Food and Nutrition Bulletin最新文献

Background: Severe acute malnutrition (SAM) contributes to a substantial number of child deaths globally per year. The mortality rates can be lowered markedly if guideline-based management protocol is properly followed. However, case-fatality rates in resource-poor centers remain high even after introducing the guidelines. Perhaps, the lack of adequate knowledge leading to inappropriate management by the health care providers is responsible for such burden.

Objective: We aimed to evaluate health care providers' knowledge, attitude, and practice regarding the facility-based management of children with SAM in Bangladesh.

Methods: This was a qualitative study where data were collected cross-sectionally from 4 district and 2 tertiary care hospitals. Twenty-six semi-structured in-depth interviews were conducted among the doctors and nurses involved in inpatient care of SAM. Twenty-eight hours of observation were done in each facility to obtain information regarding the management practices.

Results: The doctors had substantial knowledge in managing children with SAM in the facilities. However, knowledge of nurses was found suboptimal when evaluated based on the national guideline. Both doctors and nurses demonstrated favorable attitude toward management of childhood SAM. Identification of SAM at the facilities was poor due to lack of practice in relation to anthropometric measurements. In addition, improper practices related to blood glucose testing, dehydration monitoring, essential micronutrient administration, and follow-up of children with SAM were observed.

Conclusion: The study results underscore the importance of taking appropriate measures to enhance knowledge and ensure proper practice in relation to inpatient care of children with SAM according to the national guideline in Bangladesh.

Background: In homestead food production (HFP) programs, village model farmers (VMFs), after training, implement agriculture and nutrition activities to improve household knowledge and practices. Little evidence exists on what enables VMFs to remain actively engaged and for impacts to be sustained.

Objective: To examine variables explaining active engagement of VMFs, at least 4 years post-training, in an HFP program in Nepal.

Methods: We used cross-sectional data, collected from 2018 to 2019, among 4750 VMFs of Suaahara, a multisectoral nutrition program. We assessed whether respondents registered their HFP group with the local government, conducted regular group meetings, discussed vegetable growing and chicken rearing practices with group members, or engaged in saving and credit activities in their HFP group. Outcome variable was a count of these 4 activities in which the VMF engaged. Socioeconomic, demographic, and programmatic explanatory variables were identified a priori and by bivariate analysis and were adjusted in ordinal regression models accounting for clusters.

Results: On average, VMFs engaged in 1.4 activities. Having attended primary or secondary school (adjusted odds ratios [AOR] = 1.39), being a female community health volunteer (AOR = 1.27), being from an advantaged caste/ethnic group (AOR = 1.34), receiving additional trainings (AOR = 1.56) and inputs (AOR = 1.31) were associated with more active engagement of VMFs.

Conclusion: Village model farmers receiving more training and inputs were more likely to remain actively engaged. Female community health workers, people from higher caste/ethnic groups, and those with primary or secondary education were more likely to remain active VMFs and could be targeted for this role in HFP programs leading to sustained impact.

Background: Ethiopian government was implementing mandatory salt iodization program for the last decade to eliminate iodine deficiency disorders, but several recent studies reported mixed findings.

Objective: This review aimed to assess the difference in implementation of iodized salt program 10 years before and after mandatory salt iodization being implemented in Ethiopia since 2011.

Methods: In Ethiopia, legislation that enforces salt producers to iodize all salts used for human consumption started in February 2011. All studies about iodine deficiency and iodized salt conducted in Ethiopia in the last 2 decades were searched. Searches were performed in PubMed database. Google Scholar, Iodine Global Network, and Ethiopian Public Health Institute websites were also searched.

Results: A total of 235 titles and abstracts were identified. After scanning the abstracts and full papers, 43 articles were remained for final data synthesis. In this review, all studies conducted before 2011 reported a urinary iodine concentration (UIC) value of < 100 μg/L and 66.7% of them reported a goiter prevalence of > 30%. On the other hand, among studies conducted after 2011, 88.9% reported UIC value < 100 μg/L and 73.7% reported goiter prevalence of > 30%. Household availability of adequately iodized salt increased from nearly 20% in pre 2011 to more than 50% in post 2011 period.

Conclusion: Despite the efforts made by the Ethiopian government on mandatory salt iodization for the last decade, iodine deficiency is sustained in the country. Moreover, the goal of universal salt iodization program is offtrack and needs urgent revision.

Registration: Registered on PROSPERO register with reg. no CRD42021251124.

Background: Agroecological methods have the potential to impact nutrition and food security, however, to date there is limited research evaluating this approach.

