Non-communicable diseases, also known as non-communicable chronic diseases, are a group of diseases with many risk factors related to diet and inappropriate physical activity. Common non-communicable diseases in Vietnam such as cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease ... caused 77% of deaths in Vietnam in 2016 (estimated data from the World Health Organization). The increase of these diseases is mainly due to 4 main risk factors: tobacco use, lack of physical activity, harmful use of alcohol and inappropriate diet.

The current unhealthy diet includes a diet high in energy, high in fat, high in sugar, high in salt, but low in fruits and vegetables. Therefore, implementing the “3 reductions” regime: reducing (sodium) salt, reducing free sugar, reducing fat (foods containing harmful fats), and “1 increase” increasing vegetables and fruits helps prevent and fight non-communicable diseases; along with maintaining a reasonable weight, an active, healthy lifestyle such as regular physical exercise, not smoking, and limiting alcohol.

To implement a healthy diet and prevent non-communicable diseases, it is necessary to first ensure a diverse diet (ensure 15-20 types of food each day to provide 4 groups of nutrients: carbohydrates, proteins, fats, vitamins and minerals), meet energy needs, with a balanced ratio of nutrients, especially vitamins and minerals, and ensure food safety.

Reduce salt (reduce sodium)

Sodium is the main component of table salt (NaCl). Increased sodium consumption is associated with increased blood pressure, while reduced sodium consumption reduces blood pressure in adults. Increased sodium intake is also directly associated with cardiovascular diseases, especially stroke and coronary heart disease. The minimum sodium intake required for normal body function has no specific figure but is estimated to be only about 200 - 500 mg/day (equivalent to 0.5 - 1.25 g of salt, less than 1 teaspoon of yogurt). Recommended sodium intake is recommended by age: children from 3 - 5 years old: less than 3 g of salt/day equivalent to 1200 mg of sodium; school-age children from 6 - 11 years old: less than 4 g of salt/day equivalent to 1600 mg of sodium, adults: less than 5 g of salt/day equivalent to 2000 mg of sodium.

According to a study by the National Institute of Nutrition in 2011, up to 81% of daily sodium consumption in Vietnam comes mainly from salt and salty spices added during processing, cooking and eating (dipping). Adults should consume less than 5g of salt (equivalent to about a teaspoon) per day, using salt and salty spices supplemented with iodine.

Each individual and family can reduce salt intake by following very simple measures:

• Do not leave salty condiments such as fish sauce, soy sauce and salt on the dining table. 
• Limit the amount of salty spices such as salt, seasoning powder, fish sauce, etc. added to food when cooking. The maximum level is no more than one-fifth of a teaspoon of salt for one meal per person per day. 
• Limit regular use of products with high salt content such as french fries, pizza, canned foods, salted steamed foods, some traditionally processed foods such as pickles, salted eggplants, ham, sausage, pork floss, etc.
• Choose products low in salt when buying processed foods. 
• Read labels when buying prepared foods to check for salt content. 
• Children should be fed natural foods without added salt. For children under 1 year old, salt or salty spices should not be added to their complementary meals.

We can estimate the amount of salt in salty spices as follows: normally 8 g of seasoning powder or 11 g of seasoning powder or 25 g of fish sauce or 35 g of soy sauce contains the same amount of sodium as 5 g of salt.

Reduce free sugar

The amount of Free Sugar (including double and simple sugars added to foods and beverages or natural sugars found in honey, syrups, fruit juices and concentrated fruit juices...) in each person's diet should only account for no more than 10% and should be reduced to less than 5% of energy.

amount per day to get additional health benefits (WHO, 2015); that is equivalent to less than 25 - 50 g of free sugars per day for adults and less than 12 - 25 g of sugars per day for children. Therefore, it is necessary to:

• Limit all soft drinks, including ready-to-drink tea and ready-to-drink coffee.
• You should use filtered water, bottled water, and unsweetened tea instead of soft drinks.
• Limit the use of foods containing a lot of free sugars such as natural sugars (brown sugar, refined sugar, rock sugar, etc.) and sugary drinks, sweets, jams, syrups, etc.
• Limit the amount of sugar you add to foods when cooking and at the table.
• Do not add sugar to tea, coffee or any other beverage.
• Choose smaller serving sizes of sugary foods or drinks and gradually reduce the amount.
• Eat fresh, low-sugar fruit instead of sugary snacks.
• Read food labels, choose products that contain less sugar

The Vietnamese diet is based on food, which is the main source of energy, so to reduce energy and sugar in meals, in addition to reducing the amount of free sugar used in daily meals, it is necessary to use less processed rice and cereals, use whole grains to retain the amount of B vitamins, fiber and some minerals and proteins found in the bran layer of grains (unpolished rice, brown rice, wheat flour, cereals and other products made from whole grains ...); limit starches, sugars, foods with a high glycemic index, increase consumption of foods rich in fiber.

