Cooperation ofnutrition education and researchin Vietnam
Shigeru Yamamoto, RD, Ph.D.
Professor of International Nutrition,
Jumonji University Graduate school, Saitama, JapanWe have been cooperating nutrition education and research in
Vietnam since 1986 for almost 35 years.
1986年琉球大学招聘 ベトナム国立栄養研究所2代目所長
Dr. Khoi （写真左 2015年撮影）国立栄養研究所副所長 Dr. Kim Lien（写真右 2010年撮影）

Study on water supply system on health in 2004 (4施設を寄付）

4

• 1987： I invited the first Ph.D. student from HCM-NC.
• Since then I have directed more than 20 graduate students from
Vietnam (徳島大学時代）.

Publications of the first Vietnam food composition table, portion size book and Nutrition softwarewith cooperation of Japanese.ベトナム初の食品成分表、出来上がり食品400種類の栄養成分、栄養計算ソフトの開発 ホーチミン栄養研究所副所長Dr.Minh Hanh 徳島大学博士課程時代に作成

In the office of Dr. Khan, Ministry of Health March 6, 2009

（3代栄養研究所所長、その後、保健省高等教育局長になり、ハノイ医科大学に同国初の栄養学課程を設立、下右から現（2019年）国立栄養研究所学校給食部部長Dr Nhun, 食品安全部部長Dr. Hien、 お茶大の学生2名） 全員、大学院で学位指導をしました。

Award of Minister of Health for the contribution to health of Vietnamese Nov 20, 2010
厚生労働省大臣賞受賞、山本の左男性2代目国立栄養研究所所長、右女性4代目所長、山本より左二人目女性厚生労働省副大臣

Vietnam country background
Population (2015): 91.7m

Health Facilities and beds
Government Hospital Beds
sectionCentral Hos. 48
31.777- General
hospitals- Specialhospitals

20

20.31120

9.065

Local Hos.

12.750242.416Total

13.725291.975

SITUATION OF CLINICAL NUTRITION
IN VIETNAM• Providing diet: only 27,6% of the hospitals provided
the suitable diets for patients

Signed /Resource: Ministry of health report, June 2017

Nutritional status before and after operation

BMI pre and post operation

Hanoi Medical University started to think the necessityof dietitianAt Ochanomizu University in Tokyo
Oct 5, 2010
We invited the rector and two other instructors from Hanoi Medical University
and Vietnam National Institute of Nutrition

The first Nutrition and Dietetics students after theentrance ceremony in Sept 2013

Academic agreement of 2 Vietnamese and3 Japanese Institutions, March 24, 2014

Curriculam
Theory69 +Practice26 + thesis10 = Total 105credits + 500 hours internship
Theory 1 credit 45 min x 15 times,

Practice 1 credit 90 min x 15 times)

1st year: Theory 29, Practice 10, total 39 （HMU offers）
2nd & 3rd year: Theory 40, Practice 16 Total 56 (theory mainly by Japanese, Practice mainly
by Vietnamese, Practice training in Japan for some Vietnam instructors)• Basic Nutrition (include DRIs) Theory 10, Practice 4 credits (including food science)• Nutrition Biochemistry Theory 2 credits, Practice 2 credits together with Nutrition Physiology• Nutritional Physiology Theory 2 credits, Practice together with Nutritional Biochemistry• Food Science (including food and cooking chemistry) Theory 4 credits, Practice together Basic Nutrition• Food Sanitation

Theory 4 credits, Practice 2 credits.

• Community Nutrition Theory 4 credits, Practice 4 credits.
• Nutrition Therapy (including nutrition education and cooking) Theory 8 credits, Practice 4 credits

4th year (Internship 500 hours, thesis 10 credits (HMU offers)• Internship training total more than 500 hours at hospitals, communities, schools, etc.
• Research for the graduation thesis. Students will study under a supervisor every day other than internshiptraining. Practice 10 credits

We invited about 10 HMU students every year. They visitedelementary schools and hospitals to observe the dietary managements.

