European Journal of Clinical Nutrition (2007) pps

ORIGINAL ARTICLE
Obesity in adults: an emerging problem in urban
areas of Ho Chi Minh City, Vietnam
TQ Cuong
1
, MJ Dibley
2
, S Bowe
2
, TTM Hanh
1
and TTH Loan
1
1
Nutrition Centre Ho Chi Minh City, Ho Chi Minh City, Vietnam and
2
Centre for Clinical Epidemiology and Biostatistics, Faculty of
Health, University of Newcastle, Newcastle, New South Wales, Australia
Objective: To assess the prevalence of overweight, obesity and underweight among Vietnamese adults living in urban areas of
Ho Chi Minh City (HCMC), Vietnam.
Design: This cross-sectional survey was conducted in the local health stations of 30 randomly selected wards, which represent all
13 urban districts of HCMC, over a period of 2 months from March to April 2004.
Subjects: A total of 1488 participants aged 20–60 years completed the interview, physical examination and venous blood
collection.
Measurements: Anthropometric measurements of body weight, height, waist and hip circumference were taken to construct
indicators of adiposity including body mass index (BMI), waist circumference, and waist-to-height and waist-to-hip ratios. Both
systolic and diastolic blood pressure and biochemical indicators of cardiovascular disease and type II diabetes risk (lipid profile
and fasting blood glucose) were also measured.
Results: The age and sex standardized prevalence of overweight and obesity using Asian specific BMI cutoffs of 23.0 and
27.5 kg/m
2

was 26.2 and 6.4%, respectively. The prevalence of overweight and obesity was slightly higher in females (33.6%)
than males (31.6%), and progressively increased with age. The age and sex-standardized prevalence of underweight (BMI
o18.5 kg/m
2
) among Vietnamese adults living in HCMC was 20.4%. The prevalence was slightly higher in males (22.0%) than
in females (18.9%), and there was a much higher prevalence in all underweight categories in younger women than in men but
this was reversed for older men.
Conclusion: The adult population in HCMC Vietnam is in an early ‘nutrition transition’ with approximately equal prevalence of
low and high BMI. The prevalence of overweight and obesity of Vietnamese urban adults was lower than that reported for other
east and southeast Asian countries.
European Journal of Clinical Nutrition (2007) 61, 673–681. doi:10.1038/sj.ejcn.1602563; published online 13 December 2006
Keywords: obesity; overweight; Vietnamese; adults; prevalence; underweight
Introduction
There is a vast amount of evidence worldwide that shows
obesity is a chronic disease, which can predispose to
potentially fatal chronic conditions such as type II diabetes,
cardiovascular diseases and stroke (Bjorntorp, 2001). Obesity
is nowadays considered one of the most important global
health problems alongside AIDS, cancer and cardiovascular
diseases. In Western countries, the prevalence of overweight
and obesity are very high and are continuing to increase.
In Asian countries, the emerging problem of increasing
overweight and obesity was highlighted more than a decade
ago (Tee, 2002). A recent report indicates that the prevalence
of overweight (defined as BMI X25 kg/m
2
) was higher than
23% in many cities in Asia such as Beijing, Hong Kong,
Kuala Lumpur, Manila and Bangkok (Sakamoto et al., 1997).
This increase in the prevalence of overweight is probably

associated with industrialization and urbanization, which
results in changed eating habits and lifestyles in these
populations (Popkin and Gordon-Larsen, 2004).
In Vietnam, over the past 10 years, the economic situation
has improved dramatically following the introduction of the
social and economic policy reforms called ‘Doi moi’ and the
Received 29 December 2005; revised 16 October 2006; accepted 17 October
2006; published online 13 December 2006
Correspondence: Dr MJ Dibley, Centre for Clinical Epidemiology and
Biostatistics, Faculty of Health, University of Newcastle, Callaghan, New
South Wales 2308, Australia.
E-mail:
European Journal of Clinical Nutrition (2007) 61, 673–681
&
2007 Nature Publishing Group All rights reserved 0954-3007/07 $
30.00
www.nature.com/ejcn
lifting of the embargo on Vietnam by the US government. It
is considered that the resulting changes in the economy
have in part contributed to changing morbidity patterns
with decreases in infectious diseases and malnutrition and
increases in chronic diseases like type II diabetes, hyperlipi-
demia, hypertension and overweight especially in large cities
like HCMC.
Ho Chi Minh City (HCMC), with a population of
approximately seven million people, is the largest and also
the most economically dynamic urban area in Vietnam. This
urban population is the group most likely in Vietnam to be
undergoing a nutrition transition. It has a rapidly changing
nutritional situation where both under and overnutrition

