78 (0.56,
0.83 (-0.83,
1.58 (0.05,
Others
0.004
0.328
0.043
3.01)
2.50)
3.11)
Chinese1
1
1
Diabetes mellitus-1.00 (-2.07,-1.00 (-2.67,-1.23 (-2.69,
Yes
0.068
0.243
0.099
0.07)
0.68)
0.23)
No
1
1
1
Hypertension-1.49 (-3.12,-2.45 (-5.49,-0.88 (-2.62,
Yes
0.074
0.115
0.322
0.14)
0.59)
0.86)
No
1
1
1
Hypercholesterolemia-0.48 (-1.58,-1.84 (-3.36,
0.95 (-0.62,
Yes
0.398
0.017
0.235
0.63)
-0.32)
2.51)
No
1
1
1
Heart disease0.03 (-1.42,
1.03 (-0.96,-1.07 (-3.05,
Yes
0.973
0.312
0.289
1.47)
3.01)
0.91)
No
1
1
1
Body Mass Index

35

Asian Journal of Dietetics, 2024

Variable
Underweight
NormalOverweight
Obese
Age
Body Mass Index
Total Protein
Albumin
Urea
Creatinine
Potassium
Phosphate
Uric Acid
Fasting Blood Sugar
HBA1C
EGFR
Total Cholesterol

Overallβ (95%CI)
p-value
1.19 (-2.40,
0.516
4.77)
0.16 (-1.55,
0.858
1.86)
0.83 (-0.85,
0.333
2.52)
1
0.01 (-0.04,
0.618
0.06)
-0.02 (-0.14,
0.751
0.10)
0.13 (0.06,<0.0010.20)
0.80 (0.69,<0.001
0.90)-0.09 (-0.22,
0.191
0.04)
-0.01 (-0.01,
0.007<-0.001)
0.49 (-0.08,
0.093
1.06)
-1.13 (-2.23, 0.046
0.02)
0.00 (-0.01,
0.214
0.00)
-0.12 (-0.26,
0.119
0.03)
0.19 (-0.61,
0.644
0.98)
0.03 (0.00,
0.025
0.06)
-0.26 (-0.61,
0.155
0.10)

Table 1 showed a total of 300 patients were finally
recruited after considering the inclusion andexclusion criteria. There was equal distribution of
respondents between gender (50%) with Malay
ethnicity being the majority (48.7%). Most
respondents had comorbidities such as diabetes(56.5%), hypertension (51.6%) and high cholesterol(48.5%). Most of the respondents were obese(68.7%).

Referredβ (95%CI)
p-value
0.05 (-4.52,
0.984
4.62)
0.67 (-1.28,
0.502
2.62)
0.92 (-1.07,
0.365
2.92)
1
-0.01 (-0.09,
0.798
0.07)
-0.04 (-0.19,
0.611
0.11)
0.17 (0.06,
0.003
0.27)
0.80 (0.67,<0.001
0.93)-0.09 (-0.25,
0.260
0.07)
-0.01 (-0.02,
0.010<-0.001)
0.24 (-0.58,
0.564
1.06)
-4.67 (-7.25,<0.001-2.08)-0.01 (-0.01,
0.043<-0.001)-0.05 (-0.18,
0.428
0.08)
0.93 (-0.65,
0.247
2.51)
0.05 (0.01,
0.013
0.09)
-0.29 (-0.75,
0.222
0.17)

Not-Referredβ (95%CI)
p-value
3.81 (-0.77,
0.103
8.38)
-0.14 (-3.58,
0.934
3.29)
1.06 (-2.33,
0.540
4.45)
1
0.02 (-0.04,
0.463
0.08)
0 (-0.2, 0.21)
0.11 (0.02,
0.21)
0.79 (0.64,
0.95)-0.16 (-0.30, 0.02)-0.01 (-0.01, <0.001)
0.73 (0.02,
1.43)
0.12 (-0.87,
1.12)
0.00 (0.00,
0.01)-0.36 (-0.82,
0.10)-0.11 (-1.10,
0.89)
0.03 (-0.02,
0.08)-0.22 (-0.76,
0.32)

0.970
0.023
<0.001
0.023
0.044
0.043
0.809
0.640
0.126
0.831
0.241
0.430

DISCUSSION
To the best of our knowledge, this is the first study
that has been done in Malaysia involving MNT and
its effect on improvement of PNI scoring. Besides
improvement of PNI scoring, clinical implications of
our findings is that delivery of MNT by Dietitians
showed improvement in chronic kidney disease andits related parameters such as fasting blood sugar,urea, total cholesterol and albumin.

Results from Table 2 showed significant association(p<0.05) for variables such as PNI, hemoglobin, total
protein, albumin and urea. There was positive
improvement for PNI scoring, hemoglobin, total
protein, albumin. There was also reduction in urea,
potassium, phosphate, uric acid, fasting blood sugar
and total cholesterol among referred patients todietitian.

Improvement of variables such as hemoglobin,
albumin, phosphate and total protein was very much
relayed to the adequate protein that was provided
during dietary counseling (12). A low protein diethelped improved and lower down the urea levels of
respondents (13,14). A plant dominant diet generally
reduces uremic levels in the body (12,13,14). The low
protein diet is beneficial, because they reduce theproduction of protein-derived waste products, theretention of protein-derived toxins and fixed acids,
lower single nephron glomerular hyper filtration andproteinuria, and reduce dietary phosphate load (15).
Since albumin levels had increased significantly, thismight had contributed to the improved scoring of PNI.

Results from Table 3 showed significant associationof PNI with hypercholesterolemia (p=0.017),
albumin (p=0.003), total protein (p=0.003),
creatinine (p=0.01), phosphate (p<0.001), uric acid
(p=0.043) and eGFR (p=0.013) among patientsreferred to dietitian. No significant association wasnoted between BMI and PNI.

36

Nutrition Therapy in Chronic Kidney Patients
Improvement of fasting blood sugar and totalcholesterol in general wad attributed by the adequate
fiber intake (13-14). This plant based diet helps toregulate lipids and achieve better glycemic control
among diabetic nephropathy patients (13-14). The
KDOQI 2020 guidelines also emphasized oninterventions using omega 3 and 6 fats for better lipid
control (12). A reduction of saturated fatty acids(SFA) and trans-fat intake contributes to a reduction
in risk of cardiovascular disease in patient which ispart of the KDOQI 2020 guidelines (12).

study and all the team members for their participationin this study.
REFERNCES
1. Wang D, Hu X, Xiao L et al (2021) Prognostic
nutritional index and systemic immune-inflammationindex predict the prognosis of patients with HCC. J
Gastrointest Surg 25:421–427.
2. Kasymjanova G, MacDonald N, Agulnik JS,
Cohen V, Pepe C, Kreisman H, et al. The predictive
value of pre-treatment inflammatory markers inadvanced non-small-cell lung cancer. Curr Oncol.
2010;17(14):52–8.
3. Barutcu Atas D, Tugcu M, Asicioglu E et al (2022)
Prognostic nutritional index is a predictor ofmortality in elderly patients with chronic kidneydisease. Int Urol Nephrol 54:1155–1162.
4. Kanda E, Kato A, Masakane I, Kanno Y (2019) A
new nutritional risk index for predicting mortality inhemodialysis patients: Nationwide cohort study.
PLoSONE
14(3):
e0214524.
https://
doi.org/10.1371/journal.pone.0214524.
5. Masatsugu Okamura, Masaaki Konishi, Javed
Butler, Kamyar Kalantar-Zadeh, Stephan vonHaehling,Stefan D. Anker,Journal of Cachexia,
Sarcopenia
andMuscle2023
DOI:
10.1002/jcsm.13260.
6. Sijia Shang,Yajuan Huang. The relationshipbetween the prognostic nutritional index andnew‑onset pneumonia in peritoneal dialysis
patientsInternational. Urology and Nephrology(2022)
54:3017–3024
https://doi.org/10.1007/s11255-022-03233-1.
7. Cai, L.; Yu, J.; Yu, J.; Peng, Y.; Ullah, H.; Yi, C.;
Lin, J.; Yang, X.; Yu, X. Prognostic value of
inflammation-based prognostic scores on outcome inpatients
undergoing
continuous
ambulatory
peritoneal dialysis. BMC Nephrol. 2018, 19, 297.
8. Peng, F.; Chen, W.; Zhou, W.; Li, P.; Niu, H.; Chen,Y.; Zhu, Y.; Long, H. Low prognostic nutritional
index associated with cardiovascular diseasemortality in incident peritoneal dialysis patients. Int.
Urol. Nephrol. 2017, 49, 1095–1101.
9. J.; Xiao, X.;Wu, Y.;Yang, J.; Zou, Y.; Zhao, Y.;
Yang, Q.;Liu, F. Prognostic Nutritional Index as a
Predictor of Diabetic Nephropathy Progression.
Nutrients 2022, 14, 3634. https://doi.org/
10.3390/nu14173634.
10. Zhang, J.; Zhang, R.;Wang, Y.; Li, H.; Han,
Q.;Wu, Y.;Wang, T.; Liu, F. The Level of Serum
Albumin Is Associated with Renal Prognosis inPatients with Diabetic Nephropathy. J. Diabetes Res.
2019, 2019, 7825804.
11. Academy of Nutrition and Dietetics. Evidence
Analysis Library. Medical Nutrition Therapy
Effectiveness (MNT) Systematic Review (20132015). 2015 https://www.andeal.org/topic.cfm?
menu=5284. Accessed May 24, 2020.
12. KDOQI Clinical Practice Guideline for Nutrition
in CKD: 2020 Update” (Am J Kidney
Dis. 2020;76[3][suppl 1]:S1-S107).
13. Chen Y, Wu J, Yu D, Liu M. Plant or animalbased or PLADO diets: which should chronic kidney

In CKD clinics, medical nutrition therapy (MNT)
should be emphasized and requires the same level ofimportance as pharmacological treatment (16). In thisstudy, we would like to highlight that MNT should bea cornerstone of the management of CKD as well asof other chronic diseases. Provision of MNT for predialysis patients has proven evidence of delaying theneed for dialysis (17,18). All patients regardless ofstages of chronic kidney disease should be referred todietitian for better disease management and patient
outcome.
Limitations of our study was that it has a small
sample size and it was a single center study. A
prospective intervention study with larger sample
size would yield stronger clinical results. The mainstrength of our study was that the results were similarand consistent with other studies that indicates theeffectiveness of MNT in patients’ nutritional status.
Future studies on effectiveness of PNI in
improvement of patient survival should beconsidered. A cohort study specially designed todetermine whether a high PNI scoring can delay theneed for dialysis or delay the progression of kidneydisease among Malaysian CKD patients.
Conclusion
Results of current study suggests that medical
nutrition therapy is an important aspect ofmanagement for chronic kidney patients. Patientswith improved PNI scoring showed better nutritional
status compared to those patients who did not receive
dietary consultations from dietitians. Further study
with large coverage may give a concrete or better
results in future.
Conflict of Interest
The investigators declared they had no conflict ofinterest
Publication Policy
No personal information was disclosed when thefindings of the survey were published. Manuscript
were submitted to National Institutes for Health,
Malaysia for Director General’s approval prior to any
publication and presentation.
ACKNOWLEDGMENT
The authors wish to thank the Director General of
Health Malaysia for his permission to publish this37

Asian Journal of Dietetics, 2024
disease patients choose? J Ren Nutr. 2022;33:228235.
14. Sakaguchi Y, Kaimori JY, Isaka Y. Plantdominant low protein diet: a potential alternative
dietary practice for patients with chronic kidneydisease. Nutrients. 2023;15:1002.
15. Adamasco Cupisti, Maurizio Gallieni, Carla
Maria Avesani, Claudia D’Alessandro, Juan Jesus
Carrero and Giorgina Barbara Piccoli. Medical
Nutritional Therapy for Patients with Chronic Kidney
Disease not on Dialysis: The Low Protein Diet as a
Medication.J. Clin. Med. 2020, 9, 3644;
doi:10.3390/jcm9113644.
16. Kovesdy, C.P.; Kalantar-Zadeh, K. Back to the
future: Restricted protein intake for conservative

management of CKD, triple goals of renoprotection,
uremia mitigation, and nutritional health. Int. Urol.
Nephrol. 2016, 48, 725–729.
17. Mitch, W.E.; Remuzzi, G. Diets for patients withchronic kidney disease, should we reconsider? BMC
Nephrol. 2016, 17, 80.
18. Ikizler, T.A.; Burrowes, J.D.; Byham-Gray, L.D.;
Campbell, K.L.; Carrero, J.-J.; Chan, W.; Fouque, D.;Friedman, A.N.; Ghaddar, S.; Goldstein-Fuchs, D.J.;
et al. KDOQI Nutrition in CKD Guideline WorkGroup. KDOQI clinical practice guideline fornutrition in CKD: 2020 update. Am. J. Kidney Dis.
2020, 76, S1–S107.