Practice of Nutritional Biochemistry

Practice of Clinical NutritionLecture by Japanese professor in 2015

Donated instruments

The first graduation ceremony June, 2017

ハノイ医科大学 アジアの栄養食文化研究室（十文字学園女子大学）2018年

Academic agreement of Nam Dinh University of Nursing, Vietnam NIN and3 Japanese Institutions in 2018 for the education of newly established dietetic course
ナムディン看護との交流協定調印式典と第一期栄養学課程学生 ２０１８年

Cooperation of researches

Sustainable Approach to Preventing Osteoporosis in Vietnamese
Vu Thi Thu Hien, Nguyen Cong Khan, Nguyen Thi
Lam, DucSon NguyenTrung Le, Bui Thi Nhung,
Masayo Nakamori, Daisuke Kunii, Tohru Sakai,
Shigeru Yamamoto
Determining the prevalence of osteoporosis andrelated factors using quantitative ultrasound in
Vietnamese adult
American journal of epidemiology 161 (9), 824-830,
2005• Hien VT, Khan NC, Mai LB, Lam NT, Phuong TM,
Nhung BT, Nhien NV, Nakamori M, Yamamoto S.
• Effect of community-based nutrition educationintervention on calcium intake and bone mass inpostmenopausal Vietnamese women.
• Public Health Nutr. 2008 Jul 31:1-6.

Sampling procedure
Total 228 wards/communes of Hanoi City
Random sampling

30 wards/communes selected

In each ward, a list of women aged 20yrs and above wasconstructed.

80 women/ ward

sample size= 80 women/ ward x 30 wards = 2400 (women)
Finally, 2232 women agreed to participate

Percentage changes in bone massfrom baseline to the end of study

Mean changes in Ca intake
from baseline to the end of study
0

0

700

6

12

18

-0.1

600
SOS (% )Calcium intake (mg/day)

800

500
400

-0.2
intervention group-0.3
intervention groupcontrol groupcontrol group

300

-0.4

200

-0.5

100

-0.6
Months from baseline

0
0

6

12

Months from baseline

18

Repeated measures
ANOVA test, p< 0.01

se r um PTH l e ve l (p g/ml )Mean changes in PTH levelfrom baseline to the end of study

70
60
50
40
30
20
10
0

*

*

Baseline
After 18 mointervention groupcontrol group

Student t-test , * : p < 0.01

Hanoi Medical University

Life style of Vietnamese is changing rapidly, whichcause to increase the people with DM. It is estimatedthat more than 3 million people suffering from T2DM.

5.40%

6%

4%

2.70%

2%
0%
2002

2002

2012

2012

Prevalence of T2DM in 2002 and 2012

Vietnamese Type 2 DM; Average男性BMI
isnormal
女性
男女
26

男性

女性

26

Obesity （WPRO)

25

BMI (kg/m )Overweight （WPRO)

23

21

25

24

24

22

△Male FFemale 〇 Mix

23

3
3

1

22

2

1

2

1

4

2
3

1

21

2

4
20

2

20

Publications in 1990’s
1.

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

Study in 629 patients in inpatients unit of NDGD(Thủy et al)3.

Study in 504 BN ĐTĐ (Đạt et al)4.

Study in subjects with insulin resistance (Minh etal)Publications in 2000’s

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

35 BMI**30
25

Unpaired t-test**P<0.01

**

＊＊

＊＊

20
15
10
5
0

23.3

26.1

女性Taiwan
Vienaese
Femal

22.7

25.7

Vienam男性Taiwan
Male

BMI of newly diagnosed Vietnamese and Taiwanese DM**significantly different by unpaired t-test (p<oo1)
Subjects;
Number: Female V150, T 128, Male V 148, T27
Age (mean±SD); Female V58.5±6.1 , T 61.1±8.5, Male V 61.1±8.5, T61.1±8.5(Duc Son le NT et al. J Am Coll Nutr. 2005 Aug;24(4):229-34).

32

Vietnamese love WR foods

Rice noodle

Rice cake

Sticky rice

Rice dessert

Replace WR with pre-germinated brown rice (PGBR)

Rice

Brown rice

Polished rice with germ

White rice

Glycemic index
160

Pre-germinated brown rice (PGBR)
is made by soaking brown rice inwater for about 24 hours. It isslightly germinated.
Brown rice needs special cookware, but
PGBR can use the same cookware as
white rice.

Glucose

140

White
rice

120

Brown
rice

100

PGBR

80
0

30 60 90 120

Cooked
PGBR

We can cook WR and PGBR together. This lady with
DM was enjoying PGBR and could control her blood
glucose level well.

Methods: 60 subjects with IGT were selected
and 30 matched-pairs were made.
White Rice Group

4 months

PGBR Group

4 months• Consume PGBR exclusively as staple food.
• Normal activities without restriction.
• PGBR Group: Free PGBR provided every week.

