Public Health Nutrition最新文献

Objective: This study aims to contribute to enhanced food security in Haiti through proposing targeted local interventions. Employing a spatially explicit tool, the research supports decision-making by relating undernutrition to socio-economic conditions and biophysical factors.

Design: Georeferenced Demographic and Health Survey (DHS) conducted in 2016–2017 combined with spatial environmental information was used for a multivariate linear regression model to identify factors associated with stunting prevalence. Missing data were imputed through kernel density regression. We converted the structural relationship estimated for the territory of Haiti into a decision support tool by adding fixed effects at communal level. Various policy scenarios were analysed.

Setting: Haiti, with spatial data across the 134 communes.

Participants: The analysis included 5623 children under five and their mothers, sourced from DHS data.

Results: Approximately 22 % of all children were stunted. Implementation of the LimitedIntervention development scenario led to a 2·5 % reduction in stunting, while the ModerateIntervention and FullIntervention scenarios achieved more significant reductions of 6 % and 10 %, respectively. Areas with highest stunting incidence benefit most from interventions.

Conclusions: This tool supports decisionmakers by assessing the impact of interventions at commune level and selecting areas where interventions exert the most significant effects. The study suggests to apply a strategy that starts in relatively safe communes and then scales to other areas. The flexible approach adopted in this study allows applications in other countries or regions to assess the prevalence of undernutrition among children under five.

Objective: To examine how home food inventories and food procurement practices changed due to the COVID-19 pandemic.

Design: Cross-sectional baseline data from a randomised controlled trial of a home food environment intervention. Telephone interviews were conducted from October 2020 to December 2022.

Setting: Four 2-1-1 United Way agencies in Georgia, USA.

Participants: 2-1-1 clients (n 602); 80·6 % identified as Black and 90·9 % as women. Mean age was 42·8 (sd = 11·80). The majority were food insecure (73·4 %) and received Supplemental Nutrition Assistance Program (SNAP) benefits (65·8 %).

Results: A majority of participants reported smaller inventories of fresh fruits and vegetables (65·1 %) and unhealthy snacks (61·6 %) in the home relative to before COVID-19. The majority (55·8 %) also reported decreased shopping for fruits and vegetables and decreased use of fast food for family meals (56·1 %). Over half (56·2 %) started to use a food pantry, and 44·9 % started ordering groceries online due to COVID-19. A COVID-19 stressors scale was significantly associated with decreased odds of a smaller fresh fruit and vegetable inventory (OR = 0·61, CI 0·51, 0·73) and a smaller unhealthy snack inventory (OR = 0·86, CI 0·74, 0·99). COVID-19 stressors were also associated with changed food procurement practices, including increased online grocery shopping (OR = 1·19, CI 1·03, 1·37), and starting to use a food pantry (OR = 1·31, CI 1·13, 1·51).

Conclusions: The pandemic had a significant impact on home food inventories and procurement practices. Understanding how major events such as pandemics affect home food environments may help to stave off negative nutritional outcomes from similar events in the future.

Objective: Bubble tea is known to have adverse health impacts due to its high sugar content. However, the influence of digital marketing on its consumption, especially among young people, remains unclear. This study aimed to describe the digital marketing strategies of Chinese bubble tea brands.

Design: A content analysis of all marketing posts made by the top three Chinese bubble tea brands (by market share) - XIXUE, HEYTEA and NAYUKI - on Bilibili between 1 January 2023 and 31 December 2023.

Setting: Bilibili, a popular social media platform among Chinese young people, in 2023.

Participants: Not applicable.

Results: Branding is central to the digital marketing strategies of bubble team brands, with the majority of posts using brand logos (99 %), branded effects (80·1 %) and branded characters (63 %), including children's characters (19 %). Marketing strategies promoting user interaction were also common, reflected in the frequent use of hashtag campaigns (63 %), general engagement strategies (43 %) and competitions (10 %). Cultural elements that are integrated into the marketing message to resonate with the audience's cultural identity were present in 47 % of posts.

Conclusions: Bubble tea brands are using a range of digital marketing strategies to engage consumers and build brand presence in the competitive bubble tea market in China. Measures to protect young consumers from the exposure of such marketing should be considered as a way of improving population diets and reducing excess weight gain.

Objective: Management of moderate wasting (MW) is an important component of country-level strategies to address wasting, given high caseloads and susceptibility to illness and death. However, many countries experience challenges in providing targeted supplementary feeding programmes with specially formulated foods involved in managing MW. Some implementing agencies have developed a community-based programme using locally available foods (LF) for MW management known as Tom Brown. This study assessed the costs and cost-efficiency of three Tom Brown programmes (two with an 8-week supplementation duration, one with a 10-week duration).

Design: We assessed institutional costs and selected estimates of societal costs to households and community volunteers.

