Efficacy of probiotics on digestive disorders and acute respiratory infections: a controlled clinical trial in young Vietnamese children.

OBJECTIVES: To evaluate the efficacy of fermented milk containing Lactobacillus casei strain Shirota (LcS) on the incidence of constipation, diarrhea, acute respiratory infections (ARI), and nutritional status of young Vietnamese children. METHODS: A controlled field trial was conducted with 1003 children (3-5 years old) in Thanh Hoa province in Vietnam. The probiotic group (n = 510) consumed fermented milk 65 mL/day containing 108 CFU/mL of LcS for the 12-week intervention period, whereas the control group (n = 493) was not given any. The incidence of constipation, diarrhea, ARI, and anthropometry in children was determined at baseline, after 4, 8, and 12-week intervention, and after the 4-week follow-up period. RESULTS: Probiotic drink decreased the incidence of constipation after the 12-week intervention period (12.0% vs. 32.0%, OR = 0.28 (95% CI: 0.21-0.40), p < 0.001), tended to decrease the incidence of diarrhea (4.9% vs. 7.9%, OR = 0.60 (95% CI: 0.35-1.01), p = 0.068), and prevented the occurrence of ARI (15.9% vs. 24.5%, OR = 0.58 (95% CI: 0.42-0.79), p < 0.001), when compared with the control group. In contrast, no probiotic effects were observed for the duration of diarrhea or ARI. Weight gain was higher in the probiotic group than in the control group after 4, 8, and 12-week intervention and after the 4-week follow-up period (p < 0.05). CONCLUSIONS: Daily intake of fermented milk containing LcS strongly prevented the incidence of constipation and ARI in Vietnamese children. This study also revealed the potential effects of the use of a probiotic drink on diarrhea prevention as well as nutritional status improvement.

Total Dietary Intake and Health Risks Associated with Exposure to Aflatoxin B1, Ochratoxin A and Fuminisins of Children in Lao Cai Province, Vietnam.

The health burden of foodborne mycotoxins is considerable, but particularly for children due to their lower detoxification capacity, rapid growth and high intake of food in proportion to their weight. Through a Total Dietary Study approach, the objective was to estimate the dietary exposure and health risk caused by mycotoxins for children under 5 years living in the Lao Cai province in northern Vietnam. A total of 40 composite food samples representing 1008 individual food samples were processed and analyzed by ELISA for aflatoxin B1, ochratoxin A and fumonisins. Results showed that dietary exposure to aflatoxin B1, ochratoxin A and total fumonisins were 118.7 ng/kgbw/day, 52.6 ng/kg bw/day and 1250.0 ng/kg bw/day, respectively. Using a prevalence of hepatitis of 1%, the risk of liver cancer related to exposure of aflatoxin B1 was 12.1 cases/100,000 individual/year. Age-adjusted margin of exposure (MOE) of renal cancer associated with ochratoxin A was 127, while MOE of liver cancer associated with fumonisins was 542. Antropometric data show that 50.4% (60/119) of children were stunted, i.e. height/length for age z-scores (HAZ) below -2, and 3.4% (4/119) of children were classified as wasted, i.e. weight for height z-scores (WHZ) below -2. A significant negative relationship between dietary exposure to individual or mixture of mycotoxins and growth of children was observed indicating that the high mycotoxin intake contributed to stunning in the children studied.

The cost of implementing Vietnam's national plan of action for nutrition for 2017-2020.

BACKGROUND: There is an urgent need to carry out a costing exercise of the National Plan of Action for Nutrition (NPAN) 2017-2020 since the costing of nutrition-sensitive interventions was not entirely integrated and proved difficult to track the different sectors' contributions to the nutrition program. OBJECTIVE: To estimate the required budget for the activities of the NPAN in 2017-2020. METHODS: A standard ingredients approach activity-based costing was employed from the provider perspective. RESULTS: The budget amount required for the NPAN activities in 2017, 2018, 2019 and 2020 would be US$ million 269.0; 310.5; 350.2 and 378.1, respectively. State budgets (especially from Ministry of Health) would be the main funding source for the NPAN. The budget required for implementing nutrition-sensitive interventions would be the largest share (more than 90%) while less than 10% are required for nutrition-specific interventions. The four interventions requiring the largest budget proportion (in 2020) included 1) Micronutrient supplementation (28.3%); 2) Breastfeeding & complementary feeding (21.9%); 3) Treatment of severe acute malnutrition (15.6%); and 4) Disease prevention and management (13.4%). CONCLUSIONS: Based on the data from Vietnam National Health account and the data on GDP of Vietnam, the total required budget for the Vietnam NPAN 2017 (USD millions 5,082) as shares of the State budget for health, total State (Government) budget, and GDP would be 5.29%, 0.49% and 0.14%, respectively. From the estimation, Vietnam represents the nutrition strategy which prioritized on nutrition-sensitive actions, similar to most of the SUN Movement member countries.