co-exist in the same population and shows evidence of the
emergence of obesity and other chronic diseases in adults.
Preliminary evidence of an emerging problem with over-
nutrition can be found in type II diabetes surveillance data
collected from adults in HCMC in 2000 where the prevalence
of overweight (BMI X25 kg/m
2
) of Vietnamese adults (415
years) living in HCMC was 12.9% (both genders) (Hung et al.,
2002). Another study reported the prevalence of overweight
of women (15–49 years) was 9.7% (Hung and Loan, 2002).
Furthermore, a survey in 1999 of 300 middle-aged Vietna-
mese 40–60 years living in HCMC reported the prevalence of
overweight (BMI X25 kg/m
2
) in urban, suburban and rural
areas of the city as 18, 13 and 6%, respectively (Hanh et al.,
2001). However, all these previous estimates of overweight in
adults in HCMC were derived from studies that had been
designed to assess other specific health issues (such as type II
diabetes, maternal and child healthcare or middle age
health) rather than specifically designed to assess overweight
and obesity in adults. Thus, this survey was designed with
the specific purpose of assessing the prevalence and risk
factors for overweight and obesity in Vietnamese adults
living in HCMC. This study will also provide important
baseline information on obesity in adults for future
assessments.
Methods
Study design

A cross-sectional study of a representative sample of adults
aged 20–60 years living in urban areas of HCMC over a
period of 2 months from March to April 2004.
Setting and population
HCMC with its population of over five million people is the
largest and economically most advanced city in Vietnam.
The city is divided into four administrative levels; districts,
wards, quarters and hamlets. In total, it has 22 districts with
303 wards, and on average, there are 15 wards per district.
The districts have been classified into urban, suburban and
rural districts. There are 13 urban districts with 182 wards,
four suburban districts with 56 wards and four rural districts
with 65 wards. This cross-sectional study was restricted to
adults aged 20–60 years living in the 13 urban districts of
HCMC.
Sampling
The study used a multistage cluster sampling strategy. Firstly,
30 wards (clusters) were randomly selected from 182 wards
in 13 urban districts of HCMC using the proportionate to
the population size method based on the data from the
1999 Vietnam national census (HCMC Statistics Depart-
ment, 2000). Secondly, simple random sampling was used to
select one-quarter in each of the selected wards from stage
one with an assumption of approximately equal population
in each quarter. Next, simple random sampling was used to
select one hamlet from each of the selected quarters from
stage two with an assumption of approximately equal
population in each hamlet. Then, a list of all households
in each hamlet was prepared by the local health workers.
Fifty households were randomly selected from this list.

Each hamlet usually contained approximately 50 houses. If
there were less than 50 houses, then more households were
identified from a neighboring hamlet in that quarter. The
lists of all adults aged 20–60 years in each selected household
were prepared by community health workers. Finally, one
adult was selected from each household using simple
random sampling. Exclusion criteria for potential partici-
pants included pregnant women, critically ill subjects,
mentally disordered subjects and persons who had deformi-
ties that prevented accurate measurement of height and
percent of body fat.
All selected participants were visited by community health
workers in their homes to provide the information about
the study, to invite them to participate in the study and to
obtain witnessed verbal consent. The survey clinics were
held at local health stations for one morning in each of the
30 selected clusters (ward) during the study period.
A sample size of 1462 adults was required to estimate the
prevalence of overweight and obesity with precision of 2.5%.
The study protocol was approved by the Human Research
Ethics Committee of University of Newcastle, Australia and
the Research and Ethical Review Board of HCMC Health
Services, Vietnam. The Nutrition Center in HCMC Vietnam
was involved in supporting the study by providing staff for
data collection.
Measurements
Socio-demographic characteristics. An interviewer adminis-
tered questionnaire about socio-demographic status was
used, which included an assessment of the subjects’ age,
ethnicity, education, occupation and household assets.

Education level was classified into five groups: no school,
primary school, junior high school, senior high school and
college or university. Occupation was classified into five
groups: teacher/professional, government officers, small
Nutritional status of Vietnamese adults
TQ Cuong et al
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European Journal of Clinical Nutrition
business/skilled workers, labourers/street or home traders,
retired/home makers/students.
Clinical assessment
Systolic and diastolic blood pressures were measured in all
participants using the left arm by trained nurses using
appropriate sized cuffs for Matsuyoshi mercurial sphygmo-
manometers (MY 605 P-Japan). Blood pressure was measured
using the auscultatory method with the subject in the sitting
position after allowing participants to appropriately rest. The
systolic blood pressure was determined by the onset of the
‘tapping’ Korotkoff sounds (K1). The fifth Korotkoff sound
(K5), or the disappearance of Korotkoff sound, was used to
define diastolic blood pressure.
Anthropometry and adiposity
Anthropometric measurements were obtained from all
participants using standardized anthropometric measure-
ment techniques adapted from the ‘Anthropometric stan-
dardization reference manual’ (Lohman et al., 1991). Height
was measured using a Microtoise tape suspended from a
wall and was recorded to the nearest 0.1 cm. Weight was
measured by Tanita electronic scale (Tanita body fat monitor,
BF 571, Tanita Corporation, Japan) and was recorded to the