38

Special Report: Asian Young Dietitian Network
Introduction of AYDN activities: Participation at the Thai Dietetic Association Conference
F.A.Z.Firouse1, Nur Ayu Ruhmayanti2, Sumaya Islam3, Yen Ngoc Ma4
1

Asiri Surgical Hospital, Colombo, Sri Lanka
2
Indonesia Dietitian Association, Indonesia
3
Health and Hope Hospital, Dhaka, Bangladesh
4
Hanoi Medical University Hospital, Hanoi, Vietnam
Thai Dietetic Association (TDA) held the annual
conference on April 28th-30th 2024 at Bangkok,
Thailand, marking TDA's 50th anniversary, was aspecial event themed “Application of Diet Therapy into
Lifestyle Medicine: What We Should Know.” Itprovided an excellent opportunity for engagement withleading dietitian practitioners and academics. The

conference was attended by representatives fromThailand's Health Ministry, the Asian Federation of
Dietetic Associations, the Japan Dietetic Association,and dietitian representatives from various Asian
countries. The Asian Young Dietitian Network(AYDN) had the honor to be invited in this important
event for TDA.

Fig 1. Photo of AYDN members at the Thai Dietetic Association Annual Conference 2024
The AYDN is a group of young dietitians fromvarious Asian countries pledged to work
collaboratively to enhance the status of dietitians ineach country and the recognition of societies towards
dietitians’ careers. The network was establishedfollowing the workshop “Let’s Talk about the Future ofYoung Dietitians in Asia” at the Asian Congress ofDietetics in Yokohama, Japan, in 2022. With concern
about the future of dietitians, Prof. Shigeru Yamamoto
from Jumonji University yearns to establish a coregroup of dietitians and nurture them to become thefuture leaders of dietitians in the region. With thesupport of Ajinomoto Co., Inc., on December 1, 2023,

a successful kick-off meeting was held in Tokyo, Japan,
which brought 20 dietitians from 12 Asian countries. In
the meeting, all members of AYDN agreed to work
towards the three main objectives: 1) Sharing
information and experiences about participants’country nutritional issues and experiences they have
which could contribute to other participants, 2)
Conducting researches and publish them to an academic
journal (such as Asian Journal of Dietetics) to increaseskills in investigation and research to find the problems
and solutions in a logical thinking. 3) Carry out
webinars and workshops to increase scientific and nonscientific knowledge.

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

39

In 2024, a total of 21 AYDN members participatedin the TDA conference. They were from from
Bangladesh, Bhutan, India, Indonesia, Japan, Malaysia,
the Philippines, Sri Lanka, Taiwan, Thailand, andVietnam. AYDN members, dressed in their traditional
clothing, showcased their cultural heritage, unified intheir goal to advance dietetics.
In the opening ceremony, Prof. Chanida Pachotikarn
from Mahidol Unviversity and president of the Thai
Dietetic Association, delivered the presidential speech,
emphasizing the importance of updated nutrition
education and the future of dietitians. On the other
hand, various organizations and institutes presented
research awards to encourage more research in the
dietetic field. Prof. Shigeru Yamamoto's guest lectureon "What Dietitians Need for the Future: Evidencebased Dietetics" highlighted the use of technology andcreative cooking in daily practice, urging dietitians topublish more researches, especially for those whoworks in hospital. The challegen is not easy, however,
it is a way to enhance the respect dietitians work.
Goal of AYDN symposium
The 50th anniversary of the TDA marked asignificant milestone with the symposium section heldby the AYDN, themed "Exploring the Landscape of
Nutrition and Dietetic Training Program: A
Comprehensive Study Among Asian Young Dietitians
Network Member Countries." The symposiumcommenced with Ms. Nguyen Thu Trang from Vietnam
and Ms. Andrea Wakita (Ajinomoto Co., Inc.)
introducing the establishment of AYDN and unveilingthe annual plan for 2024 to 2026. Esteemed speakers,
including Mr. George from Malaysia, Mr. Tzu Yun Cha
from Taiwan, and Mr. Prem Kumar from Bhutan,
highlighted the symposium's three primary objectives:
assessing the diversity of curriculums and educational

pathways, examining practical training opportunities
for nutrition and dietetics students, and identifying
strengths and areas for improvement in AYDN member
countries' degree programs to become a registereddietitian. With the presence of several senior Asiandietitians at the conference, AYDN successfullycommunicated its mission to the participating young
dietitians and garnered valuable insights and support
from senior dietitians regarding the budding AYDN
network.
Acknowledgement
On behalf of AYDN, we express our deepest
gratitude to TDA for the invitation and kind hospitality.
We are thankful for the opportunity to present our
research at such a significant event. Our appreciation
extends to Professor Shigeru Yamamoto of Jumonji
University for his long cherished dream, vision anddedication, which made our participation possible. We
also thank Jumonji University for their support andAjinomoto Co., Inc. for their sponsorship, enabling
such as our face-to-face meeting at the TDA
conference. This support is vital for our growth, and weare committed to continue our collaboration to reach thegoals of the network.
REFERENCES
1. Asian Nutrition and Food Culture Research Center,
Jumonji University and Ajinomoto Co., Inc. Global
Communication Department. Purpose of the AsianYoung Dietitian Network. Organizer. Asian Journalof Dietetics 5: 141. 2023.
2. TT. Nguyen, A. Wakita. Special Report: AsianYoung Dietitian Network. Asian Journal of
Dietetics 5: 141 – 145. 2023.

40

Report (Bangladesh) on the Asian Young Dietitians Network Meeting in Thailand
Sumaya Islam1*, Tapati Saha2
1

Health and Hope Hospital, Dhaka, Bangladesh
SQUARE Hospitals Ltd., Dhaka, Bangladesh

2Introduction
AYDN was established on December 1, 2023 withthe general objective to elevate the status of Dietitians
in Asian countries. We desire for such a society where
people will trust dietitians, recognize, and respect theirroles. To achieve that goal we have to take proper
initiatives, our gathering in Thailand was a step towards
the goal. We would like to extend our deepest gratitude
to TDA for inviting us in their remarkable 50th
anniversary. It was a great opportunity to meet, greet

and exchange ideas among young dietitians of 11 Asian
countries under the umbrella of AYDN. We also got therare opportunity to receive the affection and valuable
directions from the respected mentors and seniorDietitians.
We also express our sincere gratitude to Professor
Yamamoto for establishing AYDN and nurturing us
towards success and honor. Moreover, our heartfelt
gratitude goes to Ajinomoto Company for sponsoring
us which is crucial for our development and growth.

Fig 1. Introducing ourselves and sharing Greetings to TDA members and participants(Tapati Saha: Left, Sumaya Islam: Right)
Personal Reflections
The warm hospitality and generosity of TDA andThai people have truly touched our hearts. From themoment we arrived we were greeted with open arms
and treated with utmost kindness that gave us a homely
and festive feeling. Thailand has a very rich foodculture and its street food is really exemplary. Enjoying
Thai cuisine together was a great experience for us
specially Tom Yum Soup, Mango Sticky Rice with
Coconut cream dessert, Rambutan and Dragon fruit.
Thai food is unique, tasty, simple, easy to digest &healthy. We also realized that people of Thailand
maintain religious ethics and respect others religious
norms, it is really heart soothing and comfortable for allof us. The TDA Conference itself was enlightening andthe inspiring presentation from esteemed figures suchas Prof. Yamamoto, Madam Mary Easaw, Dr.Teiji
Nakamura, Dr. Chwang Leh Chii, Asst. Prof. Dr
Chanida, and Senior Dietitians showed us the next pathof Asian Dietetic Profession and guided us about what
we need for the future.
While delivering his special lecture, Professor
Yamamoto explained with examples what we dietitians
need to think about what we should do so that theimportance of Dietitians role is recognized. With his
wisdom, he pointed out what are our challenges andhow we can overcome it. His lecture is eye opening andvery motivational for us. He showed a figure about theauthors of journal articles in clinical nutrition,
unfortunately there are very few Dietitians as authors.

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

41

Fig 3. AYDN members enjoying dinner together

Fig 4. Less publications from faculty members of dietetic course and important messages from Prof. Yamamoto
We must focus in this area and try our best tochange the scenario. He also mentioned that we needproper education for research. Prof.Yamamoto believes
that the cause of obesity is simple. It is just the balanceof energy intake and output despite this simple fact, nocountry in the world has succeeded in controllingobesity rates. Controlling obesity is a broad andcomplex subject encompassing dietetics, nutrition,
medicine, physiology, biochemistry, psychology,sociology, economics & philosophy. This means thatwithout the proper education for research, it is difficultfor dieticians to do research. He also showed examples
of Dietitians research.One example was modifying theschool lunch. With almost the same price how more
nutrients were added in the school lunch and it became
healthy. Moreover the children liked there new foodand ate with smiling face. The other one was use of fullautomatic rice cooker which is certainly food forthought.
Madam Mary Easaw’s passion to her profession
inspired us. Among many important messages shehighlighted on culinary skills which is very essential for
dietitians. She encouraged to modify traditional andfestival recipes in healthy ways. We also got some
precious Take Home Messages, like, collaboration with
continuity, devotion with empowerment andprofessionalism with qualification from Dr. Chwang
Leh Chii.