Setting: Northeast Nigeria.

Participants: Programme staff.

Results: Total cost per child ranged from $155 to $184 per 8-week programme and $493 per 10-week programme. Monthly LF supplementation cost per child ranged from $5 to $21. Unit costs were influenced by implementation duration and variations in programme features including storage and transportation models, the inclusion of voucher transfers and volunteer cadre models. Opportunity costs to beneficiaries and volunteers in preparing recipes were substantial. Cash/voucher components, when used, represented a cost driver for institutional and societal costs.

Conclusions: An updated WHO guideline emphasises the role of LF for supplementing MW children who lack other risk factors. Given that specially formulated foods are not necessary for all MW children to recover, programme approaches using LF are important options for managing MW. This study from Nigeria provides the first cost estimates for using LF to manage MW. Future research is needed on the effectiveness and cost-effectiveness of these approaches.

Objective: To propose nutrition-related corporate reporting metrics for Australian packaged food manufacturers, retailers and quick-service restaurants and explore their feasibility of implementation.

Design: Proposed metrics were developed based on (1) a review of current corporate reporting frameworks and relevant literature to collate nutrition-related recommendations, metrics and principles of best-practice reporting and (2) adaptation of existing recommendations into reporting metrics. Interviews with representatives from fifteen food companies were conducted to understand implementation considerations.

Setting: Australia.

Results: There is a wide range of existing globally applicable nutrition-related recommendations and reporting metrics for food companies. Based on nine key principles identified for best-practice corporate reporting on nutrition, we devised forty-one reporting metrics (including five flagged as priorities) tailored to food companies operating in Australia across five focus areas: 'corporate strategy and governance', 'product formulation', 'nutrition labelling and information', 'promotion practices' and 'product accessibility and affordability'. Company representatives expressed support for the proposed metrics, noting that additional information technology infrastructure and resources would be required for their routine reporting by companies.

Conclusions: The proposed set of reporting metrics offers evidence-based guidance for the disclosure of nutrition-related actions by Australian food companies. The proposed metrics can inform government, public health groups and investors on best-practice approaches to monitor corporate nutrition practices and guide related policy decisions. Widespread implementation of the reporting metrics would be facilitated by integration with mandatory corporate sustainability reporting standards, with routine monitoring and enforcement by government, coupled with fit-for-purpose tools for comparing the healthiness of company product portfolios.

Objective: To investigate the associations among income from work, the gender of the reference person, family and food insecurity (FI).

Design: This quantitative study used nationally representative data from the 2018 Brazilian Family Budget Survey.

Setting: The analyses estimated levels of food security and insecurity measured by the Brazilian Food Insecurity Scale according to labour income determined by the minimum wage per capita and the sex of the reference person (female/male). The logistic regression model measured the interaction between work income and gender in association with household FI.

Participants: Brazilian families living in permanent households with at least one resident earning income from employment (n 48 625).

Results: Households headed by women and with labour income ≤ ¼ minimum wage per capita had the highest percentage of moderate/severe FI (29·7 %). In these families and households with lower levels of employment income headed by men, the highest probabilities of moderate/severe FI were observed, at 10·8 and 9·6, respectively, compared with families with higher levels of employment income headed by men.

Conclusions: Lower employment income contributes to FI in families, especially those that are headed by women. The socialisation of care work and the reduction in paid labour hours contribute to greater access to the labour market for women and a lower likelihood of FI.

Objective: Although guidelines recommend targeted vitamin D testing for high-risk populations, testing has increased globally. Limited studies have examined real-world testing patterns and their relationship with deficiency outcomes. This study investigates trends, demographic determinants and deficiency outcomes associated with voluntary vitamin D testing among Taiwanese adults.

Design: A retrospective cohort study analysing electronic medical records to assess vitamin D testing trends, demographic predictors of deficiency and status changes following consecutive tests within 2 years. Vitamin D status was classified based on serum 25-hydroxyvitamin D levels as deficient (< 20 ng/ml), insufficient (20-29·9 ng/ml) or sufficient (≥ 30 ng/ml).

Setting: A tertiary medical centre in Taiwan.

Participants: Between 2013 and 2022, 13 381 outpatients underwent voluntary vitamin D testing. After excluding those aged < 18 years, with advanced renal disease, osteomalacia, rickets or hyperparathyroidism, 8383 were included in the final analysis.

Results: Testing increased sharply after 2019. Although women underwent twice as many tests, men had a higher deficiency prevalence (56·94 % v. 53·01 %). Adults aged 18-34 years had the highest prevalence (67·81 %). Obstetrics and Gynecology specialists ordered the most tests, particularly for female infertility, with 65·73 % of patients deficient. Among those with repeat tests, deficiency prevalence decreased from 59.32 % to 43·25 %.

