Introduction In recent years it has been observed epidemiological transition in the world population’s morbidity and mortality causes, indicating a shift from communicable diseases to non-communicable diseases. In 2012, cardiovascular diseases alone accounts for 30 per cent of all deaths in the world. In Mongolia, non-communicable diseases are growing steadily and becoming the leading causes of morbidity and mortality of population. According to the Global School-based Student Health Survey-Mongolia 2010, overall, 19.3 per cent of school children had 4 or more nutritional risk factors of NCD and 8,3 per cent of students were overweight and 0,8 per cent were obese. Above mentioned study shows that, the prevention of NCD should be started from childhood, improving the consumption of fruits and vegetables for school snack and lunch is important in the prevention of NCD among school children. The study is aimed at determination of types, consumption and chemical composition of food products and meals provided in school snack program. Scope and methods of investigation The investigation was performed in Ulaanbaatar and Tuv aimag. Under the our investigation included a totally 14 school canteens of Ulaanbaatar and Tuv aimag. Consumption of Food products was investigated using the Food Consumption Questionnaire method. All managers of school canteens interviewed by well-trained researchers using the time from 20 to 30 min for each of them. Food samples were obtained, keeping in cool boxes, transported to the Public Health Central Laboratory of National Center of Public Health, Mongolia. Chemical composition of food and snack samples were investigated according to the related standard methods for determination of protein, fat, carbohydrates, Vitamin C, Calcium. Results Consumption of vegetables and local fruits for school snack and meal was not enough for prevention of NCD among school children. Use of milk and milk products for school snacks and lunch were obtained only 1-3 times during the 10 days, which is too poor consumption. According to the results of chemical analysis, 83.4 per cent of all food samples had calories less than 340 kcal, which is the required value of calories of school snack per one student. With regard to protein level 50 per cent of samples had 2.57-7.7grams of protein, which is lower than the recommended level of 10-12 gr. Fat level of samples were ranged between 7.2-1.97 grams and 95.5 per cent of samples had lower fat content compared to the recommended value of 9.0 grams. When 68.7 per cent of samples had 4.5-38.03 grams of carbohydrates, which is lower than the recommended amount, some 4.5 per cent of samples had higher carbohydrates compared to the recommendation. Amount of vitamin C in school snack was extremely lower than the recommended amount that vitamin C was found between 0.02-2.31mg, satisfying only 10 per cent of the national recommendation of vitamin C amount for school snack. Amount of Calcium in milk products of school snack and meals was also low than recommended level.

Introduction. Population life expectancy and health status are directly related to adolescent health,as many chronic disease conditions are affi liated with adolescence. The Mongolia GSHS, 2010 wasstudied dietary behavior and some risk factors belong to non communicable diseases of secondaryschoolchildren among surveyed children. Overall, 5.5% of students have eating habits that are healthybased on the WHO recommendations developed form the Mongolian Ministry of Health. One in sixstudents (15.9%) ate fruits and vegetable fi ve or more times per day. 27.3% of students consumeddairy products valuable for childhood growth two or more times per day. More than one in four students(27.6%) drank carbonated beverages and soft drinks one or more times per day.Findings of this survey show that attention is needed into adolescence and period of young children toprevent and decrease NCD and thus this was a background of our study.Goal. Determine schoolchildren’s food consumption and dietary behavior.Material and Methods. The 2013 Mongolia GSHS employed a two-stage cluster sample designto produce is preventative sample of students in grades 7-12. In total, 60 schools (25 schools fromUlaanbaatar city and 35 rural, respectively) and 203 classes were selected to participate in the MongolianGSHS.School level: The fi rst-stage sampling frame consisted of all schools (urban, rural, public, or private)containing any grades 7-12. Schools were selected systematically with probability proportional to schoolenrollment size.Class level: The second-stage sampling frame consisted of randomly selecting intact classrooms(using a random start) from each school to participate. All relevant classes in each selected school wereincluded in the sampling frame. All students in the sampled classrooms were eligible to participate in theGSHS (2013).