HIEU QUA CUA BO SUNG VIEN DA VI C H A T DINH DUOTNG LEN TJNH TRANG THIEU MAU VA VI CHAT DINH DUUNG QT PHU NUT MANG THAI VUNG TAY BAC VA TAY NGUYEN
TRL/ONG HONG SON, PHAM V A N HOAN, N G U Y I N X U A N NINH Viin Dinh dwdng
N G U Y I N cdNG K H X N , V(i Khoa hgc vd Ddo t?o. Sd Y ti
TOM T A T
Muc tidu: Ddnh gid hi$u qud cda bd sung s&m viin da vi chit Idn tinh tr^ng thiiu mdu vd thiiu vi chit dinh dw&ng cua phu nO" mang thai tai cdc vOng Tdy bac vd Tdy nguydn. Phuang phdp nghidn cOv Nghidn cuv can thidp thw nghiim cdng ddng (community intervention study) cd ddi chimg. Phu nO- mang thai t^i 40 xd thudc 2 tinh Lai chdu vd Kon Tum dw&c chia vdo nhdm can thidp vd nhdm ddi chimg (20 xd cho mdi nhdm). Phu nO- mang thai tdi xd can thidp sd dwac bd sung vidn da vi chit dinh du&ng 1 vidn/
ngdy vd tiip tuc triin khai cdc ho^t ddng dinh dw&ng chung trdn todn qudc. Nhdm xd chimg chl cd cdc ho^t ddng dinh dw&ng chung. Kit qud nghidn cuv: T^i th&i diim diiu tra ban diu khdng cd s y khdc bidt cd y nghTa thdng kd khi so sdnh giira 2 nhdm vi hdm Iw&ng tmng binh hemoglobin, hdm iu-ang ferritin huyit thanh. kdm huyit thanh vd vitamin A huyit thanh. Sau can thidp, ndng dd cua hemoglobin vd cdc vi chit dinh dw&ng trdn dd tSng Idn & nhdm can thidp so v&i nhdm chuvg cd nghTa thdng kd Kit qud nghidn cOv cung ghi nh$n viic gidm ty Id thiiu cdc vi chit dinh dw&ng & phu nO' mang thai & nhdm can thidp so v&i nhdm chimg: Ty Id thiiu femtin & nhdm can thiep dd gidm tir 38,8% xudng 7,7% Tmng khi &
nhdm ddi chimg t^ li ndy tdng tu- 33.1% Idn 42%. Ty Id thiiu Vitamin A huyit thanh & nhdm can thidp giim to- 16,1% xudng 6,2% tmng khi & nhdm can thiip gidm tir 21% xudng 19.5%. Ty H thiiu kem huyit thanh & nhdm can thiip gidm tir 85% xudng 36,6%
trong khi & nhdm ddi chOvg ty Id ndy Id 84.2% & diiu tra tnr&c can thiip vd tSng Idn 87,95 & diiu tra sau can thiep. Kit ludn: Bd sung vidn da vi chit dinh dw&ng da Idm gidm ty li thiiu mdu, ddng th&i tdng hdm luang cdc vi chit dinh dw&ng nhw sit. kdm, vitamin A huyit thanh &phu nir mang thai.
Tir khda: thiiu mdu, thiiu vi chat dinh dw&ng. bd sung vi chit dinh dwang, phu nir mang thai
SUMMARY
Objective: Assess the efficacy and effectiveness of eariy micmnutrients supplements to the status of anemia, and to the status of micmnutrients deficiencies of pregnant mothers in West Norih and High Central areas. Methodology: A community inten/ention study with placebo group. Pregnant mothers in 40 communes in Lai chau and Kon Tum pmvinces were divided in contml group and placebo group (20 communes for each gmup). Pregnant mothers in inten/ention commupes were received micmnutrients supplements 1 tablet per day and
continue to implement general nutrition activities as nation wide The placebo communes were having only general nutrition activities as nation wide.