Childhood overweight and obesity amongst primary school children in Hai Phong City, Vietnam.

BACKGROUND AND OBJECTIVES: Childhood obesity is a rising health concern in Vietnam, however, research in this area is not extensive. The aim of this study was to determine the prevalence of childhood overweight and obesity, and to study associations between weight status and selected lifestyle factors, such as diet and physical activity levels, among children aged 6-10 years in Hai Phong City, Vietnam. METHODS AND STUDY DESIGN: Two hundred and seventy-six children from an urban and a rural primary school participated in this cross-sectional study. Data on weight, height and waist circumference were used to calculate BMI, and waist-height ratio to determine the proportion of children who were overweight, obese and had high central adiposity. Information on diet, physical activity and socioeconomic status of families was collected using questionnaires. RESULTS: Prevalences of overweight, obesity and high abdominal adiposity were 11.2%, 10.1% and 19.9%, respectively. Children who completed >=60 minutes of physical activity daily were 50% and 80% less likely to be overweight and have high abdominal adiposity, respectively. Computer usage increased the odds of overweight and high abdominal adiposity by 4.5 and 3.9 times, respectively. Mothers with higher education and income levels increased the risk of their children being overweight (p<0.05). CONCLUSIONS: Physical inactivity and high maternal education and income levels increased the risk of childhood overweight and obesity in this cohort. Future interventions should target parents and their children by providing both with educational modules centred on healthy eating habits, parental feeding practices and strategies for increasing physical activity.

The Brain-Derived Neurotrophic Factor Val66Met Polymorphism, Delivery Method, Birth Weight, and Night Sleep Duration as Determinants of Obesity in Vietnamese Children of Primary School Age.

BACKGROUND: Obesity is a complex disease that involves both environmental and genetic factors in its pathogenesis. Several studies have identified multiple obesity-associated loci in many populations. However, their contribution to obesity in the Vietnamese population is not fully described, especially in children. The study aimed to investigate the association of obesity with Val66Met polymorphism in brain-derived neurotrophic factor (BDNF) gene, delivery method, birth weight, and lifestyle factors in Vietnamese primary school children. METHODS: A case-control study was conducted on 559 children aged 6-11 years (278 obese cases and 281 normal controls). The obesity of the children was classified using both criteria of International Obesity Task Force (IOTF, 2000) and World Health Organization (WHO, 2007). Lifestyle factors, birth delivery, and birth weight of the children were self-reported by parents. The BDNF genotype was analyzed using the polymerase chain reaction-restriction fragment length polymorphism method. Association was evaluated by multivariate logistic regression and cross-validated by the Bayesian model averaging method. RESULTS: The most significantly independent factors for obesity were delivery method (cesarean section vs. vaginal delivery, ß = 0.56, p = 0.007), birth weight (>3500 to <4000 g vs. 2500-3500 g, ß = 0.52, p = 0.035; ≥4000 g vs. 2500-3500 g, ß = 1.06, p = 0.015), night sleep duration (<8 h/day vs. ≥8 h/day, ß = 0.99, p < 0.0001), and BDNF Val66Met polymorphism (AA and GG vs. AG, ß = 0.38, p = 0.039). CONCLUSIONS: The study suggested the significant association of delivery method, birth weight, night sleep duration, and BDNF Val66Met polymorphism, with obesity in Vietnamese primary school children.

Effects of Eggshell Calcium Supplementation on Bone Mass in Postmenopausal Vietnamese Women.