Dr. Teiji Nakamura motivated dieticians and
AYDN members to continue pursuing excellence in the
nutrition and dietetics field. Dr.Nakamura wants tounify the Asian dietetics system with ICDA standards
and also focuses on quality assurance by training
courses for dieticians and expansion of postgraduate
education for dieticians. Moreover, he highlighted
sustainable healthy diets, body, and planet friendly dietwith the emphasis on reduction of environmental
impact. If the advices provided from our mentors canbe implemented, there will be a new era for dieticians
and dietetics.
Moreover, we also gained lots of valuable ideas
from our AYDN member friends, because they are
working as dietitians in diverse settings, which is not
yet common in our country. For example, dietitians
working in community level, schools etc. andcontributing in the various areas of the society. We are
hopeful that we can also implement these ideas in ourcountry and our working places.
Bachelor of Nutrition program
In Bangladesh our Bachelor of Nutrition Program
is not unified in all the institutions. However we cannotice gradual improvement in the curriculum. There
are strengths and weaknesses as well. About thestrengths, we have 4 year long BSC programme which
consist of coursework combined with Hospital/NGO,42

Food Industry internships. The curriculum focuses on
Research methods, Research project, Field assignment.
Furthermore our present curriculum includes new areas
like food technology, We have many areas of
improvement also.
In Bangladesh we need certified programmes in
specialized areas. The curriculum does not include
dietician’s training programme. Moreover number ofProfessors or faculty members who are dietitians is verylow.
Insights gained and Action Plan to Foster AYDN in
the Future
TDA was an excellent learning platform fordieticians. From our wise mentors we are inspired that
we should be devoted to our work, acquire several
essential skills, we have to be innovative and do quality
research work and publication. We should think moreto understand our shortcomings and accept thechallenges for our professional growth. We should
expand our network and learn from each other.
We have learned a lot from our fellow AYDN
members too, as they have knowledge and skills on
various areas of dietetics. They possess soundknowledge on school lunch, culinary skill, analyticalskill, nutrition for autistic children etc. We can learn
from each other and share the ideas in our country so

Fig 5. Modifying traditional snacks to healthy snacks
by Madam Mary Easaw

that our people also get these services at wide level. For
example, school healthy tiffin or lunch program is not
regular and does not cover vast area in Bangladesh, wewill try to start these programs in various schools, it willcontribute in the physical and mental development of
our school children.
Currently AYDN is assessing the BSc in Nutrition
curriculum among the AYDN member countries. The
assessment provides a comparative scenario, where we
can observe the diversity and understand the strengths
and weaknesses of the education system of different
member countries. From the research result eachcountry can find out their area of improvement. For
example, there is no national examination for graduates
to be registered dietitian in Bangladesh; we have towork in this area.
For the development of AYDN, firstly we have tolove our profession by heart. Strong bonding andunderstanding among AYDN members is also
important. Furthermore, we have to earn necessary
knowledge and skills. We should emphasize on
necessary research work in dietetics and publish quality
research work. We believe that if we work together withdetermination success is not far

Fig 6. No opportunity for Graduates to be Registered
Dietitians in Bangladesh yet

43Report (Bhutan) on the Asian Young Dietitians Network Meeting in Thailand
Prem Kumar Neopanay1*, Chanda Dhungyel2, Hari Prasad Pokhrel3
1

Jigme Dorji Wangchuck National Referral Hospital, National Medical Services,
Ministry of Health, Bhutan
2
Wangdi Hospital, National Medical Services, Ministry of Health, Bhutan
3
Department of Public Health, Ministry of Health, Bhutan

Introduction
The Young Asian Dietitian Network (AYDN) was
founded in the beginning 2022 and has been just able toconduct some online meetings to strengthen the
network amongst the dietetic professionals in themember countries (11 Asian countries). The network
aims to establish a reliable and accessible platform forexchange of knowledge, skills and jointly conduct
researches in the areas of Nutrition and Health.
The AYDN have been doing a comparative study on
the curriculum of Dietetic training programs across themember nations and the same was presented during the50th Anniversary of Thai Dietetic Association(TDA)which was heldin Bangkok from 28 to 30th April,2024.
The opportunity to introduce and meet different
professionals among the network at such an establishedforum was only possible with the generous support
from TDA and Ajinomoto. We were invited to attend
the 50th TDA anniversary meet and travel was
supported by Ajinomoto Company’s. Professional
guidance and support from esteemed Professor
Yamamoto was instrumental in making a meeting a
success as he was involved in securing financial support
and logistic arrangement.

We could also learn so much insights bothprofessionally and personally from the presentations
made by scholars like Prof. Yamamoto, Madam Mary,Dr. Teiji Nakamura, Prof. Chanida and of courses fromall other esteemed presentations on latest advancementsin the field of diet and nutrition for the global
population. The insights gained especially in the areasof diet and nutritional research enabled us to engage inclinical researches at our work places once we get backto the country respective work places.

Personal Reflections
Initially the Bhutanese team was a bit apprehensive
as we have not travelled much to Bangkok and have
known Thai people but to our surprise we found almost
all the Thai people we encounter were very humble,
loyal and friendly that has given us much confidence
and added comfort during our stay there. Besides that,
TDA in particular was found so supportive andconsiderate in accommodating and accepting all ourneeds particularly to do with attending meeting andletting us to introduce AYDN and lastly in showcasing
our work done thus far to all the attendees of TDA
meeting. On the other note, it was very good to see that
Thailand has very rich dietary diversity extending fromsea foods to seasonal fruits and vegetables.

Action Plan to Foster AYDN in the Future
Meeting at Thailand, Bangkok was an eye opening
for all of us (Bhutanese) as we have hardly attended
such regional meetings/ conferences on diet andnutrition alone, that too organized by the dietetic
professionals. The very meeting enabled us to exchange
information on dietetic practices across member
countries and it also served a great platform forexchange of knowledge and skills amongst the fellow
dietitians. The meeting and the presentation particularly
by AYDN on curriculum comparative study, for Bhutan
it equipped us to go for the best dietitian training
programs practiced in countries like Thailand, Malaysia,
Japan and Philippines when in future Bhutan aspires tostart training programs for dietitians.

Bachelor of Nutrition program
Currently Bhutan does not have any
institute/college/ university offering any level of dietand nutrition training. All the Dietitians working in the
country have mostly completed bachelors in Nutrition
and Dietetics from India, Thailand and a few from othercountries. In Bhutan, dietitians are regulated by
Medical and Health Professionals Council, a bodyfurther governed by Bhutan Qualifications andProfessionals Certification Authority functioning under
the Ministry of Education and Skills Development,
Royal Government of Bhutan. No dietitians are allowed
to practice, without getting registered with the council
be it in the academia or in the clinical setups.

*To whom correspondence should be addressed:
pkumar@jdwnrh.gov.bt

44

Report (India) on the Asian Young Dietitians Network Meeting in Thailand
Naaznin Husein
Freedom Wellness Management, India
Introduction
The Young Asian Dietitian Network (AYDN),
established in early 2023, embarked on a mission tostrengthen the ties among dietetic professionals
across 11 Asian countries. Through online meetings,
AYDN aims to foster a platform for the exchange ofknowledge, skills, culinary, cultural habits, andcollaborative research in the domains of Nutrition
and Health. The first successful study was of
Cuisine and food culture understanding, Dietitian's
presence in the community, and an overview of
Diseases in the country presented in Japan on
December
2023.
The
Secondinitiative
AYDN includes a comparative study on the
curriculum of dietetic training programs acrossmember nations. This study culminated in apresentation at the 50th Anniversary of the Thai
Dietetic Association (TDA) in Bangkok from April
28th to 30th, 2024.

advancements in diet and nutrition research. These
learnings not only broadened our professional
horizons but also inspired us to engage in clinicalresearch upon our return. Easy to execute research
proposal with significant impacts on communities
was a great learning, One particular example that I
want to elaborate on is a research study quoted by
Dr Yamamoto-Where he explained the change inform of cutting vegetables from coarse to fine andsmaller pieces and easy to chew for young school
going children greatly increased consumption,
making the meal enjoyable -hence no wastage andbetter nutritional status among school children.
Study on Bachelor of Nutrition Program ofdifferent countries.
Every member nation representative presented theirunique data of Bachelor programs. It encompassed
Subjects of Basic Science and Nutrition. Also
Number of hours and credits devoted to subjects inthe syllabus. The study also evaluated Trainers, andinstructors- specifically scientists, clinical dietitians,
food service managers, food technologists, Nurses,
Doctors, and others.The study also attempted tounderstand the role of Regulation by the Medicaland Health Professionals Council standards set by
the country Qualifications and Professionals
Certification Authority, mandating registration forpractice in academic and clinical settings. In India,
the Dietetic Association is under the Allied HealthCouncil of the government.This was an interesting
activity as we realized that every Institute even in
India had varied and unique subjects and Syllabus.
Lack of Standardization was seen across curriculum
across member nations.

Acknowledgments
We as AYDN are in deep appreciation for Professor
Yamamoto's guidance. He continues to play apivotal role in ensuring the success of the AsianYoung Dietitian Networking enabling unity,
Friendship, Scientific exchange, and Cultural andCulinary Understanding among members from
Asian Countries. The generous support from
Ajinomoto to propel AYDN from its inception ishighly appreciated. 50th.Unmatched hospitality was
truly.TDA anniversary provided an invaluable
opportunity for AYDN to showcase its work andinteract with professionals from diverse
backgrounds. The deep dive into Thai Cuisine,
culture,and
Hospitality
washighlyappreciated.TDA's support in accommodating ourneeds and facilitating introductions enhanced oursense of belonging

Action Plan to Foster AYDN in the Future
The TDA anniversary catalyzed future endeavors
within AYDN. The exchange of information on
dietetic practices among member countries
highlighted the need for continued collaboration.
AYDN's presentation on curriculum comparison
provided valuable insights for India’s futureendeavors in establishing dietitian training programs,
drawing from best practices in countries likeThailand, Malaysia, Japan, and the Philippines. In
conclusion, the 50th TDA anniversary was atransformative experience, reaffirming AYDN's
commitment to advancing the field of dietetics inAsia through collaboration, knowledge exchange,
and collective growth

Personal Reflections: The experience in Bangkok
was enriching on both professional and personalfronts. Our Thai colleagues were extremely humble,
friendly, and immaculate in the organization leading
to seamless learning. Moreover, Thailand's richdietary diversity left a lasting impression, offering
insights into regional nutrition practices. The
presentations by esteemed scholars like Prof.
Yamamoto, Madam Mary Esow, Dr. Teiji
Nakamura, Dr Chawng Leh Chii, and Prof. Chanida
provided valuable insights into the latest*To whom correspondence should be addressed:naazninh@gmail.com.

45

Report (Indonesia) on the Asian Young Dietitians Network Meeting in Thailand
Nur Ayu Ruhmayanti1, Achmed Forest Khan2, Wita Rizki Amelia3, Ishak Halim Octawijaya 4*
1

Politeknik Kemenkes Gorontalo, Gorontalo, Indonesia
2
CV GSB, Samarinda, Indonesia
3
Dr. Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
4
School of Nutrition and Dietetics, Kanagawa University of Human Services, Yokosuka, Japan
Introduction
To mark a significant milestone, the 50th
anniversary of the Thai Dietetic Association (TDA), theAsian Young Dietitian Network (AYDN) participatedin a series of events organized by the TDA. Among thetwenty AYDN members who attended the events heldin Bangkok, Thailand, at the end of April 2024, two
Indonesian representatives, Achmed Forest Khan and
Nur Ayu Rahmayanti, actively participated in the
symposiums, the AYDN meeting, and other events.
This event served as an excellent platform for Asiandietitians and Thai dietitians to foster mutual
understanding and cooperation. It was particularly
fruitful in sharing insights on nutrition and dietetics
education at the undergraduate level in Asian countries.
The event also facilitated a discussion session for the
young dietitians to strategize future activities of AYDN.
We would like to thank the TDA for their invaluable
support in making this event possible. We also sincerely
appreciate the generous sponsorship from AjinomotoCo., Inc. Last but not least, we would like to express our
sincere thanks to Prof. Shigeru Yamamoto of Jumonji
University for his unwavering dedication and support
since the inception of AYDN. Your contributions havebeen instrumental in our journey.
Personal Reflections
One of the event's highlights was a thoughtprovoking lecture by Prof. Shigeru Yamamoto ofJumonji University, who shared insights on the dietary
standards of Japan, as well as the challenges andopportunities faced by dietitians in Japan. His lecture
included a practical example of food modification,
where several food ingredients were added to school
children's lunch menus to enhance their nutritional
value. This modification, it is hoped, will lead to
improved academic performance among school
children without significantly increasing the menu cost.
All the presenters delivered their material withoutstanding clarity and received high praise from theentire audience and all the parties involved in the seriesof activities commemorating the TDA. AYDN
Meetings are usually held online, but on this occasion,
they were held onsite. On this occasion, we discussed
the follow-up to the delivery of study results from thedietitian education system of each AYDN member
country. After this activity, it is hoped that all AYDN
*To whom correspondence should be addressed:
halim-svw@kuhs.ac.jp

