MINISTR Y OF EDUC ATION A ND TR AINI NG MINISTR Y OF HEAL TH HANOI MEDICAL UNIVERSITY DIETARY INTAKE AND PHYSICAL ACTIVITY OF ELEMENTARY SC HOOL CHILDREN IN HA NAM AND DIEN BIEN PROVINCES IN 2020 Major : Doctor of Preventive Medicine Major code : D720302 THESIS OF GRADUATION MEDIC AL DOCTOR COURSE 2015-2021 Supervisor: I Assoc Prof PhD Tran Thuy Nga Assoc Prof PhD Pham Van Phu HANOI-2021 r-u -ÍM Qỉ ugc V Hl ACKNO WLED GEM ENTS Six years studying in Doctor of Preventive Medicine Program of Hanoi Medical University (HMU) was an unforgettable experience in my life Nutrition is a challenging field, and it presented many difficulties to me when I decided to my thesis on it But as a result of it I did not only gain more knowledge, but also more skills The implementation would not be possible if I did not receive the assistance of several 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 appreciation to Assoc Prof Tran ThuyNga, head of Department of Micronutrients, National Institute of Nutrition, for her invaluable guidance, relentless encouragement, expert suggestions, constructive criticism, and supervision, all of which were essential in completing 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, encouragement 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 wonderfol environment in the school for the past six years I wish to thank all the teachers in the Department of Nutrition Institute for Preventive Medicine and Public Health Hanoi Medical University for their valuable information provided by them in their respective fields 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 unwavering support during this ordeal Your unwavering love and support gave me the strength to keep going Hanoi 2021 Duong Tmng Due -ÍM CỊỈ ugc V Hl DECLARATION I declare that this thesis represents my own work and has not been submitted for any degree in any university previously All the sources of information which have been use in the thesis and external contribution are fully referenced and acknowledged Hanoi 2021 Duong Trung Due r-u -ÍM Qỉ ugc V Hl TABLE OF CONTENT INTRODU CTION .1 CHAPTE R 1: LITERATURE RE VIEW 1.1 Dietan' intake 1.1.1 Definition of dietary intake 1.1.2 Methods of dietary intake assessment 1.1.3 Recommended dietary allowances for elementary school children 1.2 Physical activity 1.2.1 Definition of physical activity 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 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 Ph ysical activity of the research subjects 53 CONCLU SION 58 Dietary intake of the elementary school children in Ha Nam and Dien Bien province in 2020 58 Physical activity of the elementary' school children in Ha Nam and Dien Bien r-u -ÍM CỊỈ ugc V Hl province in 2020 58 RECOMMENDATIONS 59 REFERE NCES APPENDIX r-u -ÍM CỊỈ ugc V Hl LIST OF ABBREVIATIONS 24HR FFQ MVPA 24-hours Dietary Recall N IN- Moderate to Vigorous Physical Activity PA National Institute of Nutrition RDA WHO Food Frequency Questionnaire Physical Activity Recommended Dietary Allowances World Health Organization r-u -ÍM Qỉ ugc V Hl LIST OF TABLES Table Demographic characteristics of the students .25 Table 3.2 Food consumption of students by province 26 Table 3 Energy and macronutrients intake by province 27 Table Micronutrients intake of the students by province 28 Table Food consumption of students by gender 32 Table Energy and macronutrients intake by gender 33 Table Micronutrients intake of students by gender 34 Table s The proportion of protein and lipid intake by province and gender 39 Table Average of PAQ score of students by province and gender .40 Table 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 12 Frequency of students engaging in moderate to vigorous physical activity for at least 60 minutes each day in the last days by province41 Table 13 Frequency of students engaging in moderate to vigorous physical activity for at least 60 minutes each day in the last days by gender 42 Table 14 Actixities students attending in die past days by province 43 Table 15 Proportion of children cycling or xx’alking to school by prox-ince 44 Table 16 Actixities children doing during school break-time by gender 44 Table 17 Mean time children doing sedentary activities by province .45 Table 3.18 Mean time children sedentary actixities by gender 46 Table 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 LIST OF FIGURES Figure I Proportion of energy and macronutrients meeting RDA by province .30 Figure Proportion of micronutrients meeting the RD A by province 31 Figure 3 Proportion of energy and macronutrients meeting the RDAbv gender 36 Figure Proportion of micronutrients meeting the RD A by gender 37 Figure The balance of energy substances intake of students by province 3S Figure The balance of energy substances intake of students by gender 39 DIETARY INTAKE AND PH YSICAL ACTIVITY OF ELEMENTARY SCHOOL CHILDREN IN HA NAM AND DIEN BIEN PROVINCES IN 