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THIẾU MÁU THIẾU SẮT VÀ CÁC GIẢI PHÁP CAN THIỆP 27 MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NUTRITIONAL INSTITUTE KHUC THI HIEN EFFECTIVE OF MULTI MICRONUTRITION AND POWDER OF ALPINIA ZERU[.]
MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH NUTRITIONAL INSTITUTE KHUC THI HIEN EFFECTIVE OF MULTI-MICRONUTRITION AND POWDER OF ALPINIA ZERUMBET LEAVES SUPPLEMENTATION ON NUTRITIONAL STATUS AND IMMUNE INDEX OF THAI ETHNIC CHILDREN 36-59 MONTHS IN SON LA CITY, SON LA PROVINCE Specialization: Nutrition Code: 9.72.04.01 SUMMARY OF DOCTORAL DISSERTATION HANOI - 2022 Science instructor: Dr Ha Anh Duc Assoc Prof Dr Bui Thi Nhung Reviewer 1: Reviewer 2: Review 3: The thesis will be defended at the Institute-level doctoral thesis grading committee at the National Institute of Nutrition At the hour, day, month, year The thesis can be found at: -National Library - Library of the Institute of Nutrition INTRODUCTION Necessity of the thesis Currently, malnutrition remains a significant public health problem in developing countries Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization Malnutrition also weakens the immune system, especially in the period of 36-59 months At this preschool age, children have a rapid rate of physical development and are at risk of exposure to many pathogens, so they are susceptible to infections and malnutrition Intervention for micronutrient supplementation is one of the urgent and cost-effective solutions to improve the nutritional status and health of children However, the results obtained from the intervention studies of micronutrient supplementation are not uniform, some of the effects of micronutrients on the body, the optimal combined effect of micronutrients nutrition has not been fully studied Nutritional interventions are also studied towards improving the immune system, reducing the risk of diseases in children, prioritizing the use of products of natural origin, low toxicity with low cost Alpinia zerumbet, a medicinal species used by people in many countries in dishes as well as in many folk remedies, has been studied to identify, isolate, and extract biological compounds with beneficial effects, improve health and prolong human life However, there is not much research on the effects of Alpinia zerumbet on the health of children Son La, a poor mountainous province in the Northwest, has 54% of the Thai ethnic group Child malnutrition rates remain high, especially among ethnic minority children Therefore, in order to have data to evaluate the effectiveness of the combination of multimicronutrient and powder of Alpinia zerumbet leaves supplementation as a basis for developing intervention solutions that contribute to reducing the rate of malnutrition, reducing the risk of diseases of Thai children in disadvantaged areas, we conduct research on the topic with the following objectives: Assessment of nutritional status of children 36-59 months in Son La city, Son La province Evaluation of the effect of multi-micronutrient and powder of Alpinia zerumbet leaves supplementation on the nutritional status of Thai ethnic children 36-59 months Evaluation of the effect of multi-micronutrient and powder of Alpinia zerumbet leaves supplementation on immune index (IgG, IgM) and infection (diarrhea, respiratory infection) of Thai ethnic children 36-59 months New contributions of the thesis The research provided important scientific data on the nutritional status of children aged 36-59 months from different ethnic groups in Son La city The research showed that after months of intervention, multimicronutrient and powder of Alpinia zerumbet leaves supplementation for Thai ethnic children at 36-59 months with stunting and stunting risk had the effect of improving weight and height, WAZ, HAZ, Hemoglobin and IgG levels The intervention reduced the number of days in each episode of respiratory infections, and the total number of days with respiratory infections in the studied children Thesis layout The thesis consists of 142 pages (excluding references and appendices), in which: Introduction and objective: pages; Document overview: 38 pages; Objects and research methods: 27 pages; Results: 38 pages; Discussion: 33 pages; Conclusion: pages; Recommendation: page The thesis has 44 tables, 11 drawings, diagrams, 20 charts and 202 references Chapter OVERVIEW 1.1 Malnutrition Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization The double burden of malnutrition consists of both undernutrition and overweight and obesity, as well as diet-related noncommunicable diseases Undernutrition manifests in four broad forms: wasting, stunting, underweight, and micronutrient deficiencies The term malnutrition addresses broad groups of conditions: undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age); micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess; and overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabete and some cancers) 1.2 Nutrition and infections in children Studies have demonstrated that malnutrition (both undernutrition and overnutrition) is more susceptible to infectious diseases, especially undernutrition Thus, malnutrition is considered to be a strong risk factor for higher morbidity and mortality in infectious disease Since 1968, the scientist Scrimshaw has proposed a vicious cycle between nutrition and infection He said that malnutrition leads to infections, infections lead to malnutrition due to anorexia, malabsorption and vice versa, causing loss and increase in nutrient requirements Many abnormalities of the immune system, including lymphoid organ atrophy, T-cell deficiency, alteration of T-cell subsets, and decreased natural killer (NK) cell activity and cytokines have been described described in people with protein-energy malnutrition In severely malnourished children, both acquired immunity as well as innate host defense mechanisms are affected 1.3 Characteristics and studies of Alpinia zerumbet Alpinia zerumbet, commonly known as shell ginger, is a perennial species of ginger native to East Asia This plant is a rhizomatous, evergreen tropical They are grown as ornamentals and their leaves are used in cuisine and traditional medicine by people in Okinawa, Japan and many other countries (Brazil, China, Indonesia, Philippines, Thailand, Vietnam ) Many studies have found that the valuable chemical composition of Alpinia zerumbet contains many polyphenols that can minimize the damage caused by free radicals on the body, help strengthen the immune system, improve circulation blood… Makise Lifeup Laboratories (Okinawa - Japan) has produced Alpinia zerumbet leaf powder from the fermentation of leaves and is marketed as Jipang Ginger With the main composition of more than 20 polyphenols with high biological activity such as chlorogenic acid, ferulic acid, quercetin, epicatechin, catechin, and kaempferol Jipang Ginger is used by Makise clinic for Japanese children with a dose of 200mg/day and has been effective in improving immunity and reducing allergies in children Chapter STUDY SUBJECTS AND METHODS 2.1 Subjects, place and time of the study - Study subjects: + Cross-sectional study: Children 36-59 months are studying at preschools in Son La city Parents volunteered for their children to participate in the study The child had no chronic diseases and no physical disabilities affecting the anthropometric measurements + Interventional study: Thai ethnic children aged 36-59 months who participated in a cross-sectional study had HAZ scores from -3 to -1 at Hua La preschool and Chieng Xom preschool Parents volunteered for their children to participate in the study - Study location: The study was conducted at preschools in Son La city, Son La province 2.2 Study design A cross-sectional descriptive study to collect anthropometric data of children aged 36-59 months at preschools in Son La city and collect data to assess dietary intake, anemia, levels Hb, IgG, IgM of two study groups Controlled community intervention study: a controlled trial of multi-micronutrient powder of Alpinia zerumbet leaves supplementation, monitoring of infections (diarrhea, respiratory infections) and evaluation effective after months of intervention 2.3 Sample size and sample selection Sample size for cross-sectional study: n: sample size, Z (1-α/2) = 1.96 (95% confidence); e: absolute error 0.02; p = Malnutrition rate (Underweight, stunting and wasting rates in Son La in 2014 were 21.7%, 34.4%, and 10.3%, respectively) Thus, the minimum sample size is 2168 subjects In fact, surveyed 2471 children Sample size for intervention study: apply the formula to calculate sample size: 2δ2 (Zα +Zβ)2 n= (µ1 - µ2)2 n: sample size; Z α: 95% confidence Z α: = 1.96; Z β : 80% sample force, then Z β = 0.84; δ: the mean standard deviation; μ1−μ 2: mean difference Sample size for weight is 60 children/group, height is 58 children/group; Hb is 26 children/group, IgG is 42 children/group IgM is 17 children/group; diarrhea was 39 children/group, respiratory infections was 57 children/group Sample size for the dietary survey: 36 children/group Summarizing the sample size to evaluate the effectiveness of the intervention is the largest sample size of 60 children/group plus about 10% may give up, rounding out 70 children/group x groups = 140 children In fact, 72 children/group were selected Sampling method Sampling for cross-sectional study: select public preschools with favorable traffic conditions and enthusiastically participate: - Make a list of all children 36-59 months - Weigh, measure, and assess the nutritional status of all children eligible for the study Sampling for intervention study: purposefully selecting two schools: Hua La preschool and Chieng Xom preschool because these two schools have many Thai ethnic children, many stunted children and a high risk of stunting The two localities have similar socioeconomic conditions Randomly selected children from Hua La preschool as the control group and children from Chieng Xom preschool as the intervention group - Select all Thai children with HAZ from -3 to -1 - Make a list of children who meet the criteria - Notice about the research and sign the commitment to participate in the study Results: 72 children/schools were eligibled and their parents agreed to participate in the study, so the total number of children participating in the intervention study was 72 x = 144 children 2.4 Methods of data collection and evaluation of research indicators The group of general information and information about the child's illness: Information about the mother of the research subject (age, ethnicity, occupation, education level, number of children in the family); Children's illness Assessment of nutritional status: Classification of nutritional status according to WHO 2007 and classification of community malnutrition according to WHO 2007 and WHO 2018 Hematological index: Anemia when the child has Hb < 11g/dL Immune Index: Limit of IgG by age: years old: 423-1090 mg/dL, years old: 444-1187 mg/dL Limits of IgM are: years old: 45-190 mg/dL, years old: 46-197 mg/dL Evaluation of rations: Using the method of asking to record the last 24h ration Determine the average value of energy intake, the level of response of the diet compared to the recommended needs for children Infectious status: Children are monitored for signs of infection through the “Illness Monitor Book” including symptoms or signs of diarrhea/respiratory infections and time of infection 2.5 Research Deployment - Weigh and measure children aged 36-59 months at preschools; assess the nutritional status of children - Organization of the intervention: The intervention group had a pre-school teacher mix package of multi-micronutrient and power of Alpinia zerumbet supplements x days/week x 26 weeks into porridge for dinner Multi-micronutrient supplements and warm galangal leaf powder are provided every weeks to school health staff School health staff distribute products to preschool teachers weekly Every day, preschool teachers mix complementary products into porridge for children to eat and record in each child's logbook 13 Sex Boys Girls Total 1301 1170 2471 186 (14,3) 136 (11,6)2 322 (13,3) 425 (32,8) 340 (29,1)1 765 (31,0) 81 (6,2) 52 (4,4)2 133 (5,4) 53 (4,2) 27 (2,3)2 80 (3,2) Figures are presented by frequency (%) 2 test: compare the ratio between two groups The average rate of underweight is 13.3%, stunting is 31.0%, wasting is 5.4%, overweight and obesity is 3.2% There is a difference in prevalence of malnutrition by ethnic group (p