members will be directed to convey the study resultsback to the relevant parties in their respective countries
to become discussion material to improve the quality of
dietitian education in each AYDN member country.
AYDN's activities continue to enhance the reputation of
dietitians, which is in line with the primary goal of
AYDN. For the next step, we will discuss the legal
system and its application to the world of work for
dietitians. On that occasion, we also agreed on theofficial logo for AYDN and the management structureof AYDN, which consists of a coordinator and secretary
as well as other supporting roles so that AYDN can run
better and provide more significant benefits to theprogress of the Asian Dietitian profession, especially
AYDN member countries.
Together with AYDN Thai members, TDA andAjinomoto Co., Inc. have provided us with the warmest
hospitality. Our members have gratefully enjoyed thehalal Thai cuisine, the beautiful scenery, and the richculture of Thailand during our stay in Bangkok. With
the AYDN members from other countries, we haveshared the diverse Asian culture during ourcompanionship. Together, we celebrated not only the50th anniversary of TDA but also the eclectic culture ofAsia.
We were deeply inspired by Prof. Yamamoto's
dedication and passion, the Thai dietitians' diverse
perspectives, and the innovative ideas shared by the
AYDN members. This experience has reinforced ourbelief in the importance of international collaborationand knowledge sharing in advancing the field ofdietetics in Asia.
Bachelor of Nutrition program
We collect data on dietitian education based on
regulations from the Association of Indonesian Higher
Education Institutions for Nutrition (AIPGI) as areference for universities providing dietetic educationand the Association of Higher Education Institutions for
Vocational Nutrition in Indonesia (AIPVOGI) as areference for vocational colleges providing education
for dietitians in Indonesia. After holding discussions
with representatives from other countries, it was agreed
that the data from Indonesia used dietitian education atuniversities ranging from undergraduate education toprofessional dietitian education1. There are differencesin the undergraduate education system based on the
AIPGI and AIPVOGI references; however, dietitian
professional education is similar to the professional46

education administration system based on these two
references.
Among the 118 universities that provide Bachelor of
Nutrition education and nine institutions providing
professional dietitian education in Indonesia, an
institution was selected as a reference for the Bachelorof Nutrition and professional dietitian education

curriculum. A curriculum example of a Bachelor of
Nutrition education was obtained from Brawijaya
University, under the Ministry of Education, Culture,
Research, and Technology (Kementerian Pendidikan,
Kebudayaan, Riset, dan Teknologi)2. For professional
dietitian education, the curriculum of Makassar Health
Polytechnic of the Ministry of Health was referred to.

Fig 1. Halal dining and heartfelt hospitality of the Thai Dietetic Association

Fig. 2. Breathtaking scenery of Bangkok we enjoyed with young dietitian fellows of Asia
Indonesia's undergraduate nutrition education
curriculum has approximately 150-175 credits forundergraduate programs and professional education for
dietitians. Each credit is equivalent to 170 minutes andconsists of theory (onsite), practice, independent
learning, or other forms of learning. The professional
dietitian education curriculum comprises 26 practicalcredits, equivalent to 1032 practical hours in one year47

of dietetic internship education (2 semesters). The
duration of the dietetic internship hours exceeds the
500-hour standard set by the International
Confederation of Dietetics Association (ICDA)3.
Several courses are also the focus of our discussion.
In Indonesia's Bachelor of Nutrition curriculum, there
are still many general courses that students must take.
On the one hand, several nutrition courses are elective
courses, such as food microbiology, sports nutrition,
nutrition program planning, and other elective courses,
while in different countries are core courses inundergraduate nutrition education. This will be one of
the things that needs to be discussed with nutrition
education organizers in Indonesia.
Teaching resources in Indonesia are diverse. The
teaching staff consists of nutrition staff themselves,both dietitians and nutritionists, doctors, nurses,
midwives, environmental health, and public health, andthe teaching staff may come from outside the field of
science, such as science, food technology, and eventeaching staff from the legal field are also covered
inside it. As for the professional education program(dietetic internship), all clinical instructors come from
dietitians for clinical and public health programs. For
food service management programs, there are otherstaff from food technology, human resource
management, catering services, and nutrition and foodservices entrepreneurs.
Action Plan to Foster AYDN in the Future
For instance, we discussed the extent of practicaltraining in dietetics education, the need for an updated
curriculum reflecting the latest research, and the role oftechnology in enhancing nutrition and dietetic
education corresponding to nutrition issues in Asia. In
Indonesia, improving nutrition and dietetic educationmust address the needs of different communities acrossthe archipelago. We must enhance the curriculum toequip our graduates, the future nutritionists anddietitians, with skills for local nutritional interventions.
In the future, we suggest that AYDN organize more
symposiums, workshops, and exchange programs to
improve its members' knowledge and skills. We also
aim to strengthen our collaboration with other dietetic
associations and organizations to promote the field ofdietetics in Asia. We hope that activities like this cancontinue and produce the best ideas to increase thecompetence of young dietitians worldwide, especially
young dietitians in Asia.

REFERENCES
1. Kolegium Ilmu Gizi Indonesia (KIGI), DPP
Persatuan Ahli Gizi Indonesia (PERSAGI),
Asosiasi Institusi Pendidikan Tinggi Gizi
Indonesia (AIPGI). Naskah Akademik
Pendidikan Profesi Dietisien (Academic
Manuscriptfor
DietitianProfessional
Education). KIGI, PERSAGI, AIPGI. 2021.
2. Department of Nutrition, Faculty of Medicine,

3. Brawijaya University. Pedoman Pendidikan
Department Education Guidelines Academic
Jurusan Gizi TA. 2020/2021 (Nutrition Year
2020/2021). Department of Nutrition, Facultyof Medicine, Brawijaya University. 2020.
4. International Confederation of Dietetic
Associations (ICDA). Dietitians-nutritionists
around the World: Their Education and theirWork. ICDA. 2016.

48

Report (Japan) on the Asian Young Dietitians Network Meeting in Thailand
Risako Okuyama1
1

Graduate School of Aomori University Health and Welfare, Aomori, JapanAt the symposium held at the Thai Dietetic
Conference in Thailand, the Asia Young Dietitian
Network (AYDN) introduced a comparative study of
dietitian academic and training programme from themembers’ countries. There were differences in the
programmes among countries, and it was able to findadvantages and disadvantages in each country. Throughthe gathering of AYDN’s members in Thailand, thegoal was to shareing and deepen the education systemof each country to understand the current situation to
improve the education system of each country in the
future.
At the the TDA conferences, we it was able to listen
to Prof. Shigeru Yamamoto's lecture (Jumonji
University) about “What dietitians need for the future:
Researches at their workplace”. The author agree thatJapanese university system for dietitians do not placeemphasis on investigation of methology. However, thestudy of dietitians in their workplaces introduced by
Prof. Yamamoto was very interesting. One of theexample was the cooking area for the preparation ofschool lunch with the incorporation of new techologies
to improve dietitians’ work environment in Japan andanother example was the challenge for dietitians from
Vietnam to increase variety of vegetables and othernutrious foods added in school lunch meals keeping a
low cost. These cases were published in an academic
journal in order to spread to other colleges theinformation which would be very useful because it has
many similarities with the problems faced by otherdietitians in the world. Unfortunately in Japan, theresearches are only reported within a paticularcommunity or region and there are few opportunities torefer them. Therefore, the author believe that deititians
should disseminate the results of their researches
outside the community.
On the other hand, during the conference, it waspossible to interact with the members of AYDN, which
was very inspiring. The sharing of educational
programs from various countries through AYDN
activities would help to identify differences between
own and other countries, and providean opportunity toreconsider our the educational programs for the next
generation of dietitians. Furthermore, in countries that
do not yet have an established dietitian system, it may
help to create educational programs. By cooperating
and working together in the network, it is possible tocontribute not only in Japan but also in Asia as a whole
for a better academic system. Lastly, but not the least,
the author would like to acknowledge to the warmth
welcome and the hospitality of Thai Dietetic
Association (TDA) for giving the change to be present*To whom correspondence should be addressed:
1714005@ms.auhw.ac.jp

in the conference and to Jumonji University for the
preparation of the trip and the support and valuablecomments from Prof. Shigeru Yamamoto to guide the
AYDN and the sponsor from Ajinomoto Co., Inc. This
trip allows to the author to experience the treat of
dietitians of other countries, such as the participants of
TDA, and also to experience the food culture ofThailand, such as the “Khow niew ma-muang”, which
combine cold sticky rice, coconut milk and ripe mango.
Event that it was sweet, it was refreshing to eat when it
was around 40 celcius degree in Thailand. In Japan, it
is common to combine rice with sweet beans, but notwith fruits, which made this dish interesting.

Fig 1. Khow niew ma-muang
Bachelor of Nutrition program
Through the discussions at AYDN, it was able toidentify the characteristics of Japan's dietitian training
programme. Japan's dietitian training programme has ageneral framework, but not in detail comparing withother countries. Therefore, the number of faculty
members and the types of courses offered differ fromuniversity to university in Japan. The fact that
educational programme are not defined in detail is astrength of the Japanese educational programme.
In Japan, dietitians work in a wide range of
workplaces, including not only hospitals, but also
public health centers, private institutions, schools, andrestaurants. Therefore, the flexibility of the curriculum
allows students to learn about matters in the field thatinterest the undergraduate students while acquiring thenecessary knowledge as a dietitian. Another strength isthe curriculum to obtain the nutrition teacher's license.
A nutrition teacher is a position that combines thequalities of both, a dietitian and a teacher. The nutrition
teacher system began in Japan in 2005. This licenceallows dietitians to play a central role in promoting
nutrition education in school. The curriculum for49

nutrition teachers includes various subjects such as
child development, psychology, and educational
methods. On the other hand, one of the weakness ofJapan's dietitian training programs is the short time forpractical training comparing to other countries. One of
the reasons is the busy schedules of dietitians in theirworkplace. When it comes to accepting training
students, dietitians have to supervise the students inaddition to their regular tasks. However, it is not only aproblem in Japan that dietitians are busy. Therefore, weshould learn more about the situation from othercountries to improve the Japan's dietitian training
programme.
Action Plan to Foster AYDN in the Future
Through the TDA conference, it was possible tolearn the long history working together the Asian
countries The Asian Federation of Dietetic
Associations, AFDA, was created in Malaysia in 1991.
At the time of its founding, there were nine member

countries, including Japan, but now twelve countries
are members. Nowadays, the Internet has become
widespread, which able to organize meetings andsending messages anytime, and anywhere. It makes
possible to easily transmit and receive information toand from people around the world. The young dietitians
should cooperate with pioneers of AFDA.
As part of the future development of AYDN, its
need to learn more about each country. The kick-off
meeting helped us to understand each other's culture
and general nutritional situation. However, learning
more in details about the nutritional situation of eachcountry, its able to share appropriate information toeach problem. Although Asian countries have great
differences such as in history, food culture and climate,
the nutritional problems they face are similar. What is
adaptable in one country may be adaptable in another.
The hope is that this network will usher in a solution to
Asia's nutritional problems by improving the education
system of each country to enhance knowledge of
dietitians.