2020 ABSTRACT Background & objectives: Dietary intake and physical activity (PA) are not only directly affected to children's growth, but also indirectly affected to their cognitive abilities and stature development This study aims to describe the dietary intake and assess the PA of elementary school children Methods: A cross-sectional study involved 248 students aged 7-10 years in Ha Nam and Dien Bien provinces from October to November 2020 In which 225 dietary intakes were collected by 24-hours dietary recall method The PAQ questionnaire was used to assess the students’ PA Results: The mean energy consumption is under the RDA (1367.6 = 5ỐS.1 Kcal) Total pro-tein consumption is high (143.9% of the RDA) Lipid and carbohydrate are not meeting the RDA Calcium, magnesium, vitamin Bl B2, B6 folate, vitamin A D are under the RDA The energy-generating substance structure is balanced (P:L:C=16 4:23.4.60.2) The average PAQ score is 2.9 = 0.6 points Hie majority of students are moderate-active (81.8%) whereas 18.2% are low-active Students spend an average of 1.2 -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 Ha Nam and Dien Bien did not meet the RDA for energy, lipid, carbohydrate and some micronutrients 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 -c -ÍM Qỉ ugc V Hl INTRODUCTION Dietan- intake plays an important role in nutritional status and people’s health A healthy diet is considered crucial for elementary school children It does not only directly affect to their growth, but also indirectly affect to children’s cognitive abilities and learning results (1) Several studies around the world found that multiple dietary inadequacies are frequent among children from developing countries [2] [3] In Vietnam, a study by Tran Khanh Van et al in 2017 conducted in Thai Nguyen province found that the dietary intake of elementary school students aged to 10 years did not meet the recommended dietary allowances of the National Institute of Nutrition in terms of both energy and proportion of macronutrients, the study also found the lack of micronutrients in the diet [4], Lack or excess nutrients in primary school children all leads to nutritional disorders such as malnutrition and micronutrient deficiency Nutritional 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 of physical activity The role of physical activity in normal growth and development is obvious Increased physical activity, especially at school age aids in optimal height and stature development [6] Furthermore, several studies around the world have shown that physical activity can help minimize the risk of cardiovascular disease, metabolic disease, aid mental disorders [7], (8) However, several studies around the world and in Vietnam have shown that the proportion 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 school students in Qatar engaged in moderate to extreme physical activity for 30 minutes or more a day students spend an average of 58.1% of their dailytime on sedentary activities [9] In Vietnam 2016 Do Van Dung et al conducted a study on 619 grade students in Ho Chi Minh City, finding that 18% of students did not engage in physical activity, male students are more active than female students, and sedentaty activities are r-u -ÍM Qỉ ugc V Hl CONCLU SION Dietary intake of the elementary school children in Ha Nam and Dien Bien province in 2020 - The mean energy intake of students in two provinces is lower than the RDA (1367.6 = 56S Kcal) Total proteins consumption of students is high (143.9% of the RDA) Lipid and carbohydrate are not meeting the RDA (95 9% and 86.2%, respectively) - In terms of micronutrients, calcium, magnesium, vitamin Bl B2, B6 folate vitamin A D are all under the RDA The majorin' of consumption Ha Nam are higher than that in Dien Bien province The gender disparity in student nutrient consumption is not as evident as the provincial disparity - The structure of macronutrients in the students' diet is balanced (P L C=16.4.23.4.60.2) Physical activity of the elementary school children in Ha Nam and Dien Bien province in 2020 - The average PAQ score of all students is 2.9 ± 0.6 points Majority of students are moderate active (81.8%) and 18.2% of students are low active, none of the students is high active - Most students participate in MVP A for at least 60 minutes at least days week as recommended by WHO (89.9%) - Students spend an average of 1.4 hours on reading homework revision on both school day and none-school day Students tend to spend more time watching playing with electronic devices (c.g TV smartphone ) on nonc-school day (1.2 hours on school day and 1.8 hours on none-school day) Students in Ha Nam spend more time on sedentary activities than students in Dien Bien RECOM MENDATIONS From the results of the study, we have some following recommendations: It is necessary to communicate and educate students, parents, and teachers about the importance