nearest 100 g. Waist and hip circumference were measured
by non-stretch tape and recorded to the nearest 0.1 cm.
Waist circumference was measured at navel level and hip
circumference was measured at the largest level of the
buttock. Skinfold thicknesses were measured in a randomly
selected subsample of participants (600/1488 persons) using
the Harpenden skinfold caliper (H.E. Morse Co. British
Indicators, Ltd, Burgess Hill, West Sussex, UK). Four sites
were chosen: triceps, subscapular, abdominal and thigh
skinfold thickness.
Biochemical indicators
All participants were asked to fast overnight before the
survey day. A venous blood sample of 4 ml was collected
from a vein on the participants’ forearm by trained and
experienced laboratory technicians from the Nutrition
Centre HCMC. Serum biochemical indicators including
fasting blood glucose, lipid profile (triglyceride, total choles-
terol, high-density lipoprotein cholesterol, low-density lipo-
protein cholesterol) were measured using a photometer
technique (Fully Automated Bio Chemistry Analyzer, Hita-
chi, Japan) by Medic Medical Center Laboratory, HCMC.
Definition of overweight and obesity
Analyses of this cross-sectional survey data reported else-
where have identified optimal BMI and waist circumference
cutoff values for defining overweight and obesity in this
adult Vietnamese population (Cuong, 2004). The optimal
BMI cut offs for overweight were X23 kg/m
2
for both genders
and for obesity were X26.1 kg/m

2
for men and X27.3 kg/m
2
for women. WHO has suggested for Asian populations
additional BMI cut offs for overweight and obesity as ‘action
trigger points for public health action’. In this modified
definition, the cutoff values for underweight and normal
weight are similar to those recommended for Western
populations, but the differences are with the cutoff values
for defining overweight (X23 kg/m
2
)andobesity(X27.5 kg/m
2
).
Both the traditional BMI cutoff values recommended by
WHO for Western populations (overweight: BMI 25–29.9
kg/m
2
; obesity: BMI X30 kg/m
2
) and the Asian-specific BMI
cutoff values described above were used in the analyses. The
traditional BMI cutoff values derived from Western popula-
tions were used to allow comparisons with other studies.
However, the analysis based on Asian-specific BMI cutoff
values gives a better estimation of the prevalence of high
BMI associated with increased cardiovascular and diabetes
risks in populations in Vietnam (Cuong, 2004), and thus
allows a meaningful comparison of health risks across
populations.

In this Vietnamese adult population, the optimal waist
circumference cut offs for overweight were X79 cm for men
and X77 cm for women, and for obesity were X86 cm for
both genders (Cuong, 2004). These waist circumference
cutoff values for defining abdominal obesity, together with
the traditional cutoff values used in Western populations
(overweight: 94–101.9 cm (male), 80–87.9cm (female);
obesity: X102 cm (male) and X88 cm (female), were both
used in the analyses.
Statistical analysis
Household assets were used to construct a household wealth
index as an indicator of economic status. Ownership of a list
of household assets was gathered by interview and included
household vehicles, entertainment appliances and house-
hold appliances. A wealth index was constructed using
methods recommended by the World Bank Poverty Network
and UNICEF, and described by Filmer and Pritchett, (2001).
Prevalence of overweight and obesity as well as under-
weight have been calculated for each age and gender group,
and for the total population. Confidence intervals (CI) for
prevalence estimates were calculated to take account of the
first stage of the cluster sampling design using the ‘svy’
commands in STATA version 8.2 (2003; Stata Corporation,
College Station, TX, USA) (Stata, 2003). The total prevalence
was adjusted for age and sex by a direct standardization
method with the Vietnamese National Census April 1999
(HCMC Statistics Department, 2000) as the standard popula-
tion. Ninety-five percent CI for age and sex-adjusted
prevalence have been calculated using the following for-
mula: 95% CI ¼ adjusted prevalence71.96* standard error

(s.e.). The s.e. were obtained from ‘svy’ commands in STATA
and were adjusted for cluster sampling design used in the
survey (Stata, 2003).
Nutritional status of Vietnamese adults
TQ Cuong et al
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European Journal of Clinical Nutrition
Results
Socio-demographic and clinical characteristics of the sample
One thousand five hundred people were contacted, and
among them, 21% declined but were replaced by 317
participants of similar background from the same cluster.
One thousand four hundred and eighty-eight participants
completed the survey in which 48% were male, and the
mean age was 38 years 711 years. The socio-demographic
and clinical characteristics for men and women separately
and for the total population studied are presented in Tables 1
and 2. The distributions for age were different for men and
women. There were more men in the age group 20–29 years
and fewer men in the age group 50–60 years compared with
women, thus indicating the need for age-adjustment if the
calculated prevalence estimates are to represent the popula-
tion in HCMC. Migration into HCMC for work and study are
possible explanations for the gender differences in specific
age groups. There were different patterns of occupation for
men and women but no gender differences for level of
education, household wealth and ethnicity.
Men were found to have higher mean blood pressure, a
much higher prevalence of current smoking compared with
women. In contrast the prevalence of high fasting blood

