Assessment of nutritional status among ethnic minority university students, thai nguyen province, vietnam

ASSESSMENT OF NUTRITIONAL STATUS AMONG ETHNIC MINORITY UNIVERSITY STUDENTS, THAI NGUYEN PROVINCE, VIET NAM MRS TRAN THI HUYEN TRANG A THESIS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH KHON KAEN UNIVERSITY 2018 Tai ngay!!! Ban co the xoa dong chu nay!!! ASSESSMENT OF NUTRITIONAL STATUS AMONG ETHNIC MINORITY UNIVERSITY STUDENTS, THAI NGUYEN PROVINCE, VIET NAM MRS TRAN THI HUYEN TRANG A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH IN NUTRITION FOR HEALTH GRADUATE SCHOOL KHON KAEN UNIVERSITY 2018 THESIS APPROVAL KHON KAEN UNIVERSITY FOR MASTER OF PUBLIC HEALTH IN NUTRITION FOR HEALTH Thesis title: Assessment of nutritional status among ethnic minority university students, Thai Nguyen province, Vietnam Author: Mrs Tran Thi Huyen Trang Thesis Examination Committee: Prof Dr Sastri Saowakontha Chairperson Assist Prof Dr Pattara Sanchaisuriya Member Assist Prof Dr Suwalee Lowirakorn Member Assoc Prof Dr Pongdech Sarakarn Member Thesis Advisor: Assist Prof Dr Pattara Sanchaisuriya Copyright of Khon Kaen University i Tran Thi Huyen Trang 2561 การประเมินภาวะโภชนาการของนักศึกษาชาติพน ั ธุ์มหาวิทยาลัยใ นจังหวัดไทยเหงียนประเทศเวียดนาม วิทยานิพนธ์ปริญญาสาธารณสุขศาสตรมหาบัณฑิต สาขาวิชาโภชนศาสตร์เพือ ่ สุขภาพ บัณฑิตวิทยาลัย มหาวิทยาลัยขอนแก่น อาจารย์ทป ี่ รึกษา: ผูช ้ ว่ ยศาสตราจารย์ ดร ภัทระ แสนไชยสุรยิ า บทคัดย่อ ภาวะทุพโภชนาการเป็ นปัญหาสุขภาพทีส ่ าคัญในประเทศกาลังพั ฒนา นอกจากนี้ ยัง เป็ นปั ญ หาสุ ข ภาพที่ รุ น แรงของกลุ่ ม ชาติ พ ัน ธุ์ การวิจ ยั ครั้งนี้ ด าเนิ น การในกลุ่ม นัก ศึก ษาที่เป็ นชนกลุ่ม น้ อ ยจ านวน 351 ค น อ า ยุ 17 ถึ ง 29 ปี ที่ ม ห า วิ ท ย า ลั ย เภ สั ช ศ า ส ต ร์ แ ล ะ แ พ ท ย์ ศ า ส ต ร์ ไ ท ย เห งี ย น เก็บรวบรวมข้อมูลโดยการสัมภาษณ์ นกั ศึกษาตามแบบสอบถามกึง่ โครง สร้ า งที่ อ อ ก แ บ บ ไว้ ล่ ว งห น้ าป ระก อ บ ด้ ว ย ข้ อ มู ลลัก ษ ณ ะบุ ค ค ล ข้ อ มู ล โ ภ ช น า ก า ร ข้ อ มู ล ก า ร วั ด สั ด ส่ ว น ร่ า ง ก า ย และปั จ จัย ที่ มี ผ ลต่ อ สถ าน ะท างโภชน าการ ผลการศึ ก ษ า พ บ ว่ า ความชุ ก ของนัก เรีย นที่มี น้ าหนัก ต่ากว่าเกณฑ์ อ ยู่ในระดับ สู ง (ร้อ ยละ 25.4) แต่น้าหนักเกินและอ้วนมีคอ ่ นข้างน้อย (ร้อยละ 4.3 และร้อยละ 0.5, ตามลาดับ ) เพศหญิงมีภาวะน้าหนักต่ากว่าเกณฑ์สู งกว่าเพศชาย (Adjusted OR = 3.2, 95% CI: 1.55-6.80) ด้ า น พ ฤ ติ ก ร ร ม สุ ข ภ า พ พ บ ว่ า ม า ก ก ว่ า ค รึ่ ง ห นึ่ ง ข อ ง นั ก เ รี ย น ไ ม่ ไ ด้ อ อ ก ก า ลั ง ก า ย หนึ่ งในสาม ของนั ก ศึ ก ษ ากลุ่ ม ตัว อย่ า งดื่ ม เครื่ อ งดื่ ม แอลกอฮอล์ ส่ ว น อั ต ร า ก า ร สู บ บุ ห รี่ ต่ า (ร้ อ ย ล ะ 4) เ กื อ บ ร้ อ ย ล ะ 40 ข อ ง ผู้ ต อ บ แ บ บ ส อ บ ถ า ม รั บ ป ร ะ ท า น เพี ย ง ส อ ง มื้ อ ต่ อ วั น การบริโภคพลังงานและปริมาณธาตุอาหารทีม ่ ีธาตุอาหารเสริมบางอย่าง ไ ม่ เป็ น ไ ป ต า ม ข้ อ ก า ห น ด ร า ย วั น ที่ แ น ะ น า ข อ ง เวี ย ด น า ม โดยเฉพาะอย่า งยิ่ง วิต ามิ น เอ วิต ามิ น บี 12 โฟเลต เหล็ ก แคลเซี ย ม แ ล ะ เ ส้ น ใ ย การวิ เ คราะห์ ปั จ จัย ที่ มี ค วาม สัม พัน ธ์ ก ับ ภ าวะโภ ชน าการพ บว่ า เพศหญิงและการประเมินค่าน้าหนักตัวสูงเกินไปเป็ นปัจจัยทีส ่ ม ั พันธ์กบ ั ค ว า ม ชุ ก ข อ ง น้ า ห นั ก ต่ า ก ว่ า เ ก ณ ฑ์ ส รุ ป ไ ด้ ว่ า ภาวะการมีน้าหนักต่าในกลุม ่ ชาติพน ั ธุ์ชนกลุม ่ น้อยเป็ นภาวะทีน ่ ่ าตกใจโ ii ด ย เ ฉ พ า ะ ผู้ ห ญิ ง จากผลการวิจยั มีขอ ้ เสนอแนะว่าควรให้การศึกษาด้านโภชนาการมากขึ้ นโดยมุง่ เน้นทีแ ่ หล่งสารอาหารทีเ่ หมาะสมและประโยชน์ ของพฤติกรรม ก า ร กิ น เ พื่ อ สุ ข ภ า พ ร ว ม ถึ ง ก า ร อ อ ก ก า ลั ง ก า ย ้ สุขภาพไม่มีปญ เพือ ่ ให้ม่น ั ใจว่าเมือ ่ อายุมากขึน ั หา iii Tran