Pre-germinated brown rice (PGBR) reduced HbA1cof Type 2 DM patients dramaticallyPre-germinated brown rice reduced both blood glucose concentration and body weight in Vietnamese women with impaired glucose tolerance.
Nhung et al 2014)

••

Major source of fiber is vegetable
Vietnam has many kinds of vegetable

Vietnamese(2010)

Vietnamese RDA

Japanese(2008)

Vegetable intake

190 ± 126 g

300 g

342 g

Fruit intake

61 g

100 g

117 g

Vegetable consumption is lower than RDA=> Low fiber intake
tong dieu tra VDD_Tieng Viet_(3.5.13).pdf.

MONOTONOUS VEGETABLE COOKING IN VIETNAM

Traditional
methodcooking
1. Boiled

Current behaviors• Boiled vegetable is dipedwith fish sauce
2. Stir- fried • Oil, garlic, MSG (seasoning powder), fishsauce (salt)

3. Soup• Salt, MSG (seasoning powder)

Issue

Different
vegetable but
the samecooking
methods=> monotonous
vegetable
cooking method

STUDY EXPERIENCE IN JAPAN TO
DEVELOPE VEGETABLE MENUS
Example of Japanese recipe which has
a lot of vegetables
Okara hamberger

SukiyakiOkonomyaki

Oden(4 kinds of vegetables) ( many kinds of vegetable) (4-5 kinds of vegetable) (4 kinds of vegetables)

DRESSING AND MAYONNAISE TO MAKE SALAD

Results of nutrition survey

Hanoi Medical University

Dietary
intakeVegetable group

Control group

Baseline

Finalp

Baseline

Finalp

Energy (kcal/d) 1404  360

1438  327

0.56

1378  366

1453  511

0.56

Protein (g/d)

66.5  24.6

77.1  39.6

0.19

66.6  42.8

70.6  31.6

0.85

Lipid (g/d)

38.9  18.3

51.5  58.6

0.19

46.5  24.8

40.3  24.1

0.33

Carbohydrate(g/d)

202.5  52.6 202.3  48.9 0.86

192.0  58.9

200.8  71.4

0.71

Fiber (g/d)

9.3  5.7

12.1  5.6

0.051

6.6  3.5

8.0  4.3

0.22

Vegetable (g/d) 298  121

455  84

<0.001211  104301  129<0.01

p<0.01 : statistically different by paired student t-test .

Okara fiber controlled blood glucose in Vietnamesetype 2 Diabetes Mellitus

Nguyen Lieu

Comparison of Fiber in Okara and some kind of vegetables
オカラと野菜の食物繊維量の比較
100 gam
100 gam

とうがん1.0g

キャベツ1.6 g

いんげん
1.0 g

ごうや
1.1 g

ブロッコ
リー3.2
g

くうしんさ
い1.0 g11.5 gNutritive composition table of Vietnamese foods(2007).
Nutritive composition table of Japanese foods (2015).

アスパラ
ガス2.3
g

たけのこ
4.1 g

Pilot study :To assess tasty OKARA
menus
Subject• 12
10 Okara menus• Tasty score 5-1• Until average became more 4
Purpose• To choose the best cooking method

OKARA hamburger

Ingredients(a people)
Meat

Cooking time: 20
minutes

Preparition
To grindFresh Okara
Onion

Number50 g
30 g

To mince

50 g<Recipe>

Bread crumbs

10 g

1. To grind pork meat/ chicken and mince onion.
2. Stir butter and onion.
3. Mix okara, pork meat/chicken, onion, bread crumbs,
egg, soy milk, salt, peper and nutmeg together. And
then, kneading by hands to ensure they get
incorporated.
4. To knead into small pieces.
5. To fry it about 8-10 minutes until we can eat.
6. Eat together with chinsu soy sauce.

Egg

1/2

Salt

1.5 g

Peper

To grind

A small amount

Butter

4g

Oil

10 g

Roll cabbage together with okara and meat

Ingredients(a people)

Cooking time: 30 minutes<Recipe>
1. To mix pork meat, fresh okara,
tomato, onion, egg, oriander,
peper, salt and stir fry.
2. To boil cabbage sheets until we
can eat.
3. To roll cabbage sheets with
mixed spice and meat Which was
fried already.
4. Let eat together with fish sauce.

