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Significant among the 21st century's global health challenges is the growing prevalence of obesity and insulin resistance, particularly type 2 diabetes mellitus (T2DM) [1-3]. Type 2 diabetes mellitus is characterized by obesity and insulin resistance and is associated with cardiovascular disease, renal disease, neuropathy, nonalcoholic fatty liver disease, blindness and malignancy, making it a significant global cause of morbidity and mortality [2,3] Research increasingly indicates that obesity, metabolic derangement and T2DM could be interrelated through the gut Microbiome, as studies have found that obese individuals possess a Microbiome that diverges significantly from that found in lean individuals [1].
The gut Microbiome refers to the ecosystem of >1014 bacteria that reside in the human gastrointestinal tract in a symbiotic relationship with the human host [2,3]. It is well documented that the gut Microbiome plays a role in host health by synthesizing vitamins and altering bile acid solubility. The Microbiome also contributes to daily caloric intake via the breakdown of insoluble dietary components into the short chain fatty acids (SCFA) acetate, propionate and butyrate. Without the gut Microbiome, these dietary elements would be indigestible by the human enterocyte [2]. Additionally, the Microbiome influences disease states -deviations from normal gut flora impact numerous inflammatory and metabolic conditions such as inflammatory bowel disease, irritable bowel syndrome, nonalcoholic fatty liver disease, T2DM and obesity [1-4].
Current hypotheses regarding mechanisms of Microbiome impact on obesity and insulin resistance include enhanced absorption of nutrients, enhanced SCFA production and lipogenesis, decreased activity of fasting-induced adipose factor, increased inflammation and intestinal permeability and altered bile acid circulation [2]. The focus of much research in recent years has been the SCFA butyrate and its relationship to obesity and T2DM. A preliminary search of PubMed reveals that the number of papers published on "butyrate and obesity" or "butyrate and diabetes" has almost doubled in the last decade. Specific research that focuses on the role of SCFAs in obesity and T2DM indicates that butyrate may promote insulin sensitivity in peripheral tissues, contribute to glucose homeostasis and may even prevent and treat diet-induced insulin resistance in obesity [1,5]. However, the majority of studies have been performed in rodents and there is still a great deal of knowledge to be elucidated on the subject of human gut Microbiome interactions with obesity and T2DM, as well as the impact of specific SFCAs and microbial products on insulin resistance and glucose tolerance [2].
The obese Microbiome exhibits decreased bacterial species diversity and altered species -to-species ratios, both of which are associated with increased insulin resistance. Specifically, in T2DM, the populations of the phyla Firmicutes is increased, while Bacteroides is decreased [3]. Studies indicate, albeit with varying levels of certainty, that these derangements in bacterial ratios correlate with decreased numbers of butyrate-producing bacteria and increased numbers of Lactobacillus, a Firmicute. Butyrate then appears significant in the relationship between insulin resistance and the Microbiome. In fact, insulin-resistant individuals treated with vancomycin were noted to have a decrease in the number of butyrate-producing gut microbiota and an associated increase in insulin resistance. Additionally, fecal transfer of lean individuals into obese recipients results in increased insulin sensitivity and increased numbers of butyrate- producing bacteria in the Microbiome of obese recipients[4].
Studies in mice have attempted to characterize the impact of butyrate on insulin resistance and obesity, however such studies are lacking in humans. A study of mice that underwent Roux-en-Y gastric bypass (RYGB) indicates that the microbiome of post-RYGB mice is modified compared to that found in the native gut. Indeed, diabetic mice that received a fecal transplant from the gut of post-RYGB mice were noted to have weight loss, improved glucose and lipid metabolism, and an increase in butyrate-producing organisms in their gut microbiota [3]. This data, in conjunction with a study by [5] continues to lend significance to butyrate's role in modulating insulin sensitivity. In this study, obese mice received dietary supplementation with butyrate and were noted to have increased insulin sensitivity and decreased body fat content. In addition, mice receiving a high fat diet supplemented with butyrate did not develop insulin resistance and obesity. In comparison with mice not receiving butyrate supplementation, these mice had decreased adiposity, increased energy expenditure, and increased fatty acid oxidation [5] This indicates that dietary supplementation with butyrate can prevent insulin resistance in susceptible animals and halt further development of obesity in already obese mice [5].
Although some promising research has been conducted to untangle the mechanistic relationships between obesity, insulin resistance, and the function of the gut Microbiome in mice, there is a dearth of information on these subjects in humans. In order to more fully investigate etiology and treatments for T2DM, obesity and insulin resistance, research on the Microbiome and its role in these conditions needs to shift its focus into human subjects. Future studies could investigate the effect of dietary supplementation with butyrate in humans, as well as attempt to characterize the mechanism of action of SCFAs in inducing insulin-sensitivity, should that be a benefit of human butyrate supplementation. Moreover, studies could investigate the impact of diet upon the gut microbiome and attempt to characterize the relationship between changes in diet and changes in microbial populations. Mechanistic studies could characterize the most representative places in the gastrointestinal tract from which to sample the Microbiome, and still other studies could investigate the role of individual species as opposed to the "cocktail" of the entire Microbiome in inducing insulin sensitivity.