Thi Huyen Trang 2018 Assessment of nutritional status among ethnic minority university students, Thai Nguyen province, Vietnam Master of Public Health Thesis in Nutrition for Health, Graduate School, Khon Kaen University Thesis Advisor: Asst Prof Dr Pattara Sanchaisuriya ABSTRACT Malnutrition has been a critical health problem in developing countries It is also becoming a serious health problem among ethnic minority groups The research was conducted among 351 ethnic minority students aged 17-29 years old at Thai Nguyen University of Pharmacy and Medicine The semi-structured pre-designed questionnaire was used to directly interview students to gather information about characteristics of individuals, dietary data, anthropometric data and a number of factors affecting the nutritional status The results showed that the prevalence of underweight students was high (25.4%); in contrast, that of overweight and obesity were relatively low (4.3% and 0.5%, respectively) Females students were statistically significant underweight than male students (AOR=3.2, 95%CI: 1.55-6.80) A questionnaire on life style and nutrition concerns indicated that nearly half of students did not exercise, more than one-third of students drank alcoholic beverage, and smoking was low in this population (4%) Nearly 40% of participants only consumed two meals per day The energy intake and some micronutrient intake did not meet two-thirds of the Vietnamese Recommended Daily Allowances, especially vitamin A, vitamin B2, B12, folate, iron, calcium, and fiber Females and overestimating the body weight were factors related to underweight prevalence In conclusion, underweight status in ethnic minority students was an alarming condition, particularly among females More nutrition education, focusing on selective nutrient sources and the benefits of healthy eating habit as well as physical activity, should be provided to ensure good health in their adult life iv ACKNOWLEDGEMENTS First of all, I would like to express my gratitude to my advisors, Assistant Professor Dr Pattara Sanchaisuriya Thank you for all constructive guidance and statistical advice in doing this work, and constant support not only for doing this thesis but also for the whole time I was studying in Khon Kaen Thank you for tirelessly supporting my work, without ongoing encouragement, interest, and enthusiasm, I could not have completed this thesis Sincere thanks to the Faculty of Public Health, Khon Kaen University for granting the scholarship that makes my study here feasible and convenient I would also like to give my special thanks to Associated Professor Dr Kanokwan Sanchaisuriya, and all the professors and lecturers in the Department of Nutrition for providing me valuable knowledge and experience during my study I would also like to express my extremely grateful to Assistant Professor Woralap Sangvatanachai, who always supported and helped me with English writing skills, without your help, it would be very difficult for me to complete this thesis Sincere thanks also to Thai friends for helping me during difficult times, cheering me up and for all supports they provided Also great appreciation to my lecturers and my colleagues at the Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy for their suggestions and encouragement throughout my course of study Lastly, my deepest love and special thanks to my wonderful family for their love, endless support, and encouragement during my candidature v TABLE