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The prevalence of trace elements deficiencies, vitamin A deficiency, anemia, and their relationships were investigated in a cross sectional study involving 243 children aged from 12 to 72 months in rural Vietnam. Serum levels of copper, zinc, selenium and magnesium were determined by inductively coupled plasma mass spectrometer and that of retinol by high performance liquid chromatography. Hemoglobin concentration in whole blood was measured by the cyanmethemoglobin method. The prevalence of deficiencies in zinc, selenium, magnesium, and copper was 86.9%, 62.3%, 51.9%, and 1.7%, respec-tively. On the other hand, 55.6% were anemic and 11.3% had vitamin A deficiency. Deficiency in two or more micronutrient was found in 79.4% of the children. Parameters associated significantly with anemia were selenium deficiency (OR 2.80 95% CI 1.63-4.80, p = 0.0002) and serum retinol <1.05 numol/L (OR 1.83, 95% CI 1.10-3.05, p = 0.021). Magnesium deficiency (OR 3.09 95% CI 1.36-7.03) was found to be a risk factor for zinc deficiency and vice versa. The results indicate that micronutrient deficiencies are prevalent among preschool children in Vietnam. In addition, the results also demonstrate a strong relationship between selenium deficiency and anemia. Clearly, sustainable strategies are urgently required to overcome the problems in the country. [ABSTRACT FROM AUTHOR]

Microbiota colonization and development in early life is impacted by various host intrinsic (genetic) factors, but also diet, lifestyle, as well as environmental and residential factors upon and after birth. To characterize the impact of maternal nutrition and environmental factors on vaginally born infant gut microbiota composition, we performed an observational study in five distinct geographical areas in Vietnam. Fecal samples of infants (around 39 days old) and fecal and breast milk samples of their mothers (around 28 years) were collected. The microbiota composition of all samples was analyzed by 16S rRNA gene Illumina sequencing and a bioinformatics workflow based on QIIME. In addition, various breast milk components were determined. Strong associations between the geographically determined maternal diet and breast milk composition as well as infant fecal microbiota were revealed. Most notable was the association of urban Ha Noi with relatively high abundances of taxa considered pathobionts, such as Klebsiella and Citrobacter , at the expense of Bifidobacterium . Breast milk composition was most distinct in rural Ha Long Bay, characterized by higher concentrations of, e.g., docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), selenium, and vitamin B12, while it was characterized by, e.g., iron, zinc, and α-linolenic acid (ALA) in Ha Noi. Breast milk iron levels were positively associated with infant fecal Klebsiella and negatively with Bifidobacterium , while the EPA and DHA levels were positively associated with Bifidobacterium . In conclusion, differences between five regions in Vietnam with respect to both maternal breast milk and infant gut microbiota composition were revealed, most likely in part due to maternal nutrition. Thus, there could be opportunities to beneficially steer infant microbiota development in a more desired (rural instead of urban) direction through the mother's diet.

Breast-fed infants are susceptible to vitamin D deficiency rickets. The current vitamin D 'adequate intake' (AI) for 0-6-month-old infants is 10 µg/d, corresponding with a human milk antirachitic activity (ARA) of 513 IU/l. We were particularly interested to see whether milk ARA of mothers with lifetime abundant sunlight exposure reaches the AI. We measured milk ARA of lactating mothers with different cultural backgrounds, living at different latitudes. Mature milk was derived from 181 lactating women in the Netherlands, Curaçao, Vietnam, Malaysia and Tanzania. Milk ARA and plasma 25-hydroxyvitamin D (25(OH)D) were analysed by liquid-chromatography-MS/MS; milk fatty acids were analysed by GC-flame ionisation detector (FID). None of the mothers reached the milk vitamin D AI. Milk ARA (n; median; range) were as follows: Netherlands (n 9; 46 IU/l; 3-51), Curaçao (n 10; 31 IU/l; 5-113), Vietnam: Halong Bay (n 20; 58 IU/l; 23-110), Phu Tho (n 22; 28 IU/l; 1-62), Tien Giang (n 20; 63 IU/l; 26-247), Ho-Chi-Minh-City (n 18; 49 IU/l; 24-116), Hanoi (n 21; 37 IU/l; 11-118), Malaysia-Kuala Lumpur (n 20; 14 IU/l; 1-46) and Tanzania-Ukerewe (n 21; 77 IU/l; 12-232) and Maasai (n 20; 88 IU/l; 43-189). We collected blood samples of these lactating women in Curaçao, Vietnam and from Tanzania-Ukerewe, and found that 33·3 % had plasma 25(OH)D levels between 80 and 249·9 nmol/l, 47·3 % between 50 and 79·9 nmol/l and 19·4 % between 25 and 49·9 nmol/l. Milk ARA correlated positively with maternal plasma 25(OH)D (range 27-132 nmol/l, r 0·40) and milk EPA+DHA (0·1-3·1 g%, r 0·20), and negatively with latitude (2°S-53°N, r -0·21). Milk ARA of mothers with lifetime abundant sunlight exposure is not even close to the vitamin D AI for 0-6-month-old infants. Our data may point at the importance of adequate fetal vitamin D stores.

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, β-carotene, β-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 β-carotene, 0·145 for β-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.