Results: At the baseline sun/ey there is no significant difference between 2 groups about mean of hemoglobin, semm femtin, semm zinc and semm mtinol. After invention, concentration of hemoglobin and the micronutrieint in semm were increased in the contml gmup in compare to the placebo group with significant difference. Is was found that the decrease of the prevalence of micmnutnent deficiencies In pregnant mothers in contml group in compare to the placebo: prev. of low semm femtin in contml gmup was decmased fmm 38.8% to 7.7%. Wherease, in placebo gmup: the prev. incmase fmm 33.1% up to 42%. Pmv. of Vitamin A deficiency of contml gmup decrease fmm 16.1% dow to 6 2% wheamas in the placebo the pmv. decrease fmm 21% to 19 5%. Pmv of low semm zinc in the contml gmup was decmase fmm 85% dow to 36.6%, in compam to the prev. of placebo gmup is 84.2% in the baseline surtvey and increase 87.95% in the follow up sun/ey. Conclusion:
micmnutrients supelements found that contribute to decrease the pmvalence of anemia, in combine with increase the concentration of semm imn, zinc and retinol among pmgnanat mothers.
Keywords: anemia, micmnutrients deficiency, micmnutrients supelements. pregnant mother.
DAT VAN D £
Cde nghien edu khoa hoe trdn the gidi da cho thay rang tinh trang dinh dudng cda ngudi me, dde bidt la tinh trang vi chat dinh dudng trong thdi k;y' mang thai la nhan td quyet djnh ehinh ve can ndng so sinh va tiem ndng phat trieu chieu cao [9]. 0 Vidt Nam, thieu mau cua phu nd va dde bidt phu nd mang thai cdn phd bien, theo sd lidu eda cudc tdng dieu tra ve dinh dudng va thuc pham. ed tdi 32,2% phu nd cd thai bj thieu mau [5].
Cai thien tinh trang dinh dudng phu nd mang thai, dde biet la giam tinh trang thieu mau vd thieu vi ehd't dinh dudng se dam bao tre dUdc sinh ra cd tinh trang dmh dudng td't hdn. giam suy dinh dUdng bao thai vd giam ben vdng t j le suy dinh dUSng tre em [6].
Nham ddnh gid hieu qua cda can thiep bd sung vien da vi chSt sdm eho phu nd trudc vd trong khi mang thai len tinh trang thieu mau va thieu vi chat dinh dudng eOa phu nd mang thai, viec triln khai mot thd nghiem can thiep edng dong tai cac vCing Tdy nguyen, Tay bac Id het sdc can thiet [3]. Ket qua eda
V Hpc THV'C HANH (829) - SO 7/2012
nghidn edu ed the se ddng gdp vdo vide md rdng hoat ddng can thidp bo sung vidn da vi ch^t tai cdc vung ndy cho cdc ddi tUdng phu nd mang thai trong khudn khd hoat ddng eda chuong trinh phdng chdng suy dmh dudng tre em trong thdi gian tdi,
Muc tieu:
Danh gid hidu q u i cda b6 sung sdm vidn da vi chat Idn tinh trang thieu mdu vd thidu vi chSt dinh dudng eda phu nd mang thai tai cac vung Tdy B i c vd Tdy Nguyen.
D Q I TU'GNG NGHIEN CLTU:
Phu nO mang thai
Cdc tidu chudn logi trO" khdng m i c cde b$nh mdn tinh (tilu du'dng, tim mgch), khdng bj s i t tgi thdi d i l m l l y mdu.
PHU'O'NG P H A P NGHIEN Ct>U
1. T h i l t k l nghidn cd'u: Nghidn cUu can thidp thd nghidm edng ddng (community intervention study) ed ddi ehdng
Ody id mdt thU nghidm didn rdng, ddnh gid su thay ddi chung eda ed edng ddng (khdng dua trdn su thay ddi cua tUng cd t h i ) sau mdt 24 thdng can thi$p.
Ddnh gid tru'dc sd du'p'c thuc hidn d l xdc djnh tinh hinh trudc can thidp, sau dd cdc can thidp du'p'c triln khai dua trdn tinh sSn ed eua hd thdng vd su c h i p nh$n t u nguydn eda cdng ddng. Sau 24 thdng triln khai lidn tyc, d i l u tra ddnh gid sd du'p'c t i l n hdnh n h i m xde djnh lgi tinh hinh cua cdng ddng Cdc k i t ludn dup'c rut ra tU su so sdnh hai "nhdt elt" cda <Slu tra tru'dc vd sau can thi$p Id hidu qud thuc t l trdn cdng ddng eua can thidp dua trdn hogt ddng cua hd thdng hidn hdnh.
