Acceptability of Dishes with Soy-Based Meat Substituteand Their Effects on Blood Biochemistryin Vietnamese T2DM Patients

Shigeru Yamamoto, Professor, Ph.D., RDInternational Nutrition, Department of Food and Nutritional
Sciences、Graduate School of Human Life Sciences, JumonjiUniversity,

Prevelance of Diabetes in Vietnam
ベトナムにおける糖尿病の有病率

Top 10 causes of death in Vietnam-2018
1.

Stroke (No. 1 cerebral infarction)

2.

Ischemic heart disease3.

Lung cancer

4.

chronic obstructive pulmonary disease5.

Alzhemerer’s

6. Diabetes
7. Cirrhosis

7.7%
6.0%

5%
2.9%

8. Injuries
9. Lower respiratory injections
10. Tuberculosis

20122015

20172025

BMI of Vietnamese Type 2 DM is rather normal
I think that the major cause is low fiber intake (<10g/day in adults)
男性BMI (kg/m )

26

女性

26

25

25

24

24

2

23

22
21

20

23

3
3

122

2

男性

1
1

女性

男女

242
3

1221

4

Studies in 1990s

1.

Study in 241 patients in inpatients unit of NTP
hospital (Quynh et al)2.

Study in 629 patients in inpatients unit ofNDGD (Thuy et al)3.

Study in 504 BN ĐTĐ (Dat et al)4.

Study in subjects with insulin resistance (Minhet al)

20Studies in 2000s

1. Epidemiological study on diabetes in 2932 subjects in Ho
Chi Minh City (Son et al, 2004)
2. A cross-sectional study in 48 newly diagnosed diabetic
patients and 96 normal subjects (matched by age, sex andlocality) (Son et al 2004)
3. Epidemiological study on diabetes in three districts ofHanoi city with 2017 subjects (Hai et al, 2001)
4. Epidemiological study on diabetes in 3286 subjects in An
Giang province (Tuan et al, 2003)

• In the United States, soybean meat madefrom plants is often used for meat patties
sandwiched between hamburgers.
• The trend is coming to Japan, and since 2020,
the commercialization of hamburgers using
substitute meat is progressing.
• Moreover, its taste is not so different fromthe original meat, and it seems to have theadvantage of having less calories and higher
nutritional value than meat.

Meat Free Monday (2009) started by a member ofBeatles Paul Mc Cartlney
How we can make a positive difference in slowing
climate change, preserve natural resources, andbetter our health by having at least one plant-based
day a week.

We can save earth eating less meat
Methane Gas (CH4)from livestock contribute 14.5 %of global greenhouse gas emissions*

DraughtIce melt

Landmass lostThe digestion of cow feeds is firstdone by stomach bacteria. At thattime, a lot of methane gas can beproduced.

Flood

Source: Report by the United Nations Food and Agriculture

The demand for meat is increasing andmore cows are needed.

Textured Soybean Protein (Soy-based meat substitute) (Soy meat) Through the process of compressing at highpressure and temperature by Extruder,a porous texture which rich in fiber(13.6g/100g) is formed.
 High firber concentration in soy meat is
expected to be a diet treatment for diabeticpatients.

Effects of Soy Meat on improving
blood glucose, lipid profile in type 2 diabetics

Subjects
The study was approved by the ethical committee of Hai Duong Medical Technical University- asurburb of Hanoi City.

Intervention group
介入群

The following patientswere screened from1500 medical records
at a university hospital.

Blood biochemical
examination of 120subjects

 Age 40-65 years old FBG >6.5 mmol/l

 7%<HbA1<8.5%

 Fructosamine>285μmol/dl Dyslipidemia (TC, TG,HDL,LDL)

RandomlyInvited 47 subjects

 Medication and physicalactivity dose not change
during the study.
 Provide consent informControl group
対象群

Creating delicious soy meat dishes
Name ofdishes

Spring roll

Korokke

Steamegg

Cabbageroll

Mixed
vegetable

stir-friedmorning
glory

Luffa,
Sayte
bean
sproutFried egg

Name ofdishes

Guard soup

Tomato
sauce

Katuk
soup

Mustardsoup

PotatossoupVinespinachsoup

Smash
porridge

Saladcucumber

We have created a soy meat dish that is as delicious as real meatand does not smell like soybeans.

