The prevalence and some associated factors of silicosis among employees working in one factory in Thai Nguyen province, 2020

DIETARY INTAKE AND PHYSICAL ACTIVITYOF ELEMENTARY SC HOOL CHILDREN IN HA NAM AND DIEN BIEN PROVINCES IN 2020 Major : Doctor of Preventive MedicineMajor code : D720302 THESIS OF GRADUATIO

DIETARY INTAKE AND PHYSICAL ACTIVITY

OF ELEMENTARY SC HOOL CHILDREN

IN HA NAM AND DIEN BIEN PROVINCES IN 2020

Major : Doctor of Preventive MedicineMajor code : D720302

THESIS OF GRADUATION MEDIC AL DOCTOR

COURSE 2015-2021

Supervisor: I Assoc Prof PhD Tran Thuy Nga

2 Assoc Prof PhD Pham Van Phu

HANOI-2021

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challenging field, and it presented many difficulties to me when I decided to do mythesis on it But as a result of it I did not only gain more knowledge, but also moreskills The implementation would not be possible if I did not receive the assistance ofseveral individuals and organizations Thus I would like to express my sincere gratitude

to all of them even though it is impossible to list them all

First and foremost, I would like to express my heartfelt gratitude and

appre-ciation to Assoc Prof Tran ThuyNga, head of Department of Micronutrients, National

Institute of Nutrition, for her invaluable guidance, relentless encouragement, expertsuggestions, constructive criticism, and supervision, all of which were essential incompleting this thesis

I am thankfol to Assoc Prof Pham Van Phu from the Department of Nutrition.Institute for Preventive Medicine and Public Health for his great interest, en-couragement supervision and helpfol advice on thesis progress

I would like to express my deepest thanks to the Managing Board Department

of Training Hanoi Medical University who had created a welcoming and wonderfolenvironment in the school for the past six years I wish to thank all the teachers in theDepartment of Nutrition Institute for Preventive Medicine and Public Health HanoiMedical University for their valuable information provided by them in their respectivefields I am grateful for their cooperation during the period of my assignment

Finally I would like to thank my wonderful family and friends for their wavering support during this ordeal Your unwavering love and support gave me thestrength to keep going

un-Hanoi 2021Duong Tmng Due

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any degree in any university previously All the sources of information which havebeen use in the thesis and external contribution are fully referenced and acknowledged

Hanoi 2021

Duong Trung Due

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INTRODU CTION 1

CHAPTE R 1: LITERATURE RE VIEW 3

1.1 Dietan' intake 3

1.1.1 Definition of dietary intake 3

1.1.2 Methods of dietary intake assessment 3

1.1.3 Recommended dietary allowances for elementary school children 6

1.2 Physical activity 9

1.2.1 Definition of physical activity 9

1.2.2 Methods of assessing physical activity 10

1.2.3 Recommendations on physical activity for elementary school children 13 1.3 Previous studies on dietary intake and physical activity of elementary school children 15

1.3.1 In the world 15

1.3.2 In Vietnam 17

CHAPTE R 2: RESEA RCH su BJECT SAND METH ODOLO GY 19

2.1 Study subjects: 19

2.1.1 Inclusion criteria: 19

2.1.2 Exclusion criteria: 19

2.2 Study time and study sites 19

2.3 Methodology 19

2.3.1 Study design: 19

2.3.2 Sampling 19

2.3 Variables and indicators 21

2.4 Data collection 22

2.5 Potential errors and solutions 23

2.5.1 Potential errors 23

2.5.2 Solutions 23

2.6 Data management and analysis 24

2.7 Ethical issues 24

CHAPTE R 3: RESULTS 25

3 1 Characteristics of research subjects 25

3.2 Dietary intake of research subjects 26

3.3 Ph ysical activity of research subjects 40

CHAPTE R 4: DISCUSSION 4S 4.1 Dietan- intake of the research subjects 4S 4 2 Ph ysical activity of the research subjects 53

CONCLU SION 58

1 Dietary intake of the elementary school children in Ha Nam and Dien Bien province in 2020 58

2 Physical activity of the elementary' school children in Ha Nam and Dien Bien

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Food Frequency Questionnaire