50

Report (Malaysia) on the Asian Young Dietitians Network Meeting in Thailand
Georgen Thye1*, Ng Kar Foo1
1

Consultant Dietitian (Malaysian Dietitian Association, Kuala Lumpur, Malaysia)

Introduction
The goals of the Asian Young Dietitian Network(AYDN) for this gathering in Bangkok, Thailand, in
conjunction with the Thai Dietetic Annual Conference,
are to foster collaboration, share knowledge, andstrengthen the network of young dietitians across Asia.
This event aims to enhance professional development,elevate the standards of nutrition practice in the region,and present insights from our research on the dietetic
education system among AYDN member countries.
We gratefully acknowledge the hospitality andgenerous support from the Ajinomoto company.
Special thanks to Prof. Yamamoto and TDA forsponsoring AYDN's activities, ensuring a successful
and enriching experience for all participants.
Personal Reflections
During our time in Thailand, we were deeply movedby the warmth and hospitality extended by the Thai
Dietetic Association and the locals in Bangkok. The
vibrant Thai cuisine, delightful street food, and richfood culture left a lasting impression.
The TDA conferences were particularly impactful,featuring inspiring presentations from esteemed figures
such as Prof. Yamamoto, Madam Mary Easaw, and Dr.
Teiji Nakamura. Their remarkable careers serve as
powerful motivation for dietitians and AYDN members
to pursue excellence in the field of nutrition anddietetics.
Interactions with fellow AYDN members wereenlightening. The exchange of ideas and experiences
provided valuable insights that we can apply to ourwork upon returning home. Discussing the education
and working systems from different countries
highlighted the diverse approaches to nutrition anddietetics, emphasizing the importance of a collaborativeand inclusive network.
Dietetics Program in Malaysia
Dietetics education in Malaysia is governed byrigorous standards to ensure the competence andprofessionalism of dietitians. Aspiring dietitians mustcomplete a bachelor’s degree in Dietetics or Nutrition
and Dietetics from a recognized university,
encompassing extensive coursework coupled with amandatory clinical internship. These programs must be
accredited by the Malaysian Qualifications Agency(MQA) and recognized by the Ministry of Health.
Currently, there are 9 universities in Malaysia offering
dietetics programme that is designed in accordance with
*To whom correspondence should be addressed:
georgen_thye@live.com

the Programme Standards: Medical and Health Science
provided by MQA.
The Programme Standards document provides
guidelines for minimum acceptable practices in various
aspects of educational programs, including aims andlearning outcomes, curriculum design, assessment,
student selection, academic staff, resources, program
monitoring, leadership, governance, and quality
improvement. It does not specify detailed
characteristics for curricula or educational resources,
instead encouraging diversity and innovation. This
allows programme providers to customize theirofferings to create unique niches while ensuring
graduates meet professional and societal needs.
In dietetics, this Programme Standards document
aims to train dietitians to, at least but not limited to,understand food science, interpret nutrition science,
assess people’s nutritional needs, conduct dietcounseling, prescribe diets for medical conditions,
implement and manage nutrition services and healthpromotion programmes, undertake research, deliver
evidence-based nutrition care, and undertake
development of nutrition and dietetic policies. The
document also states 136 credits as the minimum
graduating credits for a bachelor’s degree in dietetics,
in which it should offer supervised professional
placement with 28-30 credits (equivalent to 1,120 to
1,200 hours). Supervised professional placement
consists of clinical, community dietetics, and foodservice settings. In the other words, aspiring dietitians
are given opportunities to access various settings
including government facilities to fulfill the placement
requirement, gain experience and advance professional
practice.
Action Plan to Foster AYDN in the Future
From the Thai Dietetic Conference and interactions
with other AYDN members, we have learned theimportance of continuous professional development
and the value of a supportive network. Applying thisknowledge, we aim to advocate for more structured
specialization programs and increased international
collaboration in Malaysia's nutrition education.
AYDN can significantly improve the undergraduate
Bachelor of Nutrition program in Malaysia byfacilitating knowledge exchange, providing access tointernational best practices, and offering professional
development opportunities. For the future developmentof AYDN, we propose the following ideas:
1. Establish
Mentorship
Programs:
Pairingexperienced dietitians with young professionals to
guide their career development.

51

2.

Promote Research Collaborations: Encouraging
joint research projects among AYDN members toaddress regional nutrition challenges.
3. Expand Training Opportunities: Organizing
workshops and training sessions on specialized
topics to enhance the skills of young dietitians.
By implementing these initiatives, AYDN cancontinue to foster excellence and innovation in the fieldof nutrition across Asia. We hope that AYDN member
countries will continue to work closely together,learning from and helping each other to grow, upskill,and improve the standards and recognition of dietitiansin the region.

1.
2.
3.

REFERENCES
Yama S, Wang LE, May AU. The effect of soybean
protein on lipid profile. J Nutr 42: 69–76. 1996.
Cho YU. Relationship between school lunch
program and Child behavior. Annu Rev Dietetics
16: 33–50. 1996.
Programme Standards: Medical and Health
Science. Malaysian Qualifications Agency. Second
Edition 2016

Fig 1. AYDN Malaysia Representatives Mr. Ng Kar Foo (left) and Mr. Georgen Thye (middle) receiving asouvenir from Prof. Dr. Chanida Pachotikarn, President of the Thai Dietetic Association (right).

52

Report (Philippines) on the Asian Young Dietitians Network Meeting in Thailand
Mabelle Yna C. Aragon1, Marita V. De Guzman2*
1 Nutritionist-Dietitians’ Association of the Philippines, Makati City, Philippines
2 Nutritionist-Dietitians’ Association of the Philippines, Makati City, Philippines
2 Accenture Inc., Taguig City, Philippines
The members of the Asian Young Dietitian
Network (AYDN) were invited by the Thai Dietetic
Association (TDA) to attend its 50th Anniversary andAnnual Conference on April 28-30, 2024 at theBerkeley Hotel Pratunam, Bangkok, Thailand. The
AYDN comprises dietitian representatives from various
Asian countries: Bangladesh, Bhutan, Cambodia, India,
Indonesia, Japan, Malaysia, Philippines, Sri Lanka,
Taiwan, Thailand, and Vietnam. This meeting was
made possible through the generous support andhospitality of the Asian Nutrition and Food Culture
Research Center of Jumonji University and AjinomotoCo., Inc. to promote professional development, enhancecross-cultural collaboration, and advance the field of
nutrition.
The recent Thai Dietetic Association conference
was a remarkable experience enriched by the warm
hospitality and vibrant culture of the Thai people.
AYDN members attended the opening ceremony andthe presentation of the TDA Research Award on April
29, 2024. The conference was incredibly inspiring,
especially with the presence of respected nutrition
experts. The lectures by Prof. Dr. Shigeru Yamamoto,
Dr. Chwang Leh-Chil, Dr. Teji Nakamura, Ms. Mary
Easaw, and Asst. Prof. Dr. Chanida Pachitikarn left alasting impression on the audience. Their careers andcontributions in the field of nutrition are strong
motivators for dietitians and members of the AsianYoung Dietitians Network (AYDN). Theirachievements demonstrated the endless possibilities ofour profession and the importance of striving forexcellence and innovation.
Interacting with other AYDN members wasanother cornerstone of the conference experience. This
was the second meeting after our first meeting in
December 2023 in Japan. This exchange was not only
social but also deeply educational. The exchange of*To whom correspondence should be addressed:
marita.deguzman_events@yahoo.com

insights and discussion of the different education andwork systems in different countries enriched ourunderstanding and broadened our perspectives. These
discussions fostered a sense of global camaraderie andshared purpose by highlighting the diversity in our field
and the universal challenges we face.
At the symposium on April 30, 2024, Asian Young
Dietitian Network members Nguyen Thu Trang andAndrea Wakita gave presentations on the network's
founding, activities and plans. Georgen Thy Choong
Jean, Chu Tzu Yun and Prem Kumar Neopanaypresented the network's research: "Exploring theLandscape of Nutrition and Dietetics Training
Program: A Comparative Study among Asian Young
Dietitian Network (AYDN) Member Countries."
AYDN members had prepared for months to collect,assess, and report data for each country’s Bachelor of
Science in Nutrition and Dietetics (BSND) program.
The symposium discussed curriculum structures,
faculty backgrounds, intern experiences, and common
strengths and opportunities for improvement in
nutrition and dietetics programs. During the discussion,
it was noted that some data collected from othercountries were only represented by one school oruniversity, which may not represent all schools oruniversities in that country. It was also noted that the
research compared various aspects such as the numberof credits required for a bachelor's degree. Therefore, itis necessary to validate the standards in each country
and conduct a new survey to update the results.
The BSND program in the Philippines is designed
to provide students with comprehensive training in boththeoretical and practical aspects of nutrition anddietetics. The program spans four years and covers awide range of subjects including biochemistry,
physiology, food science, medical nutrition therapy,
community and public health nutrition, and foodservice systems management1. In addition to classroom
learning, students gain practical experience throughsupervised internships in hospitals, community healthcenters, and food service institutions. The BSND
program is regulated by the Commission on Higher
Education (CHED)2, ensuring high academic standards
are met. The program aims to establish a strong
foundation in both nutritional science and practicalapplications, preparing graduates for various roles in
the field. It offers internships in a variety of settings toprovide valuable hands-on experience and focuses on
public health nutrition to equip students to address
broader nutrition issues in communities. However,some institutions may face challenges due to limited
laboratory and research facilities, which can affect thequality of practical training. There may also be
significant differences in the quality of education and53

training across institutions, impacting the uniformity ofgraduate competencies. Rapid advancements innutrition science require continuous updates to thecurriculum, and some programs may be slow in
integrating the latest research and technologies. Accessto the program can also be limited for students in ruralor underserved areas, affecting the diversity and reachof the profession. Overall, the BSND program in thePhilippines aims to produce well-rounded andcompetent nutritional professionals. However,addressing the challenges related to resources,
curriculum updates, and accessibility is crucial forenhancing the program's effectiveness and inclusivity.

The findings and experiences gained from thisconference will certainly have a lasting impact on our
professional lives. As we return to our respective
countries, we carry with us not only the inspiration fromthe distinguished speakers but also the practical insights
shared by our colleagues. This fusion of inspiration andpractical wisdom will undoubtedly enrich our work anddrive us to implement new ideas and approaches in ourdaily practice. In summary, the TDA conference inThailand was a mix of professional development andcultural enrichment. The warmth and hospitality of theThai people, coupled with their exquisite cuisine,formed an unforgettable backdrop to an extremely
inspiring and educational event. The lectures fromleading figures in the nutrition industry and the valuableinteractions with other AYDN members havestrengthened our overall commitment to excellence inthe field. As we continue our journey, these experiences
will remain a source of motivation and guidance,encouraging us to make a positive contribution to theglobal nutrition community.

REFERENCES
1. University of Santo Tomas. (n.d.). Department
Bachelor of Science in Nutrition and Dietetics
of Nutrition and Dietetics. Retrieved from
(CHED Memorandum Order No. 14, series of
https://www.ust.edu.ph/education/department2017). Retrieved from https://prc.gov.ph/Sites/
of-nutrition-and-dietetics/.
default/files/CMO%2014%20BS%20Nutrition
2. Commission on Higher Education. (2017).
%20and%20Dietetics.pdf.
Policies, standards, and guidelines for the54

Report (Sri Lanka) on the Asian Young Dietitians Network Meeting in Thailand
Firouse F.A.Z1*, Abeysinghe AAKS2
1
2

Asiri Surgical Hospital PLC, Department of Nutrition & Dietetics, Colombo 05, Sri Lanka
Nawaloka Hospitals PLC, Department of Nutrition & Dietetics, Colombo 02, Sri Lanka

Introduction
The Asian Young Dietitians Network (AYDN),
established on December 1, 2023, held its second
physical meeting in Thailand from April 28th to 30th,
2024. This event coincided with the Thai Dietetic
Association's (TDA) 50th anniversary celebration, with
TDA hosting and inviting AYDN members. Twentyone dietitians from eleven Asian countries—
Bangladesh, Bhutan, India, Indonesia, Japan, Malaysia,
Philippines, Sri Lanka, Taiwan, Thailand, and Vietnam
participated, Dietitians from Cambodia are part of ourmember team, but representatives from Cambodia wereunable to attend. The Sri Lanka Dietitians Association
was represented by Ms. F.A.Z. Firouse and Ms.
A.A.K.S. Abeysinghe.
The 50th anniversary of the TDA was a prestigious
event with esteemed guests. Having officials from theThai Health Ministry underscores the importance ofnutrition and dietetics in promoting public health.
Additionally, the presence of officials from the AsianFederation of Dietetic Associations (AFDA) highlights
the collaborative efforts across the region to address
nutritional challenges and promote health status. Also,
the participation of academics and dietitians from the
Asian region was remarkable. The presidential addressby Prof. Chanida Pachotikarn set the tone for the event,highlighting achievements, outlining future goals, andinspiring all attendees to continue their efforts inpromoting the field of dietetics and improving publichealth outcomes (Fig.1).
AYDN members, after several online discussions,
aimed to evaluate and enhance the academic curriculum
and practical training of nutrition and dietetics
programs across their member countries. They
surveyed with three primary objectives: assessing thediversity of curriculums and educational pathways,
examining practical training opportunities for nutritionand dietetics students, and identifying strengths andareas for improvement in member countries' degree
programs. All country representatives were actively
involved in carrying out the survey, which culminatedin a comprehensive set of information to be presented
at the TDA meeting under the theme "Exploring theLandscape of Nutrition and Dietetic Training Program:
A Comprehensive Study Among Asian Young
Dietitians Network Member Countries."
The AYDN symposium was structured into two
main segments. Initially, Ms. Nguyen Thu Trang and
Ms. Andrea Wakita played key roles, introducing theestablishment of the AYDN and presenting the annual
plan for 2024-2025. Following their presentation, Mr.
Georgen Thye, Mr. Tzu Yun Cha, and Mr. Prem Kumar*To whom correspondence should be addressed:
firouseamal@gmail.com(representing Malaysia, Taiwan, and Bhutan
respectively) shared the collective study findings. The
session was moderated and translated by Mr. Samitti
Chotsrluencha from Thailand. These speakers wereappointed through AYDN's collective decision-making
process, reflecting the organization's commitment toteamwork. (Fig.2).