5 Day Cycle Menus
The best 10 dishs for intervention trials in T2DM patients
Day 1

Day 2Day 3

Day 4Day 5

Spring roll

Mixed vegetable

Stir-fry glory morning

Luffa, Saytebean sprout

SaladVine spinach soupMustard soup

Katuk soup

Soup guard

Jute plant soup

Dish 1Maindish

Dish 2Soup

The amount of 40g Soybean- Meat (contains 6g fiber) was used.

Sensory TestCooking-10 dishes using Meat for thecontrol group.
- 10 dishes using Soy Meat(the same receipts) for theintervention group.

Sensory test
官能検査

Interview and ask forscore of each dishes byHedonic-5 point scale

Results of Sensory Test
Soydishes
MeatTSP

Meat dishes

Hedonic - 5 point scaledishes

6NsNs

Ns

Ns

Ns

3.9 4.3

4.1 4.5

Aroma

Appearance543

3.9 4.3

24

4.4

4.4

3.8

10
Overall taste Easy to eat Basic taste
総合評価

食べやすさ

Significant diffirent at p < 0.05 by Paired student t-test

味香り見栄えStudy design
Nutrition survey 3-inconsecutive dayWeek

Interventiongroup(n=24)

1st week

2nd week

3rd week

4th week

2 soybean-based meat dishes everyday(40g soybean meat/day= 20g protein)Controlgroup(n=23)
Lipid profile, Fructosamine, FBG
Height, weight, WC

Meat dishes
Lipid profile, Fructosamine, FBG
Height, weight, WC

Anthropometric indices at baseline and final

Variables

Control group

Intervention groupAge 59.1±7.5

Age 59.1±7.5

N=23 (14, M 9)

N=23 (15, M 9)

Baseline

FinalP

Weight (kg) 59.3±10.1

58.9±10.1

0.06

59.9±8.9 59.3±8.9 0.15

23.6±2.7

23.4±2.90.524.3±2.9 24.0±3.1 0.23

BMI (kg/m2)

Significant diffirent at p < 0.05 by Paired student t-test

Baseline

FinalPEnergy and nutrient intakes at baseline and final
Total Energy Intake (kcal/day)Ns

Protein Intake (g/day)
Ns

Ns

58

CONTROL GROUP

1130

1270

1263

1248

61.8

CONTROL GROUP

INTERVENTION GROUP
Baseline

Baseline

177.8

37.9

CONTROL GROUP
Baseline

37.8

62.4

INTERVENTION
GROUP
Final

Ns

*Ns

57.6

Carbohydrate Intake (g/day)

Lipid Intake (g/day)

33.9

Ns

26.5

INTERVENTION
FinalGROUP* Significant diffirent at p < 0.05 by Paired student t-test

Ns

168.8

CONTROL GROUP
Baseline

174.9160.5

INTERVENTION
GROUP
Final

Fiber intake (g)Fiber intake at baseline and final

181614121086420*NsBaseline
Final
11.9
6.7

65.5

CONTROL GROUP

INTERVENTION GROUP* Significant diffirent at p < 0.05 by Paired student t-test

Blood biochemical data at baseline and final
Control group (n=23)Intervention group (n=24)

Mean ± SD

Mean ± SD

Variables
Baseline

FinalP

Baseline

Final

P

FBG (mmol/l)

8.3±2.1

8.7±2.2

0.58

9.5±3.79.3±3.20.71

Fructosamine(μmol/l)

339.8±44.8341.2±43.5

0.84362.6±86.2

T-C (mmol/l)

5.4±1.2

5.3±1.40.75

5.2±0.9

4.8±0.80.02*

TG (mmol/l)

3.4±2.2

3.7±2.80.43

3.5±2.2

2.8±2.00.02*

LDL-C (mmol/l)

3.2±0.7

3.3±0.90.32

2.9±0.8

2.8±0.60.70

HDL-C (mmol/l)

1.4±0.3

1.2±0.40.01*

1.3±0.3

1.2±0.3

0.07

Significant diffirent at p < 0.05 by Paired student t-test

347.1±82.3 0.03*

Our previous 3 studies:
Effects of fiber intake in Vietnamese T2DM

1. Pre-germinated Brown rice

2. Vegetables and fruits 3. Okara

Pre-germinated brown rice (PGBR)
RiceBrown rice

Polished ricewith germWhiterice

Pre-germinated brown rice(PGBR) is made by soaking
brown rice in water for about
24 hours. It is slightly
germinated. PGBR contains 6times more fiber than WR.
Brown rice needs special
cookware, but PGBR can use thesame cookware as white rice.