We look forward to developments in translational research in the relationship between the gut Microbiome and obesity and T2DM.
Background: Biliary Atresia (BA) is the most common cause of chronic cholestasis in infants It is a destructive inflammatory obliterative cholangiopathy that affects varying lengths of both intrahepatic and extrahepatic bile ducts. Even after a successful surgery, scARGHing of the liver can continue, resulting in cirrhosis and its complications.
Aim: The aim of this study is to evaluate different serological markers derived from routine investigations in the prediction of liver fibrosis in infants with BA.
Methods: This retrospective study included a total of 147 infants with proved diagnosis of BA. We employed six noninvasive scores (FIB-4, FibroQ, King’s score, APRI, GUCI and AAR). Liver fibrosis was classified into 5 grades. For further descriptive purpose, we arbitrarily divided fibrosis grades into early (F1, F2 and F3) and advanced (F4 and F5) fibrosis.
Results: FIB-4, FibroQ and King’s score correlated significantly with fibrosis grade (P values were 0.007 and 0.015 respectively) while there was no significant correlation with other studied scores (P value >0.05). FIB-4, FibroQ and King’s score were significantly higher in patients with advanced fibrosis compared to early fibrosis and at cutoff values of 0.0098, 0.0085 and 0.115 respectively they were able to discriminate those with advanced fibrosis with acceptable sensitivity (61.9%-64.3%) and specificity (60.0%-62.9%).
Conclusion: Conclusion: FIB-4, FibroQ and King’s score, but not APRI, GUCI and AAR, correlated significantly with fibrosis and could predict those with advanced fibrosis with relatively acceptable performance. These markers may be of help in predicting advanced fibrosis and in long term follow up of infants with BA and reduce the need for repeated liver biopsy.
Biliary Atresia (BA) is the most common cause of chronic cholestasis in infants and the most frequent cause for surgery in cholestatic jaundice in this age group. It is a destructive inflammatory obliterative cholangiopathy that affects varying lengths of both intrahepatic and extrahepatic bile ducts [1]. If not treated, BA leads to biliary cirrhosis, hepatic failure and death within the first two years of life [2,3].
The etiology of BA has been a subject of intense investigation. However, the precise etiology remains largely unknown [4]. The initial event may be a viral infection, which targets the biliary epithelium [5]. This is followed by activation of immune cells and release of proinflammatory cytokines that perpetuates the injury and causes biliary destruction, which is followed by collagen deposition to produce the atresia phenotype [6]. Some studies suggested the involvement of biliary morphogenesis genes [7,8] or very recently discovered biliary toxin; biliatrisone [9,10].
The principal treatment of BA is based on surgical reconstruction of bile flow by Kasai portoenterostomy. However, such interventions can be insufficient to prevent further hepatic injury. Even after a successful surgery, scARGHing of the liver can continue, resulting in cirrhosis over the years. This is probably due to the ongoing inflammatory process [11].
Complications of progressive fibrosis and cirrhosis such as esophageal varices may endanger the patient’s life and necessitates urgent intervention [11]. Furthermore, the success of Kasai portoenterostomy is largely dependent on the absence of advanced fibrosis or cirrhosis [12]. For that, noninvasive prediction of liver fibrosis in such patients, avoiding the risks of repeated liver biopsy [13,14] and its limitations including sampling error, and inter- and intra-observer variability in interpretation [15], would be of value during monitoring and follow up of this devastating disease [16]. The aim of the current study was to evaluate different serological markers derived from routine laboratory investigations in the prediction of liver fibrosis in infants with BA.
This retrospective study included 147 infants with surgically proved BA attending the Department of Pediatric Hepatology, Gastroenterology and Nutrition in the period between year 2010 and 2015. Preoperative demographic (age and sex), laboratory data including total and direct bilirubin, transaminases (alanine transaminase; ALT and aspartate transaminase; AST), biliary enzymes (gammaglutamyl transpeptidase; GGT and alkaline phosphatase; ALP), total proteins, serum albumin, international normalized ratio (INR) and platelets count were collected. Hepatic histopathological features in the form of portal fibrosis, were also revised. Due to the retrospective nature of the study, an informed consent was not needed. The study was approved by the Research Ethics Committee of the National Liver Institute, Menofiya University, Egypt.