“Nationwide health survey based on schools in Mongolia 2013” covered 5393 schoolchildren (age 12-18) from 59 public and private schools. Coverage rate was 89% and total response rate was 88%.Result. According to the WHO recommendations, 18.6 percent (95%CI 17.2-20.1) of students consumedfruits and vegetables fi ve or more times per day. Additionally, consumption of fruits and vegetablesdecreases as age and grade increase.Totally, 31.3 percent (95%CI 29.3-33.3) of students consumed dairy products such as milk, yogurt andcheese two or more times per day in the past month. In addition, 33.0% (95%CI 30.5-35.5) of malestudents eat dairy products compared to 29.5% of female students; that is males consume 3.5% morefruits and vegetables; however there is no statistical difference. On the other hand, 43.4 percent ofchildren aged 12 years or younger consumed dairy products, 32.9 percent of children aged 13 to 15years old and 24.8 percent of children aged 16 years old or older consume dairy products; thus, showinga decreasing trend with age.One of three (33.6%) of students drank carbonated beverages one or more times per day during the pastmonth. Consumption of carbonated beverages differed between males and females (37.6% vs. 29.7%)and increased by age. By age group, high consumption of carbonated and soft drinks was observedamong students aged 16 years old or older (34.4-35.2 percent), while 33.8 percent of children aged13-15 years old, and 29.4 percent of students 12 years old or younger consumed carbonated and softdrinks.Amongst all students, 55.3 percent (95%CI 52.0-69.3) ate breakfast “usually or always”, 26.1 percentate breakfast “sometimes”, and 13.7 percent ate breakfast “rarely or never”. About 1.9% of studentswent hungry to school “usually or always” during the past one month because of insuffi cient food in theirhome.Among participated school children, 26.4 percent (95%CI 21.5-31.9) of students ate fast food three ormore times within the last seven days at restaurants such as Max Burger, Mondonald and their schoolcafeteria. Percentage of students that ate regularly at fast food restaurants or school canteens wasincreased by 8% than the indicator of the previous survey result.Conclusion1. Fruits and Vegetables: One in fi ve students consumed fruits and vegetables in accordance withthe dietary guidelines for healthy eating and this indicator are increased by 2.7% compared to theprevious study.2. Dairy products: Consumption of dairy products is increased by 4% compared to the previous study;however, it is decreased with age.3. Carbonated Beverages: Consumption of carbonated beverages by students was at similar level inboth, urban and rural areas, and it is increased by 6 points from the previous study level, especiallyhigher consumption was observed among male students.4. Fast Food: Percentage of students that ate regularly at fast food restaurants or school canteens wasincreased by 8% than the indicator of the previous survey result.

IntroductionAfter discovering an important biological function of selenium, selenium content and its deficiency arestarted to be extensively studied in numerous epidemiological studies that have been conducted inmany countries in the world. In Mongolia, as a country geographically located in unstable climate zone,there are no studies conducted on selenium so far since the last century, except one study determiningselenium deficiency signs in livestock.GoalTo determine selenium (Se) content in Mongolian wheat and livestock meatMaterials and MethodsIn total 30 samples of wheat planted in Dornod, Uvs, Tuv and Selenge aimags of Mongolia and 142samples of Mongolian beef and beef imported to Russia from China, respectively were underwent inlaboratory analysis. Wheat was hold at room temperature to reach the regular weight, and muscletissue of meat was dried in a lofildryer. Dried wheat and meat were then powdered into homogenousconsistency and were kept in air proof polyethylene container at room temperature until being analyzed.Selenium content was determined by fluorometric method [2].ResultsOut of wheat sorts grown in Mongolia, selenium was detected in extremely low level in wheat of Khalkhingol sort of Dornod aimag (7±1 mkg/kg) and Selenge sort of Selenge aimag (8±1 mkg/kg), and in wheatsold in retail outlets of Baruunturuun soum of Uvs aimag (7±1 mkg/kg) and Khongor soum of Darkhan-Uul aimag (8±1 mkg/kg). However, selenium content was relatively higher in wheat samples of Darkhan34 sort of Baruunturuun soum of Uvs aimag (31±5 mkg/kg) and of Altaiskaya sort of Jargalant (29±3mkg/kg) and Bornuur (32±1 mkg/kg) soums of Tuv aimag, and in sample of retail wheat of Sagil soum(29±1 mkg/kg) of Uvs aimag.When determined the selenium content in Mongolian livestock meat, in average, the selenium contentwere 109-296 mg/kg in beef, 94-200 mg/kg in lamb, 120-225 mg/kg in horse meat and 124-197 mg/kg ingoat, and the differences were not statistically significant (p>0.5). The highest selenium content of 400mg/kg was detected in horse meat of Govi-Altai aimag.Conclusion: The selenium content in wheat and livestock meat which are the mean stable food forMongolians is considerably low.