How to make pre-germinated brown rice (PGBR)

The brown rice was soaked in lukewarm water at 30 degrees
Celsius for about 20 hours.
When it had sprouted about 1 mm, it was dried.

Energy and nutrient intakes
Baseline

Final

Variables
PGBR (n=28)

WR (n=27)

p-value

PGBR (n=28)

WR (n=27)

p-value

Energy (kcal)

1485381

1453360

0.758

1448329

1462256

0.86

Carbohydrates (g)22863.7

23765.5

0.63

23757.4

23159.4

0.689

Protein (g)60.415.3

61.2200.87

6115.4

58.211.6

0.44

Lipid (g)35.918.6

29.111.6

0.11

28.79.2

3411.1

0.56

7.94.8

7.93.2

0.959

10.94.6

7.73.2

0.05

Dietary fiber (g)*Data are meanSD. P-values obtained by unpaired t-test

PGBR reduced HbA1c of DM patients dramatically
7.2

P> 0.057
6.8

𝒇𝒊𝒃𝒆𝒓 𝟔. 𝟖 ± 𝟒. 𝟏 𝒈 𝒓/𝒅𝒂𝒚

P> 0.05

p= 0.33

White rice6.6

p=0.001

6.4
6.2

p< 0.001

PGBR

𝒇𝒊𝒃𝒆𝒓 𝟏𝟑. 𝟏 ± 𝟒. 𝟑 𝒈 /𝒅𝒂𝒚p< 0.05

6p< 0.001

5.8
5.6
Baseline

2 months

4 months

As a staple food, WR or PGBR was given for 4 months. A remarkable effect wasseen in PGBR group. The main reason seems to be the difference in fiber intake.
The fiber intake was 6.8 g in WR group, but 13.1 g in PGBR group.
Pre-germinated brown rice reduced both blood glucose concentration and body weight in Vietnamese women with
impaired glucose tolerance. Nhung et al 2014)

Effects of vegetable and fruit intakes onblood glucose concentration
Vegetable consumption was about 230g/day (2020) whichmeet only half of recommendation. Popular vegetable inVietnam has low in fiber < 2g per 100g

DietitanPatientThe advantage of this software is that patients can receive nutritional guidance
without having to come to the hospital.

Vietnam Food
Composition table

Photos of 500 dishes
and nutrients in Hanoi

Photos of 400 dishes
and nutrients in HCM

Vegetable intervention by education
Weeks
123

• HbA1c• Nutrition survey for
3 days456

7

Nutrition survey for
3 days andnutrition education

89101112• HbA1c• Nutrition surveyfor 3 days

Baseline characteristics of the population by Study group

HbA1c (%)
Age (years)
Years with diabetesSexFemale
MaleBMI (kg/m2)<18.5
18.5-24.9≥25Intervention Group(n=30)

Control Group(n=30)

8.17±0.73
57.8±9.0
6.0±4.3

8.05±0.77
60.6±8.2
6.5±5.920
1020
10020
1002010P values obtain from unpaired t-test between intervention and control groups

Comparison of vegetable and fruit intake at baseline and finalof intervention and control group

Intervention group(n=28)

Vegetableand fruit
intakes (g)Control group(n=30)

Baseline

Final

Baseline

Final

234 ±130326 ±173*161 ±118187 ±132*Significantly different from baseline to final within the group (p<0.05)

Energy and nutrient intakes at baseline and final
Intervention group(n=28)

Control group(n=30)

Baseline

Final

Baseline

Final

Energy (kcal)

1399±294

1377±234

1398±315

1378±296

Protein (g)66.4±18.3

62.6±16.961.5±15.758.9±17.1

Fat (%E)