OF CONTENTS Page ABSTRACT (in Thai) i ABSTRACT (in English) ii ACKNOWLEDGEMENTS iii TABLE OF CONTENTS iv LIST OF TABLES vi LIST OF FIGURES vii LIST OF ABBREVIATIONS viii CHAPTER I INTRODUCTION 1.1 Background 1.2 Research question 1.3 Objectives 1.4 Hypothesis 1.5 Significance 1.6 Definition of terms CHAPTER II LITERATURE REVIEW 2.1 Overview of nutritional status in the world 2.2 Overview of nutritional status in Vietnam 10 2.3 Overview of ethnic groups in Vietnam 13 2.4 Nutritional status assessment tools 17 2.5 Factors effecting nutritional status among university students 22 2.6 Conceptual Framework 30 CHAPTER III RESEARCH METHODOLOGY 32 3.1 Study design 32 3.2 Study population 32 3.3 Sample size and sampling technique 32 3.4 Data collection 33 3.5 Data analysis 36 vi TABLE OF CONTENTS (Cont.) Page 3.6 Ethical considerations CHAPTER IV RESULTS 36 37 4.1 Sample characteristics 37 4.2 Eating habits, self-perceived weight status, and physical activity 37 4.3 Nutritional status 38 4.4 Food consumption patterns 38 4.5 Dietary intake 39 4.6 Factors associated with nutritional status 40 CHAPTER V DISCUSSIONS 60 5.1 Nutritional status and related factors 60 5.2 Dietary intake patterns 66 5.3 Limitation of the study 70 CHAPTER VI CONCLUSIONS AND RECOMMENDATIONS 71 REFERENCES 72 APPENDICES 81 vii LIST OF TABLES Page Table Summary of studies about nutritional status among university students Table Classification of nutritional status in adults according to BMI 18 kg/m2 Table Summary of studies about prevalence and socio-economic 25 factors of nutritional status Table General characteristics of study population 41 Table Eating habits among ethnic minority students 42 Table Self-perceived weight status among ethnic minority students 44 Table Doing exercise among ethnic minority students 45 Table Anthropometric data of ethnic minority students according to 45 gender Table Nutritional status and abdominal obesity index according to 46 gender Table 10 Frequency of food consumption 47 Table 11 Average nutrients intake and percentage of Vietnamese 49 Recommended Dietary Allowances among students by gender Table 12 Association of socio-demographic variables with nutritional 54 status Table 13 Multinomial logistic regression analysis of factors associated with nutritional status 57 78 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 WHO, Global recommendations on physical activity for health 2010: Geneva: WHO publication Kerkadi, A., Evaluation of nutritional status of United Arab Emirates University female students Emir J Agric Sci, 2003 15(2): p 42-50 Cilliers, J., M Senekal, and E Kunneke, The association between the body mass index of first-year female university students and their weight-related perceptions and practices, psychological health, physical 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attitudes towards banning alcohol sales on campus among European university students Public health, 2009 123(2): p 122-129 Sinaga, H.T., I Chakma, and R Herkutanto, Nutritional status with emphasis on iron status of adolescent female students in urban and rural secondary schools in Chumpae district northeast Thailand 1995, Queensland: Khon Kaen: Khon Kaen University 79 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 Health, M.o.P., Nutritive Composition Table of Vietnamese Food 2000, Medical Publishing House: Hanoi, Vietnam, Nutrition, N.I.o., Recommended Dietary Allowances for Vietnamese Medical Publishing House ed 2016 