Moderate to Vigorous Physical Activity

National Institute of Nutrition

Table 3.2 Food consumption of students by province 26

Table 3 3 Energy and macronutrients intake by province 27

Table 3 4 Micronutrients intake of the students by province 28

Table 3 5 Food consumption of students by gender 32

Table 3 6 Energy and macronutrients intake by gender 33

Table 3 7 Micronutrients intake of students by gender 34

Table 3 s The proportion of protein and lipid intake by province and gender 39

Table 3 9 Average of PAQ score of students by province and gender 40

Table 3 10 Lex el of physical activity of students by proxince 40

Table 3.11 Lex el of physical activity of students by gender 41

Table 3 12 Frequency of students engaging in moderate to vigorous physical activity for at least 60 minutes each day in the last 7 days by province41 Table 3 13 Frequency of students engaging in moderate to vigorous physical activity for at least 60 minutes each day in the last 7 days by gender 42 Table 3 14 Actixities students attending in die past 7 days by province 43

Table 3 15 Proportion of children cycling or xx’alking to school by prox-ince 44

Table 3 16 Actixities children doing during school break-time by gender 44

Table 3 17 Mean time children doing sedentary activities by province 45

Table 3.18 Mean time children do sedentary actixities by gender 46

Table 3 19 Electronic device students use most often by province 46

Table 3.20 Ax erage evening sleeping time of students by province and gender 47

Figure 3 3 Proportion of energy and macronutrients meeting the RDAbv gender 36Figure 3 4 Proportion of micronutrients meeting the RD A by gender 37Figure 3 5 The balance of energy substances intake of students by province 3SFigure 3 6 The balance of energy substances intake of students by gender 39

Background & objectives: Dietary intake and physical activity (PA) are not onlydirectly affected to children's growth, but also indirectly affected to their cognitiveabilities and stature development This study aims to describe the dietary intake andassess the PA of elementary school children

Methods: A cross-sectional study involved 248 students aged 7-10 years in Ha Namand Dien Bien provinces from October to November 2020 In which 225 dietaryintakes were collected by 24-hours dietary recall method The PAQ questionnaire wasused to assess the students’ PA

Results: The mean energy consumption is under the RDA (1367.6 = 5ỐS.1 Kcal) Totalpro-tein consumption is high (143.9% of the RDA) Lipid and carbohydrate are notmeeting the RDA Calcium, magnesium, vitamin Bl B2, B6 folate, vitamin A D areunder the RDA The energy-generating substance structure is balanced (P:L:C=164:23.4.60.2) The average PAQ score is 2.9 = 0.6 points Hie majority of students aremoderate-active (81.8%) whereas 18.2% are low-active Students spend an average of1.2 -1.8 hours on sedentary activities even- day Students in Ha Nam spend more time

on sedentary activities than students in Dien Bien

Conclusion: The dietary intake of elementary school children aged 7-10 years in HaNam and Dien Bien did not meet the RDA for energy, lipid, carbohydrate and somemicronutrients However, the composition of macronutrients reached the RDA Majority

of students are moderate active

Keywords: dietary intake, physical activity , elementary school children, Ha Nam, Dien Bien.

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Dietan- intake plays an important role in nutritional status and people’s health Ahealthy diet is considered crucial for elementary school children It does not onlydirectly affect to their growth, but also indirectly affect to children’s cognitive abilitiesand learning results (1) Several studies around the world found that multiple dietaryinadequacies are frequent among children from developing countries [2] [3] InVietnam, a study by Tran Khanh Van et al in 2017 conducted in Thai Nguyen provincefound that the dietary intake of elementary school students aged 7 to 10 years did notmeet the recommended dietary allowances of the National Institute of Nutrition interms of both energy and proportion of macronutrients, the study also found the lack ofmicronutrients in the diet [4], Lack or excess nutrients in primary school children allleads to nutritional disorders such as malnutrition and micronutrient deficiencyNutritional disorders are thought to be caused mostly by an inadequate diet [5]

In addition to a healthy diet, children will benefit from a regular schedule ofphysical activity The role of physical activity in normal growth and development isobvious Increased physical activity, especially at school age aids in optimal height andstature development [6] Furthermore, several studies around the world have shown thatphysical activity can help minimize the risk of cardiovascular disease, metabolicdisease, aid mental disorders [7], (8)

However, several studies around the world and in Vietnam have shown that theproportion of students who meet the recommendations of physical activity is still low.According to study conducted by Zimmo L et al in 2017 only 39% of primary schoolstudents in Qatar engaged in moderate to extreme physical activity for 30 minutes ormore a day students spend an average of 58.1% of their dailytime on sedentaryactivities [9] In Vietnam 2016 Do Van Dung et al conducted a study on 619 grade 5students in Ho Chi Minh City, finding that 18% of students did not engage in physicalactivity, male students are more active than female students, and sedentaty activities are