glucose and the lipid profiles were similar for men and
women.
Prevalence of overweight and obesity
Using the traditional BMI cutoff values recommended by
WHO for Western populations (overweight: BMI 25–29.9
kg/m
2
;obesity:BMIX30 kg/m
2
)(WorldHealthOrganisation,
1998), the age-standardized prevalence of overweight and
obesity among Vietnamese adults in HCMC was 15.4 and
1.8%, respectively. Using the traditional waist circumference
cutoff values for defining abdominal obesity (overweight:
94–101.9 cm (male), 80–87.9 cm (female); obesity: X102 cm
(male) and X88 cm (female)) (World Health Organisation,
1998), the age-standardized prevalence of abdominal over-
weight and obesity among Vietnamese adults living in urban
area was 8.1 and 3.3%, respectively.
However, using the Asian-specific BMI cutoff values
(overweight: BMI 23–27.4 kg/m
2
; obesity: BMIX27.5 kg/m
2
)
(Barba et al., 2004) the age-standardized prevalence of
overweight and obesity among Vietnamese adults in HCMC
was much higher at 26.2 and 6.4%, respectively (Table 3).
Similarly, using the Vietnamese-specific cutoffs for defining
abdominal overweight (waist circumference X79–85.9 cm

in males and X77–85.9 cm in females), and abdominal
obesity (waist circumference X86 cm in both sexes), the age
standardized prevalence of abdominal overweight and
obesity among Vietnamese adults living in urban areas was
18.7 and 10.0%, respectively (Table 3).
Prevalence of under-weight
The age-standardized prevalence of underweight among
Vietnamese adults living in HCMC was 20.4%. Overall, the
age-standardized prevalence of underweight (BMI o18.5
kg/m
2
) was higher in males than in females although this
difference was not significant (Table 4). However there was
a markedly different age-specific pattern of underweight
for each sex. There was a much higher prevalence in all
underweight categories in younger women than in men, but
this was reversed for older men. These gender differences
were statistically significant as seen from the CI for the age
group 50–60 years, but not for the younger age groups
(Table 4).
Household wealth status
The prevalence of overweight (both defined by BMI and
waist circumference) grouped by household wealth status is
presented in Table 5. The prevalence of overweight defined
by BMI or waist circumference differed by sex across the
Table 1 Sociodemographic characteristics of 1488 Vietnamese adults
aged 20–60 years in HCMC, Vietnam 2004
Characteristics Men
(N ¼ 717)
%

Women
(N ¼ 771)
%
Total
(N ¼ 1488)
%
Age (years)
20–29 32.6* 18.4* 25.3
30–39 26.5 26.2 26.3
40–49 27.6 33.9 30.9
50–60 13.3* 21.5* 17.5
Education level
No schooling 1.8 1.8 1.8
Primary school 13.9 18.6 16.3
Junior high school 34.5 32.2 33.3
Senior high school 33.8 32.8 33.3
College/University 15.9 14.7 15.3
Household wealth index
Lowest 19.9 19.9 NA
Second 19.8 20.1 NA
Middle 20.5 19.5 NA
Fourth 21.2 18.8 NA
Highest 18.6 21.7 NA
Ethnicity
Vietnamese 88.0 90.1 89.1
Chinese 11.9 9.9 10.8
Other 0.1 0 0.1
Occupation
Teacher, Professional 10.0 10.3 10.2
Government officers 19.3 10.8 14.9

Small business, Skilled workers 19.7 16.3 17.9
Labourers, street or home traders 25.7 23.1 24.3
Retired/home maker/students 7.7* 33.9* 21.3
Others 13.7* 3.6* 8.5
No Job 4.0 1.9 2.9
Abbreviations: HCMC, Ho Chi Minh city; NA, not available.
*Statistically difference (Po0.05) between two gender.
Nutritional status of Vietnamese adults
TQ Cuong et al
676
European Journal of Clinical Nutrition
household wealth categories. In men, the prevalence of
overweight progressively increased as household wealth
status increased and the difference between the men from
the highest vs lowest household wealth categories was
statistically significant as seen from the CI (Table 5). In
women, there were no differences in the prevalence of
overweight across the household wealth categories.
Discussion
The results from this survey show that both overnutrition
and undernutrition are present in this Vietnamese urban
adult population. Overweight and obesity (defined as BMI
23–27.4 kg/m
2
and BMIX27.5 kg/m
2
) were found in 26.2 and
6.4%, respectively, of the population, whereas underweight
(defined as BMI o18.5 kg/m
2