26.3±6.2

24.9±3.1

24.7±4.3

25.5±3.8

Carbohydrate

54.7±8.2

57.1±4.4

57.7±5.5

57.6±4.9

6.4±2.5

8.3±3.0***

5.5±1.85.9±2.1(%E)
Fiber (g)*** Significantly different from baseline to final within the group (p<0.0001)

Comparison of HbA1c at baseline and finalof intervention and control group
Intervention group(n=28)

HbA1c (%)

Control group(n=30)

Baseline

Final

Baseline

Final

8.16±0.75

7.79±0.8*8.05±0.77

8.39±1.33*Significantly different from baseline to final within the group (p<0.05)

結果
A群 （発芽玄米群）(n=28)
BeforeAfterp–value

B群 （白米群）(n=27)
BeforeAfterp-value

Weight (kg)60.068.96 60.188.97

0.531

57.8210.3
57.8010.780.964

BMI

23.92.39

23.92.54

0.688

23.22.88

23.22.94

0.864

Body fat (%)

30.06.3

28.56.6<0.00129.346.6

26.986.66<0.001

Glucose(mmol/L)

9.171.80

7.962.3

0.021

10.01.80

9.732.83

0.639

6.92  0.36 6.19  0.77

<0.0017.03  0.46 7.12  0.84

0.375

TC (mmol/L)

4.96 0.72

4.75 0.67

0.122

4.96  0.91

4.74 0.71

0.296

TG (mmol/L)

2.382.00

1.750.64

0.083

2.992.85

1.870.92

0.029

HDL-C (mmol/L)

1.30.135

1.220.17

0.071

1.310.16

1.170.16

0.003LDL-C (mmol/L)
2.820.50
2.840.51
2.840.87*Data aremeanSD. P-values
obtained0.851
by paired t-test.

2.870.57

0.798

HbA1c (%)

Okara fiber controlled blood glucose in
Vietnamese type 2 Diabetes Mellitus
Okara is a by-product of making tofu. Okara is a byproduct of making tofu. It is mainly the soybean
skin and fiber.
In Japan, it is used as human food, but in Vietnam,
it is used as animal feed.

How to get Okara

tofu shop by product

Home made soybean milk residue

New Vietnamese menus with Okara

Methodology
Design: Intervention studynBaseline

Control30

Okara
30

2 weeks intervention
First week

Second week

We contacted to the subjects every day and ask Okara consumption• Nutrition education• AnthropometricMeasurements• Blood Collection

We had nutrition educationand gave subjects Okara menus

Energy and nutrient intakes
Control groupn=30

Variables

Okara groupn=28

Baseline

Finalp-value

Baseline

Finalp-value

Energy (kcal)

1378366

14535120.561084402

1139312

0.99

Carbohydrates(g)

191.958.9

200.871.4

0.71

166.951.6

165.153.3

0.39

Protein (g)66.642.8

70.631.6

0.85

53.925.9

59.721.4

0.14

Lipid (g)46.524.8

40.324.1

0.33

22.317.3

26.713.8

0.13

6.63.5

8.04.4

0.22

7.57.1

13.44.4<0.010005430

Dietary fiber(g)Dietary Okara(g)*Data are meanSD. P-values obtained by unpaired t-test

Results of Blood biochemistry
Variables
Glucose(mmol/L)

Control Group
n=30

Okara Group
n=28

Baseline

Finalp-value

6.82  1.61

6.75  1.88

0.638

Baseline

Final

6.30  1.73 5.39  1.44

p-value<0.05

Fructosamine(µmol/L)TC (mmol/L)

308  40317  45

0.178

3504031437<0.01

4.29  0.93

4.80  1.13

0.032

5.04  1.64

5.01  1.65

0.798

TG (mmol/L)

1.06  0.31

1.16  0.33

0.109

2.13  1.79

2.21  1.75

0.762

HDL-C (mmol/L)

2.60  0.85

3.09  1.18

0.035

1.20  0.30

1.19  0.29

0.598

LDL-C (mmol/L)

2.18  1.21

2.40  2.27

0.293

3.33  1.28

3.30  1.47

0.854

*Data are meanSD. TC = total cholesterol, TG = triglycerid, HDL-C = high-density lipoproteincholesterol, LDL-C = low-density lipoprotein cholesterol. P-values obtained by unpaired t-testありがとうございます。