of providing high-quality meals for students Parents and caregivers should provide diverse diets, adequate energy, balance nutrients, and pay more attention to choosing reasonable foods rich in micronutrients or foods fortified with micronutrients in order to enhance the quality of students' meals In addition, students, parents, and teachers must be communicated and educated about the importance and benefits of physical activity' so that they can engage in physical activity (such as sport, cycling, skipping, jogging or running and so on) to meet recommended requirements and minimize sedentary activity time (watching TV, playing electronic devices ) at school and at home RE FERE NCES Florence M D.» Asbridge M and Veugelers P.J (200S) Diet quality and academic perfomiance JSch Health 78(4), 209-215; quiz 239 241 Tarini A Bakari s and Delisle H (1999) [The overall nutritional quality of the diet is reflected in the growth of Nigerian children] Sante 9(1), 23 31 Muller and Krawinkel M (2005) Malnutrition and healtìi in developing countries CMiJ, 173(3X279-286 Tran Khanh Van, Tran Thuy Nga and Nguyen Song Tu (2020) Dietary intake of elementary school 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University of Saskatchewan -c -ÍM CỊỈ ugc V Hl 45 Le Danh Tuyen H T Due Ngan and H T Thao Nghiên (201S) Reliability of a physical activity questionnaữe used in children aged 6-10 years old Journal of Food and Nutrition Sciences 14 46 BoeingH Bechthold A Bub A,et al (2012) Critical review: vegetablesand fruit in the prevention of chronic diseases Eur JNutr 51(6), 637 663 47 Wang X., Ouyang Y Liu J., et al (2014) Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer, systematic review and dose-response meta-analysis of prospective cohort studies BMJ 349.g4490 48 Ministry of Health - Department of Preventive Medicine (2013) Dinh dưỡng hợp lí trng học 49 Horne P.J Hardman C.A Lowe C.F., et al (2009) Increasing parental provision and children's consumption of lunchbox fruit and vegetables in Ireland: the Food Dudes intervention EurJ Ciin Nutr, 6X5), 613 618 50 Upton D., Upton p„ and Taylor c (2013) Increasing children’s lunchtime consumption of fruit and vegetables: an evaluation of the Food Dudes programme Public Health Nutr 16(6), 1066 1072 51 Ratsavong K van Elsacker T Dovngvichit D , et al (2020) Are dietary intake and nutritional status influenced by gender0 The pattern of dietary intake in Lao PDR: a developing country Nuưition Journal 19(1) 31 52 General Statistical Office (2019) Statistical Yearbook of Vietnam 53 Remer T (2000) Influence of diet on acid-base balance Semin Dial 13(4) 221226 54 Henderson K.E., Grode G.M O'Connell M.L Ct al (2015) Environmental factors associated with physical activity in childcare centers JntJ Behav Nutr Phys Act, 12,43 55 Nguyen T Thi Tho and Nguyen Nhat Cam (2016) Status of physical activity of adolescent students in Hanoi Journal of Preventive Medicine 27(1) 110 56 Tang Kim Hong (2013) Environmental and lifestyle factors associated with overweight and obesity among secondary school students in Ho Chi Minh City Journal of Food and Nutrition Sciences 9(3) 23-29 57 Al Salman Z.H Al Debel F.A Al Zakaria F.M et al (2020) Anxiety and depression and their relation to the use of electronic devices among secondary school students in Al-Khobar Saudi Arabia 20 IS 2019 J Family Community Wed, 27(1), 53 61 58 Spaeth A M Hawley N L Raynor H A., et al (2019) Sleep, energy balance and meal timing in school-aged children Sleep Med 60 139 144 59 Li s Shen X Jin X et al (2008) [Sleep habits and sleep disturbance in school-age children of China] Zhonghua Er Ke Za Z/n 46(3) 185-189 60 Fatima Y Doi s a R and Mamun A A (2015) Longitudinal impact of sleep on overweight and obesity in children and adolescents a systematic review and biasadjusted meta-analysis Obes Rex 16(2), 137 149 61 Roth T Schwartz J.R.L Hirshkowitz M., et al (2007), Evaluation of the Safety of Modafinil for Treatment of Excessive Sleepmess J Clin Sleep Med 3(6) 595 602 -c -ÍM Qỉ ugc V Hl APPEND IX Physical Activity Questionnaire (PAQ-3Í): Please answer all questions with your children, stick on the space provided, select only ONE answer for each question Part A: Physical activity When does your child study in school ? Morning Afternoon In the last days, on how many day s was your child engaged in moderate to vigorous physical activity for at least 60 minutes each day? (This can be accumulated over the entire day by any phy sical activity done more than 10 minutes) Moderate to vigorous activity is any activity that increases the heart rate, gets your child out of breath some of the time and increased sweating, (i e walking briskly, dancing, jogging, hiking, cycling, swimming, others) None day day s days day s days Ổ days days Has your child done any of the following activities in the past days? If YES how many times he/she did these activities? -c -ÍM Qỉ ugc V Hl