Fifteen milliliters venous blood samples were taken by sterile venipuncture, without frothing and after minimal venous stasis using disposable syringes. The blood samples were distributed as follows: 5 ml of venous blood were delivered in a vacutainer plain test tube. Blood was left for a sufficient time to clot; serum was then separated after centrifugation at 3000 rpm/min for 10 min for liver function tests. Five milliliters of venous blood were delivered in a vacutainer plastic tube containing EDTA for complete blood count (CBC). Five milliliters of venous blood were delivered in a vacutainer plastic tube containing Sodium Citrate for INR. CBC was performed on Sysmex KX-21 (Wakinohamakaigandori, Kobe, Hyogo, Japan). Liver function tests [ALT, AST,albumin, total protein, total bilirubin, direct bilirubin, ALP and GGT] were conducted using Integra 400 autoanalyzer (Roche- Diagnostics, Mannheim, Germany). Prothrombin time and INR were conducted using Sysmex CA 1500 coagulometer
infection received peg-interferon and ribavirin treatment for 48 weeks, out of nine patients showed Resistance to the treatment. Blood sampling were made on at start and end of the treatment. Based on the therapeutic response to antiviral treatment, those 18 patients could divide into two groups: Treated (Responder, R) 9 patients, and Resistant (Non-responder, NR) 9 patients.
Ultrasonography-guided liver biopsy was done for all patients using a tru-cut needle. Biopsy specimens were fixed in formalin and embedded in paraffin. Five-micron thick sections were cut and stained with Hematoxylin-Eosin, Mason-Trichrome, Orcein and Perls’ stains for routine histopathological evaluation. Portal fibrosis was assessed using a semi-quantitative histopathological score as described by Russo et al. [17].
The employed scores was calculated as follows; AST-toplatelet ratio index (APRI) was calculated according to the formula; APRI = AST / upper limit of normal x 100 / platelet count (109/L) [18]; Fibrosis-4 (FIB-4) = Age (years) x AST / platelet count (109/L) x (ALT)1/2 [19]; Fibro-quotient (FibroQ) index using this formula 10 × (age in years × AST × INR)/(ALT × platelet count) [20]; King’s score using this formula Age (years) x AST (IU/L) x INR/platelet count (109/L) [21]; AST/ALT ratio (AAR) [22]; Göteborg University Cirrhosis Index (GUCI) using the formula (Normalized ASTxINRx100)/platelet count (109/L) [23].
This retrospective study included 147 infants with surgically proved BA attending the Department of Pediatric Hepatology, Gastroenterology and Nutrition in the period between year 2010 and 2015. Preoperative demographic (age and sex), laboratory data including total and direct bilirubin, transaminases (alanine transaminase; ALT and aspartate transaminase; AST), biliary enzymes (gammaglutamyl transpeptidase; GGT and alkaline phosphatase; ALP), total proteins, serum albumin, international normalized ratio (INR) and platelets count were collected. Hepatic histopathological features in the form of portal fibrosis, were also revised. Due to the retrospective nature of the study, an informed consent was not needed. The study was approved by the Research Ethics Committee of the National Liver Institute, Menofiya University, Egypt.
The current study included 147 infants with BA. Their mean age was 76 ± 41 days and 55% were females. Other baseline laboratory parameters and histopathological fibrosis grades were as presented in Table 1.
The selected scores were compared according the individual fibrosis grades. In all the six scores, the values were at its lowest in F1 and was highest in F5 except for FibroQ and AAR, the values were lower than that of F4, yet, there was no significant statistical difference among the different grades of fibrosis (Figure 1). On the other hand, correlation analysis revealed a significant positive correlation of FIB-4, FibroQ and King’s scores with fibrosis grades (P values were 0.007 and 0.015 respectively) while there was no significant correlation with the other studied scores (P value >0.05) as shown in Table 2.
APRI: AST-to-platelet ratio index; FIB-4: Fibrosis-4; FibroQ: Fibro-quotient; AAR: AST/ALT ratio; GUCI: Göteborg University Cirrhosis Index.
For descriptive purpose, we arbitrarily divided fibrosis grades into early (F1, F2 and F3) and advanced (F4 and F5) fibrosis. Again, FIB-4, FibroQ and King’s scores showed a significantly higher values in those with advanced fibrosis (P values were 0.007, 0.017 and 0.009 respectively) while there was no significant difference using the other studied scores (P value >0.05) as shown in Table 3.
The three scores (a cutoff value of 0.0098 for FIB-4; 0.0085 for FibroQ and 0.115 for King’s score) showed nearly a comparable performance in discriminating advanced fibrosis (Table 4).