Fig 1. TDA 50th Anniversary Inauguration
Ceremony with prestigious guests

Fig 2. AYDN Symposium
The meeting's success was significantly bolstered byseveral key contributors. The generous financial
support from Ajinomoto Corporation provided crucial
resources that facilitated the gathering. Additionally,
the invaluable guidance of Professor Shigeru
Yamamoto from Jumonji University, Japan, wasinstrumental. Prof. S.Yamamoto, a visionary leader in
dietetics with extensive networking connections among
senior Asian dietitians and industrial partnerships in thefield of nutrition and dietetics, played a pivotal role in55

offering expert insights and strategic direction thatsignificantly shaped the objectives and activities of theAYDN. With his wealth of experience and deep

understanding of the challenges and opportunities in thefield (Fig. 3).

Fig 3. Prof.S.Yamamoto directing and networking at
the conference

Fig 4. Warm and welcoming hospitality received
from TDA members

The TDA also played a crucial role in the event's
success. Celebrating its 50th anniversary, the TDA
extended warm hospitality to all participants, creating awelcoming and conducive environment for fruitfulexchanges and collaboration (Fig:4) This support fromthe TDA not only enhanced the experience for theattendees but also underscored the collaborative spiritthat is essential for advancing nutrition and dietetics
across Asia.

support and encourage research and innovation in thefield of dietetics and nutrition.
Moreover, the conference provided an opportunity
to meet key figures from the Asian Federation of
Dietetic Associations (AFDA), expanding the Sri
Lankan dietitians' network through potential AFDA
membership. Interactions with fellow AYDN members
offered valuable insights into diverse educational andworking systems, presenting potential strategies for
implementation in our home country (Fig.6).
As AYDN members chose to represent theircountries in their traditional cultural attire, it fostered adeeper understanding and appreciation of each other'scultures. Additionally, AYDN and TDA made sure toarrange food and other facilities following participants'
religious values, ensuring a respectful and inclusive
environment.

Personal Reflections
The warmth and hospitality at the TDA conferencein Thailand left a lasting impression, highlighting theshared richness of Asian hospitality. As a team of
dietitians, we were eager to explore different dishes
according to local cultures and were delighted to taste
some authentic Thai dishes, which are highly nutritious
from a dietitian's perspective.
Esteemed figures such as Prof. Shigeru Yamamoto,Prof. Teiji Nakamura, Dr. Leh-Chii Chwang, and Dr.
Mary Easaw delivered inspiring presentations,motivating dietitians and AYDN members to pursue
excellence in nutrition. This exposure to field experts
was particularly beneficial for young dietitians from Sri
Lanka. The key takeaway for Sri Lankan dietitians was
the importance of engaging in more research in addition
to routine clinical practice (Fig.5).
One of the most memorable events was the grandcelebration of the TDA's 50th anniversary. The TDA
not only marked this milestone with grandeur but alsooffered several research grants and awards acrossdifferent categories. These opportunities extended fromschool students to postgraduate students, involving
academic organizations and industrial partnerships toBachelor of Nutrition program
In Sri Lanka, only one bachelor's degree is offeredto produce registered dietitians recognized by the Sri
Lanka Medical Council. The Bachelor of Science inFood Science and Nutrition program at Wayamba
University of Sri Lanka features a robust andcomprehensive curriculum that integrates essential
basic science subjects and professional courses. The
program is distinguished by its qualified faculty,
predominantly experienced dietitians serving as
academics and preceptors, and its emphasis on practicaltraining through extensive clinical internships. Despite
these strengths, the absence of a national examination
for dietitian registration poses a challenge forstandardization and recognition of qualifications.
Additionally, while the clinical internships are wellstructured, the training in community and food service

56settings would benefit from increased and morestructured hours.
Action Plan to Foster AYDN in the Future
To foster AYDN in the future, several actionable
steps for improving nutrition and dietetics education in
Sri Lanka include: implementing a standardized
national examination for dietitian registration andregistration renewal process to enhance professional
credibility; increasing the duration and structure ofcommunity and food service internships to meetinternational standards; and maintaining collaboration
within AYDN to exchange best practices andinnovative educational strategies, benefiting theundergraduate program in Sri Lanka.
Future Development of AYDN
As a young organization, AYDN has establishedplans extending to 2026. For the years 2024 to 2025,
AYDN is focusing on playing a crucial role instandardizing dietetics education across Asia. By
creating a network of highly qualified dietitians, AYDN
is dedicated to enhancing the field of Dietetics andNutrition throughout the region.

Fig 5. An eye-opening slide presented at the conferenceby Prof.S.Yamamoto & take-home message of
Sri Lankan dietitians

57

Fig 6. Sri Lankan dietitians networking with
AFDA, TDA officials and AYDN teamReport (Taiwan) on the Asian Young Dietitians Network Meeting in Thailand
Tzu-Yun Chu1, Zi-Xuan Lin2*
1

Clinical Dietitian, Dietetics and Nutrition Department, Taipei Veterans General Hospital, Taiwan
2
Clinical Dietitian, Department of Dietetics, National Taiwan University Hospital, Taiwan

Introduction
The Asia Young Dietitian Network (AYDN)'s goals
for this gathering in Thailand Dietetic Association(TDA) conference, Thailand, are to promote member
interaction and cooperation, and to advance the field of
nutrition. We acknowledge the hospitality and generous
support received from Ajinomoto company, and thesponsorship of AYDN's activities by Prof. Yamamoto
and TDA.

2.

Personal Reflections
In Thailand, we experienced the warmth andhospitality of the Thai people, along with ourappreciation for Thai cuisine, street food, and foodculture. The diverse and delicious food is not only
enjoyable but also a significant part of the culture,reflecting the creativity and warmth of the Thai people.
The TDA conference had a profound impact on us.
The inspiring presentations from esteemed figures suchas Prof. Yamamoto, Madam Mary Easaw, and Dr. Teiji
Nakamura highlighted their careers, which serve as
motivation for dietitians and AYDN members tocontinue pursuing excellence in the field of nutrition.
Interactions with fellow AYDN members werehighly beneficial. These exchanges not only help with
our individual work upon returning home but also
provide valuable insights into the education andworking systems of different countries.

Weaknesses:
1. Many Certifications but Not Specialized:
Dieticians often need to get extra certifications tostay competitive. This broadens their knowledge
but doesn't deepen expertise. They spend a lot oftime and money on these certifications but
struggle to gain trust in their consulting services,leading to negative effects.
2. InsufficientInternship
Hours:
Althoughinternships are emphasized, there aren't enoughhours, and the quality varies. Some hospitals offer
internships just to meet requirements without
providing real clinical experience, leaving
students unprepared for the job market.
3. Low Salary Levels: Dieticians in Taiwan
generally earn low salaries, forcing many to seek
extra income through writing, consulting, or
speaking engagements. While this helps raise
income, it can commodify services and harm theprofessional image.

Bachelor of Nutrition
Taiwan's Bachelor of Nutrition provides diverse
employment opportunities but also faces challenges.
Here are the strengths and weaknesses of career paths
for graduates:
Strengths:
1. Diverse career options: Graduates can work in
hospitals, schools, public health agencies, fitness
centers, and food companies, holding positions
like clinical dieticians, community dieticians, andresearchers.

3.
4.

Professional certification: National exams grant
nutritionist licenses, enhancing competitivenessand professional reputation.
Variety of internships: Emphasizing practicalexperience, the program offers internships in
hospitals, schools, and communities.
Continuous education: Professional associations
offer workshops and courses for skill
enhancement.

Action Plan to Foster AYDN in the Future
From TDA and other AYDN members, we havelearned many valuable lessons that will help improve
the situation in our country. AYDN can enhance the
Bachelor of Nutrition program in Taiwan by promotinginternational exchange and sharing best practices. Our
future development plans include establishing moreinternational collaboration projects, encouraging
resource sharing, and regularly organizing professional
training and seminars to enhance members' professional
skills and knowledge.

*To whom correspondence should be addressed:
qoopooh721@gmail.com

58

Report (Thailand) on the Asian Young Dietitians Network Meeting in Thailand
Samitti Chotsriluecha1,2,3*, Yupa Chanwikrai4
1

Clinical Nutrition Unit, Department of Internal Medicine, Phramongkutklao andCollege of Medicine, Bangkok, Thailand
2
Graduate student in Doctor of Philosophy Program in Nutrition, Faculty of Medicine
Ramathibodi Hospital and Institute of Nutrition, Mahidol University, Bangkok, Thailand
3
Thai Dietetic Association
4
Department of Nutrition, School of Medical Sciences, University of Phayao, Phayao, Thailand

Introduction
Asian Dietitian Network’s was established forsharing information and experience toward Asian
country, and developed research and publication toenhance future direction of dietetic framework. The
Asian Young Dietitian Network (AYDN) activities goon to Thailand for sharing knowledge in the Thailand
Dietetic Association Conference 2024. This activity
was supported by Prof. Shigeru Yamamoto (Jumonji
University),
Ajinomoto
Co.,
Inc.
GlobalCommunication, and Thailand Dietetic Association(TDA). This report may aim to provide personalreflection of experience gathering in conference as wellas to express appreciation of all hospitality andgenerous support received from all those who
cooperated.
Asian Young Dietitian Network Symposium
On TDA conference 30 April 2024, AYDN
Symposium was established to demonstratecollaboration and network working group. The purposeof the symposium was to propagate AYDN initiative
group and share the knowledge and dietetic information
among each country. The speaker of symposiumincluding Mr.Samitti Chotsriluecha, Chairman(Thailand), Ms. Andrea Wakita, Co-chairman (Japan),
Ms. Trang Thu Nguyen (Vietnam), Mr. Georgen Thye

(Malaysia), Mr. Markus Chu (Taiwan), Mr. Prem
Kumar (Bhutan).
The first session composed of Establishment of
Asian Young Dietitian Network, which presented by
Ms. Trang Thu Nguyen, including the contents of gap
between dietitian across Asian country, theestablishment of AYDN, and future direction of AYDN.
The second session displayed “Exploring theLandscape of Nutrition and Dietetics Training
Program: A Comparative Study among Asian Young
Dietitian Network (AYDN) Member Countries. Thissession was presented aim to presented three objectives.
First, to assess curriculum diversity and educational
pathways in AYDN member countries. Second, toexamine practical training opportunities for nutritionand dietetics students in AYDN member countries.
Third to identify strengths and areas for improvementin AYDN member countries' degree programs. Thissession provides great value of informative learning
programs among nutrition and dietetic course from eachcountry, which lead us to enhance the competencies ofdietetic students and make the new frontier of specificnutrition integrate with oriental intellectual such as
phytonutrient from herbs and spices, Chinese
traditional medicine, Ayurveda medicine, and also
traditional Thai traditional medicine.