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common in both genders (10]

Adequate diet and physical activity are the prerequisites for children’s growth.Economic growth also contributes to social changes, including changes in children’seating and exercise behaviors As a result, many countries around the world areinterested in studying children's dietan’ intake and physical activity It provides ascientific basis for the government to establish interventional strategies and other healthstrategies to improve children's health However, in Vietnam, studies on elementaryschool children's dietary intake and physical activity are still not really interested Forthe above reasons, we conduct the research ••Dietary intake and physical activity ofelementary school children in Ha Nam and Dien Bien provinces in 2020” with twofollowing objectives:

1 To describe the dietary intake of elementary school children in Ha Nani and DienBien provinces in 2020

2 To assess the physical activity of elementary' school children in Ha Nani and DienBien provinces in 2020

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CHAPTER 1: LITERATURE REVIEW1.1 Dietary intake

1.1.1 Definition of dietary intake

Dietan’ intake is the amount of food consumed in one day to fulfill the body’senergy and nutrient requirements [11]

The per-subject intake was determined by the amount of meals consumed perday the distribution of meals at different times of the day taking into consideration mealtiming, and a balanced distribution of energy ratios among meals [11]

1.1.2 Methods of dietary intake assessment

Dietan' assessment is an evaluation of food and nutrient intake and dietarypattern of an individual or individuals in the household or population group over time It

is one of the four approaches in nutrition assessment to evaluating the nutritional status

of individuals comprehensively The other three are anthropometries, biochemicalparameters and clinical examination [12]

Dietary intake can be assessed by subjective report and objective observationSubjective assessment is possible using open-ended surveys such as dietary recalls orrecords or using closed-ended surveys including food frequency questionnaires Eachmethod has inherent strengths and limitations Subjective dietary assessment methodsthat assess an individual's intake include the 24-hour dietar.' recall (24HR) dietar.-record (DR), dietary history, and FFQ Data are collected with the help of a trainedinterviewer or by self-report [13]

24-hours dietan- recall (24HR)

The 24HR is conducted in an in-depth interview manner and typically requires

20 to 30 minutes to complete a single day recall Subjects are asked to report all foodsand beverages consumed in the past 24 hours This can be done via telephone or face-to-face interview Trained staff must conduct the interview to prompt for details, such ascooking methods and portion sizes [2] (4]

Detailed data about food preparation methods, ingredients used in mixed dishes,and the brand name of commerc ial products may be required according to the researchquestion The amounts of each food consumed are estimated in reference to a common

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size container (e.g bowls, cups, and glasses), standard measuring cups and spoons, athree-dimensional food model, or two-dimensional aids such as photographs Oneadvantage of the 24HR is that a relatively minimal burden is imposed on respondentsHowever an inevitable limitation is that all information depends on the respondents'memory and the skills of a well-trained interviewer to minimize recall bias [11] [13].

Another limitation is that this method is mainly focused on short-term intake,but long-temi dietary exposure is especially of interest when investigating chronicdiseases Thus, to measure average intake, multiple 24HRs are needed Repeatedmeasurement not only requires a lot of resources and time, but survey repetition canalso influence a respondents' diet A further disadvantage is from the open-endedformat, which requires significant effort during data collection, entry and analysis Theresearch team must carefully renew each questionnaire to ensure that all recorded data

is included After initial review, all foods and mixed dishes consumed according to thedetailed descriptions of the respondents should be matched and coded with the mostappropriate food listed in the food composition database Moreover the quantity’ of foodconsumed should be converted to its actual weights When the reported information ischanged to the corresponding food code and weight, actual intakes can be calculated[11], [13]

Dietary record

Subjects record all food and beverages consumed over three consecutive days(two weekday’s and one weekend day) The consumed items can be measured using ascale or other household items, such as measuring cups or spoons, or estimated using aportion-size guide Trained staff must provide detailed instructions on how to recordintake (15]

The main advantage of dietary record is its potential to collect accurate titative information on individual foods consumed during the registration period.Because of the quality of the dietary data, the dietary record is considered to be the goldstandard of the dietar,’ methods and is often used as a reference in calibration orvalidation studies using other less involved and less expensive methods The weighteddietary record provides more precise estimates of intakes for individuals which can be