The prognosis of chronic cholestatic diseases depends, in part, on the extent of liver fibrosis [24,25], while it markedly influences the outcome of Kasai protoenterostomy in infants with BA [12]. In addition, it identifies those in need of liver transplantation whether in those who performed a previous Kasai operation or not [26,27] For that follow up of fibrosis progression is of utmost importance. Liver biopsy, being the gold standard in assessment of liver fibrosis, is not largely accepted when repeated, especially in the pediatric population. For that , the use of noninvasive predictor of liver fibrosis is needed [28,29].
Several noninvasive markers and scores have been applied satisfactorily in hepatitis C virus [18] and non-alcoholic fatty liver diseases [30], while studies on its use in BA are very limited. APRI score has been used in predicting liver fibrosis in BA. Yet, the results are contradictory. Kim et al. [31] reported that APRI significantly discriminated F3 and F4 Metavir score in infants with BA. AUROC for F≥3 and F=4 were 0.92 and 0.91, respectively. Distinct optimal cutoff values of APRI for F≥3 and F=4 were obtained (1.01 and 1.41, respectively). In addition, Grieve et al. [16] using a cutoff value of 1.22 [AUC 0.83] showed a sensitivity of 75% and a specificity of 84% for macroscopic cirrhosis. Native liver survival was significantly different but improved only for those with the lowest APRI quartile (P=0.009). Similar results were also reported by Yang et al. [32].
On the other hand, Lind et al. [33] found that APRI did not significantly differ in various fibrosis Metavir scores (P = 0.89) and was not correlated with transplant-free survival (r=0.08; P=0.67) in infants with BA. Our results are in agreement with that of Lind et al where APRI value neither differ significantly with different Russo fibrosis grades (P = 0.445) nor correlated with fibrosis (r=0.15; P = 0.07). Nonetheless, APRI values increased successively as fibrosis increases with its lowest in F1 and highest in F5.
Other scores have been used in predicting fibrosis in HCV, all of which are dependent on the routine laboratory tests regularly performed in these patients. Leung et al. [34] found that APRI performed better than FIB-4 in predicting fibrosis studied in children with cystic fibrosis liver disease. In the current study, contrary to APRI, FIB-4 was significantly correlated with fibrosis in BA (P = 0.007) and was significantly higher in those with advanced fibrosis (Russo F4 and F5; P=0.007). With AUROC of 0.644, FIB-4 could predict advanced fibrosis with 61.9% sensitivity and 61.9% specificity. On the other hand, Chen et al. [35] reported that FIB-4 failed to correlate with fibrosis stage. This may be due to the small number of patients in Chen’s study (n = 24) compared to our study (n = 147).
GUCI and AAR were able to predict fibrosis in HCV and hepatocellular carcinoma in addition to predicting response to antiviral therapy [36-38]. In our study, both scores were not correlated with liver fibrosis (P = 0.063 and 0.523 for GUCI and AAR respectively) and could not discriminate advanced from early fibrosis. Unfortunately, there are no reported studies for their use in BA.
On the other hand, FibroQ and King’s score showed a significant positive correlation with fibrosis grade (P = 0.015 for both) and at a cutoff value of 0.085 and 0.115 respectively, both could discriminate advanced fibrosis from early fibrosis with comparable sensitivity (64.3% for both) and specificity (60.0% and 62.9% respectively). King’s score has been used in assessing fibrosis in chronic hepatitis B [39] and hepatitis C [21] but no reports about its use in predicting fibrosis in BA. Combining the three scores (FIB-4, FibroQ and King’s score) did not improve the performance compared to the performance of each score individually. Although statistically significant, the performance of these scores was found to be better in adult studies with chronic hepatitis C. This may be due to the fibrogenic nature of BA and the relatively high platelet counts even in cases with advanced fibrosis [40] which may influence the performance of platelet count-based scores.
In conclusion, FIB-4, FibroQ and King’s, but not APRI, GUCI or AAR, correlated significantly with fibrosis grade in infants with BA. These noninvasive serological markers, which are derived from simple routine laboratory tests, may be of help in predicting advanced fibrosis and in long term follow up of infants with BA, and minimize the need for repeated follow up liver biopsies.
Telomeres are structures at the ends of eukaryotic chromosomes and consist of tandemly repeated DNA sequences. Telomeres shorten with each cell division, and it is well known that telomere length in peripheral blood mononuclear cells (PBMCs) decreases with age. High oxidative stress can lead to accelerated telomere shortening, which causes premature cell senescence. In summary, this review shows the short Telomere Length has been identified in a limited number of population studies as a risk factor for development of T2DM. Also, it is importantly to notice the antioxidant properties of Curcumin which may play a key role in the prevention and treatment of premature aging while preserving the length of the telomeres.