Frequency_ Activities None 1-2 3-4 5-6 times times tunes times a Badminton b Football (Soccer) e Bicycling d Basketball/Netball e Tag (children chasing each oth er) f, Walking for exercise g In-line skattng/Roller blading h Jogging or running i Swimming j Dance k Skipping Rowing/ Canoeing/ Kayaking m Skateboarding n Volleyball o Tennis p Table tennis/ Ping pong q Martial arts (silat/taekwondo/karate/wushu) Ỉ Others, please specify- In the last days, during physical education (PE) classes, haw often was your child very active? (i.e running, Jumping, throw big, playing hard, others) -■c -ÍM Qỉ ugc V Hl My child doesn 'I PE Hardly ever active Sometimes active Often quite active Always active In the last days, what did your child most of the time during school recess? (besides eating and drinking! Sat down (i.e chatting, reading, doing schoolwork, others) Stood around or walked around Ran or played a little bit Ran around and played quite a bit Ran and played hard most of the time Ộ In the last den s, what did your child light after lunch? Sat down (I.e chatting, reading, doing schoolwork, others) Stood around or walked around Ran or played a little bit Ran around and played quite a bit Ran and played hard most of the time In the last days, on how many days right BEFORE FTER school (2 6pm), did your child sports, dance, or play games in which he/she was very active? No days day day s days days s In tlte last days, on how many EVENINGS (6 8pm), did your child sports, dance, or play games in which he/she was very active? No days -c -ÍM Qỉ ugc V Hl days days Ỉ day days On the last WEEKEND how many times did your child sports, dance, or play games in which he/she was very active? No time 2-3 times 4-5 times >5 times 10 Which one of the following describes your child best for the last days'* Read all five statements before deciding on the one answer that describes your child .411 or most of my child's free time was spent doing things that involve little physical effort -Vft child sometimes (1-2 times per week) did physical things in his/her free time (i.e sports, running swimming, cycling, aerobics, others) My child often (3 - times per week) did physical things in his/her free time My child quite often (5 - times per week/ did physical things in his/her free time My child very often (7 or more times per week) did physical things in his/her free time 11 How often did your child physical activity ii.e playing sports, games, doing dance, others) during the past days? ONE answer for each day) Freq None Li ale bù a Monday b Tuesday c Wednesday d Thursday -c -ÍM Qỉ ugc V Hl Medium Often Very of ten e Friday f Saturday g Sunday 12 a Does your child walk or cycle to school? Yes, my child walks all the way to school Yes my child walks to the bus stop or train station Yes, my child cycles all the way to school Yes, my child cycles to the bus stop or train station No (JfNO Please proceed to Question Ỉ3.a> b How many minutes does it take your child to walk or cycle? minutes 13 a Does your child walk or cycle home from school? Yes my child walks all the way to school Yes, my child walks to the bus stop or train statton Yes my child cycles all the way to school Yes, my child cycles to the bus stop or train station No (ự NO Please proceed to question 14.a> b How many minutes does it take your child to walk or cycle? minutes Part B: Sedentary Behaviour 14 On an average school day about how many hours a day does your child spend on the following when he/she is nor in school? a Reading/ Homework/ Revision None hour or less hours hours hours -c -ÍM Qỉ ugc V Hl Õ hours or more b Watching/playing with eỉecưomc devices fi.e 77< smartphone, computer, tablet, play station, others) (do NOT include screen use for homework) None hour or less hours hours hours hours or more 15 On an average non-scltool day (e.g.: weekend), about how many hours a da) does your child spend on thefollowing? a Reading/ Homework/ Revision None hour or less hours hours hours hours or more b H'atching/playing with electronic devices (i.e TV smartphone, computer, tablet, playstation, others) (do NOT include screen use for homework) None J hour or less hours hours hours hours or more 16 Which device your child use most often? -c -ÍM Qỉ ugc V Hl Computer Smartphone Ip ad or tablet Electronic game Other, specify _ Part C: Sleeping time Write ill your child's usual amount of sleep each day hours minutes -c -ÍM Qỉ ugc V Hl ... vitamin c vitamin pp vitamin B5 and vitamin Bl2 in the students diet met the RDA The remaining micronutrients were under the RDA There were a significant difference between the amounts of calcium,... the dietary intake of elementary school children in Ha Nani and Dien Bien provinces in 2020 To assess the physical activity of elementary' school children in Ha Nani and Dien Bien provinces in. .. Purine (nag) *Mann- Whitney test Table 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