Public Health Nutrition最新文献

Objective: To examine underlying political economy factors that enable or impede the integration of nutrition considerations into food system governance.

Design: Comparative political economy analysis of data collected through (1) value chain analyses of selected healthy and unhealthy commodities and (2) food system policy analyses, using a theoretical framework focused on power, politics, interests and ideas.

Setting: Ghana and South Africa.

Participants: Value chain actors relevant to healthy and unhealthy foods (Ghana n 121; South Africa n 72) and policy stakeholders from government (Health, Agriculture, Trade and Industry, Finance), academia, civil society, development partners, Civil Society Organization (CSO) and private sector (Ghana n 28; South Africa n 48).

Results: Nutrition was a stated policy priority in both countries; however, policy responsibility was located within the health sector, with limited integration of nutrition into food system sectors (including Agriculture, Trade and Industry). Contributing factors included a conceptions of policy responsibilities for nutrition and food systems, dominant ideas and narratives regarding the economic role of the food industry and the purpose of food system policy, the influence of large food industry actors, and limited institutional structures for cross-sectoral engagement and coordination.

Conclusions: Integrating nutrition into multi-sectoral food policy to achieve multiple food system policy goals will require strategic action across jurisdictions and regional levels. Opportunities included increasing investment in healthy traditional foods, strengthening urban/rural linkages and informal food systems, and strengthening institutional structures for policy coherence and coordination related to nutrition.

Objective: This commentary highlights the release of findings now available in the report International Food Policy Study Youth Surveys: Summary of Findings 2019-2021.

Design: The survey data described in this commentary consist of repeated cross-sectional surveys conducted annually beginning in 2019.

Setting: Online surveys were conducted in 2019 to 2021 among respondents living in Australia, Canada, Chile, Mexico, the United Kingdom and the United States.

Participants: Survey respondents were youth aged 10 to 17 years in 2019 (n=12,031), 2020 (n=11,108) and 2021 (n=10,459).

Results: The report described in this commentary summarizes findings on food and nutrition behaviours, attitudes, and knowledge among youth, including their diet sources and patterns, school nutrition environments, food security, diet intentions, weight perceptions and weight loss behaviours, sugary drink perceptions, awareness of public education and mass media campaigns, perceptions of food labels, and exposure to food and beverage marketing.

Conclusion: Results from the IFPS Youth surveys provide important insights into key policies of global interest, including front-of-package nutrition labelling, levies on sugary beverages, and restrictions on marketing unhealthy food and beverages to children. As policymakers continue to seek effective strategies to improve adolescent health outcomes, ongoing cross-country monitoring of food and nutrition-related indicators, such as the data from the International Food Policy Study, will be critical in assessing dietary trends and evaluating upcoming policies.

Objective: To understand the dietary patterns of adults and explore their association with iodine nutritional levels and thyroid function in adults.

Design: We randomly collected 5 ml of adult urine samples and measured urinary iodine concentration by cerium arsenate-catalyzed spectrophotometry. A serum sample of 5 ml was collected for the determination of free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH), and diet-related information was collected through a food frequency questionnaire. Dietary patterns were extracted by principal component analysis and the relationship between dietary patterns and iodine nutrition levels and thyroid function was explored.

Settings: A cross-sectional study involving adults in Xinjiang, China was conducted.

Participants: A total of 435 adults were enrolled in the study.

Results: The overall median urinary iodine of the 435 respondents was 219.73 μg/L.The dietary patterns were PCA1 (staple food pattern), PCA2 (fruit, vegetable, and meat pattern), PCA3 (fish, shrimp, and legume pattern), and PCA4 (Dairy-based protein pattern). The correlation analyses showed that PCA1 and PCA3 were positively correlated with the urinary iodine concentration (UIC). The results of the multivariable analysis showed that PCA1, Q1, Q2, and Q3 were associated with an increased risk of iodine deficiency compared with Q4 [ (OR): 260.41 (95%CI: 20.16, 663.70)], 59.89 (5.64, 335.81), and 2.01 (0.15, 26.16), respectively]. In PCA2, Q3 was associated with an increased risk of iodine deficiency compared with Q4 [OR: 0.16 (0.05, 0.53)]. In PCA3, Q3 was associated with an increased risk of iodine deficiency compared with Q4 [OR: 0.23 (0.06, 0.90)]. In PCA4, Q1 was associated with an increased risk of iodine deficiency compared with Q4 [OR: 31.30 (4.88, 200.64)].

Conclusion: This study demonstrated that of the four dietary patterns, the least dependent staple food pattern (Q1) had a higher risk of iodine deficiency compared to the most dependent staple food pattern (Q4). However, the current evidence on the effect of dietary patterns on thyroid function needs to be validated by further longitudinal studies that include long-term follow-up, larger sample sizes, and repeated measures.

Objective: To understand the characteristics of food environments in the Pacific region, and the broader economic, policy, and sociocultural surroundings that influence food choices and interventions to improve food environments for Pacific communities.