Diabetes Mellitus 2 (T2DM) is a multifactorial complex disorder which is emerging as a major cause of morbidity and mortality [1]. Telomeres are structures located at the extreme ends of chromosomes and are considered as indicators of biological age [2]. Increased telomere shortening has been demonstrated in several diseases, including diabetes type [3-6]. Telomere shortening increases with the diabetes duration, in our study, we established the potential importance of telomere dynamics in T2DM. We associated the time of disease duration closely in parallel to the progressive increased of inflammation and/or oxidative stress and both played a direct role in telomere shortening [7]. However, a study based on Chinese population found no relationship between Telomere Length and either the onset time or the Diabetes Mellitus 2 duration [8]. Genetic regulation of telomere could potentially explain telomere shortening and also an increased risk for Diabetes Mellitus 2. Zee et al. [9], analyzed 11 telomere pathway genes and their relationship to the development of Diabetes Mellitus 2. A total of eleven tSNPs within TERF1, TNKS, TEP1, ACD and TERF2 were associated with Diabetes Mellitus 2 risk [9]. These findings suggest that genetic variation within the telomere pathway gene loci examined may be a useful predictor for Diabetes Mellitus 2 risk assessment [10,11]. Paik JK, et al. [12], did not observe an association between the selected TL-related SNPs and the presence of Hypertension and Coronary Heart Disease in [12]. These findings tell us the great importance of telomere dynamics in T2DM and the need for translational research.
Endogenous factors that cause telomere shortening are aging inflammation and oxidative stress. Telomere attrition (expressed in WBCs) can serve as a biomarker of the cumulative oxidative stress and inflammation [13,14]. The association of UCP2 gene involved in the production of reactive oxygen species and functional promoter variant in mitochondria with the telomere length implies a link between mitochondrial production of reactive oxygen species and shorter telomere length in Diabetes Mellitus 2 [15]. Oxidative stress exerts a major influence on telomere dynamics by two principal mechanisms; firstly, the GGG triples on the telomere sequence are highly sensitive to the hydroxyl radical. Masi et al. [16] demonstrated that antioxidant defenses are important to maintain telomere integrity, potentially reducing the progression of vascular ageing in patients with T2DM. Secondly in contrast to genomic DNA, telomeric DNA was reported to be deficient in the repair of single-strand breaks. Consequently telomeres appear to be especially vulnerable to the accumulation of ROS-induced DNA- strand breaks [17,18].
Recent studies propose that telomere shortening and abnormal telomerase activity occur in patients with diabetes mellitus 2 and targeting the telomere-telomerase system has become a prospective treatment for diabetes mellitus [19]. Dietary supplementation of antioxidants has been proposed as alternative treatment to reduce oxidative stress caused by obesity and diabetes. Different studies have shown that curcumin has antioxidant and antihyperglycemic properties in diabetes and obese animal models [20-24]. Hyperglycemia modifies oxygen consumption rate, NO synthesis and increases TBARS levels in mitochondria from the liver and kidneys of diabetic mice, whereas curcumin may has a protective role against these alteration [25-27]. Antioxidant properties of curcumin could play a key role in the prevention and treatment of chronic inflammation diseases [28]. Zhou et al. [29] demonstrated that diet ingredients significantly have an impact on inflammation and oxidative stress markers, which probably also have an effect on Telomere Length. Diabetes patients with normal plasma glucose levels had longer Telomere Length [29].
Telomere Length has been identified in a limited number of population studies as a risk factor for development of T2DM, antioxidant defences are important to maintain telomere integrity, Curcumin which may play a key role in the prevention and treatment of premature aging while preserving the length of the telomeres.
This paper reviews the development of dairy cow raising in Vietnam in the last two decades. In the period 2001-2017, fresh milk production growths annually 14.7%. The households have the tendency to raise more 10 cows. Processing companies invested much in dairy cow raising with total number of cows in company farms represent about one third. Processors buy milk directly from households or through their cooperative. The contribution of rapid growth of dairy cow raising in Vietnam are increased need of fresh milk, improved income of household, increased urban population and total population, very higher profit of dairy cow raising, improved technique and high technology, support of public services and policy.
The dairy cow raising has been introduced to Vietnam from 1920s. Before 2001, the dairy cow raising in Vietnam was at a very small scale and low development level. The dairy cow raising began growing vigorously from 2001 thanks to promoting policy of Vietnamese Government. The fast increase of the income of Vietnamese people and the positive awareness of consumers create favorable condition for milk industry of Vietnam to fast develop in the last two decades. Thanks to that, the dairy cow raising also grows rapidly, resulting in positive transformations in direction of the enlargement of cow production scale and enhance the performance of the sector. This paper reviews the development of dairy cow raising sector of Vietnam, in particular in the last 10 years. Concretely, the paper presents the development of cow herd, milk production, productivity, model of production, dairy cow raising at small household, the coordination in value chains and factors affecting this development. The review is based on existing documents and analysis from secondary data.