Linh, D.T and N.T Liem, Prevalence and variation of underweight and overweight among adult population in Thai Nguyen province of Vietnam, in Proceedings of the 27th International Union for the Scientific Study of Population 2013: Busan, Republic of Korea Heo, J., et al., Wealth gradient-based divergence in the prevalence of underweight among women by 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135 136 137 138 139 140 141 142 Hagstromer, M., P Oja, and M Sjostrom, Physical activity and inactivity in an adult population assessed by accelerometry Med Sci Sports Exerc, 2007 39(9): p 1502-8 Bergmann, G.G., et al., Prevalence of physical inactivity and associated factors among adolescents from public schools in Uruguaiana, Rio Grande Sul State, Brazil Cadernos de saude publica, 2013 29(11): p 2217-2229 Goje, M., et al., Physical Inactivity and Its Associated Factors among University Students IOSR Journal of Dental and Medical Sciences (IOSRJDMS), 2014 1: p 119-130 Abdullah, A., et al., Factors related to non-participation in physical activity among the students in Hong Kong International journal of sports medicine, 2005 26(07): p 611-615 Bianchini de Quadros, T.M., et al., The prevalence of physical inactivity amongst Brazilian university students: its association with sociodemographic variables Revista de Salud Pública, 2009 11(5): p 724-733 Laillou, A., et al., Hypovitaminosis D and mild hypocalcaemia are highly prevalent among young Vietnamese children and women and related to low dietary intake PLoS One, 2013 8(5): p e63979 Pasricha, S.-R., et al., Anemia, iron deficiency, meat consumption, and hookworm infection in women of reproductive age in northwest Vietnam The American journal of tropical medicine and hygiene, 2008 78(3): p 375-381 Mai, T.t.T., et al., Micronutrient status of primary school girls in rural and urban areas of South Vietnam Asia Pacific journal of clinical nutrition, 2003 12(2) an alarming status of Vietnamese people consume less vegetables and fruits 2016; Available from: https://baomoi.com/bao-dong-tinh-trang-nguoi-viet-luoian-rau-trai-cay/c/20315153.epi Al-Otaibi and H Hazam, The pattern of fruit and vegetable consumption among Saudi university students Global journal of health science, 2014 (2): p 155 Van Bui, T., et al., Fruit and vegetable consumption in Vietnam, and the use of a ‘standard serving’size to measure intake British Journal of Nutrition, 2016 116(1): p 149-157 Global School-based Student Health Survey (GSHS) 2013; Available from: https://www.cdc.gov/gshs/countries/westpacific/vietnam.htm/ Bipasha, M.S., T.S Raisa, and S Goon, Sugar Sweetened Beverages Consumption among University Students of Bangladesh International Journal of Public Health Science (IJPHS), 2017 6(2): p 157-163 81 APPENDIX-A CONSENT FORM FOR THE STUDENTS Hello, we are a group of researchers from Khon Kaen University, Thailand We are implementing scientific research on “Assessment of Nutritional Status among Ethnic Minority University Students, Thai Nguyen Province, Vietnam” The study aims at investigating the nutritional status, the food consumption patterns and factors associated with nutritional status of ethnic minority undergraduate students The result of the study will contribute to the useful recommendations for the nutrition education intervention strategies targeting students Thus, we are looking forward to your participation in interviews based on the questionnaire below The information that you provide