While literature has noted the presence of a nutrition transition in terms of changing nutrition outcomes in Vietnam, very limited evidence linking changes in upstream food system factors to downstream diet and nutrition changes exists. Combining available data from different sources and analyzing it through a conceptual food systems framework, our study examines different pathways of nutrition transition through food supply, food prices, household food expenditures, diets, and nutrition outcomes in Vietnam. Our findings show that while Vietnam is at the start of its nutrition transition, change is happening rapidly. Undernutrition is falling, obesity is rising, and nutrition-related chronic diseases account for a significant burden of diseases and death. In terms of changes in healthful foods, the supply of vegetables and fruits is plentiful, and expenditure on vegetables remains consistent and small. Notably however, vegetable consumption has dropped, and increasing meat and milk consumption have been double-edged swords for nutrition. In terms of foods associated with the negative sides of the nutrition transition, the availability of sweets and sweetened beverages has risen in recent years, with oils and fats rising less. The expenditure share on food eaten away from home, in many contexts a marker for less healthful diets, has increased over time. While these changes are typical of a nutrition transition, Vietnam is also somewhat of an outlier in some respects: wet markets and daily fresh food purchases continue to dominate food purchasing behaviour, and food eaten away from home means a different thing in a country renowned for its diverse and healthy street food and roadside restaurant culture. While this study brings together important data on the food system drivers of a nutrition transition in Vietnam, it cannot link each of these issues into a standard statistical model of change due to data gaps at different levels, calling for data collection improvement in future diet and food systems research. Vietnamese health policy explicitly acknowledges nutrition transition issues, with targets for obesity reduction. This work on the food system drivers of the nutrition transition points to the need to further adapt policy in other sectors beyond health, however. At the same time as making nutrient-rich foods more accessible, nutrient-poor or ultra-processed foods need to be made less accessible and desirable if additional income is to contribute to a healthy diet in limiting Vietnam’s emerging nutrition transition.

Vietnam has successfully reduced population stunting, but ethnic minority groups are being systematically left behind, limiting progress on national reductions. This mixed methods study aims to understand how policy drivers of stunting reduction differ between ethnic majority and minority communities. We used decomposition analysis to explain key determinants of stunting change between 2000 and 2010; and framework analysis to qualitatively assess changes in policy, actors and narratives that have underpinned these over decades. Our analysis shows that stunting reductions are associated with increased household wealth (accounting for 61% of change), improved access to specific health services (16%), and changes in level of maternal education (12%). Despite multiple actors involved in change and a large set of policies designed to address inequities, many among Vietnam’s defined ethnic minority groups are not finding themselves able to effectively engage with central government plans for their communities, and central policies often do not consider their preferences or limitations. This in turn impacts the nutrition of minority groups through the determinants above. Vietnam has achieved the easier portion of stunting reduction through national economic growth and sustained commitment to socially-oriented policy. In order to tackle the remaining pockets of high malnutrition, more attention, thought and funding will need to focus on marginalised ethnic minority communities. The current national development discourse aims to incorporate minorities into mainstream majority systems. This paper argues that policy should rather take into account their particular needs and preferences to address and overcome the identified determinants of malnutrition.

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Background Adolescents’ consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents’ fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices. Objective This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence–based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app. Methods A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory. Results Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users’ medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app’s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent’s feedback to improve its acceptability, usability, and likability. Conclusions A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale.

Global trade has shaped food systems over centuries, but modern trade agreements are hastening these changes and making them more complex, with implications for public health and nutrition transition. This study aimed to understand the impact of the 2018 Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) on the policy space for public health nutrition in Vietnam. We conducted comparative document review and key informant interviews, and our analysis drew on a framework of policy space and the theory of advocacy coalitions. We identified 10 CPTPP sections with potential public health nutrition implications; and 50 Vietnamese policies relevant to nutrition having one or more tensions with one or more CPTPP sections. A majority of policy tensions were in sections of the CPTPP relating to technical barriers to trade and government procurement; most tensions related to protecting policy-making from vested interests. Different groups of policy actors hold different beliefs and interests on these issues, and therefore promote different framings and policy approaches. We identified two advocacy coalitions working very separately on issues affecting nutrition policy space: a trade coalition holding the policy position that free trade improves nutrition by default; and a nutrition coalition holding the policy position that nutrition should be explicitly considered in trade policy. The policy space for nutrition in Vietnam has important potential constraints through written policy, and the trade and nutrition coalitions will need to interact more regularly and constructively in order to foresee where these tensions will arise in practice, and create plans for their mitigation. This study adds to global evidence of free trade agreement impacts on nutrition policy space, and we extend previous work by explaining these actor groupings in the policy space through the theory of advocacy coalitions.

