Journal of Health, Population, and Nutrition最新文献

Introduction: Sustainability in food systems has been widely discussed due to the environmental, social and economic impacts of collective meal production. University restaurants play a strategic role due to the large volume of meals served daily, ensuring students' access to food security and serving as ideal environments for implementing sustainable practices. However, there are still gaps in the understanding of the main strategies adopted and the dimensions of sustainability most frequently assessed in these spaces.

Methods: This study carried out a scoping review, following the guidelines of the Joanna Briggs Institute (JBI) and writing according to PRISMA-SCR, with the aim of identifying the main sustainability strategies applied in university restaurants and mapping the stages of the production process most investigated in the scientific literature. The search was conducted in databases such as PubMed, Embase, Scopus, and the Virtual Health Library, and it included quantitative studies that evaluated aspects of sustainability in these restaurants. The extracted data was analyzed and categorized according to the principles of the 5Rs (Rethink, Reduce, Reuse, Recycle and Refuse).

Results: 58 studies were included, 52.54% from South America, with Brazil predominating. Most of the research focused on the post-distribution phase (70.69%), with a focus on waste management and food waste. The sustainability principle most frequently addressed was "Reduce" (91.4%), followed by "Rethink" (50%), while "Reuse" and "Refuse" were little explored. Strategies aimed at changing menus and educational campaigns targeting consumers were the predominant interventions.

Conclusion: Sustainability in university restaurants has been mostly addressed through waste reduction, with limited focus on structural changes and on the broader 5Rs framework. Future studies should integrate environmental strategies with nutritional adequacy, dietary quality, and student health to maximize the impact of sustainable initiatives in these settings.

Background: Remnant cholesterol and systemic inflammation are two key, interrelated pathways in atherosclerosis. We examined whether the remnant cholesterol inflammatory index (RCII; remnant cholesterol × C-reactive protein/10) predicts incident cardiovascular disease (CVD) among adults in early cardiovascular-kidney-metabolic (CKM) stages.

Methods: We analyzed 5,961 China Health and Retirement Longitudinal Study participants aged ≥ 45 years (baseline 2015; follow-up through 2020) classified as CKM stages 0-3 and free of baseline CVD. Incident CVD (heart disease or stroke) was identified from self-reported physician diagnoses. We used multivariable Cox models with hierarchical adjustment, assessed dose-response patterns using restricted cubic splines, and conducted prespecified subgroup and exploratory mediation analyses.

Results: Over a median follow-up of 5.00 years (IQR, 5.00-5.09), 1,080 incident CVD occurred (18.1%). Each 1-unit increase in log-RCII was associated with higher CVD risk in the fully adjusted model (hazard ratio [HR] 1.070, 95% CI 1.016-1.127; P = 0.010). Compared with quartile 1, quartile 4 had increased risk (HR 1.239, 95% CI 1.029-1.492; P = 0.024; P for trend = 0.043). The dose-response association was linear (P for nonlinearity = 0.795), and no effect modification was detected (all P for interaction > 0.05). Systolic blood pressure mediated 5.0% (95% CI 1.10% to 17.00%) of the RCII-CVD association.

Conclusions: Higher RCII was modestly associated with incident CVD across early CKM stages, suggesting a simple research marker to identify individuals at higher risk during a prevention window. Standardized thresholds and external validation of incremental predictive value are needed before clinical use.

Background: Obesity prevalence has been rising globally, including in Jordan. This study seeks to examine the socio-demographic factors associated with obesity among adult ever-married women in Jordan, utilizing the most recent data from the 2023 JPFHS.

Methods: This cross-sectional study analyzed data from the 2023 JDHS, encompassing a representative sample of 4,048 Jordanian women aged 15-49. Socioeconomic variables examined included age, education level, wealth index, urban or rural residence, and media consumption habits (television, radio, magazines/newspapers, internet usage) along with smoking status. Multivariate logistic regression was employed to determine the associations between these factors and obesity risk.

Results: Of the 4,048 married women included in the analysis, 1,697 (41.9%) had a normal BMI, while 2,351 (58.1%) were classified as obese. Multivariate analysis revealed that increasing age (45-49 years: AOR 20.93, 95% CI 13.40-32.70), daily internet use (AOR 1.33, 95% CI 1.02-1.74), listening to the radio less than once a week (AOR 1.40, 95% CI 1.03-1.91), and residing in Karak (AOR 2.13, 95% CI 1.34-3.38) or Ajloun (AOR 1.75, 95% CI 1.12-2.72) were significantly associated with higher odds of obesity. Conversely, reading newspapers or magazines at least once a week and daily cigarette smoking were linked to a reduced risk of obesity. No significant associations were observed between obesity and place of residence, wealth index, educational level, television viewing habits, or residence in other governorates.