Fig 1. Asian Young Dietitian Network Symposium
In my point of view, dietitian should integrate andcollect nutrition and dietetic knowledge according toevidenced-based and scientific methodology with the*To whom correspondence should be addressed:
samitti.ch@gmail.com

traditional intellectual. However, research in field of
integrate medicine need to be further warrant of require
more publication among nutrition and dietetic approach.
This could be a strong point among Asian dietetic in
future direction, which collaborate scientific59methodology with traditional intellectual towardsustainable development and nutrition for all.
Bachelor of Nutrition and Dietetic Program in
ThailandIn Thailand, nutrition and dietetic programs
composed of 19 courses as certified becoming
registered dietitian. By the regulation of Dietetic
Professional Council, the course syllabus of nutritionand dietetics program should be more than 120 credits
incorporated with general education (> 24 credits),
specific course on nutrition and dietetic (>72 credits),
internship in nutrition and dietetic (>18 credits, > 900
hours), and elective course (> 6 credits).
The specific courses of nutrition and dietetic
including introduction of food science and nutrition,
food safety and sanitation, principles and culinaryscience, human nutrition, community nutrition,
nutrition in life cycle, principle of nutrition and dietetics,
nutrition assessment, medical nutrition therapy,
nutrition counseling and behavior modification,
seminar in nutrition and dietetics, research in nutritionand dietetics, and ethical and legal issues in dietetics,
which are the fundamental course to enhance the corecompetency of dietitian. The additional course are
special programs depend on university arrangement andrequirement of professional dietetics such as
personalized nutrition, sports nutrition, integrated
nutrition, nutrition and pharmacology, innovation
healthy food and disease-specific food, or sustainable
food security.
The internship in nutrition and dietetic wasregulated by law at least 900 hours, which including
nutrition management and food service (>150 hours),
clinical nutrition and dietetic (>300 hours), community

nutrition (>150 hours), and interesting internship (>300
hours). The regulation of internship hour in Thailand
was higher than the International Confederation of
Dietetic Associations (ICDA) standard at 500 hours, inadditional some university able to provide 1,200 hours
to dietetic student.
The strong point of Thai nutrition and dietetic
curriculum was high internship hours, variety of special
nutrition and dietetic course, which able to enhance ineach field of nutrition e.g. public and community
nutrition, food service and management, and clinicalnutrition. However, there are also have the gap to fillwith the improvement in specialist in each field such as
certified specialist nutrition support board in specificdisease, and also to improve the career pathways andemployability.
Action Plan to Foster AYDN in the Future
The network leads us to opportunities for learningand sharing. AYDN provides a platform to exchange
nutrition and dietetic knowledge, enhancing ourcompetencies based on the course curriculum. My
suggestions for future development include
standardizing and expediting dietitian competencies
within multidisciplinary teams, sharing nutrition
knowledge not only within Thailand but also acrossAsia, and conducting research on personalized andlocalized nutrition to ensure sustainable food andnutrition practices in Asia. Each Asian country faces
unique nutrition challenges, but these can betransformed into exciting opportunities that call for
ongoing collaboration and support. AYDN, as aproactive group of young dietitians, guides us towards
growth and fortifying the dietetic field for the future.

Fig 2. AYDN members with Prof.Shigeru Yamamoto (center), Dr.Chanida Pachotikarn: the president of TDA(left of center) and Dr.Sunard Taechangam: advisory committee of TDA (right of center)60

Report (Vietnam) on the Asian Young Dietitians Network Meeting in Thailand
Trang Thu Nguyen1* , Yen Ngoc Ma2,3
1
Nutrition and Food Culture Research Center, Jumonji University, Saitama, Japan
2
Nagasaki University, School of Tropical Medicine and Global Health, Nagasaki, Japan
3
Nutrition and Dietetic Department, Hanoi Medical University Hospital, Hanoi, Vietnam
Following the success of the Asia Young Dietitian
Network (AYDN) kick-off meeting in person was held
for the first time in Tokyo, Japan, in November 2023,
this year, thanks to the generous support from Professor
Yamamoto Shigeru of Jumonji University, the Thailand
Dietetic Association (TDA), and Ajinomoto Co., Inc.
Global Communication Division, Japan, members of
AYDN from 12 Asian countries had the golden
opportunity to gather and discuss the curriculum of
bachelor of nutrition programs at the undergraduatelevel. This meeting took place in Thailand alongside the50th-anniversary celebrations of TDA Thailand.
With this honored opportunity, we had a greatchance to present our country’s data and engage in a
fruitful exchange of ideas, focusing on the strengths andweaknesses of bachelor of nutrition training programs.
Furthermore, we built strong connections among all
members and committed ourselves to dedicating ourtime and efforts to thriving the future of AYDN.
Personal Reflections on Widening the International
Dietitian Circle (From Ms. Yen’s perspective as a newmember)“I have been a new member of AYDN since
February 2024. Over the past three months, I
participated in numerous online meetings to discuss ourconcerns about the nutrition education system and how
to improve it through the AYDNetwork. I was worried
about our first meeting in Thailand because it was myfirst time meeting many international dietitians.
Moreover, as a newbie, I was concerned about how tomake friends with my new colleagues, even though weusually had monthly online meetings. However, all myworries disappeared immediately when I attended thefirst in-person meeting in Thailand. I felt that everyone
was amiable and energetic, and I also sensed theenthusiasm for nutrition from my colleagues. Throughmultiple conversations, I gained a better understandingof the nutrition system in my friends' home countries. I
am very grateful for the support from all our sponsors,
including Professor Yamamoto Shigeru, Ajinomoto Co.,
Inc., Global Communication, and the Thailand Dietetic

Association. Without their generous support, we
AYDN members would not have had the opportunity tomeet each other in person.
AYDN serves as a vital network for connecting
young dietitians, facilitating the exchange of insights
and experiences among members from different
countries, which we sometimes cannot find in academic
papers. It is not only enhancing our understanding of
the education system but also improving our
professional performance.
During the conference, I had the privilege ofmeeting international colleagues specializing in diverse
areas through AYDN. For instance, RD Zi Xuan Lin(Joy) from Taiwan specializes in pediatric dietetics,
while RD Palmy from Thailand specializes indysphagia management. I vividly recall the words that
Joy told me when I asked her, “Can I contact you if I
face some challenges while taking care of my children's
patients?" Without any hesitation, she told me, “Sure!
I will help you as much as I can. Let’s improve ourdietitian community.” I was delighted at the time, and I
am confident that one of the best choices I made thisyear was to join AYDN. The AYDN gives me theimpression that I have arrived at a hub of dietitians,
something I would not have been able to easily find in
my own country due to disparities in the nutrition
workforce.
In Vietnam, our nutrition training programs are
generally broad, lacking specialization in specificclinical areas such as pediatrics, endocrinology, ICU
care, and dysphagia management. Therefore,
interactions with colleagues specializing in these areas
offer invaluable learning opportunities. I can seek
advice from these experts when encountering
challenging cases involving children or dysphagia
patients. Moreover, I can share this knowledge with mycolleagues and nutrition students during theirinternships at my hospital.
For me, AYDN is a priceless resource that will
enable me to broaden my perspective and also go
beyond my limited understanding of the nutrition
education system.”*To whom correspondence should be addressed:
trangnn27@gmail.com

61

Fig 1. Friendship among AYDN’s members

Fig 2. Vietnam AYDN’s members and Prof.
Chanida (the President of TDA)

Bachelor of Nutrition program
Up until 2024, Vietnam being one of the latest
countries to establish dietetic courses did not have astandard curriculum for the Bachelor of Nutrition
program. It has been only more than 10 years sinceHanoi Medical University with the Ministry of
Education and Training’s permission started the firstenrollment and specialized training of Bachelor of
Nutrition (BN) students, with the job code 7720401 in2013 (1). On the bright side, this means that Vietnam
can inherit the comprehensive curriculum from Japanand other countries (Australia and America) that have
many years of experience. Another strength of theVietnamese training program is that with the increasingawareness of the importance of nutrition, numerous
hospitals offer opportunities for students to gain clinicaland hands-on experience by learning directly frompatients, starting from their bachelor's degree studies.
However, as mentioned before, Vietnam’s nutrition
field is still relatively new, and the number of humanresources is still lacking; thus, almost all the professors
and instructors are not from the background of dietitians
but rather from doctors, and public health personnel.
Therefore, when we looked at the fact that 100% of
instructors are dietitians in other countries like Japan,
Malaysia, and Taiwan…, we hope that in the future theopportunity for this career position will be more open
to all Vietnamese dietitians.
Not only the background of lectures but the content
of the current curriculum also needs to be constructed.
In Vietnam, the curriculum does not help students
specialize in three different areas of nutrition: foodsafety and hygiene, community nutrition, and clinicalnutrition. It is highly recommended to reorganize theprogram, allocating two and a half years to train
students in fundamental nutrition knowledge and one
and a half years for specific areas in which students areinterested (practice and internship-specific knowledge).
This restructuring could help students navigate theircareer pathways later in life. Moreover, there is a
critical need to augment on-site practice hours to meetat least the ICDA standard (500 hours). Although,during the 4-year program, the students get to spend
many hours training at the on-site hospitals, they only
focus on learning about diseases but not nutrition,
which makes the actual number of internship hours in
Vietnam lower than in other countries. The lack ofvariety in on-site training facilities related to foodtechnology, school nutrition, and food services is also a
problem. Integrating nutrition into subjects taught at
hospitals and expanding practical facilities caneffectively address this issue.
Action Plan to Foster AYDN in the Future
Upon hearing different courses from various Asian
countries during the presentation of AYDN at theThailand Dietetics Association, we learned many
intriguing and helpful ideas that can help improve ourprogram in Vietnam. For example, we hope that we canadapt some of the unique subjects that are being offeredin others such as, Japan has a lot of subjects that aid theunderstanding of cooking science, which can enabledietitians to improve their menu planning abilities andenhance communication with cooks. Or in the era ofadvanced technology and mass media, it is necessary to
introduce the students to the advanced technology that
can assist the dietitian’s job. This can be achieved byintroducing subjects related to software applications
and having some subjects such as social marketing,mass communication, and information technology likein Sri Lanka. Vietnam can also learn how to distributethe number of internship hours to cover all the areas of
dietitians’ expertise from countries like the Philippines
with their training regulation with one must have 600
hours of training at the hospitals, 300 hours at
community nutrition, and 300 hours at food companies.
There are still many things that Vietnamesedietitians can learn from all their Asian colleagues in
the Asia Young Dietitian Network, not only inenhancing the bachelor’s training program but also invast aspects such as the law system, registration
system… With the pool data from all the member
countries of AYDN, we can publish many meaningful
articles that can serve as references for the recently
established system like Vietnam, Cambodia… This canbe a notable support for young dietitians when theywant to approach the officials and the government topropose enhancement in the structure or procedures.
We firmly believe that AYDN can be the new voice ofall dietitians with their burning passion for making achange in the nutrition field and lifting the image of
dietitians so that they can get their deserved recognition.
Along with the tight-knit friendship from all our fellow
members in the network, we, Vietnamese dietitians,
will also devote our best to improving our country’s

62dietetics and are eager to contribute to the developmentof the network.
REFERENCES
1.
Ministry of Health L and W. Nutrition
Policy in Japan to Leave No One Behind - For
Achieving Sustainable Societies. 2019.