Bone mass decreases along with aging, especially for women after menopause because of lower estrogen secretion together with low calcium intake. This study was conducted to study the effect of eggshell calcium supplementation on bone mass in 54 postmenopausal Vietnamese women living in a farming area about 60 km from Hanoi, Vietnam. Sets of 3 subjects matched by age, bone mass, BMI and calcium intake were divided randomly into 3 groups with 18 subjects in each group. The eggshell calcium group was administered 300 mg/d calcium from eggshell, the calcium carbonate group 300 mg/d calcium from calcium carbonate and the placebo group received no calcium supplementation. Bone mass (Speed of Sound (SOS)) was measured at the beginning (the baseline), the middle (6th month) and the end of the study (12th month) by the single blind method. SOS of the eggshell group increased significantly at 12 mo (p<0.05) and was significantly higher than that of the placebo and calcium carbonate groups at 12 mo (p<0.05). The SOS of the calcium carbonate group tended to be higher than that of the placebo group but without a significant difference (p>0.05). In conclusion, eggshell calcium was more effective in increasing bone mass than calcium carbonate in postmenopausal Vietnamese women.

Residues of 2-hydroxy-3-phenylpyrazine, a degradation product of some ß-lactam antibiotics, in environmental water in Vietnam.

Antibiotic-resistant bacteria have become a serious problem worldwide, caused in part by the excessive use and discharge of antibiotics into the environment. Ampicillin (ABPC) is a widely used antibiotic. However, this chemical rapidly decomposes in water containing divalent cations like Ca2+ and Mg2+, thus, detection of ABPC in environmental water is difficult. This study was carried out to evaluate the presence of 2-hydroxy-3-phenylpyrazine (HPP), one of the degradation products of ABPC and ß-lactam antibiotics with an ABPC substructure, in environmental water. An analytical method for HPP monitoring in environmental water was developed using liquid chromatography/tandem mass spectrometry. The analyte was extracted from water samples and enriched using a solid-phase extraction cartridge. The quantification limit was 1 ng L-1. The HPP recovery rates from spiked water samples of 25 and 125 ng L-1 were 84.1 and 86.1%, respectively. The method was then used to determine HPP residue levels in 98 environmental water samples from rivers, household ponds, and aquacultural ponds in Vietnam. HPP residues were detected in 60 samples. The HPP detection rates in rivers and household ponds were 42 and 79%, respectively. HPP was not detected in aquacultural ponds. HPP residue concentrations in the samples ranged from 1.3 to 413.3 ng L-1. The residue levels in rivers flowing through city centres were higher than levels in other sampling locations. The findings of this study suggest that HPP is a promising marker for assessing the discharge of ABPC and ß-lactam antibiotics with an ABPC substructure into the environment around sampling sites.

Nutrition assessment and its relationship with performance and Glasgow prognostic scores in Vietnamese patients with esophageal cancer.

BACKGROUND AND OBJECTIVES: To determine the nutritional status of patients with esophageal cancer, and to investigate its relationship with performance status and prognosis. METHODS AND STUDY DESIGN: This clinical, cross-sectional study was conducted from August 2014 to February 2015 at National Cancer Hospital, Hanoi, Vietnam. Stage III/IV esophageal cancer patients were assessed for their nutritional status (patient-generated subjective global assessment (PG-SGA) and SGA scores, BMI, mid-arm circumference (MAC), energy and protein intakes, weight changes, Karnofsky and Eastern cooperative oncology group performance scores (KPS/ECOG), and Glasgow prognostic score (GPS). RESULTS: Sixty-four male patients were enrolled. The mean ± standard deviation of PG-SGA score was 9.88±4.41. SGA revealed 44% as class B and 6.2% as class C. The BMI revealed 43.8% of patients were underweight. MAC measurement revealed 29.7% of undernourished patients. Patients with an energy intake <25 kcal/kg/d comprised 54.7%, and 48.4% with <1 g/kg/day of protein. Totally, 68.8%, 84.4% and 92.2% patients exhibited weight loss past 2-weeks, one-month and six-months, respectively. The PG-SGA and SGA strongly correlated with the KPS (r=-0.717 and 0.632, both p<0.001) and ECOG (r=0.672 and 0.626, both p<0.001), but were weakly correlated with the GPS (r=0.332 and 0.278, p<0.01 and 0.05). The KPS, ECOG, BMI, MAC, energy and protein intakes, and weight change were not correlated with the GPS. CONCLUSIONS: Malnutrition, weight change, and insufficient intake were noteworthy in esophageal cancer patients. The PG-SGA and SGA were strongly correlated with the performance status, but weakly correlated with prognostic indices.

Rice Bran Extract Reduces the Risk of Atherosclerosis in Post-Menopausal Vietnamese Women.