Conclusion: With obesity rates continuing to rise, targeted health programs for Jordanian women of reproductive age are essential. National health initiatives should focus on promoting healthy lifestyle habits, addressing regional disparities, and encouraging balanced media consumption to mitigate obesity risk. Region-specific prevention and awareness campaigns are also vital for effective intervention.

Background: Falling has become a global public health problem. Individuals with arthritis have a higher risk of falling because of joint pain, poor muscle strength, and decreased proprioception; however, there is no all-inclusive risk assessment model for fall risks in the Chinese population based on multi-health data.

Methods: This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) to develop a machine learning (ML)-based predictive model for fall risk among adults with arthritis. Multidimensional health data were integrated to identify key risk factors. Nine ML models, including XGBoost, were employed to assess predictive performance. The dataset was randomly divided into a training set (70%) and a test set (30%). Model performance was evaluated using AUC, calibration curves, and decision curve analysis, among other metrics.

Results: Among the 4,536 participants, 927 fall incidents were recorded, with a fall incidence rate of 20.44%. LASSO regression identified six key risk factors: age, sleep time, diabetes, depression, grip strength, and ADL score. The XGBoost model demonstrated the best performance, with AUC values of 0.746 (95% CI: 0.726-0.763) in the training set and 0.734 (95% CI: 0.702-0.768) in the test set. Calibration curves showed good agreement between predicted and observed probabilities, and decision curve analysis indicated significant clinical benefits.

Conclusion: The ML-based predictive model developed in this study effectively identifies fall risk among adults with arthritis, providing a valuable tool for clinical management and public health strategies. Further validation in external datasets is needed to confirm the model's generalizability and clinical utility.

Background: Inflammation and its dynamic changes are intricately linked to cardiovascular diseases. This research aimed to explore the predictive significance of residual inflammatory risk (RIR) in evaluating the likelihood of developing cardiometabolic multi-morbidity (CMM).

Methods: Data were sourced from the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS) and panzhihua central hospital. Inflammation status was assessed using at least two high-sensitivity C-reactive protein (hsCRP) measurements taken at baseline and follow-up, with a minimum interval of four weeks. High RIR was characterized by an hsCRP level exceeding 2 mg/L. Participants were categorized into four groups: persistent high RIR, increased RIR (initially low, subsequently high hsCRP), attenuated RIR (initially high, subsequently low hsCRP), and persistent low RIR. Multivariable Cox proportional hazards regression and subgroup analyses were employed to examine the relationship between RIR and CMM.

Results: The study included 5,572 participants from the CHARLS (56.26% female, mean age 57.87 years), 3,856 participants from the HRS (60.35% female, mean age 65.74 years), and 2,446 participants from the panzhihua central hospital (54.17% female, mean age 58.65 years). Utilizing Cox proportional hazards regression, participants with persistent high RIR exhibited a significant association with an increased risk of developing CMM compared to those with persistent low RIR (CHARLS: HR = 2.2, 95% CI = 1.79-2.69, P < 0.001; HRS: HR = 1.79, 95% CI = 1.47-2.18, P < 0.001; panzhihua cohort: HR = 3.97, 95% CI = 2.52-6.27, P < 0.001). This association persisted after comprehensive adjustment for potential confounders (CHARLS: HR = 1.81, 95% CI = 1.47-2.23, P < 0.001; HRS: HR = 1.69, 95% CI = 1.38-2.08, P < 0.001; panzhihua cohort: HR = 3.74, 95% CI = 2.34-5.99, P < 0.001). Subgroup analyses further confirmed the robustness of the association between persistent high RIR and CMM across all examined subgroups.

Conclusion: Persistent high RIR was correlated with an increased risk of CMM. Future research is needed to determine whether anti-inflammatory strategies targeting RIR reduction could mitigate CMM risk.

Background/objective: Dietary antioxidants have been suggested to play a protective role against chronic diseases. This prospective study aimed to examine the association between the composite dietary antioxidant index (CDAI) and the risk of type 2 diabetes (T2D), hypertension, and abdominal obesity.

Methods: This prospective cohort study included 7357 adults aged ≥ 18 years who participated in the third and fourth phases of the Tehran Lipid and Glucose Study. Dietary intake was assessed using a validated 168-item food frequency questionnaire, and CDAI scores were calculated accordingly. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for T2D, hypertension, and abdominal obesity across quartiles of CDAI.