Design: Systematic searches were conducted for articles related to food environments or factors influencing food choices from 1993-2024 in five academic databases, Google, Google Scholar, and relevant organizations' websites. Studies were included if they meet the eligibility criteria. Two authors independently reviewed the title and abstract of identified articles. Full-text screening was conducted before data was extracted from eligible studies. A narrative analysis was informed by an existing food environments framework.

Setting: Pacific Island countries or territories that are a member of the Pacific Community (SPC).

Participants: Not Applicable.

Results: From the 66 included studies (of 2520 records screened), it was clear that food environments in the Pacific region are characterized by high availability and promotion of ultra-processed unhealthy foods. These foods were reported to be cheaper than healthier alternatives and have poor nutritional labelling. Food trade and investment, together with sociocultural and political factors, were found to contribute to unhealthy food choices. Policy interventions have been implemented to address food environments; however, the development and implementation of food environment policies could be strengthened through stronger leadership, effective multisectoral collaboration and clear lines of responsibility.

Conclusions: Interventions focused on improving physical, economic, policy, and sociocultural influences on food choices should be prioritized in the Pacific region to improve the food environment and mitigate barriers to healthy eating.

Objective: To investigate the relationship between violence and the nutritional status of pregnant women, and whether mental health could be a mediator in this relationship.

Design: Cross-sectional study. Violence and mental health status were investigated using the following questionnaires: World Health Organization Violence Against Women (WHO-VAW), Abuse Assessment Screen (AAS), Patient Health Questionnaire (PHQ-9), and General Health Questionnaire (GHQ). Demographic, socioeconomic, obstetric, and lifestyle factors (smoking/alcohol consumption) were also investigated. The nutritional status of the women was assessed by the body mass index.

Setting: Data were collected from February 2021 to August 2022 in Araraquara city, Brazil.

Participants: Four hundred pregnant women recruited at 34 health units and the municipal maternity hospital.

Results: Experience of violence was reported by 52.2% of the women and psychological violence in the last 12 months was the most prevalent type of domestic violence (19.5%). Approximately 43% of the women showed mental health changes and 59.7% had a risk of major depression. Women with mental health changes had an increased risk (OR=2.34) of obesity. Psychological violence in the last 12 months was associated with obesity (p=0.01) when mediated by mental health changes. The mediation effect was significant (β=0.708; 95%BCa CI=0.004-1.460), with mental health changes mediating 46.1% of the relationship between psychological violence and obesity.

Conclusions: The relationship between psychological violence and obesity during pregnancy was mediated by changes in mental health. This original study shows that nutritional status is not limited to biological factors and highlights the importance of social, mental, and psychological factors.

Objective: To evaluate whether changes in starch intake (in terms of amount and food sources) were associated with increments in dental caries among adults.

Design: 11-year longitudinal study (2000-2011) with duplicate assessments for all variables. A 128-item food frequency questionnaire was used to estimate intake of starch (g/day) and six starch-rich food groups (potatoes, potato products, roots and tubers, pasta, wholegrains, and legumes). Dental caries was assessed through clinical examinations and summarised using the number of decayed, missing and filled teeth (DMFT score). The relationship between quintiles of starch intake and DMFT score was tested in linear hybrid models adjusting for confounders.

Setting: Northern and Southern regions of Finland.

Participants: 922 adults, aged 30-88 years.

Results: Mean starch intake was 127.6 (SD: 47.8) g/day at baseline and 120.7 (55.8) g/day at follow-up. Mean DMFT score was 21.7 (6.4) and 22.4 (6.2) at baseline and follow-up. Starch intake was inversely associated with DMFT score cross-sectionally (rate ratio for highest versus lowest quintile of intake: -2.73, 95%CI: -4.64, -0.82) but not longitudinally (0.32, 95%CI: -0.12, 0.76). By food sources, the intakes of pasta (-2.77, 95%CI: -4.21, -1.32) and wholegrains (-1.91, 95%CI: -3.38, -0.45) were negatively associated with DMFT score cross-sectionally but not longitudinally (0.03, 95%CI: -0.33, 0.39 and -0.10, 95%CI: -0.44, 0.24, respectively).

Conclusion: Changes in the amount and sources of starch intake were not associated with changes in dental caries. Further studies should be conducted in different settings and age groups while focusing on starch digestibility and specific sources of starch.

Objectives: Child undernutrition among under 5 aged children is a prevalent global issue, especially in Bangladesh. This study aimed to explore relationships of household environmental conditions (HECs) with child under-nutrition in Bangladesh, with a specific focus on rural-urban differences.

Design: We analysed children's data from the 2017/18 Bangladesh Demographic Health Survey (BDHS). The outcome variable considered were measures of child under-nutrition, including stunting, wasting, and underweight. The major exposure variable considered was indicators of HECs. We used a hierarchical Poisson regression model to explore the association between outcomes and exposures adjusted for potential confounders.

Setting: Nationally representative cross-sectional survey.

Participants: 8,057 under-5 aged children.

Results: The prevalence of stunting, wasting and underweight in Bangladesh was 31%, 8% and 22%, respectively, with significant urban-rural variations. Under-5 children who lived in houses constructed with unimproved materials (aRR: 1.17), exposed to household air pollution (HAP) (aPR: 1.37), had unimproved drinking water sources (aPR: 1.28), or had poor handwashing facilities (aPR: 1.24) had a greater likelihood of stunting compared to their counterparts. Similar associations were observed for underweight. The likelihood of stunting and underweight increased with increasing scores of poor HECs, varying significantly across urban-rural areas.