Preparition

NumberPork meat
Fresh okara
Cabbage sheet

To grind

35 g
20 g
60 g

TomatoTo chop

10 g

Egg

1/2

Onion

To grind very thin

3g

OrianderTo clean and grind

3g

Salt

3g

OKARA fried egg and green onion

Ingredients(a people)

Time cooking: 20
minutes<Recipe>
1. To grind pork meat
2. To make clean and chop lolot.
3. To mix egg, pork meat, green
onion, lolot, fish sauce and salttogher.
4. To fry with oil until we can eat.

Preparition

Egg
Pork meat

Number1

To grindFresh Okara

30 g
20 g

Lolot

To chop

2-4 sheetGreen onion

To chop

5g

Fish sauce

2g

Salt

1g

Oil

A coffee spoon

Study design
Time study：4/2017ー 5/2017
Design: Intervention study

Control
30

n

Okara
30

2 weeks intervention
Baseline

First week

Second week

I contacted to the subjects every day and ask Okara consumption••••

Nutrition education
Anthropometric Measurements
Blood Collection
Nutrition Survey

We had nutrition educationand given subjects Okara
menus directions

Anthropometric measurements

Biochemical Parameters results
Control groupn=30

Variables

Okara groupn=28

Baseline

Finalp-value

Baseline

Finalp-value

Glucose (mmol/L)

6.82  1.61

6.75  1.88

0.638

6.30  1.73

5.39  1.44

<0.05

Fructosamine(µmol/L)TC (mmol/L)

308  40317  450.178

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 lipoprotein cholesterol, LDL-C = low-density lipoprotein cholesterol.
P-values obtained by unpaired t-test

Fiber consumption between Okara group andcontrol groupp<0.01

Gram/day

15
p>0.0
5

10

Controlgroup

50Baseline

After 2 weeks

p-valuesChanges in obesity rate in Vietnam
Prevalence of overweight and obesity in
Ho Chi Minh City (1996-2014)

Prevalence of overweight andobesity in Hanoi (1995-2013)✓ Survey in HCM 1996 - 2014:prevalence of primary school children
who sufferedfrom overweight and obesity increases
from 12.2% to 51.8%✓ Survey in Hanoi 1995 - 2013:prevalence of primary school children
who sufferedfrom overweight and obesity
increases from 3.3% to 40.6%%

Survey to find mother's perception
Subject: Six hundred pairs of mother and child (children from 6
to 10 years old)
Study design: Cross sectional study
Study areas and subjects: 6 elementary
schools in Ha Noi, Hai Phong and Da Nang.
In each city, we selected 1 primary school in urban areaand 1 primary school in a suburban area.

Actual BMI of children

Mother's identificationof their own child’s
nutritional status%

Wasting Normal Overweight Obesity

Wasting Normal Overweight Obesity

Summary of actual nutrition status and mother’s identificationof their child's nutrition status in 3 cities

Effect of school lunch program on obesity
After school lunch sleep for about 1 hourChildren with school lunch

Children without school lunch buy
empty foods around schoolWe obtained therental smartphone
and

夕食
食品重量を
入力
ｇ

栄養量の計算Energy intake from snacks in children
with or without school lunch
ｎ=５０
200

160

150
kcal

123

100

50
0

129

Without schoo lunch

12

34

35

36
With school children

713
13-15 15-17
15-17
13-15時
時
Time
時間

13
9-11
11-13
9-11
時 11-13時

給食がある

39

給食がない

16
17-19 19時以上
1917-19時

＊＊No-Lunch (n=50)

Lunch (n=50)
給食がある(50人）

給食がない（５０人）

2500

2000

1972

2101
＊＊

＊＊
＊＊

1500

kcal

＊＊
1000

538 579

617 554582 561

401

500

235
0
全体

Total

朝食

BF

昼食

Lunch

夕食

おやつ

Dinner Snack＊＊ Ｐ＜０．０１

Energy intake for 3 days
with or without school lunchPrevalence of obesity
35%

Ｎ＝５０
Ｐ＝０．０５

30%

30%
25%

20%

18%

15%

10%
5%
0%

With school lunch肥満Without school lunch
給食がある

給食がない

DIETARY MANAGEMENT IN DYSPHAGIAELDERLY IN VIETNAM

トラン フォン タオ
MA17502

Japan, 2/2019

66

背景

６0歳以上

６５歳以上

The number of elderly people are increasing in Vietnam
ベトナムでも人口の高齢化が急速に進んでいる

Dysphagia is the common problem in aging population
高齢者では、嚥下障害は一般的問題である。
67

NUTRITIONAL MANAGEMENT BETWEENVIETNAMESE AND JAPANESE HOSPITAL
ベトナムと日本の嚥下障害者の栄養管理
Japanese hospital
日本の病院