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related to health indices, such as nutritional status measured by blood analytes As foodsare recorded as consumed, it is less likely to omit forget food items and moreover, thedescription thereof is more accurate When the dietary record uses open-endedquestions, abundant information can be collected and analyzed in various aspects Forexample, if sufficient das's are recorded, day-to-day variation can be studied Also,detailed descriptions of the foods consumed, and all eating occasions are prosided It can

be easily applied to diverse groups with a wide range of eating habits and may be used

to estimate the average intake of a certain population since provides excellent estimatesfor energy, nutrients, foods and food groups Dietary record is suitable in metabolic and

in tervention studies (13) (16)

Since the diet varies greatly from day to day the reported data can only resent the current diet, not the normal diet However, if the procedure is repeated, theusual intake may be calculated Those who may fill out dietary record (interviewees orcaregivers) must be both inspired and literate (if done on paper), which can restrict theiruse in certain populations (people with low literacy, immigrants with low languageskills, children, elderly, people with difficulty writing ) Because the DR require highcooperation limits the type of population that can be applied and this could compromisethe generalizability of the results to the wider population [13], [16]

rep-Dietary history

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To assess individual long-temi dietary intake Burke developed a dietary historymethod in 1947 [17] This method requires that subjects complete a 24HR 3’ day fooddiary, and checklist of foods usually consumed Highly skilled professionals arc required

to collect information on tile participant’s usual diet using an in- depth interview(approximately 90 minutes to complete) Thus, this method is rarely used inepidemiological studies [13], [17]

Food frequency questionnaire (FFQ)

The FFQ is an advanced form of the checklist in dietary history method and asksrespondents how often and how much food they ate over a specific period Presentingabout 100 to 150 foods, this questionnaire takes 20-30 minutes to complete and can beself-administered or collected via interview This method enables the assessment oflong-term dietary intakes in a relatively simple, cost-effective, and time-eòìcientmanner Thus, various FFQs have been widely employed as a practical instrument sincethe 1990s FFQs should be developed specifically for each study group and researchpurposes because diet may be influenced by ethnicity, culture, an individual'spreference, economic status, etc (11], [13]

1.1.3 Recommended dietary allowances for elementary school children

The Food and Nutrition Board of the US National Academy of Sciences definesThe Recommended Dietary' Allowance (RDA) is the average daily dietary’ intake levelthat is sufficient to meet the nutrient requirements of nearly all (97 to 9S percent)healthy individuals in a specific life stage and gender group The RDA is intendedprimarily for use as a goal for daily intake by individuals [IS],

1.1.3.1 Requirements of energy, proteins, fat and carbohydrates

Children need energy on a daily basis for basic metabolism, physical activity, celldevelopment and lifespan Food is an energy source The three main macronutrients inthe body are carbohydrates, proteins, and lipids The kilocalorie is the unit formeasuring energy purity (Kcal) [IS], Primary school children aged 6 to 11 years old.according to the National Institute of Nutrition need between 1270 and 2400 Kcal perday to meet their body’s growth and development [19]

Protein has been described as the most crucial material or factor in the creation of

life Protein assists in the creation, maintenance, and repaữ of body tissues It isespecially important for a child's growth Meat fish, poultry, milk, and milk productsare all good sources of protein for children Protein requirements depending on age.gender, physiological status, and medical issue Protein RDAs for elementary schoolchildren range from 33 to 50 grams per person per day Protein can account for 20-30%

of dietan' energy at this age with animal protein accounting for 50% of that [19], [20]Lipid is a common organic compound present in plant and animal cells It can befound in butter, fat oil milk meat, and other foods Lipid is known to be an importantcomponent of food It provides more than twice the amount of energy as protein andcarbohydrates (about 9 kcal 1 gram of lipids) Furthermore, lipid is a canier of lipid-soluble nutrients including vitamin A D E K The body’s ability to absorb lipidsdetermines the biological value of fat-soluble substances According to the RDA forVietnamese, the lipid requirement for children aged 6 to 11 years is 32-72g per personper day, with lipids contributing for 20-30% of total energy Arachidonic acid, a poly -unsaturated fatty acid found in animal fat is essential for the rapidly developingchildren's body, so the ratio between animal lipids and vegetable lipids is recommended

at 70% and 30% respectively [19] [20]

Carbohydrate which includes staple foods, sugars, and fiber, are the most sential ingredient accounting for the majority of meal volume It is also the body's mainsource of energy (1 gram of carbohydrates provides 4 kcal) The body's main energysupply is food Carbohydrates contribute to shaping and controlling body movements,

es-as well es-as being a source of fiber According to the RDAs for Vietnamese primary'school children's carbohydrate requirement ranges from 210 to

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This term therefore includes the full range of human movement from competitivesport and exercise to hobbies or activities involved in daily living Conversely, physicalinactivity can be described as “a state in which bodily movement is minimal and energyexpenditure approximates the resting metabolic rate" (26 ].