We investigated whether pre-germinated brown rice bran extract containing acylated steryl glucosides (PSG) reduces the risk of atherosclerosis in post-menopausal Vietnamese women. A total of 60 post-menopausal Vietnamese women (45-65 y old) with high LDL cholesterol levels (over 140 mg/dL) were randomly divided into PSG (n=30) and placebo (n=30) groups. The subjects in the PSG group were assigned a daily intake of 6 capsules containing 50 mg PSG, and the subjects in the placebo group were assigned a daily intake of 6 capsules containing corn oil for 6 mo. Before baseline and after month 2, month 4, and month 6 of the intervention, we conducted anthropometric measurements, blood biochemical examinations, a nutrition survey, and physical activity, flow-mediated dilation (FMD), and cardio-ankle vascular index (CAVI) measurements. Serum LDL cholesterol concentrations were significantly reduced from 163.6±25.3 (mg/dL) to 135.9±26.8 (mg/dL) compared to the placebo group (p<0.001). FMD values of the placebo group were significantly reduced from 6.6±5.1 (%) to 4.7±2.6 (%) compared to the PSG group (p<0.05). Tumor necrosis factor (TNF)-α concentrations in the PSG group were significantly reduced from 19.8±11 (pg/mL) to 10.6±5.5 (pg/mL) compared to the placebo group (p<0.05). The findings suggest that PSG may improve LDL cholesterol, TNF-α levels, and FMD values. PSG might be considered in reducing the risk of atherosclerosis in post-menopausal Vietnamese women with high LDL cholesterol.

Dietary exposure to aflatoxin B1, ochratoxin A and fuminisins of adults in Lao Cai province, Viet Nam: A total dietary study approach.

Aflatoxins, fumonisins and ochratoxin A that contaminate various agricultural commodities are considered of significant toxicity and potent human carcinogens. This study took a total dietary study approach and estimated the dietary exposure of these mycotoxins for adults living in Lao Cai province, Vietnam. A total of 42 composite food samples representing 1134 individual food samples were prepared according to normal household practices and analysed for the three mycotoxins. Results showed that the dietary exposure to aflatoxin B1 (39.4 ng/kg bw/day) and ochratoxin A (18.7 ng/kg bw/day) were much higher than recommended provisional tolerable daily intake (PTDI) values mainly due to contaminated cereals and meat. The exposure to total fumonisins (1400 ng/kg bw/day) was typically lower than the PTDI value (2000 ng/kg bw/day). The estimated risk of liver cancer associated with exposure to aflatoxin B1 was 2.7 cases/100,000 person/year. Margin of exposure (MOE) of renal cancer linked to ochratoxin A and liver cancer associated with fumonisins were 1124 and 1954, respectively indicating risk levels of public health concern. Further studies are needed to evaluate the efficiency of technical solutions which could reduce mycotoxin contamination as well as to determine the health effects of the co-exposure to different types of mycotoxins.

Fructans in the first 1000 days of life and beyond, and for pregnancy.

Inulin-based prebiotics are non-digestible polysaccharides that influence the composition of the gut microbiota in infants and children, notably eliciting a bifidogenic effect with high short chain fatty acid levels. Inulin, a generic term that comprises ß-(2,1)-linked linear fructans, is typically isolated from the chicory plant root, and derivatives such as oligofructose and long chain inulin appear to have different physiological properties. The first 1000 days of a child's life are increasingly recognized as a critical timeframe for health also into adulthood, whereby nutrition plays a key role. There is an ever increasing association between nutrition and gut microbiota composition and development, with life health status of an individual. This review summarizes the latest knowledge in the infant gut microbiota from preterms to healthy newborns, as well as in malnourished children in developing countries. The impact of inulin or mixtures thereof on infants, toddlers and young children with respect to intestinal function and immunity in general, is reviewed. Possible benefits of prebiotics to support the gut microbiome of malnourished infants and children, especially those with infections in the developing world, are considered, as well as for the pregnant mothers health. Importantly, novel insights in metabolic programming are covered, which are being increasing recognized for remarkable impact on long term offspring health, and eventual potential beneficial role of prebiotic inulins. Overall increasing findings prompt the potential for gut microbiota-based therapy to support health or prevent the development of certain diseases from conception to adulthood where inulin prebiotics may play a role.

Nutritional status and feeding practices in gastrointestinal surgery patients at Bach Mai Hospital, Hanoi, Vietnam.