Dairy cows raising in Vietnam registered in rapid growth since 1990s. The number of dairy cows and milk production has been incessantly increasing. In 1990, total dairy cows of Vietnam were only about 11 thousand of head, and then in 2017 is 301.6 thousand of cows. In the period 1990-2000, the cow increased every year about 2327 heads (annual growth rate is 11.6%), the equivalent numbers in period 20010-2012 are 9114 cow (9.8%), and for period 2013-2017 are 28580 cows (11.8%). The fastincreasing number of cows in the period 2013-2017 come from the increase of cows raised by big companies as TH True Milk and Vina milk. In 2017, the fresh milk production of Vietnam achieved 881.3 thousand of tons, compared to 36.0 thousands of tons in 1990 and 55.1 thousand of tons in 2000 respectively. In the period 2001-2017, annual growth rate of domestic fresh milk production is 14.7%. The increase of domestic milk production has made the contribution of increased number of cows and increased milk productivity. The increase of milk yield happens both in household farming and in big farms of companies. The data from Ho Chi Minh city, a big area of dairy cow raising, indicated the increase of milk productivity of a cow increased from 3.1 tons per milking cycle to 5.5 tons in 2013. However, milk productivity of companies is much higher because they use pure exotic breed while household mainly use cross breed of F1, F2, even F3 (Figure 1).
In 2001, dairy cow raising registered only in 12 provinces, in 2005, dairy cow raising was expanded in 33 provinces and stable until now. However, cow herd is concentrated in some provinces. From 2010 to 2017, 10 provinces always represent more 90% of total cow herd of the whole country. In 2017, 2 provinces have biggest cow herd are Ho Chi Minh (28.0%) and Nghe an (21.4%). Some provinces have the sharp increase of cow herd thanks to investment of big companies in dairy cow raising. For example, the number of cows increased spectacularly in Nghe an province in last years because of number of cows raised by 2 big companies as TH True Milk and Vina milk. Only TH True Milk reported its cow herd of 45000 and Vina milk has just invested a mega farm of cow. Generally, the provinces having high number of dairy cows have climate condition favorable to dairy cow raising. The distribution of cow herd by region and by province is presented in Figures 2 & 3.
Dairy cow raising in Vietnam started in 1920s by the introduction of foreigners. In this period, dairy cows only were raised in farms of foreigners in 2 cities as Ha Noi and Sai Gon. The number of cows were about 300 heads and the milk productivity were very low (2-3 kg/head/day) [1]. In the South of Vietnam, before 1975, dairy cows were mainly raised in the suburb of Saigon city and at household level with scale of 10-20 heads/household, to provide fresh milk for the restaurants and consumers. Contrariwise, in Northern area from 1960 the Government developed State farms to raising dairy cows. These State farms were developed in the provinces with favorable natural condition (weather, land) as Ha Noi, Son La, Quang Ninh, Lai Chau, Lao Cai, Thanh Hoa. Dairy cow scale of State farms is less than 1000 heads, with breed of Holstein Friesian (HF). After the reunification in 1975, State farm for dairy cow raising is established in Lam Dong province in 1976 [1]. In summary, in the period of before 1986 when Vietnam had implemented centralized and planning economic system, dairy cow raising in Vietnam were mainly in the form of State farms. The dairy cow raising at household scale was not developed. The “innovation process” has been implementing in 1986 allows the development of household economics. Then, the dairy cow raising at household scale has been developed in the suburb of Ha Noi and Ho Chi Minh cities. The model of dairy cow raising household appeared firstly at the suburbs surrounding the big cities because of locating near the milk processing plants to save the transportation cost and avoid the quality damage caused by the inconvenient traffic and unsuitable preserved tools. In period 1986-1999, the dairy herds grew at average of 11% per year.
Since the Government support policy was issued in 2001, the dairy cow raising of households has been strong developing, expanded in several provinces. In 2016, Vietnam has 32349 dairy cow raising households, representing 0.3% of agricultural – forestry - fishery households. While dairy cow raising at household level develops rapidly, the State farms operate ineffectively. Consequently, the Government had the plan to restructure State farms in 2005. State farms were either privatized or redistributed their land to households for creating joint venture companies. Then, dairy cow raising consists of both individual households and milk processing companies. According to data of Department of Livestock Production [2], in 2018 the number of dairy cows owned by companies represent about one third of total herd of Vietnam. Some companies have numerous cows as TH True Milk (45000 cows), Vina milk (27000 cows), Moc Chau (25000 cows).