Background: Disorders in the human body due to selenium defi ciency are associated with geographiclocation or environment, especially selenium concentrations in water and in soil. Selenium concentrationsin the blood of populations around the world, varies greatly. To date, no research has been conducted onaverage serum selenium level of adult Mongolians.Goal. To conduct a comparative study on the average serum selenium level of adult Mongolians bygeographic regions.Materials and Methods. In this study were participated 2339 healthy subjects randomly selectedfrom sampling units based on 4 geographical regions of Mongolia. For the study were used thequestionnaire and biochemical methods. Blood samples were collected from all subjects and serumselenium concentration was measured by the thermo fi sher scientifi c analyzer using atomic absorptionspectrophotometer method.Result: The mean serum selenium level in adult Mongolians was 0.78 μmol/l. A comparative analysisshowed a statistically signifi cant difference (ð<0.0001) in the mean serum selenium level of adultMongolians living in different geographic regions. In particular, the mean serum selenium level ofadult Mongolians was 0.85 μmol/l in the Altai Mountain, 0.57 μmol/l in Khangai mountain, 1.0 μmol/l inGobi, 0.71 μmol/l in Dornod steppe regions and thus indicator was 0.75 μmol/l among adult citizens ofUlaanbaatar. Majority of residents living in Khangai mountain and Dornod steppe regions were at a riskof selenium defi ciency.Conclusions:1. Comparative analysis of the average serum selenium level of adult Mongolians by region showedthat the Gobi region has highest (1.0 μìîë/ë) and Khangai region has the lowest (0.57 μìîë/ë).2. Study fi ndings showed that 7 – 8 individuals out of 10 residents of Dornod steppe and Khangairegions were at the risk of selenium defi ciency.

IntroductionThe imported food products are more than 60 percent of total food consumption of Mongolia. Thelead residue in food products causes chronic and acute poisoning to the human health when exceedsmaximum residues limits, and human exposure and significant public health problems in many partsof the world.GoalTo assess lead residues and health risk of some commonly consumed imported food productsamong Mongolian population.Objectives:1. To determine consumption of some imported food products of Mongolian population;2. To investigate lead residue in some commonly consumed imported food products;3. To assess potential health risk related lead residue.Materials and MethodsThe research used analytic study of cross-sectional study design. Randomly selected 1290 people’simports food consumption was analyzed by questionnaire and body weight measurements. Tooksamples from 145 import products, identified lead residue with Academy of Sciences Soil ResearchLaboratory`s, ASS (USA, 2002) equipment.Results60.7% of imported food samples were lead residues exceeded to Maximum Residues Limits, suchus mean lead residues in meat product were 1.55 mg/kg, in milk product 1.22 mg/kg, in cerealproducts 1.15 mg/kg, in vegetables 1.57 mg/kg, in fruit and fruit juice 1.03 mg/kg, in alcohols drink1.31 mg/kg, and in tea 1.93 mg/kg (p=0.001). Estimated Provisional Tolerable Weekly Intake (PTWI)of lead exposure for survey responses was 0.079mg/kg body weight.Conclusions:1. 60.7% of imported food samples were lead residues exceeded to Maximum Residues Limits,such us mean lead residues in meat product, milk products, fruits and vegetables.2. Imported vegetables (54.0%), cereal 8.4% products (15.5%), fruit and fruit juice (11.8%), andmilk products (8.4%) is main contributing to lead residues in imported food.3. Estimated Provisional Tolerable Weekly Intake (PTWI) of lead exposure for survey responseswas 0.079mg/kg body weight, which is 3.2 times higher than toxicological guidance (PTWI 0.025mg/kg per 1 kg human body weight) and the high health risk level.