BACKGROUND AND OBJECTIVES: The nutritional status and hospital feeding practices of surgical patients in Vietnam are not well documented. Based on a cross-sectional study at Bach Mai Hospital (BMH), the prevalence of malnutrition was found to be 33% in the surgical ward using a body mass index (BMI<18.5 kg/m(2). We conducted an observational study over a three month period to evaluate the feeding practices in the gastrointestinal (GI) surgery ward at Bach Mai Hospital (BMH) in Hanoi, Vietnam. METHODS AND STUDY DESIGN: Investigators from the U.S. and the Vietnamese National Institute of Nutrition (NIN) enrolled 72 subjects admitted for elective GI surgery in an observational study at BMH. Baseline anthropometrics and changes over time, body mass index (BMI), Subjective Global Assessment (SGA) and daily kcal and protein intake from oral diet, tube feeding, and parenteral nutrition (PN) from admission until discharge were documented. RESULTS: A total of 50% of subjects scored a B or C on the SGA; 48% of subjects had a BMI<18.5, while mean mid upper arm circumference was in the lownormal range (24±4 cm). Nearly all patients (98%) were given PN postoperatively, with oral feeding starting on an average of postoperative day 4. Only one patient was tube fed. Mean daily total calorie intake was 15 kcal/kg/day and protein intake was 0.61 g/kg/day during hospitalization. Micronutrient supplementation was minimal in subjects receiving PN. CONCLUSIONS: Hospital malnutrition in surgical patients in Vietnam is a significant problem, peri-operative feeding appears suboptimal and use of early postoperative PN was routine.

Calcium and Vitamin D Deficiency in Vietnamese: Recommendations for an Intervention Strategy.

In recent years, reports have described various roles of vitamin D in human health. Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Vietnamese context, it has been reported to be present in a majority of the population in spite of the wide availability of sunlight. Vitamin D and calcium are essential nutrients for bone health. The proposed health benefits of vitamin D and calcium have attracted increased interest from health care professionals, the media, and the public. The aim of this paper is to summarize the published data on vitamin D and calcium intake as well as on the prevalence of vitamin D deficiency in the Vietnamese population, and to provide recommendations for a proper strategy to control calcium and vitamin D deficiency in this population. The national authorities should adopt policies aimed at improving vitamin D and calcium status by using measures such as dietary recommendations, food fortification, vitamin D supplementation, and judicious sun exposure.

Limited transmission of bla(CTX-M-9)-type-positive Escherichia coli between humans and poultry in Vietnam.

We examined whether Escherichia coli isolates that produce CTX-M-9-type extended-spectrum ß-lactamases (ESBL) are transferred between humans and chickens in a Vietnamese community. The phylogenetic group compositions, sequence types, antimicrobial resistance profiles, the prevalence of plasmid antibiotic resistance genes, and the plasmid replicon types generally differed between the human and chicken E. coli isolates. Our results suggest that transmission of the bla(CTX-M-9)-positive E. coli between humans and poultry was limited.

Wide dissemination of extended-spectrum ß-lactamase-producing Escherichia coli in community residents in the Indochinese peninsula.

Recent studies have reported a widespread distribution of extended-spectrum ß-lactamase (ESBL)-producing bacteria, not only in the nosocomial setting, but also in the community; some local communities in Southeast Asia have been reported to show a high prevalence of ESBL-producing bacteria. However, the details regarding the quantitative/qualitative state of ESBL-producing bacterial spread in Southeast Asia are currently unclear. Thus, the aim of this study was to assess the state of ESBL-producing bacterial spread in community residents from the Indochinese peninsula, as a representative region of Southeast Asia. In order to achieve this aim, local community residents in Laos and Vietnam were examined for fecal carriage of ESBL-producing Enterobacteriaceae, and the findings were compared with data from a previous study in Thailand which was conducted in the same manner as this study. Between 47.0%-70.2% of the Laotian and Vietnamese residents carried ESBL-producing CTX-M genotype Enterobacteriaceae. The most common sub-genotypes of CTX-M were CTX-M-1 (33.0%-47.5%) and CTX-M-9 (47.5%-64.1%), and these rates were similar among all three countries. Taken together, these results confirmed that ESBL-producing Enterobacteriaceae are widely disseminated in Indochinese countries, such as Thailand, Laos, and Vietnam.

Organoleptic qualities and acceptability of fortified rice in two Southeast Asian countries.