Physical activity is a complex, multi- dimensional behavior Many differentmodes of activity contribute to total physical activity; these include occupational

household (e.g caregiving, domestic cleaning), transport (e.g walking or cycling to work) and leisure- time activities (e.g dancing, swimming) Exercise is a subcategory of

leisure- time physical activity and is defined as "physical activity in which planned,structured and repetitive bodily movements are performed to improve or maintain one

or more components of physical fitness" [26], [27]

Physical activity can be classified further according to its frequency, duration.and intensity The frequency and duration of an activity refer to how frequently and forhow long it is done The amount of energy expenditure that an activity necessarilyrequires is referred to as intensity (26)

1.2.2 Methods of assessing physical activity

Physical activity is a multifaceted behavior that can be assessed in a range ofmethods For measuring energy expenditure and more precisely, physical activity, avariety of instruments are available, including objective and self-reporting methodsBoth physical activity' and inactivity (sedentary behavior such as sitting or televisionviewing) can be measured using these methods [26] [2S]

Self Report Questionnaires

These questionnaires are the most common method of PA assessment [29] andrely on participants' recall ability Questionnaires vary by what they measure (eg., mo-

de duration, or frequency of PA): how data are reported (eg activityscores time,calories), quality of the data (eg measures of intensity differentiating between habitualand merely recent activities inclusion of leisure and non-leisure activity), and how dataare obtained (e g., paper and pencil assessment, computerized questionnaire, interview)[30]

Their advantages include cost effectiveness, ease of administration, and

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curacy in measuring intense activity, determining discrete categories of activity level(eg., low, moderate, high), ranking individuals or groups in their PA providing detailsabout the PA and showing improvement across groups or individuals Potentialdisadvantages are that self-report questionnaires are less robust in measuring light ormoderate activity, assessing energy expenditure and may be limited by the dependency

on written language (j e questions) and external factors (i.e social desirability,complexity of the questionnaire, age and seasonal variation) Self-report questionnaữesare significantly more reliable at the group than the individual level as well as when thequestionnaire is structured chronologically and with discrete periods [26], [28], [31]

Self-Report Activity Diaries Logs

Self-report diaries require participants to record PA in real time which providesthe most detailed data and can overcome some limitations of questionnaữes (i.e., lesssusceptible to recall errors, social desirability bias, measurement bias) To illustrate.Bouchard's Physical Activity Record (BAR) is a widely used diary in which participantsreport PA for each 15-minute interval over three days Activities are rated on a scale of

1 to 9 (1 = sedentary activity, 9 = intense manual work or high intensity sports) to yield

a total ener gy expenditure score; however, the diary is burdensome, particularly forindividuals with cognitive dysiunction In addition, questionnaires not completed in realtime could be subject to memory bias as well as participant reactivity, the phenomenon

of behavior change due to awareness of beingobserved [28], [30],

Objective methods [28]

Direct Observation

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In direct observation an independent observer monitors and records PA Thismethod of assessment is often used when activity is restricted to a delineated space (eg

a classroom) It is also a popular method for young children as they have difficultyrecalling their PA This flexible method is valuable in gathering contextual infoimation(eg., preferred location, time, and clothing) and details of the PA (eg., type, personalizedvariations to activities) Disadvantages include high cost of time and energy, potentialreactivity, difficulty obtaining ethical approval, and the lack of objective measures ofenergy expenditure

Devices: Accelerometers

In recent decades, accelerometers have gained popularity given their accuracy,ability to capture large amounts of data, and ease of administration, particularly in largestudies Accelerometers measure acceleration (counts) in real time and detect movement

in up to three orthogonal planes (anteroposterior, mediolateraL and vertical) Thesecounts are then translated into a metric of interest, which can be biological (eg energyexpenditure) or PA patterns (e.g stationary) Devices can be worn in numerous places onthe body, including waist, hip and thigh