Background: In order to study and evaluate the nutrition situation of the Mongolian people. The 2016-2017 NNS V includes 5 different age groups from Mongolian’s four economic development regions and Ulaanbaatar. The NNS V survey quantifies the prevalence of the nutrition conditions that are of greatest concern to the population, particularly young children and pregnant women. Goal: To establish the prevalence of micronutrients deficiency and estimate micronutrient intake in pregnant women Materials and Methods: Totally 2220 pregnant women included in cross-sectional study from urban and rural area. Survey procedures consisted of interview, anthropometric measurements, clinical examinations, and the collection of biological (blood and urine) samples for pregnant women. Micronutrient deficiencies were assessed by tests for hemoglobin, serum, ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), 25-hydroxyvitamin D {25(ОН)D}, spot urine samples for determination of urinary iodine concentration. Result: The prevalence of anemia, as measured by hemoglobin, was 21.4% and the iron deficiency anemia (IDA) was 10.5%, as measured by adjusted serum ferritin or soluble transferrin receptor (sTfR) was 29.6%.
Prevalence of iron deficiency as measured by serum ferritin was also highest in Western 35.1% and lowest in Eastern region 21.5% (P<0.01). The prevalence of vitamin D in pregnant women was high with 75.4% and 4.4% of all pregnant women had sufficient vitamin D status. An additional 20.2% of pregnant women having insufficient levels. The median concentration of 120.5µg/l indicates inadequate iodine status in pregnant women, as the desired range for adequate iodine nutrition in pregnancy 150-249 µg/l. Conclusion
1. One in every 5 pregnant women (21.4%) is anemic.
2. Vitamin D intake among pregnant women (7.3%) is very low, with 75.4% having vitamin D deficiency and vitamin D insufficiency –by 20.2%.
3. Median urinary iodine concentration of pregnant women is 120.2mg/l, considerably lower than WHO recommended reference range, indicating pregnant women are at risk of iodine deficiency.
4. Despite visible growth in vitamin and mineral supplements intake by pregnant women, compared to 2010, the infrequency of intake and failure to consume recommended number of supplements as instructed in the relevant guides persist.

Nutrition is a key factor in the normal functioning of the immune system, and malnutrition is one of the most common causes of immunodeficiency worldwide today. However, the public health policies on immune system and infection lacks the nutritional strategy to ensure the optimal functioning of the immune system Loss of cellular immunity, phagocyte function, blood protein complex, cytokine synthesis, and A-immunoglobulin secretion are generally associated with protein-energy deficiency.
Some vitamins and minerals, such as A, B6, B12, C, D, E, folic acid, zinc, iron, selenium, magnesium, and copper, plays an important role in the immune system function. Deficiency or low levels of micronutrients can negatively affect the immune system and reduce the ability to fight infections.