2. Cd mau:
Nghien edu ndy dUa tren so sanh gida trung binh khdc biet tordc vd sau can thidp gida 2 nhom
ap dung edng thdc tinh toan ed mdu [8]
n = ( Z a + Z p ) 2 ' ( 8 1 2 + 812) Trong do: n la sd cd the trong moi nhdm Vdl luc m l u la 80% vd mdt y nghTa 95%: tuong duong vdi 0,84 vd 1,96
Za = 1.96 (0.05 a, 2 phia). Zp = 0.84 (0.20 p. 1 phia)
51. 82: dd lech chuan trudc vd sau can thidp cda chl sd quan tam
P1-M2: Trung binh khac bidt trude vd sau can thidp gida 2 nhdm
Vdi ty le bo cude d u kien la 10%, cd m i u eho danh gid hidu qua can thiep la 270 ddi tUOng eho m l i nhdm Id dd d l bao tnjm Idn vide theo ddi todn bd cde ehi s6 quan tdm vdi mUe khde bidt k^f vpng theo cdc nghidn cUu g i n ddy trdn t h i gidi vd Vidt Nam [7].
3. Chpn m l u vd phdn nhdm nghidn cu>u Hai tinh d u p ^ chpn chu dIeh. dgi di$n cho 2 vung trpng d i l m v l dmh dudng Id Lai Chdu (vung tdy ble) vd Kon Tum (vung Tdy nguydn).
Ddy Id 2 tinh hidn ed t j 1$ suy dmh dudng cao nhit d trdn ca nu-dc 6" ca hai vung nghidn cdu d l u
Id nh&ng vdng nghdo. Cde can thidp bd sung vi chjt dinh dudng, b l sung s i t cho phy n d mang thai d^u chua dup'c thuc hi§n.
Vdi sd lup'ng m l u vd edn c d trdn sd li$u ecr bSn cda dja bdn nghidn cdu. tinh todn cho t h l y ein 10 xd cho mSi huydn vd 2 huydn eho m6i tinh sS du eho si lu'png m l u . Todn bd phy nO- mang thai tgi cde xS s5 du'pc mdi tham gia vdo d i l u tra ban d l u vd dilu tra ddnh gid sau khi k i t thdc can thi$p
S6 m l u dup'c chpn nhu sau trong 2 tinh chpn 2 huydn n g l u nhidn trong 2 tfnh Id cdc huy$n Phong Th6. Tam Du-dng (Lai Chdu). vd Dak Hd. Kon RSy (Kon Tum).
40 xd du'p'c chpn n g l u nhidn cda 2 huydn nSy du'p'c chia d l u n g l u nhidn vdo 2 Id can thi$p vd doi chUng Hai huydn vd edc xd trong huy|n ed su tu'ong du'O'ng v l cdc chi tidu kinh t l , t^ Id hO nghdo, nghl nghidp, cdc chl tidu xd hOi vd y t l .
Md td cdc bu'dc t i l n hdnh nghidn cdu D i l u tra ban d l u . di/pc t i l n hdnh tgi Lai Chdu vd Kon Tum vdo thdng 6/ 2006. Tdp h u i n . chuin h6a cdc k9 thu$t vd k i l m djnh c h i t lup'ng d i l u tra vidn trudc khi t i l n hdnh d i l u tra. Cdc chi tidu thu th$p Igi d i l u tra ban d l u vd d i l u tra sau can thidp d eS 2 nhdm bao gdm edc chi sd stnh hda v l vi chit dinh dudng (hemoglobin, ferritin huylt thanh, kdm huylt thanh, retinol huylt thanh) vd cdc thdng tin Iidn quan.
Can thidp; tidn hdnh Ildn tyc t d thdng 7/ 2006 din thdng 7/ 2008 tgl edc nhdm nhu sau:
•:• Nhdm xd ddi ehdng. t r i l n khai cdc hogt ddng PCSDDTE vdi edc hogt ddng chung trong cd nud'c.
•:• Nhdm xd can thidp' bdn cgnh vide triln khai cdc hogt ddng cua PCSDDTE, t i l n hdnh b l sung vi6n da vi c h i t (1 vidn/ ngdy) eho ddi tuvng phy nO mang thai.
Vidn da vi c h i t du'p'c s u dyng theo cdng thdc khuyin nghj cda WHO vd dup'c cung e l p bdi Unicef trong nhilu ndm qua.
Cdc hogt ddng dup'c t r i l n khai, theo ddi, gidm sat trong khudn khd vd theo qui 6\nh qudn ly eua chuong trinh mye t i l u q u i c gia.