) was found in 20.4% of the
population. This finding of a high prevalence of both
underweight and overweight provides evidence of a ‘nutri-
tion transition’ (Popkin et al., 2001) occurring in this urban
population in Vietnam, and further supports the relevance of
this concept.
Compared with other countries in the region, the problem
of overweight in urban areas of Vietnam is less severe. The
prevalence of overweight (defined as BMI 25–29.9 kg/m
2
)of
Vietnamese adults living in HCMC Vietnam of 15.4% was
lower than Malaysian adults nationwide (20.7%) (Tee, 2002),
Malaysian urban adults (29.0%) (Tee, 1999), Singapore adults
nationwide (24.4%) (Ministry of Health Singapore, 1999),
Japanese men (24.5%), Japanese women (17.8%) (Yoshiike
and Kaneda, 22–24 April 2002), Hong Kong Chinese adults
(28.9%) (Ko et al., 2001), Thai adults (28.3%) (Aekplakorn
et al., 2004) and Chinese adults (18.6%) (Wang et al., 2001).
Similarly, the prevalence of obesity (defined as BMI
X30 kg/m
2
) of Vietnamese adults living in HCMC Vietnam
(1.8%) was also lower than adults in Malaysia nationwide
(5.8%) (Tee, 2002), Malaysia urban adults (12.0%) (Tee,
1999), Singapore adults nationwide (6.0%) (Ministry of
Health Singapore, 1999), Japanese men (2.3%), Japanese
women (3.4%) (Yoshiike and Kaneda, 22–24 April 2002),
Hong Kong Chinese adults (3.6%) (Ko et al., 2001), Thai
adults (6.8%) (Aekplakorn et al., 2004) and Chinese adults

(2.5%) (Wang et al., 2001).
These differences in prevalence of overweight and obesity
between Vietnam and other countries in the region indicate
the early stage of the nutrition transition in Vietnam.
However, the trend in overweight is more important than
the absolute prevalence. In HCMC Vietnam, the prevalence
of overweight (BMI 25–29.9 kg/m
2
) in Vietnamese adults
living in urban areas has increased from 13.8% (in adults
X15 years) in 2001 Hung et al., 2002) to 15.4% in adults
20–60 years in our survey in 2004. Although the age ranges
of the populations assessed in this comparison were not
exactly identical, the analysis does give an indication that
the prevalence of overweight in adults in HCMC has tended
to increase over the past few years. A similar rapid trend of
increasing prevalence of overweight in adults can also be
seen in other countries in the region. For example, in China
the prevalence of overweight in urban areas has increased
from 9.7% in 1982 to 14.9% in 1992, and to 18.6% in 2001
(Ke-You and Da-Wei, 2001). Other examples of this trend
pattern can be seen in Malaysia, Thailand and Philippines
(Tee, 1999; World Health Organisation, 2000; Aekplakorn
et al., 2004). However, the prevalence of overweight and
obesity seems to have stabilized in some countries for
example Japan, Hong Kong, and Singapore at around
20% of the adult population. Differences in the speed of
Table 2 Clinical characteristics of 1488 Vietnamese adults aged 20–60 years in Ho Chi Minh City, Vietnam 2004
Characteristics Men (N ¼ 717) % Women (N ¼ 771) % Total (N ¼ 1488) %
High blood pressure

a
11.3 8.9 10.1
High blood glucose
Blood glucose of 6.1–6.9 mmol/l 1.5 1.7 1.6
Blood glucose X7 mmol/l 2.7 2.6 2.6
Blood glucose (mmol/l) mean (s.d.) 4.7 (1.2) 4.8 (1.2) 4.8 (1.2)
Total cholesterol (mmol/l) mean (s.d.) 4.1 (0.8) 4.3 (0.9) 4.2 (0.9)
HDL-cholesterol (
Mmol/l) Mean (s.d.) 0.76 (0.19) 0.84 (0.23) 0.80 (0.2)
LDL-cholesterol (mmol/l) mean (s.d.) 2.6 (0.7) 2.8 (0.8) 2.7 (0.7)
Triglycerides (mmol/l) mean (s.d.) 1.9 (1.1) 1.8 (0.9) 1.8 (1.0)
Systolic blood pressure (mm Hg) mean (s.d.) 123.8 (17.5) 120.0 (18.4) 121.8 (18.0)
Diastolic blood pressure (mm Hg) mean (s.d.) 77.8 (10.8) 74.7 (10.8) 76.2 (10.9)
Percent body fat (skinfold method)
b
mean (s.d.) 18.2 (6.2) 29.7 (6.3) 23.9 (8.5)
Smoking habits
Non/ex-smoker 37.8 98.6 69.3
Current smoker 62.2 1.4 30.7
Abbreviations: BMI, body mass index; CI, confidence interval; HDL, high-density lipoproteins; LDL, low-density lipoproteins.
a
High blood pressure defined as systolic blood pressure 4140 mm Hg, or a diastolic blood pressure 490 mm Hg.
b
Percent body fat (using skinfold method) measured in a sub-sample of 301 men and 301 women.
Nutritional status of Vietnamese adults
TQ Cuong et al
677
European Journal of Clinical Nutrition
economic change, the rate of dietary change, the underlying
traditional diets, the nutritional experiences of the adults