Devices: Pedometers

Pedometers measure the number of steps taken with a horizontal, suspended lever arm which is deflected when the subject's hip accelerates verticallywith a force beyond a chosen threshold Pedometers correlate strongly with uniaxialaccelerometers, and directly observed duration of activities Their simplicity, relativelylow cost, and ability to pick up short durations of PA (often missed by self- reportmeasures) make these devices popular Pedometer data also tend to be correlated withbiological outcomes and predictors (e g age BMI) Pedometers appear to yield the mostaccurate data for running and moderate walking, as these behaviors require forwardvertical motion

spring-Devices: Heart-Rate Monitors

Heart rate monitoring is a physiological indicator of PA and energy expenditure

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providing real-time data on the frequency, duration and intensity 0-f PA in anunobtrusive (eg the)' can be worn as watches or on the chest), low-effort way forperiods up to one month HR monitors capture energy expenditure during activities notinvolving vertical trunk displacement that many accelerometers and pedometers missand are best suited to categorize subjects’ PA levels (Ĩ.C highly active, somewhatactive, sedentary) as opposed to the exact amount of PA These devices tend to showdiscrepancies particularly at very high and low intensities

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CHAPTER 2: RESEARCH SUBJECTS AND METHODOLOGY

2.1 Study subjects:

Students of elementary school in Ha Nam and Dien Bien provinces

2.1.1 Inclusion criteria:

■ Chi ldren aged 7 10 years at the time of the survey

- Family (caregiver) voluntarily agrees and signs a commitment to participate in the study

2.1.2 Exclusion criteria:

- Children were away, absent during the study period

- Children with physical and mental deformities affecting anthropometric

- Family (caregiver) with a mental illness could not be interviewed

- Family (caregiver) did not voluntarily agree to participate in the study

2.2 Study time and study sites

- Study time: from August 2020 to April 2021

- Survey time: from October 2020 to February’ 2021

- Study sites Ha Nam province and Dien Bien province

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Using multi-stage sampling method:

- Province selection purposively select two provinces (Ha Nam and Dien Bien)

- School selection randomly select 3 school each province

• In Ha Nam province: Thi Son Primary School Kim Bang District Nguyen LyPrimary School and Hoa Hau Primary School - Ly Nhan District

• In Dien Bien province: Ta Sin Thang Primary School Tua Chua District NaNhan Primary School and Nong Ư Primary School Dien Bien Phu City

- Research subjects sampling: make a list of all students in each age group from 7 to

10 Randomly select a target sample of 10 students per age group in each school.Simultaneously collecting the information about dietary intake and physical activity

of each student

2.3 Variables and ind icators

Group of general variables:

Groups of variables and indicators and dietary indicators:

■ Average consumption of food according to 14 food groups specified in the VietnamFood Composition Table 2007 [43]

- Nutritional value of the diet (calories of the diet, macronutrients of the diet, value ofvitamins and minerals in the diet)

- The level of energy and micronutrient requirements of the diet to be met (comparedwith the recommended dietary allowances of Vietnamese people in 2016) [19]

Group of variables and indicators on physical activity status:

- Average PAQ score

- Level of PA classified according to the cut-off score of Kowalski LC et al [44],

- Frequency of students engaging in MVP A at least 60 minutes day in the past 7

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CHAPTER 3: RESULTS3.1 Characteristics of research subjects

Table 3 I Demographic characteristics of the students

In terms of ethnic distribution, the Kinh people account for more than otherethnic groups 54% and 46% respectively However, there are differences in ethnicdistribution between the two provinces In Ha Nam 100% of the students are Kinh while97.4% of the students in Dien Bien are ethnic minorities (including: Thai Mong Hoa)

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3.2 Dietan intake of research subjects

Table 3 2 Food consnntpỉion of students by province

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Table 3.4 shows food consumption of students bv provinces In general, cerealsand their products was the main staple food consumed by students of the two provinceswith the highest consumption (243.4 = 120.5 g) followed by meat and meat products(106.9 = 94.7g); milk and their products (16.8 = 27.9g); vegetables and their products(84.8 = 76.9g): fruits and their products (61.7 = 9S.5g).