Background: Iron is an essential mineral needed for physical and cognitive development with iron needs greatest during pregnancy, infancy, childhood, and adolescence. Iron is vital throughout the lifespan as it is a component of haemoglobin, the protein responsible for transporting oxygen from the lungs to body cells for energy production. Iron deficiency results from a depletion of body iron stores due to increased iron needs, inadequate dietary iron intake, reduced iron absorption, or loss of iron from infections caused by malaria, hookworms, and other intestinal parasites. In advanced stages, iron deficiency leads to iron deficiency anaemia, a condition of low red blood cells and reduced oxygen-carrying capacity. Goal: This study aimed to determine body iron stores in Mongolian children aged 6-59 months, and estimate prevalence of iron deficiency among of studied children. Materials and Methods: In this study were used materials that collected during the fifth national nutrition survey conducted in 21 provinces of 4 economic regions and 8 districts of Ulaanbaatar city of Mongolia. The fifth national nutrition survey was household based survey; therefore sampling unit was household with 5 year-old child. We had used demographic information collected by interview methods and laboratory examination results on ferritin, soluble transferrin (sTfR), C reactive protein (CRP) and α1-acid glycoprotein (AFP) in serum samples collected from 6 to 59 months old children, pregnant women and 15–49 year-old men living in child’s households. Serum Ferritin and soluble transferrin (sTfR) were used as a biomarker for iron store and iron deficiency and C reactive protein (CRP) and AFG were used as indicators for acute and chronic infection. The determination of iron status is challenging when concomitant infection and inflammation are present because of confounding effects of the acute-phase response on the interpretation of most iron indicators. Effects of C reactive protein (CRP) and AGP concentrations on estimates of ID according to serum ferritin (SF) and soluble transferrin receptor (sTfR) were considered in the study. Ethical considerations : The survey protocol was discussed at the scientific committee of the Public health institute and approved by director of scientific committee of PHI on June 28, 2016. Ethical approval for conducting the survey, including obtaining biological samples was obtained from the Medical ethics committee under the Ministry of Health of Mongolia on July 7, 2016. Participation in the survey was voluntary, oral and written informed consent was obtained from each participants and adult caregivers of under 5 year-old children. Results: Biomarkers of iron status were adjusted with inflammation indicators and estimated iron deficiency (ID) and total body iron store in 1732 children 6-59 month-olds. The study findings showed that adjusted mean concentration of serum ferritin and soluble transferrin receptor was 33.7 µg/l and 8.8 mg/l in children age of 6-59 months, respectively. The calculated total body iron store by using adjusted SF and soluble transferrin receptor was 2.8 mg/kg among surveyed children. Iron deficiency was estimated by using 2 different biomarkers among selected population group. The prevalence of iron deficiency estimated by using SF was 20.7% in children 6-59 months. Iron deficiency in children defined by using serum soluble transferrin receptor was 27.7%. Conclusions
1. The average serum ferritin and soluble transferrin receptor concentrations was 33.7 µg/l and 8.8 mg/l in children age of 6-59 months, respectively. Total body iron store estimated by using SF and soluble transferrin was 2.8 mg/kg among surveyed children.
2. The prevalence of iron deficiency estimated by using SF and sTfR was 20.7% and 27.7% in children 6-59 months, respectively. According to the WHO recommendation, prevalence of iron deficiency among Mongolian children aged 6-59 months is classified as “prevalent”.
3. Overall proportion of children with low body iron store was 22.4%. The prevalence of iron depletion is relatively common in boys, young children aged 6–23 months, and rural children aged 6-59 months.

Background : Overweight and obesity are conditions of over nutrition resulting from consumption of more calories than the body requires leading to excess body fat accumulation. The prevalence of both overweight and obesity is increasing globally in all age groups in high, middle, and low-income countries and is largely attributed to the “nutrition transition” with a shift from traditional diets to readily available and inexpensive, low-nutrient unhealthy foods high in energy [1].