as young children and environmental changes leading to
reduced-physical activity might all explain some of the
differences in the rate of change of the prevalence of
overweight in adults among these countries in Asia.
We found that the adjusted prevalence of overweight
(defined by both cutoff values: BMI 25–29.9 kg/m
2
or BMI
23–27.4 kg/m
2
) was similar for men and women. However,
women did have a higher prevalence of obesity compared to
men (see Table 3). These findings are consistent with others
studies from Thailand (Aekplakorn et al., 2004) and China
(Wang et al., 2001) and with the majority of studies
worldwide, which have reported slightly higher prevalence
of obesity in women (James et al., 2001). The reason for this
difference is probably biological and related to differences in
the ability of men and women to deposit fat vs lean tissues
when in energy imbalance, or might be related to gender
differences in behavior change in response to alterations in
the environment. In addition, social and environmental
factors may also contribute to this difference in the
prevalence of obesity between men and women. Women
are more often in a domestic environment with constant
access to food that is more conducive to recurrent eating
(James et al., 2001). Finally, differences in physical activity
and occupation or even smoking might in part explain the
gender differences.
The prevalence of overweight (defined as BMI 23–27.4

kg/m
2
) and obesity (BMI X27.5 kg/m
2
) in Vietnamese adults
more than doubled between the age groups 20–29 and 50–60
years (Table 3). This pattern is similar to that reported from
other countries where usually the prevalence of overweight
and obesity progressively increases with age, although the
extent of this increase varies in different countries (James
et al., 2001). However, in our study population there were
gender differences in this age pattern of the prevalence of
overweight and obesity. In men, the prevalence of over-
weight and obesity gradually increased and reached a peak at
Table 3 Age-specific prevalence (%) of overweight defined by BMI and waist circumference using cutoff values for Asian populations
a
among
Vietnamese adults (n ¼ 1488)
Anthropometric categories Age-specific prevalence Adjusted
b
total prevalence
20–29 year %
(95% CI)
30–39 year %
(95% CI)
40–49 year %
(95% CI)
50–60 year %
(95% CI)
%(95%CI)

BMI
Overweight
Men 17.1 (12.6–22.7) 31.1 (26.5–36.1) 35.9 (28.3–44.3) 28.4 (19.6–39.2) 26.4 (22.5–30.3)
Women 11.3 (7.7–16.2) 30.2 (24.1–37.1) 37.2 (31.6–43.1) 43.4 (35.8–51.3) 26.1 (23.1–29.1)
Adjusted total
b
14.1 (10.3–17.9) 30.6 (25.8–35.4) 36.6 (31.7–41.5) 36.9 (31.2–42.6) 26.2 (23.5–28.9)
Obesity
Men 3.4 (1.7–6.6) 5.8 (3.0–11.0) 5.6 (3.3–9.1) 9.5 (4.3–19.6) 5.2 (3.5–6.9)
Women 3.5 (1.3–9.2) 7.4 (5.0–10.0) 12.3 (8.2–18.0) 12.1 (7.3–19.2) 7.5 (5.3–9.7)
Adjusted total
b
3.5 (1.7–5.3) 6.6 (4.6–8.6) 9.2 (6.6–11.8) 10.9 (5.6–16.2) 6.4 (4.9–7.9)
Overweight and obesity
Men 20.5 (15.6–26.4) 36.9 (32.4–41.5) 41.5 (33.1–50.3) 37.9 (27.4–49.7) 31.6 (27.9–35.3)
Women 14.8 (10.5–20.5) 37.6 (31.0–44.8) 49.5 (43.1–55.8) 55.5 (47.2–63.4) 33.6 (30.0–37.2)
Adjusted total
b
17.6 (13.6–21.6) 37.2 (32.8–41.6) 45.8 (41.2–50.4) 47.8 (40.7–54.9) 32.6 (30.0–35.2)
Waist circumference
Overweight
Men 9.4 (6.0–14.5) 21.6 (16.1–28.3) 28.3 (23.4–33.7) 24.2 (16.0–34.8) 18.4 (15.6–21.2)
Women 7.8 (4.4–13.3) 19.3 (14.1–25.9) 28.4 (23.7–33.5) 38.0 (31.1–45.4) 19.0 (15.9–22.1)
Adjusted Total
b
9.7 (7.0–12.4) 23.5 (18.9–28.1) 30.4 (27.0–33.8) 36.5 (30.9–42.0) 18.7 (16.5–20.9)
Obesity
Men 4.7 (2.8–7.9) 13.7 (9.8–18.8) 19.2 (14.0–25.8) 21.1 (14.6–29.4) 12.0 (10.0–14.0)
Women 1.4 (0.4–5.4) 7.9 (5.0–12.2) 13.0 (9.2–18.1) 22.3 (16.0–30.2) 8.1 (5.6–10.6)
Adjusted total