is very important for our research We hereby declare that all your information will be kept completely confidential and only for scientific research purposes You have the right not to answer any questions that you not want to answer However, in order to achieve significance in the study, we hope you will respond positively and completely THANK YOU If you agree to participate in research, please sign your name at the bottom lines Signed: Full name: Date _ 82 APPENDIX-B QUESTIONNAIRES Code:……… ASSESSMENT OF NUTRITIONAL STATUS AMONG ETHNIC MINORITY UNIVERSITY STUDENTS, THAI NGUYEN PROVINCE, VIET NAM Date of survey: … /… /…… Please fill in the blank or check (x) in the appropriate box to answers the question: A SOCIO – DEMOGRAPHIC SECTION Q.No A1 Question ID code Response Var …………………………………… A1 Gender A2 Male A2 Female A3 Class of participant …………………………………… A3 A4 Phone number A4 Birthday Day A5 month year A5 Ethnicity Tay A6 Nung San Diu Dao Muong A6 83 Other ethnic: ……………… Have you got any chronic disease? A7 No A7 Yes -> Stop interview Have you ever got any sickness A8 within last two weeks? No A8 Yes -> Stop interview Where you stay now? Home with parents A9 Outside by yourself A9 University residential hall A10 Pocket money per month VND A10 Do you regular exercise? A11 No -> Move to A13 A11 Yes If yes, what type of exercise you do? Walking/ Jogging Swimming A12 Aerobics A12 Badminton Other………… A13 A14 A15 How many days in week you spend for exercise per day? ……………………… Day/ week How long you spend for exercise per day? How you think about your ……………………… minutes A13 A14 A15 84 body weight? Underweight Ideal weight Overweight Obesity B EATING HABITS B1 How many meals you usually Weekday………meals/day take per day? Weekend………meals/day Please write x in blanket the [ ] Breakfast (meal 1): from the meal you usually take in moment waking up to breakfast weekday finished B1 [ ] Morning snack (meal 2): after breakfast before lunch [ ] Lunch (meal 3): main meal at midday B2 [ ] Afternoon snack (meal 4): B2 after lunch and before dinner [ ] Dinner (meal 5): the main meal in the evening [ ] Midnight snack(meal 6): after dinner and before waking up the next day B3 Please write x in blanket the [ ] Breakfast (meal 1): from the meal you usually take in moment waking up to breakfast weekend finished [ ] Morning snack (meal 2): after breakfast before lunch [ ] Lunch (meal 3): main meal at B3 85 midday [ ] Afternoon snack (meal 4): after lunch and before dinner [ ] Dinner (meal 5): the main meal in the evening [ ] Midnight snack (meal 6): after dinner and before waking up the next day How often you eat breakfast? Almost everyday B4 to times a week B4 to times a week Rarely or never How often you eat lunch? Almost everyday B5 to times a week B5 to times a week Rarely or never How often you eat dinner? Almost everyday B6 to times a week B6 to times a week Rarely or never Do you drink alcohol? B7 No Yes B7 86 Do you drink beer? No B8 B8 Yes Do you smoke? B9 No -> Move to part C B9 Yes How many cigarettes you B10 smoke per day? B10 …………… cigarettes/ day C FOOD FREQUENCY QUESIONNAIRE SECTION Instruction: Tell the participants that the reference time in the last months Repeat the following question for each food item row: “In the last months, how often did you eat (food item)?” Average use during past months Q No Food item Day Week Month Never Var eating C1 Rice and products C1 C2 Maize and products C2 C3 Wheat flour and bread C3 C4 Noodle C4 C5 