The move away from traditional to “junk” foods often occurs at the same time as the move of populations away from daily physical activity and increase in sedentary activities such as time spent in front of a phone, computer, or television, furthering increasing the risk of becoming overweight. People who are overweight or obese are at higher risk for serious health problems including hypertension, heart disease, stroke, diabetes, some cancers, and osteoarthritis. The increase in overweight and obesity is accompanied by a dramatic increase in prevalence of above mentioned chronic conditions in the worldwide. While the long-term repercussions of overweight and obesity are severe, they are largely preventable and treatable through healthy diets and healthy lifestyle behaviors [2]. Materials and Methods: The fifth National nutrition survey (NNSV) was implemented in 21 provinces (aimags) in 4 socio-economic regions (Central, Eastern, Khangai, and Western) and the capital city of Ulaanbaatar. Given the regional differences in dietary patterns and nutrition status, target populations were stratified into 5 strata based on 4 regions and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design. In total, 1750 school children data on demographic and dietary information collected by interview methods and anthropometric measurement results were used in this study. Ethical considerations: The survey protocol was discussed at the Scientific Committee of the Public Health Institute (recently named by National Center for Public Health) and granted by order of director of Scientific committee of PHI on 28th June, 2016. Ethical approval for conducting the NNS V was obtained from the Medical Ethics Committee under the Ministry of Health of Mongolia on July 7, 2016. Participation in the survey was voluntary, oral and written informed consent were obtained from adult caregivers of each children. Results: Consumption of unhealthy or junk (high-calorie, low-nutrient) foods in the past week was nearly universal (99.0%) among school children 6-11 years of age. Over half of children (51.4%) consumed junk foods at least once per week and 45.7% consumed junk foods a few times a week. Consumption of sugar-sweetened beverages was high with 80.9% of children consuming these at least once in the past week. Overall consumption of fried foods was lower than consumption of junk foods or sugar-sweetened beverages with 22.7% of children not consuming any fried foods in the past week and only 8.5% of children consuming fried foods a few times per week. Consumption of sweet foods was high with nearly all children having consumed sweet foods in the past week, 45.9% of children 6-11 years having consumed sweet foods a few times per week.
The prevalence of overweight (BMI > +1 SD) was 22.2% and prevalence of obesity (BMI > +2 SD) was 6.4%. Overweight prevalence was higher in boys (26.6%) compared to girls (17.8%) and in urban (23.9%) compared to rural (17.6%) areas with the highest prevalence in Ulaanbaatar (25.6%) compared to other regions. Children 6 years old (26.1%) and 7 years old (25.6%) had a higher prevalence of overweight than older children. Conclusion
1. Consumption of unhealthy foods and drinks is common to 6-11 year olds group, with almost all children (99.2%) consuming any type of unhealthy foods and drinks at least once per week, in particular, 8 out of 10 children were found consuming sugary drinks and/or deep fried food.
2. The consumption of unhealthy foods was not differing by child’s sex, there were revealed significant differences between living area and regions. Proportion of the school children 6-11 years of age was relatively higher in Ulaanbaatar city and urban settings.
3. The prevalence of overweight and obesity in school children aged 6-11years sharply increased from 2010 NNS IV level and reached 22.2% and 6.4%, respectively. Among children with obesity consumption of any unhealthy foods and sugary drinks were 1.4–1.9 times higher than nonobese children, respectively.

Background: Chemotherapy-related acute exacerbation or hepatitis flares related to HCV positive B cell non-Hodgkin’s lymphoma (B-NHL) is one of the significant clinical issues Material and Method: We studied anti-HCV incidences among patients newly diagnosed with B-NHL, from 2015 to 2018. Survey data were collecting from medical history, electronic medical record system of First Central Hospital was acquired and collected according to the research ethics (approved by Ethics Committee of Ministry of Health, No.4 on June 19, 2017). Also, cases of chemotherapy-related acute exacerbation (AE) for HCV-RNA positive cases were studied. Student’s t-test or nonparametric statistics were utilized to test for statistically significant differences in continuous variables, whereas the chi-square or Fisher’s exact test was used for categorical variables. p<0.05 was considered statistically significant. Results: The study showed that 39.5% of 233 cases with B-NHL are anti-HCV positive. Anti-HCV positive prevalence among B-NHL subjects was significantly higher compared to the general population. Chemotherapy-related AE occurred in 21.05% for the anti-HCV positive group and 36.36% for HCV-RNA positive group. Furthermore, before chemotherapy alanine aminotransferase (ALT) median was 15.2 for the group without AE, whereas it was 48.2 for the group with AE (p<0.01). Conclusions Our study showed that the prevalence of anti-HCV positive among B-NHL patients was significantly higher than the general population prevalence. For all cases of AE, HCV-RNA was positive, and these patients were treated with only chemotherapy without any anti-viral treatment. Anti-viral therapy needs to be introduced urgently to prevent AE since liver fibrosis is aggravated quickly after AE.