Background There is a gap in data on dietary intake of adolescents in low- and middle-income countries. Traditional methods for dietary assessment are resource intensive and lack accuracy with regards to portion size estimation. Technology assisted dietary assessment tools have been proposed but few have been validated for feasibility of use in LMICs. Objectives We assess the relative validity of FRANI (Food Recognition Assistance and Nudging Insights), a mobile Artificial Intelligence (AI) application for dietary assessment in adolescent females (n = 36) aged 12–18y in Vietnam, against weighed records (WR) standard, and compared FRANI performance to a multi-pass 24-hour recall (24HR). Methods Dietary intake was assessed using 3 methods: FRANI, WRs and 24HRs undertaken on three non-consecutive days. Equivalence of nutrient intakes was tested using mixed effect models adjusting for repeated measures, using 10%, 15% and 20% bounds. The concordance correlation coefficient (CCC) was used to assess the agreement between methods. Sources of errors were identified for memory and portion size estimation bias. Results Equivalence between FRANI app and WR was determined at the 10% bound for energy, protein and fat and four nutrients (iron, riboflavin, vitamin B6 and zinc), and at 15% and 20% bounds for carbohydrate, calcium, vitamin C, thiamin, niacin, and folate. Similar results were observed for differences between 24HR and WR with 20% equivalent bound for all nutrients except for vitamin A. The CCCs between FRANI and WR (0.60,0.81) were slightly lower CCCs between 24HR and WR (0.70,0.89) for energy and most nutrients. Memory error (food omissions or intrusions) was ∼21% with no clear pattern apparent on portion size estimation bias for foods. Conclusions AI assisted dietary assessment and 24HR accurately estimate nutrient intake in adolescent females when compared to WR. Errors could be reduced with further improvements of AI-assisted food recognition and portion estimation.

Unhealthy diets are a critical global concern while dietary measure methods are time consuming and expensive. There is limited evidence that phone-based interventions can improve nutrition data collection and dietary quality, especially for adolescents in developing countries. We developed an artificial-intelligence-based phone application called Food Recognition Assistance and Nudging Insights (FRANI) to address these problems. FRANI can recognize foods in images, track food consumption, display statistics and use gamified nudges to give positive feedback on healthy food choice. This study protocol describes the design of new pilot studies aimed at measuring the feasibility (acceptability, adherence, and usability) of FRANI and its effects on the quality of food choice of adolescents in Ghana and Vietnam. In each country, 36 adolescents (12–18 years) will be randomly allocated into two groups: The intervention group with the full version of FRANI and the control group with the functionality limited to image recognition and dietary assessment. Participants in both groups will have their food choices tracked for four weeks. The control groups will then switch to the full version of FRANI and both groups will be tracked for a further 2 weeks to assess acceptability, adherence, and usability. Analysis of outcomes will be by intent to treat and differences in outcomes between intervention and control group will use Poisson and odds ratio regression models, accounting for repeated measures at individual levels. If deemed feasible, acceptable and usable, FRANI will address gaps in the literature and advance the nutrition field by potentially improving the quality of food choices of adolescent girls in developing countries. This pilot study will also provide insights on the design of a large randomized controlled trial. The functioning and dissemination of FRANI can be an important step towards highly scalable nutrition data collection and healthier food choices for a population at risk of malnutrition.The study protocol and the methods and materials were approved by the Institutional Review Board (IRB) of the IFPRI on April 29th, 2020 (registration number #00007490), the Thai Nguyen National Hospital on April 14th, 2020 (protocol code 274/ĐĐĐ-BVTWTN) and the University of Ghana on August 10th, 2020 (Federalwide Assurance FWA 00001824; NMIMR-IRB CPN 078–19/20). The study protocol was registered in the International Standard Randomized Controlled Trial Number (ISRCTN 10681553; https://doi.org/10.1186/ISRCTN10681553) on November 12, 2021.

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