Starchy and products C5 C6 Peanut, seeds and products C6 C7 Beans and products C7 C8 Soybeans and products C8 C9 Leaf vegetables C9 C10 Other Vegetables C10 C11 Fruits C11 C12 Oils C12 87 C13 Lards C13 C15 Pork and products C15 C16 Other meat (beef, buffalo…) C16 C17 Chicken, duck,… C17 C18 Other poultry C18 C19 Viscera (kidney, stomach…) C19 C20 Meat products (sausage, ) C20 C21 Canned/ tinned meat C21 Average use during past months Q No Food item Day Week Month Never Var eating C22 Fishes C22 C23 Crab, shrimp C23 C24 Other fishes C24 C25 Tinned fishes C25 C26 Products fishes C26 C27 Egg and products C27 C28 Other tinned foods C28 C29 Sweet (snacks, candy, cake…) C29 C30 Fish sauce C30 C31 Other condiments (salt, MSG) C31 C32 Beverages C32 C33 Beer C33 C34 Alcohol C34 C35 Tea C35 C36 Coffee C36 D 24 HOUR DIETARY RECALL SECTION Instruction: 88 Ask the participant about the following questions and fill in the responses in the table below The interviewer helps the respondent remember all that was consumed during the period in question and assists the respondent in estimating portion sizes of foods consumed Starting from the last meal up-to 24 hours backwawrd, please name all foods and beverages that the participant consumed What amounts of food/ beverages did the participant consume and how were they prepared? Using the picture and photographic atlases of food portion sizes to help estimate portion sizes of food consumed Time of Name of food Place eaten meal or beverage consumes Method of cooking Ingredients Source of / Food dishes items (self- (Detailed cooking, description buying, , give given from brand relative/fri name if ends, applicable) gathering) Amou nt consu med E ANTHROPOMETRIC SECTION Q.No E1 E2 Question Height Weight Response Var Trial , cm E1.1 Trial , cm E1.2 Trial , kg E2.1 89 Waist circumference E3 Trial , kg E2.2 Trial , cm E3.1 Trial , cm E3.2 APPENDIX-C ETHNIC MINORITY AND LANGUAGE GROUPS Language group Ethnic minority group Muong Chut, Muong, Tho Tay – Thai Bo Y, Giay, Lao, Lu, Nung, San Chay, Tay, Thai Ba na, Brau, Bru-Van kieu, Cho-ro, Co, Co-ho, Co-tu, Gie-trieng, Hre, Khang, Kmer, Kho mu, Ma, Mang, Mon – Khmer M’Nong, O-du, Ro-mam, Ta-oi, Xinh-mun, Xo-dang, Xtieng Kadai Co lao, La chi, La ha, Pu peo Mong – Dao Dao, Mong, Pa then Malayo- Polynesian Cham, Chu-ru, E de, Gia-rai, Ra-giai Han Hoa, Ngai, San diu Tibeto – Burman Cong, Ha Nhi, La hu, Lo lo, Phu la, Si la 90 APPENDIX-D RECOMMENDED DIETARY ALLOWANCES FOR VIETNAMESE ADULT Nutrients Male Female 15-19 years 2820 2380 20-29 years 2570 2050 15-19 years 74 63 20-29 years 69 60 15-19 years 63-94 53-79 20-29 years 57-71 46-57 15-19 years 400-440 330-370 20-29 years 370-400 320-360 15-19 years 38 26 20-29 years 38 25 Energy (kcal) Protein (g) Lipid (g) Carbohydrate (g) Dietary fiber (mg) 91 Vitamin B1 (mg) 15-19 years 1.4 1.2 20-29 years 1.3 1.1 Vitamin B2 (mg) 15-19 years 20-29 years 1.7 1.5 1.4 1.2 Vitamin B3 (mg) 15-19 years 16 14 20-29 years 16 14 15-19 years 2.4 2.4 20-29 years 2.4 2.4 15-19 years 100 100 20-29 years 100 100 15-19 years 15 15 20-29 years 15 15 15-19 years 300 400 20-29 years 400 400 15-19 years 1000 1000 20-29 years 800 800 15-19 years 1250 1250 20-29 years 700 700 Vitamin B12 Vitamin C (mg) Vitamin D Folate ( Calcium (mg) Phosphorus (mg) Iron (mg) 92 15-19 years 17.5 29.7 20-29 years 11.9 29.6 15-19 years 600 600 20-29 years 600 600 15-19 years 10 20-29 years 10 15-19 years 850 650 20-29 years 850 650 Na (mg) Zn (mg) Vitamin A