Breast milk is considered to be the best nutrient source for infants. However, nutritional compositions of breast milk in developing countries, especially among malnourished women, have not been fully investigated. This study aimed to assess nutritional status and nutrient composition of breast milk in lactating mothers in rural Vietnam. Sixty breastfeeding mothers at 6 to 12 mo postpartum, free from any medical disorder and/or medication, and not pregnant were randomly selected in Yen The, Bac Giang, Vietnam. Their nutritional status, breast milk concentration and dietary intakes were assessed. Among the study participants, anemia (39.0%) and low serum zinc concentration (55.4%) were frequently observed. Dietary assessment revealed lower intakes of iron (10.2+/-2.5 mg/d) and zinc (10.4+/-2.2 mg/d) than estimated requirements. The breast milk concentration of iron, zinc and copper was 0.43+/-0.15 mg/L, 0.56 (0.37, 0.82) mg/L and 0.19+/-0.05 mg/L, respectively. The breast milk concentration of iron, zinc and copper was not correlated to the serum concentration or dietary intakes. In conclusion, we uncovered a high prevalence of anemia and zinc deficiency in lactating mothers in rural Vietnam. The findings demonstrate a low breast milk zinc concentration among the participants, but need further investigation.

Objective: To examine the effect of community-based nutrition education intervention on calcium intake and bone mass in Vietnamese postmenopausal women., Design: A controlled trial was conducted in two groups as intervention and control. The intervention group was given nutrition education during 18 months to improve calcium intake, while the control subjects had the usual diet. Calcium intake and bone mass were evaluated every 6 months. Bone mass was assessed by speed of sound (SOS) at calcaneus, referred to as quantitative ultrasound measurement. Anthropometric indices and serum parathyroid hormone (PTH) were determined at baseline and at the end of intervention., Setting: Two rural communes of Hai Duong province located in the Red River Delta in Vietnam., Subjects: A total of 140 women aged 55-65 years, who were more than 5 years postmenopausal and with low calcium intake (<400 mg/d), were recruited. After 18 months of intervention, 108 women completed the study., Results: Calcium intake in the intervention group had increased significantly (P < 0.01) while it had no significant changes in controls. SOS values were not changed significantly in the intervention subjects while it decreased significantly by 0.5 % in the controls (P < 0.01). The intervention led to a decrease in serum PTH by 12 % (P < 0.01). In the controls, there was an increase in serum PTH by 32 % (P < 0.001)., Conclusion: Nutrition education intervention was effective in improving calcium intake and retarding bone loss in the studied subjects.

A cross-sectional study of 292 primary school children was conducted in rural Vietnam to investigate the relationship among micronutrient deficiencies, and other risk factors for anemia. Serum levels of iron, copper, zinc, selenium and magnesium were determined by inductively coupled plasma mass spectrometry and that of retinol by high performance liquid chromatography. Hemoglobin concentration in whole blood was measured by the cyanmethemoglobin method. The incidence of low serum zinc, selenium, magnesium, and copper in the children was 91.4, 75.6, 59.5, and 8.6%, respectively. Forty-five percent of the children were anemic and 11.3% suffered from vitamin A deficiency. A parameter significant associated with anemia was low serum selenium and vice versa (OR 1.85, 95% CI 1.06-3.24, p<0.05). Other factors associated with anemia were serum retinol <1.05 micromol/L (OR 2.05, 95% CI 1.25-3.36, p<0.01), and age in years (OR 1.59, 95% CI 1.16-2.18, p<0.01). The study showed that low selenium is associated with anemia among school children in Vietnam. Interventions are required to gain insight into the potential role of selenium on prevention and control of anemia.

Objective: To evaluate the effect of combined iron-zinc supplementation on micronutrient status, growth and morbidity., Design: Randomized, double-masked, placebo-controlled supplementation trial., Setting: Rural district of Que Vo, in the Red River Delta in Vietnam., Subjects: A total of 915 breast-fed infants aged 4-7 months were included and 784 completed the study., Interventions: The Fe-group received daily and for a 6-month period 10 mg of iron, the Zn-group 10 mg zinc, the Fe-Zn group 10 mg iron+10 mg zinc and the placebo group a placebo. Hemoglobin (Hb), serum ferritin (SF) and zinc (SZn), and anthropometry were measured before and at the end of the intervention. Morbidity was recorded daily., Results: Changes of Hb and SF were higher in both Fe and Fe+Zn groups (respectively 22.6 and 20.6 g/l for Hb; 36.0 and 24.8 microg/l for SF) compared to Zn and placebo groups (Hb: 6.4 and 9.8 g/l; SF: -18.2 and -16.9 microg/l, P<0.0001). SZn increased more in Zn group (10.3 micromol/l) than in Fe+Zn group (8.0 micromol/l, P=0.03) and more in these groups compared to Fe and placebo groups (1.6 and 1.2 micromol/l, P<0.0001). Weight gain was higher in the Zn group. No significant effects of supplementations on growth in length or morbidity., Conclusions: Combined iron-zinc supplementation had a positive effect on iron and zinc status in infants. However, the positive effect of zinc alone on SZn and weight would indicate a negative interaction of iron when added to zinc supplements., Sponsorship: UNICEF New York.