Objective: A 5-year participatory research project with farming households in north and central Malawi was designed to train farmers on agroecological practices, alongside raising awareness on nutrition and gender equity. This cross-sectional study aimed to explore the relationships between crop diversity, food security at the household level, and individual diversity for women, within the context of an agroecology, nutrition education, and farmer mentoring program.

Methods: Participating farmers were trained in and experimented with different farming methods. These farmers subsequently trained other farmers on these short-term agroecological practices and provided mentorship using community-based educational methods designed to address both household food security and nutrition. In year 4 of the intervention, a cross-sectional survey assessed farm practices, food security, and individual dietary diversity of 851 participating households.

Results: Households with lower crop diversity were significantly less likely to be food secure (odds ratios [OR] = 0.829, P < .001). Women in households with higher crop diversity were more likely to have higher individual dietary diversity (OR = 1.120, P < .01), eat vitamin A rich foods (OR = 1.176, P < .01), and legumes, nuts, and seeds (OR = 1.141, P < .01).

Conclusions: These findings suggest that within a participatory agroecological training combined with community-based nutrition education with a focus on social equity, crop diversity is associated with less household food insecurity and poorer diet quality for rural farming households. Crop diversity may improve dietary diversity by making nutritious foods more available.

Background: In 2016, a Peace Agreement, explicitly addressing the right to food, was signed, marking the end of more than 50 years of armed conflict and the longest war in the Americas. The expectation was that the years to follow would be marked by rapid social and political change, with the potential to improve food security.

Objectives: (i) Ascertain changes in the prevalence of food insecurity in Colombia between 2016 and 2019; (ii) examine which population subgroups (eg, urban women, rural women, urban men, and rural men) were most vulnerable; and (iii) determine significant individual-level factors predicting food insecurity in these 2 years.

Methods: This study used the Gallup World Poll 2016 and 2019 nationally representative samples of Colombian adults aged 15 and older for the analyses (n ≈ 1000 per year). Food insecurity was measured using the Food Insecurity Experience Scale. Descriptive statistics and logistic regression analyses were conducted using IBM SPSS Complex Samples (version 26).

Results: Food insecurity in Colombia increased by 7 percentage points between 2016 and 2019 (from 33% to 40%); women living in rural areas in 2019 reported the highest prevalence (50%). Results from logistic analysis confirm low income, unemployment, and lack of social support were significant predictors of food insecurity in both years. In 2019, gender, low education, and lack of autonomy were also significant predictors. Further research on the determinants of food insecurity is necessary to inform Colombian policies and programs that address food insecurity. The urgency to act is more apparent than ever, given the country's worsening food security profile.

Background: Nutrition literacy is an emerging term which is increasingly used in policy and research. Progression is limited by the lack of an accepted method to measure nutrition literacy in Chinese adults, even as research in this area is growing.

Objective: The objective of this study is to develop a valid instrument to assess nutrition literacy in Chinese adults.

Methods: The process involved 2 steps: constructed nutrition literacy conceptual framework, and developed potential items of scale based on literature review; and conducted 2 rounds of Delphi consultation to select items of the preliminary questionnaire.

Results: In the Delphi survey, the content validity index for each domain, level, and dimension of nutrition literacy was 1.0, coefficient of variation was less than 0.10, and Kendall's coefficient of concordance was greater than 0.83. All of the 2 domains, 3 levels, and 6 dimensions initially formulated by our research team were reserved in the conceptual framework of nutrition literacy. Furthermore, a 43-item nutrition literacy measurement scale was established. Each item kept in the final scale reaches a high degree of concentration and a high degree of coordination, with the mean of importance ranging from 4.38 to 5.00.

Conclusions: A nutrition literacy measurement scale with multiple features was established for Chinese adults, providing an operationalized tool to assess comprehensively nutrition literacy for research and practice in the field of nutrition, diet, and health.

Background: Socioeconomic factors influence diet quality during pregnancy. However, a dearth of evidence about the influence on energy and macronutrients adequacy calls for research.

Objective: To analyze the association between socioeconomic factors and adequacy rates of energy and macronutrient intakes in pregnant women from Merida, Yucatan, Mexico.

Methods: During September to December 2019, we applied a socioeconomic questionnaire and three 24-hour dietary recalls to 83 pregnant females resident in Merida, Yucatan. Energy and macronutrient intakes were compared with the estimated trimester-specific energy and macronutrient requirements to calculate adequacies (%). Outcome variables were average adequacy of energy, carbohydrates, total fat, and protein intakes and the main predictors were maternal education, monthly family income, working status, and marital status. Descriptive statistics of adequacy were calculated for each category of predictors. The association between socioeconomic factors and outcome variables was analyzed through simple and multiple linear regression models.