Nearly 70% of cow herd is raised in small households. In 2016, there were 32349 cow raising households with an average of 6.4 cows per household [3]. The number of cows per households is very different among households and among regions. The current trend of dairy cow raising in Vietnam shows that the cow herd sized under 5 heads is now decreasing and the one sized over 5 heads is increasing. For example, in Ho Chi Minh city in 2005, households having less than 5 cows accounted for about 56 % but this figure in 2013 is only 20%. The number of households with cow herd sized from 10-49 has sharply increased (Table 1). The number of households with less 10 dairy cows reduced because unit production cost per milk kg of these households is higher than households with more than 10 cows (Table 1). Lower unit production cost of household with more 10 cows come from the exploitation of economic scale in using feed and labor [4]. In addition, in some cases, the trading companies wouldn’t like to buy the milk from households with less than 10 cows. Remark: a Family labor for dairy cow raising is priced at cost for hired labor; b Turnover includes the revenue from selling milk, calf and waste; 1 USD = 23 255 VND at exchange rate in April 2019 (Figure 4).
Source: Author’s calcul from data of Ho Chi Minh [3].
Even increased, the milk productivity of households is much less than one of companies. That comes from the fact that about 90% of dairy cows raised in households are crossbreed, mainly F2 and F3. Only about 10% of cows are pure exotic breed. About 50% of households use only calves reproduced by their cows and 50% remain households use both their calves and calved bought outside households [4]. Nearly 100% of households use industrial feed for cows, in which 50% only used industrial feed and 50% use both bought industrial feed and feed mixed by themselves (Table 2) (Figure 5).
Source: Synthesis from Hoang Vu Quang and Ta Van Tuong [10].
Because of characteristics of fresh milk is quickly spoiled in normal condition, fresh milk need to be preserved in cool condition just after milking, so the vertical coordination in fresh milk supply chain is very high. Nearly 100% of households have presently the contract with milk processors.
Based on stakeholders involved in fresh milk supply chain, it can classify in 5 supply chains in Vietnam in present time as following:
a. Supply chain 1: Household - local and small processor - local market. This supply chain represents a small proportion of producers and milk volume. For example, about 4% of fresh milk in Lam Dong province in 2017 were not signed the contract with processing companies. That come from new producers or households violated the engagement with buyers and are out of contract as punished measure. These producers sell their milk to small processors to produce milk cake or artisanal milk processing [5].
b. Supply chain 2: Household - processing companies - domestic market. This is important chain in term of milk volume. For example, 84% of fresh milk produced in Lam Dong provinces are sold in this chain [5]. The processing companies sign contract farming directly with individual household. The cow producers normally have to meet the requirement of processors as cow scale, used feed, hygiene and disinfection measures, antibiotic use, etc. The processing companies can support households as giving training course, support for treating diseases [6]. The companies usually put collecting stations nearly households to receive their milk.
c. Supply chain 3: Household - cooperative - processing companies - domestic market. Some processing companies purchase fresh milk from cooperative. In this case, the cooperatives like fresh milk collecting stations for the companies. These cooperatives have the infrastructure and equipment for buying, preserving milk in cooled system. However, we registered in 2018 only some cooperatives in doing that such Eve growth cooperative in Soc Trang and Tan Thong Hoi cooperative in Ho Chi Minh [7]. The companies do not want to sign the contract with agricultural cooperative because of limited capacity of cooperatives.
d. Supply chain 4: Household - cooperative - domestic market. One new tendency emerging from 2017 is that the cooperatives involves directly in milk processing and commercialize milk products. These 2 cooperatives have experience in preserving fresh milk and good operation. They want to involve in processing milk in aiming to ensure the market for fresh milk and have more added values for their members. This event happens in Eve growth cooperative in Soc Trang and Tan Thong Hoi cooperative in Ho Chi Minh [7]. However, the processing scale is very limited when the cooperatives have to compete with well-known companies and to face difficulty in looking for the market for their products.
e. Supply chain 5 (closed chain): big fames of processing company - processing companies - domestic market. Some milk processing companies organize dairy cow raising to self-supply fresh milk to their processing factories. Normally, these are mega farms with high tech application and pure exotic breed. For example, TH True Milk have mega farm of 45000 imported exotic cows and raised in housing with Israeli technology. Vina milk organizes also mega farms of exotic breeds and organic farm.
In summary, milk processors are main actor in supply chains of fresh milk when they are main buyers and producers.
The results from VHLSS 2008 -2016 indicated that the proportion of households the consume liquid milk and consumption volume of liquid milk have been incessantly increasing in this period. Concretely, in 2008, 21.1% of households consuming liquid milk with the volume of 17.1kg/year and in 2017 there are 36.4% households consuming 29.0 kg/year [6]. The increase in consumption of liquid milk is registered both in rural and urban areas (Table 3). The awareness of the consumers on positive effects of milk on the growth, development, human health and disease prevention is an important factor in fostering the milk consumption. The communication programs given by public media, private sector, etc. play a key role in the change of consumer’s awareness. As an evidence, the study result of Hoang Vu Quang in 2019 [8] indicated that the consumption of liquid milk increases averagely every year, if all others remain unchanged, 2.33 kg/HH.