Vietnamese hospital
ベトナムの病院え
Pasted foods

Nasogastric tube (EN) 経管栄養

Foods with jelly

68Dietary guide for dysphagia depending upon the condition
嚥下障害患の状態別食事法
Japanese hospital
日本の病院

Vietnamese hospital
ベトナムの病院

Current diet 現在のダイエット
1. Soup (tube feeding and eat)
スープ（経口、経管）

2. Soft diet: noodle, porridge
柔らかい食事：麺、お粥Japanese Dysphagia Diet 2013 by
JSDR dysphagia committee

3. Regular diet
普通の食事

69

This graduate student from HMU have learned assessment methods anddietary management for dysphagia patients from Japanese dietitians

70Dysphagia screening test
嚥下障害スクリーニング検査
Repetitive Saliva Swallowing test (RSST)
反復唾液嚥下試験（RSST）<3回/ 30秒
嚥下障害≥3回/ 30秒
次の検査

次のスライド71

Water swallowing test (WST)
水飲みテスト
3mLの水を飲む
むせ・誤嚥
ない

あり
嚥下障害

30mLの水を飲む

むせ・誤嚥なく5秒以内に一度に飲み込める 正常

むせ・誤嚥なく飲み込むために、5秒
以上、２回以上の嚥下が必要。
嚥下障害の疑い72

Mini Nutrition Assessment-Short form (MNA-SF) questionnaires

簡易栄養状態評価表73

Hand grip strength test 握力 テスト

Hand grip strength relates well withthe muscle strength for swallowing
74She has studied the prevalence of dysphagia
in1,007 hospitalized elderly patients

Dysphagia

166(16.5%)

320(31.8%)

521(51.7%)

NormalHigh risk ofdysphagia
嚥下障害

嚥下障害のリスク

嚥下障害

75

Evaluation of foods for dysphagia patients by the student
食事の粘度、味が適切であるかどうかの栄養士による評価

76

The student is teaching to medical
staff who take care of dysphagia
patients

The student is teaching
how to make foods fordysphagia patients 77

The first publication in Vietnam about the dietary
management for dysphagia patients by the student
嚥下障害者への食事管理に関するベトナム初の論文発表Nguyễn Thuỳ Linh, Trần Phương Thảo (2018), Ứng dụng chất lỏng có độ nhớt tiêuchuẩn trên bệnh nhân đột quỵ não khó nuốt. Tạp chí Dinh dưỡng – Thực phẩm 5: 23-28

78

Publication of the student in 2 years• Article
1. Tran Phuong Thao, Nguyen Thuy Linh, Hiroshi Nishiyama, Fumio Shimura andShigeru Yamamoto, Higher vegetable intake improved blood glucose level in
Vietnamese with type 2 Diabetes Mellitus, Int J Clin Nutri and Diet, 124 (3), 2017.
2. Linh Nguyen Thuy, Thao Tran Phuong, Phuong Duong Thi. The feeding practicesof post-operative gastrointestinal patients in Hanoi Medical University Hospital, Vietnam.
Journal of Medical Research, 116 (7), 2018.
3. Nguyễn Thùy Linh, Trần Phương Thảo, Bùi TH, Phạm TTC. (supported by Jumonji
University). Application of thickened liquid on stroke patients with dysphagia. Journal offood and Nutrition sciences 5:23–28, 2018.
4. Linh NT, Thao TP, Vân nb. Effect of nutritional intervention by the high fiber diet oftype 2 diabetes mellitus patients, Journal of Medical Research, 113 (4), 2018.
5. Lieu Thi Nguyen, Tu Huu Nguyen, Linh Thuy Nguyen, Sumiko Kamoshita, Thao
Phuong Tran, Huong Thi Le, Fumio Shimura and Shigeru Yamamoto. Okara improved
blood glucose level in Vietnamese with type 2 diabetes mellitus. Journal of Nutritional
Science and Vitaminology, 65, 61-66, 2019.
• Booklet
1. Nguyen Thuy Linh and Tran Phuong Thao. (supported by Jumonji University) (2018).
Nutrition support for dysphagia patients. Medical Publishing House, Vietnam.
79

The student published a booklet and distributed it to the whole country

80The first symposium in Vietnam about dietary management fordysphagia patients was held in 2018 and there were many participants

81

82

The workshop was reported bya nation-wide TV news

83

Thank you very much for your patience84