Results: During the follow-up period, the incidence rates were 12.5% for T2D (mean follow-up: 10.8 ± 3.64 years), 23.4% for hypertension (mean follow-up: 10.0 ± 4.09 years), and 33.5% for abdominal obesity (mean follow-up: 10.1 ± 4.29 years). After adjustment for age, sex, physical activity, energy intake, education, marital and occupational status, smoking, and outcome-specific baseline clinical variables, higher CDAI scores were associated with a lower risk of T2D (HR = 0.68; 95% CI: 0.48-0.96; P for trend = 0.025), hypertension (HR = 0.65; 95% CI: 0.52-0.83; P for trend = 0.014), and abdominal obesity (HR = 0.53; 95% CI: 0.42-0.68; P for trend < 0.001).

Conclusions: Higher adherence to a diet with greater antioxidant capacity, as reflected by higher CDAI scores, may be related to a reduced risk of T2D, hypertension, and abdominal obesity among Iranian adults.

Background: Detectable viral load (DVL) after ≥ 6 months of antiretroviral therapy (ART) and underweight are common among adolescents with HIV (AWH) but remain understudied. We assessed the association between underweight at ART initiation and DVL among AWH in rural eastern Uganda.

Methods: We retrospectively reviewed program data for AWH aged 10-19 years from 11 clinics in eight districts. Underweight was defined as body mass index (BMI) for age <5th percentile at ART initiation. DVL was defined as the first viral load ≥ 1,000 copies/mL after ≥ 6 months on ART. Associations were examined using multi-level mixed-effects Poisson regression, adjusting for individual-level factors and accounting for clustering by district and health facility.

Results: We analyzed 525 AWH, of whom 47.6% were aged 10-14 years and 51.0% were male. At ART initiation, 79.2% were underweight, and 19.0% had DVL after ≥ 6 months on ART. In multivariable analysis, underweight at ART initiation was significantly associated with DVL (adjusted risk ratio [aRR] 1.66, 95% confidence interval [CI] 1.07-2.56). DVL was also associated with baseline CD4 count ≤ 200 cells/µL (aRR 1.36, 95% CI 1.12-1.66), and there was no statistically significant association with interruption in ART (aRR 1.43, 95% CI 0.89-2.29).

Conclusion: Among AWH in rural eastern Uganda, the prevalence of DVL was nearly four times the UNAIDS target of ≤ 5%. DVL was linked to underweight and severe immunodeficiency. Interventions such as nutritional support, targeted adherence counseling, early HIV diagnosis, and prompt ART initiation are critical to achieving viral suppression in this setting.

Background: Atherosclerosis, the primary pathological basis of cardiovascular diseases, exhibits a strong association with glucose metabolism dysregulation. While cross-sectional studies have linked fasting blood glucose (FBG) to atherosclerosis risk, the dose-response relationship and threshold characteristics of long-term FBG trajectories remain poorly characterized. This retrospective cohort study aimed to investigate longitudinal FBG trajectory patterns and their associations with atherosclerosis risk prevalence, incidence, and recovery in Chongqing, China, while also identifying population-specific risk thresholds.

Methods: Based on the three-year longitudinal follow-up data collected annually from 2017 to 2019, a population-based trajectory model (GBTM) was adopted to identify the dynamic trajectory of FBG. The association between FBG and atherosclerosis risk was analyzed using multivariable logistic regression. Restricted cubic splines (RCS) were used to assess the non-linear relationship between FBG and atherosclerosis risk and to determine risk thresholds. Confounding factors such as age, sex, body mass index (BMI), blood pressure, and lipids were adjusted for in the regression models, and subgroup analyses were performed to examine the interactions of age, sex, and BMI.

Results: Longitudinal analysis showed that compared with the Trajectory Normal Glucose Regulation (NGR) group, the Trajectory Prediabetes Mellitus group (Pre-DM) group had significantly higher prevalence (OR: 2.02, 95% CI: 1.63-2.51) and incidence (OR: 1.66, 95% CI: 1.15-2.39) of atherosclerosis risk. The Trajectory Pre-DM group also had a significantly lower likelihood of atherosclerosis risk recovery than the Trajectory NGR group (OR: 0.55, 95% CI: 0.39-0.79). Dose-response analysis revealed a non-linear association between FBG and atherosclerosis risk prevalence, with a risk threshold at 5.10 mmol/L. This suggests that the atherosclerosis risk threshold in Chongqing is significantly lower than the international prediabetes standard of 5.60 mmol/L. Subgroup analyses showed sex and age differences, with lower thresholds in women and younger individuals.

Conclusions: Long-term elevation of FBG was associated with increased atherosclerosis risk. The study suggests that intervention strategies should be based on dynamic blood glucose trajectories and population-specific thresholds, especially lower thresholds for women and younger individuals. This study provides evidence-based support for regional atherosclerosis risk prevention and control.