Trong thdt gian nghidn cdu khdng ed edc ho^t ddng b l sung vidn s i t / vidn da vi c h i t vd khdng c6 cdc can thidp sdc khde ndo tdng cudng thdm li&n quan d i n dinh dudng ngodi cdc hogt ddng dinh dudng chung.
Dieu tra ddnh gid sau can t h i | p dup'c t i l n hdnh vdo thdng 6/ 2008 (24 thdng sau can thidp vd cCing vdi thdi d i l m thdng 6 cda d i l u tra ban dlu).
Chpn m l u vd cdc chi tidu d u v c thu thdp wS Phu'O'ng phdp thu th$p s6 lidu d d i l u tra ban dlu vS vd d i l u tra ddnh gid sau can thidp Id gilng nhau & tSt cd cde ^ a bdn nghidn cdu.
Phu-cng phdp thu th$p s 6 lidu vd tidu chujn ddnh gid
Xdc dinh ndng dO Hemoglobin: N i n g dO Hb du?c xdc djnh b l n g phuong ph^p cyanmethemoglobin,J^
ddng m,y Hemocue. ^ Quy trinh xdt nghidm Femtin: phucng phdp ELISA,
Y H p c THVC HANH (829) - SO 7/2012
sd dyng KIT Ramko - USA, Cdc m l u ndy dupe phdn tieh tgi Khoa Vi chit - Vidn Dinh Du'dng vdo hai thdi dilm dilu tra ban d l u vd d i l u tra ddnh gid.
Xu- ly vd phdn tich s d li#u: Chu'ong trinh EPI INFO 6 0 dup'c dung d l nh|ip sd lidu. S6 lidu dw&c idm sgch trudc khi phdn tieh. Phdn tieh s6 lidu dw&c tiln hdnh trdn p h l n m I m SPSS 15.05 vdi cdc test thong kd thdng thu-dng.
Dao difc nghien cd'u: Du'pc sy eho phdp triln khai nghidn cdu Hdi ddng Khoa hpc vd Hdi ddng dgo dUe nghidn edu- Vidn Dmh Du-dng, s u nhit tri cua chinh quyin dia phu-ong vd ddi tu'p'ng nghidn cdu.
K i t qud vd bdn Iu$n: Tgi thdi d i l m d i l u tra ban d l u khdng cd s u khdc bidt ed 'i/ nghTa t h i n g kd khi so sanh giQ'a 2 nhdm v i hdm lu'p'ng trung binh hemoglobin Tgi thdi d i l m d i l u tra ddnh gid, k i t qud d bang 1 cho t h l y trung binh chenh l$ch hemoglobin tru'dc vd sau can thidp cua hai nhdm cd su khde bidt cd y nghTa thing kd vdi p<0,001 giUa nhdm can thidp
(5,6g/l) so vdi nhdm ehdng (2,3g/l). K i t qud nghien cdu d hinh 1 cOng eho t h l y ty Id thilu mdu d nhdm can thidp gilrn t d 36.6% xudng 24,5%, trong khi dd d nhdm ddi chUng gldm t d 37,1 xudng 31,6% (khdc bidt giOa 2 nhdm cd y nghTa thdng kd). Hidu qud can thidp thd cua nhdm can thidp Id 12,1% vd hidu qud can thidp thuc Id 6,6%.
Chi sd ferritin huylt thanh d hai nhdm tgi d i l u tra trudc can thidp id khdng khdc bidt ed if nghTa thdng kd, Tgi d i l u tra sau can thidp cd su khdc bidt gida hai nhdm v l ehl s i ferntin huylt thanh, eao hon d nhdm can thidp vdi p<0,05, T test). Trung binh chdnh Idch trudc vd sau can thidp giQ'a hai nhdm cQng cd su khdc bidt cd y nghTa thdng kd vdi p<0,001 (tdng 2,6 pg/L d nhdm can thidp vd gidm 0,6 pg/L d nhdm doi chUng), d i l u ndy t h i hidn d u trO* s i t d phy nO mang thai dd tdng rd r$t d nhdm can thidp.