Results: Adequacy rates of energy and macronutrients decreased as education and familial income levels increased, as well as among unemployed women. Consistently with these results, simple linear regressions showed that years of education, family income, and working status (i.e., women working to earn money), were negatively associated with adequacy rates of energy and macronutrients intakes. When all predictors and covariates were included in a multiple linear regression model, only having a job was significantly associated with adequacy rates. Marital status was not associated with outcomes.

Conclusions: Women in disadvantaged socioeconomic conditions (unemployed and low levels of education and familial income) show greater energy and macronutrient intakes.

Background: Aquatic animal source foods (AASF) can provide vital nutrients and bioactive factors essential for human health, yet disparities in consumption patterns prevail globally. Limited evidence exists for the implications of AASF access on child health outcomes.

Objective: This study aimed to examine global AASF intakes longitudinally in association with critical nutrient intakes and childhood stunting and anemia.

Methods: The analysis draws from compiled longitudinal country data (1993-2013) based on a constructed conceptual framework encompassing social and ecological factors that influence fish consumption and human health. Longitudinal generalized linear models were used to estimate the association of apparent AASF intake on country-level nutrient availability (docosahexaenoic acid [DHA], choline, vitamin B₁₂, iron, and zinc) and prevalence of undernourishment, child stunting, and child anemia.

Results: Across 175 countries, the median per capita daily apparent intake of all AASF was 37.87 g, with marginally significant differences observed between countries with low (46.65 g) versus high child mortality (23.50 g). The combined category of all AASF was significantly associated with increased total apparent intakes of DHA, choline, and vitamin B₁₂ and reduced child stunting. Finfish (pelagic and demersal) and crustaceans inversely correlated with child stunting, while apparent intakes of mollusks and crustaceans were associated with reduced child anemia.

Conclusions: This study uniquely showed that AASF were associated with improved child health outcomes and the critical nutrients necessary for growth, development, and maintaining health throughout the life course. Policies should ensure increased access to AASF across food systems and within sustainable healthy diets globally.

Background: Vegetables are an essential element in healthy diets, but intakes are low around the world and there is a lack of systematic knowledge on how to improve diets through food system approaches.

Methods: This scoping review assessed how studies of food systems for healthy diets have addressed the role of vegetables in low- and middle-income countries. We apply the PRISMA guidelines for scoping reviews to narratively map the literature to an accepted food systems framework and identify research gaps.

Results: We found 1383 relevant articles, with increasing numbers over 20 years. Only 6% of articles looked at low-income countries, and 93% looked at single-country contexts. Over half of articles assessed vegetables as a food group, without looking at diversity within the food group. 15% looked at traditional vegetables. Issues of physical access to food were among the least studied food system topics in our review (7% of articles). Only 15% of articles used a comprehensive food system lens across multiple dimensions. There is also a research gap on the impacts of different policy and practice interventions (13% of articles) to enable greater vegetable consumption.

Conclusions: Food system studies necessarily drew on multiple disciplines, methods and metrics to describe, analyze, and diagnose parts of the system. More work is needed across disciplines, across contexts, and across the food system, including understanding interventions and trade-offs, and impacts and change for diets particularly of marginalized population groups. Filling these gaps in knowledge is necessary in order to work toward healthy vegetable-rich diets for everyone everywhere.

This study assessed the status and factors that affected the food security of Filipino households and their access to social protection programs and coping mechanisms during the coronavirus disease 2019 (COVID-19) pandemic in the Philippines. A rapid nutrition assessment survey through telephone interview was conducted on November 3 to December 3, 2020, among households covered in the 2019 Expanded National Nutrition Survey (ENNS) to compare the status of household food security before and during the pandemic. A total of 9 provinces and highly urbanized areas were selected as study sites based on risk to COVID-19 infection categorized as low, medium, and high. A total of 5717 households with contact numbers participated in the study. Results showed that almost two-thirds (62.1%) of the households experienced moderate to severe food insecurity when strict community quarantines started. The increase in the proportion of moderate to severe food insecurity was higher in the low- and medium-risk areas of COVID-19 infection than in high-risk areas (P < .05). The poorest households were 1.7 times more likely to become moderate to severely food insecure compared to middle-income households. No money to buy food (22.1%) was the top concern of food-insecure households. Purchasing food on credit, borrowing food from family, and loans from relatives and friends are the top coping strategies of food-insecure households. The results imply the need to extend assistance equitably to households and areas with fewer resources and minimal or no benefactors.