Students in Ha Nam had the average consumption of cereals, meat, eggs milk andfruits, respectively 257.7 ± 133 lg 130.4 = 100.6g, 19 9 ± 29 5g 130.4 = 136 6g, 79 6 =

109 lg This intake was higher than that of students in Dien Bien (224.0= 9S.2g 74.8 =75.5g, 12 6 = 25.1.29 3 = 89 6g 37.2 = 75.5g, respectively) These differences arestatistically significant with p <0.05 (Mann-Whitney test) In contrast, students in DienBien consumed more seeds and nuts than in Ha Nam (21.6 = 51.7g and 7.4 = 28.1g:

respectively) The difference is statistically significant with, p <0.01 (Mann-Whitneytest)

Table 3 3 Energy and macronutrients intake by province

Vegetable lipid (g) 12.2 = 25.8 8.4 = 53 10.6= 19.9 0.357Carbohydrate (g) 217.3= 102.0 180.9 = 75.7 201.9 = 93.4 0.001

*Mann- tTnitney test

The table above shows the value of macronutrients in the diets of students byprovince The mean energy of students in two provinces is 1367 6 = 56S 1 Kcal Totalproteins, lipids and carbohydrates were 56 4 = 27.lg 37.4 = 29.9g 201 9 = 93.4g.respectively In Ha Nam province, the value of energy and macronutrients

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are higher than in Dien Bien The average energy totalprotein, total lipids and carbohydrates consumption of HaNam students are 1537.7 ± 605 4 kcal, 65.5 = 28.3g 45.8 ±33.7g 217.3 ± 102.0g respectively Meanwhile, in Dien Bien,these indexes are 1134.7 = 413.9 kcal 43 8 = 19 5g 25 9 ±18.2g, 180.9 = 75.7 g respectively The difference isstatistically significant with p<0.01 (Mann-Whitney test).

Table 3 4 Micronutrients intake of the students by province

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Vitamin E (mg) 1 8 = 1.6 2.2 = 1.6 1.9 =1.6 0.028Vitamin K (mg) 150.7 = 255.4 304.5 = 344.7 215.6 = 305.3 0.000Vitamin A (mcg) 376.0 = 657.2 161.6 = 187.7 285.5 = 524.2 0.000Beta-carotene

*Mann- Whitney test

Table 3 4 shows micronutrients intake of the students bv province In general except for manganese, the values of minerals in the diets of students in Ha Nam province are higherthan those of Dien Bien province Some minerals are almost twice as high as calcium (443.8 = 294.3 g in Ha Nam 228.8 = 155.1 g in Dien Bien), sodium (698.7 = 567.S g in

Ha Nam, 351.0 = 367.4 g in Dien Bien) These differences are all statistically significant withp<0.05 (Mann-Whitney test)

Regarding vitamins in the diet, vitamin c and B vitamins in the diets of Ha Namstudents are mostly higher than in Dien Bien Particularly, the amount of folate of DienBien is higher (132.1 = 1090mcg in Ha Nam and 184.1 = 142.5mcg in Dien Bien).Vitamin A in the diets of Ha Nam students is higher than in Dien Bien (376.0 = 657.2mcg and 161 6 ± 187.7 mcg respectively), although the amount of beta-carotene in thediets of students in t>ien Bien was higher (2259.5 = 3281.7 mcg in Ha Nam and 3980.8 =4286.5 mcg in Dien Bien) The amount of vitamin D in the diet of Ha Nam students is 4times higher than that of Dien Bien (16 = 1.8 mcg and 0.4 = 0 9 mcg respectively) Inaddition, vitamin E and K levels of Dien Bien students are higher than those of Ha Namstudents (2.2 = 1.6mg and 304.5 = 344."mg in Dien Bien: 1.8 = 1.6mg and 150.7 = 2554mg in Ha Nam respectively) Except

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□ II* Nam 61 139 10? 90 115 160 104 105 79 11? 13? ICO 60 13$ 74 11

□ Ha Nam DDkm8<m □ Total

Figure 3 2 Proportion of micronutrients meeting the RDA by province.

Figures 3.5 shows the proportion of micronutrients meeting the RDA by provinceAccording to the chart, only phosphorous, iron zinc, copper, vitamin c vitamin pp.vitamin B5 and vitamin Bl2 in the students diet met the RDA The remainingmicronutrients were under the RDA There were a significant difference between theamounts of calcium, vitamins Bl pp B12 A and D between the two provinces Theproportion of micronutrient deficiency compared to the RDA in Dien Bien were higherthan in Ha Nam

-c -ÍM CỊỈ HCC V Hl HỈỈ

Table 3.5 Food consumption of students by gender

-ÍM Qỉ ugc V Hl