Increase intake of vegetables and fruits

Eating at least 400 g, or 5 portions (5 servings) of fruit and vegetables per day helps reduce the risk of non-communicable diseases. A serving of fruit and vegetables is 80 g in fresh form and does not include the waste, after processing. Fruits and vegetables provide fewer calories, and are a source of vitamins and minerals, as well as antioxidants so can help control weight, replace high energy density foods (high in fat) to help reduce energy, reduce fat, slow down the aging process.

We can estimate as follows: 1 unit of vegetables 80g is equivalent to 1 small bowl of boiled mustard greens, boiled beans, stir-fried water spinach, stir-fried pumpkin... or equivalent to 1 large bowl of amaranth soup, Malabar spinach soup, Malabar spinach soup... 1 unit of fruit (fruit) 80g is equivalent to 1 piece of mango, half a custard apple, 15 longans, 11 grapes, 1 piece of dragon fruit, 1 medium sapodilla.

A very important nutrient in vegetables and fruits, beans is fiber, which slows down the absorption of starch and limits rapid increases in blood sugar. Fiber helps prevent some diseases such as constipation, colitis, cancer, obesity and cardiovascular disease. Fiber makes food larger, thus creating a feeling of fullness, avoiding the consumption of too many energy-producing substances. Fiber also absorbs harmful substances in the digestive tract such as cholesterol, oxidants, carcinogens... You should drink plenty of water, because fiber absorbs a lot of water in the intestines.

• To increase daily fruit and vegetable intake, you need to:
• Always have vegetables in every meal.
• Eat fresh fruits and raw vegetables as snacks;
• Eat fresh seasonal fruits and vegetables;
• Eat a variety of different fruits and vegetables
• Steam or boil instead of frying when cooking;
• Vegetable dishes should be used in salad form, mixed vegetables...

People with high blood pressure and high cholesterol: should eat a lot of vegetables and fruits (about 500g/day) to supplement potassium, contributing to lowering blood pressure. On the other hand, people with high blood pressure often have high blood cholesterol, eating a lot of vegetables and fruits will help eliminate cholesterol in the intestines, contributing to lowering blood cholesterol.

Fat loss

The daily diet should have less than 30% of total energy from fat. Unsaturated fats (found in fish, avocados and nuts, and in sunflower, soybean, and olive oils) are preferable to saturated fats (found in fatty meats, butter, palm and coconut oils, cream, cheese, and lard) and trans fats - all types, including industrially produced trans fats (found in baked and fried foods, and snack foods and prepackaged foods) and trans fats (found in meat and dairy products from animals, such as cows, sheep, goats, and camels).

Note that food should be steamed or boiled. If you want to fry, boil until cooked, drain the water, then pan-fry until golden brown on both sides.

With foods rich in fat, you should: limit animal fat (pork, beef), use seed oils (sesame oil, canola oil, soybean oil... do not use coconut oil). Do not eat viscera such as: liver, testicles, brain, heart, intestines, bone marrow of animals...

For foods high in protein, you should eat lean meats (lean pork, skinless chicken, etc.); fish (if it is fatty fish, remove the skin). Do not eat meats high in fat: lamb, duck, goose, pork sausage, smoked meat, kidney, lung.

Replace butter and lard with oils rich in unsaturated fats such as soybean oil, canola oil, sesame oil, sunflower oil, etc.

Limit your intake of grilled and fried foods, and snacks and prepackaged foods.

Increase intake of fish, beans, sesame, peanuts.

A healthy diet throughout life helps prevent all forms of malnutrition and a range of non-communicable diseases. However, increased production of processed foods, rapid urbanization and lifestyle changes have led to changes in diet. Diets vary from person to person depending on age, gender, lifestyle and physical activity levels, cultural background, local food availability and dietary customs. Current food consumption trends are high consumption of foods high in energy, fat, free sugars and salt/sodium and insufficient intake of fruits, vegetables and other dietary fibres such as cereals. Therefore, nutritional advice for the prevention of non-communicable diseases is a “3-reduce” diet: reduce (Sodium) salt, reduce free sugars, reduce fat and “1-increase”: increase vegetables and fruits.

MSc. Dr. Ngo Thi Ha Phuong - National Institute of Nutrition