b
3.0 (1.2–4.7) 10.7 (8.0–13.4) 15.9 (13.1–18.7) 21.8 (16.4–27.2) 10.0 (8.4–11.6)
Overweight and obesity
Men 14.1 (10.2–19.2) 35.3 (29.7–41.2) 47.5 (40.5–54.5) 45.3 (35.9–55.0) 30.4 (27.4–33.4)
Women 9.2 (5.2–15.6) 27.2 (21.4–33.9) 41.4 (35.7–47.3) 60.2 (51.4–68.4) 27.1 (23.5–30.7)
Adjusted total
b
11.6 (8.3–14.9) 31.1 (26.6–35.6) 44.2 (40.4–48.0) 53.8 (47.1–60.5) 28.7 (26.0–31.4)
Abbreviations: BMI, body mass index; CI, confidence interval.
a
Asian-specific BMI cutoff values (14), with overweight defined as a BMI of 23–27.4 kg/m
2
, and obesity as a BMI of X27.5 kg/m
2
; and Vietnamese-specific waist
circumference cut-off values (9): with overweight defined as a waist circumference of X79 cm in men and X77 cm in women and obesity as a waist circumference of
X86 cm for both two genders.
b
Age and sex adjustment based on Vietnamese National Census April 1999 using direct standardization method.
Nutritional status of Vietnamese adults
TQ Cuong et al
678
European Journal of Clinical Nutrition
40–49 years and then dropped at age 50–60 years (Table 3).
On the other hand, the prevalence of overweight and obesity
in women progressively increased from age 20–29 to 50–60
years. Overweight and obesity are strongly related to
economic status and occupation in men and by age 40–49
years many men will have reached the highest position in
their career and have their highest income (Cuong, 2004).

For Vietnamese women, biological factors like pregnancy
and menopause might be more important and economic
status and occupation less important.
Remarkably, we found that the increasing prevalence of
overweight associated with higher economic status, as
measured by the household wealth index, was only observed
in men. Overweight (BMIX23 mg/m
2
) in men increased
from 22.6% in the lowest household wealth category to
44.9% in the highest household wealth category. This
pattern is the reverse of the pattern usually seen in Western
countries where the prevalence of overweight and obesity
decreases with increasing economic status especially in
women rather than men (Sobal and Stunkard, 1989; James
et al., 2001). However, in developing countries, the relation-
ship between socio-economic status and obesity is strong
and consistency in the reverse direction and is equally
between men and women (Sobal and Stunkard, 1989).
Table 4 Age-specific prevalence (%) of underweight defined by BMI among Vietnamese adults (n ¼ 1488)
Low BMI categories Age-specific prevalence Adjusted
a
total prevalence
20–29 year %
(95% CI)
30–39 year %
(95% CI)
40–49 year %
(95% CI)
50–60 year %

(95% CI)
% (95% CI)
BMI o16 kg/m
2
Men 1.7 (0.6–4.6) 1.1 (0.3–3.9) 1.0 (0.2–4.2) 2.1 (0.5–8.4) 1.4 (0.4–2.4)
Women 3.5 (1.3–9.5) 1.5 (0.5–4.4) 0.8 (0.2–3.0) 0 1.9 (1.1–2.7)
Adjusted total
a
2.6 (1.1–4.1) 1.3 (0.3–2.3) 0.9 (0.09–1.7) 0.9 (-0.2–2.0) 1.7 (1.1–2.3)
BMI 16–16.9 kg/m
2
Men 5.1 (2.6–9.8) 4.2 (2.2–8.0) 4.0 (1.7–9.1) 6.3 (2.6–14.5) 4.7 (3.0–6.4)
Women 8.5 (4.5–15.2) 3.0 (1.5–5.9) 1.2 (0.4–3.4) 0.6 (0.08–4.4) 4.4 (3.2–5.6)
Adjusted total
a
6.8 (3.5–10.1) 3.6 (2.0–5.2) 2.5 (1.0–4.0) 3.0 (1.1–4.9) 4.5 (3.3–5.7)
BMI 17–18.4 kg/m
2
Men 19.7 (14.6–25.9) 17.4 (13.4–22.3) 8.6 (4.6–15.4) 10.5 (5.6–19.0) 15.9 (13.2–18.6)
Women 21.8 (15.4–30.1) 8.4 (5.4–12.9) 6.5 (3.9–10.7) 5.4 (2.7–10.5) 12.7 (10.4–15.0)
Adjusted total
a
20.8 (17.1–24.4) 12.8 (9.9–15.7) 7.5 (4.4–10.6) 7.6 (5.1–10.1) 14.2 (12.4–16.0)
BMI o18.5 kg/m
2
Men 26.5 (20.5–33.5) 22.6 (16.8–29.7) 13.6 (8.5–21.1) 19.0 (11.7–29.2) 22.0 (18.5–25.5)
Women 33.8 (26.5–42.0) 12.9 (9.2–17.7) 8.4 (5.1–13.7) 6.0 (3.0–11.6) 18.9 (16.1–21.7)
Adjusted total
a
30.2 (25.5–34.9) 17.7 (14.1–21.3) 10.8 (6.8–14.8) 11.5 (8.3–14.7) 20.4 (18.2–22.6)