Fortified rice has the potential to improve the micronutrients status of vulnerable populations. However, fortified rice has to have acceptable organoleptic--the sensory properties of a particular food--qualities. Few data exist on the acceptability of fortified rice in Asia. To assess the acceptability of two types of fortified rice (cold and hot extruded) in Vietnam and Cambodia, triangle tests were conducted in Vietnam (53 women) and Cambodia (258 adults), testing fortified rice against conventional rice, with participants being asked to score the organoleptic qualities. In addition, Cambodian schoolchildren (n = 1700) were given conventional rice and two types of fortified rice for two week periods as part of a World Food Program school meal program, with intake monitored. Fortified rice differed significantly in organoleptic qualities from conventional rice, with most subjects correctly identifying fortified rice (P < 0.001). However, fortified rice was found to be highly acceptable in both countries. In Cambodia, schoolchildren consuming fortified rice had higher intakes than when consuming conventional rice (176 g/child/day and 168 g/child/day, respectively; P < 0.05). This study shows that fortified rice is acceptable in two countries in Southeast Asia. However, specific information is needed to explain the organoleptic qualities of fortified rice as perceived by end-users.

Development and implementation of a locally produced ready-to-use therapeutic food (RUTF) in Vietnam.

BACKGROUND: In Vietnam, malnutrition remains a public health problem, even though much progress has been made in the last decades. The number of cases of severe acute malnutrition (SAM) is more than 200,000 per year. To accelerate the treatment of SAM, community-based treatment with ready-to-use-therapeutic foods (RUTFs) is preferred. However, a locally available and acceptable RUTF for the treatment of SAM was lacking. OBJECTIVE: In a joint effort by the National Institute of Nutrition, UNICEF, and the Institut de Recherche pour le Développement, a local RUTF was developed and tested. METHODS: The product was optimalized for impact and acceptability. At the same time, capacity for the Integrated Management of Acute Malnutrition (IMAM) was developed. RESULTS: The local product was found to be highly acceptable and effective. After training of health staff the product could be introduced in the IMAM program. CONCLUSIONS: The IMAM program was highly successful in treating children with SAM, with more than 90% of the children recovering. Production capacity of the factory is currently being increased to enable up-scaling of the IMAM program and potential export of the product to countries in the region.

Relationship of serum carotenoids and retinol with anaemia among pre-school children in the northern mountainous region of Vietnam.

OBJECTIVE: To characterize the relationship between serum carotenoids, retinol and anaemia among pre-school children. DESIGN: A cross-sectional study was conducted in two groups: anaemic and non-anaemic. Serum levels of retinol, α-carotene, ß-carotene, ß-cryptoxanthin, lycopene, lutein and zeaxanthin were measured in the study subjects. SETTING: Six rural communes of Dinh Hoa, a rural and mountainous district in Thai Nguyen Province, in the northern mountainous region of Vietnam. SUBJECTS: A total of 682 pre-school children, aged 12-72 months, were recruited. RESULTS: Geometric mean serum concentrations of carotenoids (µmol/l) were 0·056 for α-carotene, 0·161 for ß-carotene, 0·145 for ß-cryptoxanthin, 0·078 for lycopene, 0·388 for lutein and 0·075 for zeaxanthin. The mean levels of Hb and serum retinol were 108·8 g/l and 1·02 µmol/l, respectively. The prevalence of anaemia and vitamin A deficiency was 53·7 % and 7·8 %, respectively. After adjusting for sex and stunting, serum retinol concentrations (µmol/l; OR = 2·06, 95 % CI 1·10, 3·86, P = 0·024) and total provitamin A carotenoids (µmol/l; OR = 1·52, 95 % CI 1·01, 2·28, P = 0·046) were independently associated with anaemia, but non-provitamin A carotenoids (µmol/l; OR = 0·93, 95 % CI 0·63, 1·37, P = 0·710) were not associated with anaemia. CONCLUSIONS: Among pre-school children in the northern mountainous region of Vietnam, the prevalences of vitamin A deficiency and anaemia are high, and serum retinol and provitamin A carotenoids are independently associated with anaemia. Further studies are needed to determine if increased consumption of provitamin A carotenoids will reduce anaemia among pre-school children.

Food in health security in South East Asia.

With a global economic crisis, undernourished peoples in South East Asia, as elsewhere, face even greater food insecurity. Future challenges to food availability include increasing food prices, increasing population size and climate change. National policies are required which emphasise improved intersectoral coordination, enhanced government credibility and accountability, as well as a shift in food aid to investment in agriculture and the empowerment of independent institutions.