Bang 1: Hidu qud eua b l sung da vi chit hdng ngdy Idn cde ehi sd sinh hda cda phy nO* mang thai 1 xa doi chdng 1 Xa can thi^p 1 p 1 (n=272) 1 (n=2731 1 Him lu'Q'nq Hemoglobin (q/L, X±SD)
Hemoglobin tru'dc can thi$p Hemoglobin sau can thi$p
Hemoglobin chfinh l$ch
114,2 ±16,2 114,5 ±15,5 2,3 ± 5.5
111,5±16,2 117,1 ±15,2
5,6 ± 5,8
>0,05
>0,05
<0,001 Ham iLTQ'ng Ferritin huy^t thanh (uq/L, X±SD)
Ferritin huydt thanh Inft^c can thi$p Ferritin huyM thanh sau can thi$p
Femtin huylt thanh chenh Idch
30,6 ± 17 30.0 ± 23
30,6 ±18 33,2 ± 24 -0,6 + 1,2 1 2,6 ±1,0
>0,05
<0,05
<0,001 Ham lu-grnq Kem huyet thanh (umol/L, X±SD)
Kem huyet thanh trirfrc can thi$p Kem huyet thanh sau can thi$p
Kem huydt thanh ch&nh l^cti
9,96 ±0,81 9,10 + 1,41 -0,86 + 1,33
9,87 ± 0,83 10,95 ±1,29 1.08±1,14
>0,05
<0.001
<0.001 Ham lu'O'nq Retinol huy^t thanh (umol/L, X±SD)
Retinol huyet thanh lru'6'c can thi$p Retinol huySt thanh sau can thi^p
Retinol huydt thanh chenh Idch
0,78 ± 0,07 0,77 ± 0,06 -0,01 ±0,03
0,79 ± 0.07 0.81± 0,07 0,02 ± 0,03
>0,05
<0,001
<0,001 So sdnh giira hai nhdm, test T
Ham lupng retinol huyet thanh d hai nhdm tai dieu tra trude can thidp Id khdng khde bidt ed ]/ nghTa thong kd (p>0,05, T test). Tgi d i l u tra sau can thidp, ket qua eua nhdm can thidp Id cao hon so vdi nhdm chUng (0,81pmol/L so vdi 0,77Mmol/L), su khde bidt ndy Id ed y- nghTa thdng kd vdi p<0,001, T test). Bdn canh dd, trung binh chdnh Idch tm-dc vd sau can thidp gida hai nhdm cQng cd s u khdc bidt cd :? nghTa thong kd vdi p<0,001 (tdng 0,02 pmol/L d nhdm can thiep vd gidm 0,01 pmol/L d nhdm ddi chdng).
Bdn cgnh vide tang ndng 36 cdc vi c h i t dinh dudng trong mdu, k i t qud nghidn edu cOng ghi nh$n vide giam ty Id thilu cdc vi c h i t dinh dudng d phy nO- mang thai d nhdm can thi§p so vdi nhdm ehdng (bilu do 1): TJ Id t h i l u femtin d nhdm can thidp dd giam t d 38,8% xudng 7,7%. Trong khi d nhdm d i i chdng t j Id ndy tdng tU 33,1% Idn 42%. Ty Id thilu Vitamin A huyet thanh d nhdm can thidp giam t d 16,1% xuong 6,2% trong khi d nhdm can thidp giam t d 2 1 % xudng 19,5%. Ty l§ thilu kdm huylt thanh d nhdm can thidp
giam tU 85% xuing 36,6% trong khi d nhdm doi ChUng ty Id ndy Id 84,2% d d i l u tra tru'dc can thidp vd tdng Idn 87,95 d dieu tra sau can thidp. Su khde bi$t v l giam t j 1$ ferritin huylt thanh thip, giam ty Id vitamin A huylt thanh t h i p vd giam ty Id kem huyet thanh t h i p giOa hai nhdm Id cd y nghTa thdng kd
Bilu dd 1; Ty Id thilu vi chit dmh dudng cua phu
PYTK Y HQC THVC HANH (829) - SO 7/2012
nO' mang thai trude vd sau can thidp (%) K i t qud cua nghiln cdu ndy dd cho t h l y hi$u qud cda b l sung da vi c h i t l l n cde tdng hdm lup'ng hemoglobin, gidm ty 1$ t h i l u mdu Bdn cgnh ede hi$u qud dd, b l sung da vi c h i t dinh du'dng cdn dem lgi cdc hidu qud tich cue trong vi|c tdng hdm lup'ng cdc vi chit trong huylt thanh vd gidm ty Id t h i l u eua Vitamin A vdkSm.