Abbreviations: BMI, body mass index; CI, confidence interval.
a
Age and sex adjustment based on Vietnamese National Census April 1999 using direct standardization method.
Table 5 Gender-specific prevalence (%) of overweight according to tertiles of household wealth status among Vietnamese adults (n ¼ 1488)
Household wealth status
BMI (X23 kg/m
2
)
Lowest % (95% CI) Middle % (95% CI) Highest % (95% CI)
Male 22.6 (18.1–27.6) 30.9 (24.5–38.5) 44.9 (38.1–51.9)
Female 40.5 (35.0–46.5) 41.1 (35.9–46.2) 42.2 (36.3–48.4)
Total 31.9 (27.8–36.2) 36.3 (32.2–40.6) 43.6 (39.0–48.2)
Abdominal overweight
a
Lowest % (95% CI) Middle % (95% CI) Highest % (95% CI)
Male 24.3 (20.4–28.3) 32.2 (26.2–39.2) 42.5 (36.6–48.6)
Female 35.4 (29.7–41.9) 36.1 (31.0–41.3) 35.9 (29.7–42.5)
Total 30.0 (26.2–34.1) 34.3 (29.9–39.0) 39.1 (34.8–43.6)
Abbreviations: BMI, body mass index; CI, confidence interval.
a
Overweight defined as waist circumference X79 cm for male and X77 cm for female.
Nutritional status of Vietnamese adults
TQ Cuong et al
679
European Journal of Clinical Nutrition
Weight perception and weight control behaviour are possible
explanations for the difference (Cuong, 2004). Results from
this study (data not presented here) (Cuong, 2004) indicate
men in HCMC are less concerned about their weight and
are less concerned to lose weight if there are overweight

compared with women. Men in Vietnamese society may
perceive fatness as a sign of success and wealth.
There is limited survey data about underweight in adults
in East Asia and Southeast, Asia making it difficult to
compare the prevalence of adult underweight in Vietnam
with other countries in Asia. Most of the reports about
underweight are for children. Our findings indicate that
underweight in Vietnamese adults in urban areas is as
important a public health problem as overweight, because
the prevalence of both conditions was similar. From the
limited data available in other countries, it appears that the
prevalence of underweight in Vietnamese urban adults is
higher than for Chinese urban adults (9% in China in 1992
(Wang et al., 2001) versus 20.4% in Vietnam) but quite
similar to Thailand in 1996 (25.1 and 16.1% in men and
women, respectively) (Kosulwat, 2002). Within HCMC, the
prevalence of underweight has decreased slightly from
24.9% in 2001 (Hung and Loan, 2002) to 20.4% in 2004.
This trend was evident in all age groups (data not shown),
indicating that differences in the age structure of the samples
for the two surveys did not account for the trend to
decreasing prevalence of underweight between 2001 and
2004.
Although countries in East Asia and Southeast Asia are all
undergoing a ‘nutrition transition’, they are at different
stages in this process. The further the nutrition transition
has progressed, the higher the prevalence of overweight and
the lower the prevalence of underweight. Urban areas in
Vietnam at present are at a stage behind other East Asian and
Southeast Asian countries in this ‘nutrition transition’. This

can be seen from the slightly higher prevalence of under-
weight than overweight in Vietnamese urban adults.
Vietnam needs to formulate appropriate public health
policies to deal with both those nutrition issues.
In conclusion, urban areas in Vietnam currently confront
an early nutrition transition with the double burden of
underweight and overweight in the adult population. The
problem of overweight and obesity was slightly more
prevalent in females than in males, in older age groups and
in men of high economic status. Appropriate public health
policies are needed to deal with both problems and
continued surveillance is required to estimate the trends in
nutritional status of Vietnamese urban adults and to provide
information to evaluate future interventions.
Acknowledgements
We are grateful to Health Consequences for Population
Change Program of The Wellcome Trust, United Kingdom
for financial support for this study.
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