Conclusions: The increase in voluntary vitamin D testing with demographic disparities highlights the importance of understanding testing behaviours and public health implications. Improved vitamin D status at follow-up suggests potential benefits in identifying high-risk individuals and emphasises the need for further research to evaluate outcomes and guide prevention strategies.

Objective: To examine the intra- and inter-device reliability of devices using pressure-mediated reflection spectroscopy (the Veggie Meter®).

Design: A cross-sectional research study was conducted across eight sites in the USA. Using two Veggie Meters® at each site, participants completed five, counter-balanced pairs of finger scans. Intra-device comparisons included intra-class correlation coefficients (ICC) and calculation of the CV and 95 % CI of each device/site; hypothesised to be ≤ 6 %. Inter-device comparisons included ICC, absolute relative differences (ARD) and 95 % CI, and equivalence; both hypothesised to be ≤ 10 %.

Setting: Eight sites across the USA.

Participants: Across sites, participants' (n 282) average age ranged 24·7-39·0 years; sex ranged 60·0-85·7 % women and Non-Hispanic White ranged 20·0-94·3 %.

Results: Intra-device ICC ranged from 0·77 to 0·99. The CV ranged from 6·2 to 14·2 %, with an average of 8·8 %. A majority (63 %; n 10) of the Veggie Meter® devices had significantly higher CV from the hypothesised 6 %. Inter-device ICC ranged from 0·58 to 0·94. The ARD ranged from 7·5 to 22·0 %, with an average of 13·9 %. ARD in a majority (n 5) of sites was significantly higher than the hypothesised 10 %. Five sites (63 %) demonstrated equivalence below the hypothesised 10 %.

Conclusions: Our study demonstrates the intra-device and inter-device reliability to be moderate to high, as per ICC. The observed margin of difference within a device was up to 14 %, with an average of 9 %. The observed margin of difference between devices was up to 22 %, with an average of 14 % between devices.

Objective: During the COVID-19 pandemic, the US Department of Agriculture allowed all US schools to offer meals at no cost regardless of family income, a policy known as Universal Free Meals (UFM). Despite the recognised benefits of UFM, the policy expired in June 2022. The goal of this study was to gather perceptions of school staff in Arizona about school meals, UFM and the discontinuation of UFM.

Design: This mixed-method study collected data using an online survey. Open-ended survey questions were analysed using qualitative thematic analysis, and closed-ended questions were analysed using descriptive analysis.

Setting: The survey was distributed to school staff in the two major metropolitan areas in Arizona between September and October 2022, soon after the UFM policy expired.

Participants: Survey responses were received from 1255 school staff, including teachers, cafeteria staff, administrators and other staff.

Results: Most school staff (93 %) were supportive of UFM, and the support was consistent across all staff categories and across different political leanings. Thematic analysis demonstrated that staff felt UFM helped to meet students' basic needs, reduced stigma and lessened the burden on teachers to use their own resources to provide food to students. Despite strong support, some staff reported concerns about food quality, programme waste and time available for lunch.

Conclusions: UFM policies were strongly supported by school staff, despite some concerns about programme implementation. Understanding these views is important to the discussion of expanding UFM policies in the USA and globally.

Objective: This study compared dietary diversity and nutrient adequacy across age groups and seasons within an indigenous Karen community.

Design: Cross-sectional survey.

Setting: Dietary intake was assessed using a single-day 24-h dietary recall among Karen community members living in two villages of Laiwo subdistrict, Sangkhlaburi district, Kanchanaburi province, Thailand.

Participants: In total, 312 Karen people participated during the rainy season and 344 during the dry season, including school-age children (6-12 years), working-age people (19-59 years) and older people (≥ 60 years).

Results: Dietary diversity scores and food variety scores significantly differed across age groups for both seasons. However, seasonal dietary diversity score differences were not observed within any group, except for the food variety scores of school-age children. Over 70 % of participants in all age groups had inadequate intake of key micronutrients - Ca, Fe, vitamin A, vitamin C, Zn, vitamin B₆ and vitamin B₁₂ - as indicated by nutrient adequacy ratios < 0·75. Moderate to strong positive correlations between dietary diversity scores and nutrient adequacy ratios for energy, vitamin B₂, vitamin C, niacin and mean adequacy ratio (r = 0·418-0·691, P < 0·001) were observed exclusively in the dry season and across all age groups.

Conclusions: Among the Karen people, who are also facing triple burden malnutrition, dietary diversity is limited, micronutrient inadequacy is prevalent and overall dietary quality is insufficient despite frequent vegetable consumption. Findings highlight the need to address systemic challenges related to food variety and to promote education on appropriate food quantities, preparation methods and sustainable traditional food systems to improve nutrition.