Trong nhilu ndm qua, t l chUc y t l t h i gidi dd du'a ra ede khuyin nghj chinh thUe v l vide s d dyng vidn sit/ acid folic nhu* id mdt gidi phdp can thidp don gidn vd kinh t l trong gidm ty l | t h i l u mdu d cdc nude dang phdt triln [10], Vdi hdm lupng 60mg s i t nguydn td trong thdnh p h l n , l i l u b l sung hdng ngdy cho phy nO" mang thai dd dup'c dp dyng vd dd dem Igi hidu qud trong vide tdng nIng dd hemoglobin, hdm lu'png femtin huylt thanh, Tuy nhidn edu hdi v l vide gidm l i l u s i t trong thdnh p h l n b l sung v i n t i l p tyc du'p'c d$t ra vdi nhO'ng \&\ Ich v l gidm phdn Ung phy, gidm khd ndng nhilm trung thdng qua gidm oxy hda (vl dy n i n g dd tdng malnodialdehyde (MDA) vd gdy Uc c h l cho cde hogt ddng enzyme oxy hda [6], Thuc t l , nIng dd s i t t u do eao cd t h i kich thich tdng sdn xult gdc t u do thdng qua ede phdn Ung Fenton vd Haber-Weiss [6], [9]
Kit qud cda nghidn cdu ndy cho t h l y cd t h i cd hidu qua ngay ed khi s d dyng da vi c h i t vdi hdm lupng s i t trong thdnh p h l n / vidn Id 30mg. Xu hudng b l sung da vi chit (multi-micronutrients) cho ede doi tup'ng nguy eo cao dang cd xu hu'dng dup'c xem xdt d i n , thay vl b l sung cdc vi c h i t don I I nhu tn/dc ddy. Vide b l sung da vi c h i t theo nhUng cdch khdc nhau dd dupe khuyin nghj nhu* mdt trong nhO'ng g i l l phdp thilt thuc de gidi quylt tinh trgng thilu mdu dinh du'dng hi$n nay thu-dng do nguydn nhdn t h i l u nhilu logi vi chit cdng Idc chU khdng phdi chi thilu dan Ie mdt vi chit. B i n cgnh dd vide b l sung da vi chit trong phdng chdng t h i l u mdu cd t h i tdng h i | u qua d i l u tq nhd k i t hp-p mdt s i logi vi c h i t eung vdi nhau sd giup tdng hidu qud can t h i | p nhd tdc dyng tuong h i tieh cue cua cdc vi c h i t vdi nhau vd tdng cudng t j l | h i p thy s i t trong co t h i .
K £ T L U A N
1. B l sung v i i n da vi c h i t dinh dudng dd Idm gidm t j 1$ t h i l u mdu d phy nC mang thai
2. B l sung vidn da vl c h i t dinh dudng cho phi^
n d mang thai d nhdm can thi$p dd Idm tdng ndng ij^
edc vi c h i t dinh dudng trong h u y l t thanh (ferritin, kdm, vitamin A) so vdi nhdm chUng. Cdc ty Id thi^u edc logi vi c h i t ndy cOng dd gidm nhilu hem tgi nhdm can thidp so vdi nhdm ddi chdng.
KHUYEN NGH|:
B l sung vidn da vi c h i t dinh dudng dgi trd cho phy nO' mang thai d cdc vung khd khdn Id mdt giai phdp mang Igi hidu qud trong cdi thi$n tinh tr^ng thilu mdu vd t h i l u vi c h i t dmh dudng d phy nft mang thai
TAI LI$U THAM K H A O
1. Bd Y t l (2009) Hw&ng din qudc gia vi cdc djch vu chdm sdc sOc khoi sinh sdn (Ban hdnh kdm theo Quylt dinh sd 4620/QD-BYT ngdy 25/1/2009 cua B^
t a r d n g B d Y t l ) .
2 Dgi hpc Y Hd Ndi (2012), Dinh du«ng vd v$ iM an todn thuc phim, Nhd xult bdn Y hpc, Hd Ndi-
3. Nguyin Cdng Khin (2004) "Phdng chdng thiiu vi chit dinh dw&ng & Vidt Nam th&i gian t&i: Chdng daimQ nhiiu thdch thuc." Tgp chf thdng tin Y tiw&c 6, HA NOi,
4. Nguyin Cdng Khin vd edng sy (2008). "Chuong trinh phdng chdng thiiu Vitamin A vd thiiu mdu M dw&ng & Vidt Narrf. tgp chi Dinh du'dng vd Th\fc phSm 4(2), Hd Ndi.
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Y HQC THU'C HANH (829) - SO iM
