Vietnamese teenagers face a double burden of malnutrition

The first study on micronutrient deficiencies among teenage girls in Vietnam shows that both overweight and malnutrition are critical health concerns.

Xiaomian Tan, Dr Pui Yee Tan, Somphos Vicheth Som, Professor Bernadette Moore and Professor Yun Yun Gong from the School of Food Science and Nutrition collaborated with researchers from the National Institute of Nutrition in Vietnam on the study.

The paper, titled ‘Micronutrient deficiencies and the double burden of malnutrition in Vietnamese female adolescents: a national cross-sectional study in 2020’ is now published in The Lancet Regional Health - Western Pacific.

Double burden of malnutrition

Despite the importance of nutrition to the health of adolescents and their future adult life, including potential children, there have been no previous studies on micronutrient deficiency in Vietnamese adolescent females.

To rectify this, the researchers assessed data for over 1,400 10–18-year-old females in Vietnam in 2019 and 2020.

They analysed their physical health and nutrition status, identifying micronutrient deficiencies (MNDs) and their outcomes such as anaemia.

To understand the nuances of nutrition in this group, the researchers noted the demographic and socioeconomic differences of the participants. This included ethnicity, region and household income.

They found a “double burden of malnutrition,” meaning a steep rise in overweight co-existing with undernutrition, including micronutrient deficiencies, in adolescent girls in Vietnam.

Health and nutrition inequalities

The research team found that more female adolescents were overweight than undernourished in Vietnam in 2020. However, undernutrition, low serum zinc and iron deficiency were prevalent.

More than 39% had low serum zinc and over 13% had iron deficiency. The effects of these deficiencies in severe cases include hair loss, skin conditions, compromised immunity and fatigue.

The results showed that 16-18-year-olds, those in ethnic minorities, with lower wealth index and with inflammation had more MNDs. These factors often overlap.

For example, iron deficiency was four times higher in older female adolescents from rural than from urban areas.

There are many reasons for this difference, including access to healthcare and education, location, food availability and exposure to illness in childhood.

Overall, this result highlights the health inequalities that marginalised communities face.

Professor Bernadette Moore, corresponding author, said: "Often females are more susceptible to discriminative cultural, social, and gender norms. These discriminatory norms manifest in increased poverty, illiteracy, inequality, and early marriage, which individually and collectively increase the risk of MNDs in female adolescents globally, particularly in marginalised communities."

Nutrition interventions

The researchers advocate for food system change in Vietnam to support nutrition and related health outcomes in young people.

The results show a mixture of issues—overweight, stunting, micronutrient deficiencies—showing up in different ways across demographics.

Therefore, the research team advocates for tailored interventions to improve outcomes for each issue.

Their recommendations include food (bio)fortification, targeted supplementation and nutrition education for the most vulnerable adolescents.

The results of this study will inform the design and delivery of nutrition policies and programmes in Vietnam and beyond. It can also support policymakers and practitioners in addressing the socioeconomic inequalities that contribute to MNDs.

Informing policy and public for the prevention of the double burden of nutrition

Professor Yun Yun Gong, the Primary Investigator, said: “This project addresses the pressing issue of children's double burden of malnutrition (DBM) and seeks effective prevention using a combined food system approach, in China and Southeast Asia.

“This prestigious award from BBSRC Grand Challenge Research Fund (GCRF) between 2020-2025 demonstrated the excellent global health research in the School of Food Science and Nutrition and Faculty of Environment.

“Implemented by a multi-disciplinary multi-country research team, the research provides rich evidence informing policy and the public for the prevention of the double burden of nutrition in Low- and Middle-Income Countries (LMICs). It forges strong partnerships with researchers and key stakeholders in these countries through capacity-building and knowledge-transfer activities.

“We are excited to see this paper being published as one of the series of research reports generated from this project.”