The study of Hoang Vu Quang in 2019 found positive effect of household’s income and urban population on liquid milk consumption. Accordingly, the income elasticity is 0.079 and an urban household consumes higher 6.3kg/year than rural household. The innovation of economic mechanism, the industrialization, urbanization and the depth integration into world economy allow Vietnam to have high growth rate of GDP in long period and improve the income of households (Table 4). In the period 2000-2017, the GNI per capita increase annually 4.7%. The liquid milk consumption of urban area is higher than rural area in term of household proportion, volume and share of income (Table 3). So, rapid growth of urban population (Table 4) speeds up milk consumption in Vietnam. The continuous urbanization process fosters the volume of milk for food in Vietnam in the coming time.
Source: Author’s calcul from VHLSS 2008, 2010, 2012, 2014, 2016.
Source: data on GDP, GNI per capita from World Bank [14]; data on population from GSO [13].
The dairy cow raising brings higher income for the farmers than other agricultural production activities (as poultry, pork, rice). The study in 2012 of Le Thi Phi Van [9] indicated that annual income of a dairy cow is equivalent to income of raising 106 pork’s. In Tien Giang province, profit rate is 37%, in Ho Chi Minh city, the profit rate is from 1.9 % to 27% in function of raising scale (1.9% for scale less than 5 cows and 27% for scale from 50 cows and over). Study of Hoang Vu Quang and Ta Van Tuong in 2018 [6] also indicated that a dairy cow raising brings to farmers in Northern provinces an income of 28.3 million VND and 1 ha of annual crop land can cultivate the grass and provide to 13 cows. Meanwhile, 1 ha of rice only brings to farmer from 10 to 20 million VND. So, in term of land use performance, 1 ha of land used for cultivating cow grass can bring an income of 15 time higher if this land is used for rice cultivation. In addition, in the last 20 years there was no crisis of milk price as happened with pork price [10-12]. The profitable rate of dairy cow raising is key factor for booming of dairy cow raising at household level in the last two decades.
The role of milk processing companies is manifested in 2 aspects: 1) because of domestic need to fresh milk increase rapidly, the milk processing companies have to reinforce milk purchase from farmers, support the cow farmers (providing milk cow, technique training and guidance, advance feed, etc.). This fosters the farmers to invest in dairy cow raising (increase the number of cow farmers, increase the number of cows per farmer); 2) the companies invest directly in the activity of dairy cow raising. Several provinces change suddenly the number of cows in some years due to the investment of processing companies in dairy cow raising in these provinces. With numerous cows and high milk productivity, the processing companies have big contribution into increase of milk production of Vietnam in last year’s [13,14].
Advanced technique, modern and high technology have made important contribution to the development of dairy cow raising in Vietnam. The use of industrial feed in combination with green feed allow the farmers to increase the number of dairy cow and improve milk productivity. Most dairy cow farmers use machine, equipment in caring cows, and doing hygiene, disinfection measures. That increase labor productivity and the number of cows raised by a labor. The artificial insemination is applied in all farms with exotic sperm. That helps to improve the quality of dairy cow. With companies, the tendency is to use exotic breed with high productivity, applied high technology, so milk productivity of companies is very high.
The Government has several policies and measure to support the dairy cow producers and attract the companies to invest in dairy cow raising. For individual households, the government provide training course, including trainings on caring, feed use, veterinary measure, use of antibiotics, hygiene and disinfection, milking, etc. The households are supported for vaccination, use of diet test, artificial insemination, buying equipment for caring animals (grass cutting machine, feed slicer, spraying machine, etc.). For company, they are supported in the building of infrastructure for dairy cow raising as road, electricity system, water system, animal waste treatment system, factory and buying equipment. The companies are supported by 10 million VND/head for imported dairy cow with high milk productivity. The companies also are facilitated in renting land for dairy cow farms and are exempted or reduced the tax on land use right.
The dairy cow raising of Vietnam registers a rapid transformation in the last two decades. Dairy cow raising is expanded in more than a half of provinces with 32349 dairy cow raising households. The households with less than 10 cows tend to be reduced while households with more 10 cows increase. Several big processing companies invested in dairy cow rising help to increase rapidly milk production of Vietnam. The development of dairy cow raising in Vietnam has made contribution from several factors. The consumption needs of liquid milk thanks to increased income, the increase of population and urban people, increased awareness of consumers on positive effect of milk.Improved technology helps to increase milk productivity and labor production, facilitating the farmers to increase their cow herd. The most important element can be higher profit from dairy cow raising than several other agricultural activities. The development of dairy cow households has the support of public services in providing training courses, guidance in the application.
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