Conclusion: The high prevalence of stunting and underweight in Bangladesh is linked to poor HECs. Therefore, policies and programs aimed at reducing child undernutrition need to account for household environmental conditions, with a particular focus on children in poor household environments.

Objective: This study examined the relationship between reformulation and food price in Canadian packaged foods and beverages between 2017 and 2020.

Design: Matched foods and beverages in the University of Toronto Food Label Information and Price 2017 and 2020 databases were analyzed (n=5774). Price change by food category and by retailer were compared using Wilcoxon signed-rank tests. The proportion of products with changes in calories and nutrient levels were determined and mixed-effects models were used to examine the relationship between reformulation and price changes. The Food Standards Australia New Zealand (FSANZ) nutrient profiling model was applied to calculate nutritional quality scores and mixed-effects models were used to assess if changes in nutritional quality score were associated with price changes.

Setting: Large grocery retailers by market share in Canada.

Participants: Foods and beverages available in 2017 and 2020.

Results: Food price changes differed by retailer and by food category (e.g., increased in Bakery, Snacks etc; decreased in Beverages, Miscellaneous etc.). Nutrient reformulation was minimal and bidirectional with the highest proportion of products changing in sodium (17.8%; 8.4% increased and 9.4% decreased). The relationship between nutrient reformulation and price change was insignificant for all nutrients overall and was not consistent across food categories. Average FSANZ score did not change (7.5 in both years). For Legumes and Combination dishes, improvements in nutritional quality were associated with a price decrease and increase, respectively.

Conclusions: Stronger policies are required to incentivize reformulation in Canada. Results do not provide evidence of reformulation impacting food prices.

Objective: To investigate the association between food insecurity (FI) and diet quality in private sector service workers.

Design: Data were collected via electronic questionnaires (2019) and the national register data (2018-2019). FI was measured using Household Food Insecurity Access Scale (HFIAS), and diet quality using a food frequency questionnaire and a modified Healthy Food Intake Index (mHFII). The associations between HFIAS and mHFII were studied using ANOVA and ordinal regression analysis.

Setting: Cross-sectional survey and register data for all municipalities in Finland in 2018 - 2019.

Participants: Individuals (n=6435) belonging to the Finnish Service Union United (PAM). The members are predominantly women and work mainly in retail trade, tourism, restaurant and leisure services, property maintenance, and security services.

Results: Overall diet quality, measured by mHFII, was significantly lower in those experiencing severe FI than in those who were food secure (8.0 vs. 9.1). Additionally, those with severe FI were less likely to have higher (more optimal) scores in sugar-sweetened beverages (OR: 0.67), fibre-rich grains (OR: 0.79), vegetables (OR: 0.54), fruits and berries (OR: 0.61), vegetable oil (OR: 0.80), fish (OR: 0.65), milk (OR: 0.89), and nuts and seeds (OR: 0.66) than food-secure participants. Severe FI was associated with higher odds for less frequent consumption of red and processed meat (OR: 1.15, higher score represents less frequent consumption).

Conclusions: Severe FI was linked to both lower overall diet quality and suboptimal consumption of several food groups. Individuals experiencing severe FI may be predisposed to accumulating dietary risk factors for chronic diseases.

Objective: Growth faltering is widespread in many low- and middle-income countries, but its effects on childhood bone mass accrual are unknown. The objective of this study was to estimate associations between length (conditional length-for-age z-scores, cLAZ) and weight (conditional weight-for-age z-scores, cWAZ) gain in 3 age intervals (ages 0-6, 6-12, 12-24 months) with dual-energy x-ray absorptiometry (DEXA)-derived measures of bone mass (total-body-less-head (TBLH) bone mineral content (BMC), areal bone mineral density (aBMD), and bone area) at 4 years of age.

Design: Associations between interval-specific growth parameters (cLAZ and cWAZ) and bone outcomes were estimated using linear regression models, adjusted for maternal, child, and household characteristics.

Setting: Data collection occurred in Dhaka, Bangladesh.

Participants: 599 healthy children enrolled in the BONe and mUScle Health in Kids Study.

Results: cLAZ in each age interval was positively associated with TBLH BMC, aBMD, and bone area at 4 years; however, associations attenuated towards null upon adjustment for concurrent height-for-age z-scores (HAZ) at age 4 years and confounders. cWAZ from 0-6 and 6-12 months was not associated with bone mass, but every SD increase in cWAZ between 12-24 months was associated with greater BMC (7.6g; 95%CI:3.2, 12.0) and aBMD (0.008g/cm2; 95%CI:0.003, 0.014) after adjusting for concurrent WAZ, HAZ, and confounders.

Conclusions: Associations of linear growth (birth to 2 years) with bone mass at age 4 years were explained by concurrent HAZ. Weight gain in the second year of life may increase bone mass independently of linear growth in settings where growth faltering is common.