2.
Ministry of Education and Training. Quyết
định số 5158/ QĐ-BGDĐT ngày 21 tháng 11 năm2012 của Bộ Giáo dục và đào tạo vè việc cho phépTrường đại học Y Hà Nội đào tạo đại học nghành
Dinh dưỡng (Decision No. 5158/QD-BGDĐT dated
November 21, 2012 of the Ministry of Education
and Training regarding the permission for Hanoi
Medical University to offer undergraduate programsin Nutrition). 5158 Vietnam; Nov 21, 2012.

63

Asian Journal of Dietetics, 2020

Special Report: The Cambodian food culture

The Observation of Eating Habits between Cambodian and Japanese

On Sothida, Ry Manydine
Nutrition and Food Culture Research Center, Jumonji University, Saitama, Japan
ABSTRACT：The delicacy of food is a representation of each nation. Deeply rooted fromgeneration to generation, people’s eating habits evolved and resulted in a reflection of foodcultures and family dynamics. This report aims to detail the eating habits between Cambodia
and Japan. While both countries, located in Asia with rich cultures and traditions, are fascinatedby many other countries, the diversity between eating habits and food cultures within family
and society can be seen.
INTRODUCTION
In Cambodia, the tradition of eating together is astandard that has been practiced for many centuries.
These traditional habits emphasize the importance ofcommunity and family bonds. Meals are often
prepared and enjoyed by family members andsometimes extended to neighbors and friends.
Cambodians normally gather around a table, orsometimes they eat directly on the floor, on a layer ofCambodian style’s mat. We can often see that
Cambodian meals consist of a few dishes per meal thatare served in a big bowl to be shared with family
members or friends. On the other hand, Japaneseeating habits present a dining culture that is equallycommunal but marked by a distinct feature on
etiquette and healthy balanced nutrition. The act ofsharing food in Japan is also a way to reinforce social
bonds but it is characterized by a tradition that is
known as “Teishoku”. “Teishoku” or set-meal is often
enjoyed by many Japanese. It has been rooted for avery long time, which can be seen in many daily
common meals such as home meals, school lunches,
hospital meals, and also restaurants. It is often come ina one-person portion, that is not need to be shared
between family members. On the other hand,
Japanese eating habits present a dining culture that isequally communal but marked by a distinct feature on
etiquette and healthy balanced nutrition. The act ofsharing food in Japan is also a way to reinforce social
bonds but it is characterized by a tradition that is
known as “Teishoku”. “Teishoku” or set-meal is often
enjoyed by many Japanese. It has been rooted for avery long time, which can be seen in many daily
common meals such as home meals, school lunches,
hospital meals, and also restaurants. It is often come ina one-person portion, that is not need to be shared
between family members.

Picture 1. Cambodian’s eating habit

Picture 2. Japanese’s eating habit*To whom correspondence should be addressed:
sotida0962333632@gmail.com

64

Asian Journal of Dietetics, 2024

The contrast between these two cultures leads
to a curiosity about how they differ from one another,moreover, this report will deeply analyze the foodplating and preparation between each country and soas the pros and cons that come with it. It will be a guideto understanding a perspective of both Japanese andCambodian cultures.

1.2 Japan
While Cambodians like to share their food, it isless common for Japanese people to do so. Even so,Japanese meals are also made with effort andtechniques. The visuals of food are very important to
the Japanese, to make it look more appealing andattractive, they often serve one main dish and several
side dishes per person. Regarding plating in Japan,
they typically place the rice on the left and the soup on
the right. The main dish is positioned at the top right,
while the side dishes are placed on the lower right. It
is believed that Japanese food presentation emphasizes
visual appeal, with attention to the arrangement,
colors, and shapes of the food. Dishes are often
designed to evoke natural landscapes and seasonal
themes.

1. Meal and plate preparation
1.1 Cambodia
In Cambodia, we believe that the quality of thefamily can be seen at every mealtime. Traditionally,mothers prepared meals with love and care. Time andeffort are needed to receive a plate of delicious dishes.
Cambodian meals normally consist of rice and a main
dish. Talking about the main dish, there are normally
two to three dishes, various from soup, fried, stirredfried, or even boiled meal. The main meal can consistof different foods, since Cambodia has a variety ofmeals that can be chosen from, it also depends on thefamily’s economic status. The main dish is served in a
big bowl or plate, then it is shared among the wholefamily.

The picture below shows a Japanese set-meal“Teishoku”. It includes rice, salad dish, fried fish, andsoup. It is a meal prepared for one person that does notneed to be shared.

The picture below (Picture 3) shows how
Cambodian people enjoyed their food. There are 4
main dishes, including stirred-fried vegetables (1),seaweed soup (2), deep-fried pork (3), and minced
pork salad (4) that are shared between 3 to four people.

Picture 4: Japanese’s style meal
The eating habits of both countries, even though it has
their uniqueness and style that make their respective
population follow and have been practicing for somany years, have some strengths and weaknesses thatcan be seen within both cultures. The table below
shows the advantages and disadvantages that can bewithdrawn from how Cambodian and Japanese eating
habits are like. To further discuss this matter, details
about each point will be analyzed

Picture 3: Cambodian’s style meal

65

Japan and Cambodia eating habits

Table 1: Comparison of eating habits between Japanese and Cambodian

Advantages

Disadvantages

Cambodia•••

Sharing mentality
Satisfaction
Time sufficient•••

Unbalance nutrition
Insanitation
Unappealing

Japan

•
•
•

Balance nutrition
Sanitation
Appealing•••Non-sharing mentality
Dissatisfaction
Time insufficient

2. Comparison
2.1 Cambodia (Advantages)• Sharing mentality
In Cambodia, we believe that love can be shown by
sharing. Unexceptionally, food sharing is a norm thatcan be seen in Cambodian people. This kind of actionis thought to be a family bonding moment. In thisrecent society, family members tend to have different
schedules depending on their careers, however, during
meal time all members are gathered which means thatthey can share about what is going on in their life andso as catch on with what the family members are up
to. This small action is a reason that leads to the bonds
and connections that represent the family dynamic. To
a certain point, in some families, it feels like is a duty
to eat with your family members for every meal.
• Satisfaction
Meal-sharing cultures often embrace joy andfulfillment among family members. Most Asian
country, including Cambodia, tends to have a variety
of dishes that include diverse and nourishingingredients. Ranking from vegetables to many types ofprotein. Food sharing allows everyone to indulge intheir favorite dishes, which means even the pickiest
eaters do not need to adjust their preferences. For

66

instance, children can just pick whatever ingredients
they like from the dishes without worrying about
leaving any leftovers on their plates. This can be seen
as a satisfaction to their mentality since it is believedthat being able to eat what you like will be an
improvement to your mood.
•Time sufficient

In this modern society, time is the most valuable thingthat humans cherish. It means that everything had tobe done efficiently. But how did meal-sharing can besuch an important method of saving time? It is soconvenient to just cook a meal for once and then shareit with your family or partner. This helps reduce theamount of time that is needed to put into preparation.
Moreover, it is also such a help when it comes tocleaning. Meal-sharing required less cooking andplating utensils, which led to a reduction in time andlabor.

Asian Journal of Dietetics, 2024

2.2 Cambodia (Disadvantages)

result, they always cooked in a manner that show
cleanliness and sanitary. Also, the separation of meals• Unbalance nutrition
Despite having all the benefits, some flaws can be seen
within the eating habits of Cambodian people. Directly
picking whatever you prefer from the table, tends tolead to an unbalanced nutrition intake. For example,
during a family meal a child who is picky about theirfood only picks up their ingredients such as meat fromthe dish, this can lead to the problem of unbalanced
nutrition. Even if the meal is made as a nutritious meal,
it still can be an issue if it is not eaten correctly.

between families makes the spread of germs evenmore impossible. This is one of the customs thateveryone should learn, especially from a country thathas a healthy eating routine such as Japan.

• Insanitation
In some cases, eating a meal from the same plate asother people can be seen as an unsanitary form ofaction. Germs and cross-contamination can betransferred from one person’s saliva. It is easy for adisease to spread, especially a cold or flu that can betransmitted easily. In addition, it is also very common
in Cambodia to eat directly on the floor. However, it
is not hygienic to do so, since a lot of dust and dirt are
mostly gathering on the floor. These norms could be areason that leads to a health hazard. This type of habit
has been normalized without much consideration in
Cambodian culture. More attention should be given tothis kind of habit by being more careful and hygienic
to prevent more issues.

• Appealing
There is always some form of art within Japanesefamily meals. To be exact, it is very appealing toseparate each meal as a one-person portion size. It canalso boost the appetite of the consumer as it looks
more delicious and well-organized. Japanese foodalways consists of different ingredients that havedifferent colors, and the detailed attention that is given
to the dishes brings out the arts and deliciousness thatstay within the already nutritious meal. In addition,
Japan’s seasonal change also influenced theingredients and theme of the meal this thought had
been ideal in many families, schools, and restaurants.
2.4 Japan (Disadvantages)• Unappealing
Taste is the most important factor in food, however,appearance is another factor that boosts the remanencein food. In Cambodian household culture, they do notcare about the outside appearance of the food but more
focus on the flavor. In restaurants, it might benecessary to make the food more appealing to theconsumer, on the other hand, in family households isless common to spend some time on making the meal
look more eye-pleasant.

• Non-sharing mentality
It is less common for Japanese to share what they eat
with the other family members since it is already
decided with portion control as a one-person meal.
Sometimes, the mentality of sharing and eating meals
with your family members is not necessary. It is also
noticed that eating alone is more practiced in Japanrather than in Cambodia. Although family dynamics
can be composed in many other ways, sharing meals
with them can be one of the efficient ways to make thebond stronger.

2.3 Japan (Advantages)• Balance nutrition
It is known worldwide that Japan is a country that has
one of the longest life expectancies. Many reasons arebehind this phenomenon but one of the main reasons
is due to the eating habits and portion control of theJapanese. The culture in their household of having amain dish, side dish, and soup plays an important inbalancing out the nutrition intake of an average
Japanese. The habits of eating “Teishoku” make thefamily members feel responsible for finishing what
they have in front of them. The sense of responsibility
will lead to a cycle of consuming a nutritious meal
every day.

• Dissatisfaction
When a portion size is controlled, it is difficult tosatisfy the need and freedom of choosing what theyeat. For example, when a picky eater is served
ingredients that they do not like, they have no choice
but to eat it or in another way, they can leave it which
will result in food waste. In Japanese culture, it is rude
to have leftovers because it is a sign of disrespect
toward the people who cooked for them. That is why
many people have to force themselves to finish
everything that had been served on the plate. This had
become a sense of responsibility for many Japanesepeople.

• Sanitation
From cooking to plating, Japanese people are very
conscious about the hygiene. Since raw fish is one of
the most eaten sources of protein in most households,
it is very common for food poisoning to occur. As a

• Time insufficient
Effort and time are one of the core factors that cause
into making Japanese food. Every home meal is very
deliciated and time-consuming. “Teishoku” also
known as set meals is a component of many dishes thattake up much more time than normal meals. Even if it

67

Japan and Cambodia eating habits
is pleasant to have the privilege of enjoying a variety
of dishes during a family meal it is also a trouble to do
the preparation and cleaning
3. Conclusion
All eating cultures around the world are treasured
in many ways, not so different from each otherJapanese and Cambodian eating habits portray theculture that represents most of the daily activities
among the people. This article shows the traits of bothcountries and also a comparison of how the twocountries from the same continent can be so different
from one another. Both good and flaws can be seen in
every country, though it is fruitful to deeply analyze
and understand this study, it is also fascinating to learn
and adapt from each other especially, in this modern
and diverse society where continuous improvement
and adaptability are emphasized. It is like an eyeopening experience to be conscious of the Japaneseand so are the Cambodians’ eating cultures and habitsleading to a future of better acknowledgement
between both countries.

Reference:
Picture 1: https://shorturl.at/jqTJT
Picture 2: https://shorturl.at/E9LBp
Picture 4: https://shorturl.at/u9rd968