Public Health Nutrition最新文献

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.

Objective: To identify and present (i) how responsibility for poor diets in the UK is framed across the public, mass media and the government and (ii) how groups experiencing socio-economic disadvantage are presented within this framing.

Design: A scoping review of peer-reviewed literature was conducted using six databases. A systematic narrative synthesis guided by qualitative content analysis was applied to summarise the findings.

Results: Thirty-six articles were included. Studies exploring public perceptions of poor diets acknowledged personal and broader systems drivers, with individual responsibility predominating across studies. Research analysing media portrayals showed similar patterns of individual responsibility among right-leaning newspapers, which focused on individual lifestyle changes. However, left-wing newspapers highlighted the role of the food industry and the government. Studies analysing government policies identified citizens as the primary agents of change through rational decision-making. Framing from socio-economically disadvantaged groups showed a preference for prioritising their own choice, but were limited by household income, food prices and family food preferences. Policies and media portrayals provided limited emphasis on these populations, with individual responsibility narratives prevailing.

Conclusions: The framing of responsibility for poor diets in the UK centred on the individual, obscuring the powerful influence of food manufacturers and retailers and the role of government in providing safe, healthy environments for all. This review highlights the urgent need to challenge this narrative, with the public health nutrition community working collectively to force a radical shift in public, media and policy framing and incite strong regulatory action by governments.

Objectives: Household food insecurity (HFI) is a social determinant of health globally. Rates of HFI have risen in many high-income countries in recent years, particularly in households with children. The health outcomes associated with HFI for children and adolescents have not been systematically synthesised. This review was conducted to support advocacy efforts for meaningful policy action to reduce HFI in households with children.

Design: A systematic search was conducted in Medline, Embase and PsycInfo databases. Primary studies measuring the association between physical or mental health outcomes and HFI were included. Studies were appraised and population, setting, measures and outcomes were extracted. Findings were grouped by related outcomes. Due to heterogeneity, findings were synthesised narratively. Rapid review methodology was used to accommodate resource constraints.

Setting: High-income countries.

Participants: Youth aged less than 18 years.

Results: Thirty-six studies were included. Most were cross-sectional studies conducted in the USA. Outcomes included general health, early childhood, cardiometabolic, asthma, dental caries, mental health, sleep, diet and anaemia. Despite substantial heterogeneity in HFI measures and analysis, findings support associations between HFI and negative outcomes for general health status, asthma, dental caries and mental health. Findings for other outcomes were mixed.

Conclusions: This review clarifies the effects of HFI on children and adolescents. Findings highlight trends for negative physical and mental health outcomes associated with HFI during youth, particularly related to mental health, oral health, asthma and general health status. Policy-level action should address rising rates of HFI and long-term effects on these vulnerable populations.

Objective: To describe Brazilian parents' perceptions of non-sugar sweeteners (NSS) in beverages consumed by children and their views for NSS front-of-package labels (FOPL).

Design: A qualitative-driven mixed-methods embedded design was used. Seven focus groups with parents of children explored perceptions of NSS. Qualitative data were coded and analyzed using thematic analysis. Participants also completed a closed-ended survey assessing familiarity with NSS-containing beverages, ability to identify NSS on ingredient labels and perceptions of NSS FOPL. Survey responses were summarised using descriptive statistics.

Setting: Public and private schools and early childhood education centres in urban areas of two municipalities in the State of São Paulo, Brazil.

Participants: Forty parents of children aged 2-5 and 6-11.

Results: About 35 % of participants reported their children consumed at least one NSS-containing beverage weekly in the past month; 17 % reported daily consumption. Parents expressed a preference for natural products and confusion over the term 'edulcorantes' (Portuguese for NSS). They shared concerns about the health effects of both sugar and NSS, particularly for children. NSS were seen as acceptable in specific cases, such as if a child has diabetes. Most parents supported a FOPL like Mexico's, stating 'not recommended for children'. In the survey, 85 % of the parents correctly identified beverages with NSS, but 82 % misclassified non-NSS ingredients (e.g. sugar syrup, caramel) as NSS. The Mexico-style FOPL was preferred by 95 % of the parents, who found it helpful and easy to understand.

Conclusions: A FOPL clearly indicating NSS presence, especially one recommending against consumption by children, may help parents make informed choices and reduce children's intake of NSS-containing beverages.

Objective: To assess the nutritional composition, adequacy and environmental impact of menus served, consumed and wasted by 11-12-year-old students in public and charter schools in northern Spain.

Design: A cross-sectional observational study (2017-2018) involving photographing menus before and after consumption, visual portion size estimation using a validated photographic catalogue and food waste assessment via the quarter-waste visual method. Nutritional composition was analysed using food composition databases and greenhouse gas emissions using life cycle assessment data.

Setting: Ten primary schools (five public and five charter) in northern Spain.

Participants: 1000 school menus for students aged 11-12 years.

Results: Menus served exceeded energy recommendations (791·5 (sd 176·7) kcal) and were high in fat (39·7 (sd 13·4) g), protein (29·7 (sd 10·0) g) and Na (980·4 (sd 302·2) mg) but low in carbohydrates (74·7 (sd 18·1) g), fibre (8·8 (sd 3·7) g) and several micronutrients. Food waste averaged 140·5 g per menu, mainly vegetables and fruit, leading to nutrient losses, particularly in fibre, vitamins A and C and Fe. The carbon footprint of menus averaged 1·489 kg CO₂-eq, primarily from meat and fish, with waste contributing 0·298 kg CO₂-eq. Public schools served more nutrient-dense food but had higher waste (public 151·5 (sd 112·3) g v. charter 129·5 (sd 86·3) g, P < 0·001); charter schools served more energy-dense food, with higher Na and fat (P < 0·001).

Conclusions: Menus showed nutritional imbalances, with excessive energy and Na and insufficient fibre and several micronutrients. Food waste worsened dietary adequacy while increasing environmental impact. Public schools offered more nutrient-rich food but faced greater waste compared with charter schools. Institutional differences suggest the need for tailored strategies to enhance both nutritional quality and sustainability.

Objective: The primary aim of this rapid review was to provide a summary of the mechanisms by which household food insecurity (HFI) is associated with child and adolescent health outcomes. The secondary aim was to identify key HFI determinants, provide an updated account of HFI-associated child/adolescent health outcomes and build a conceptual map to illustrate and consolidate the findings.

Design: A rapid review was performed using EMBASE, Medline, Web of Science and the Cochrane Library. Inclusion criteria were observational high-income English-language studies, studies evaluating the mechanisms and associations between HFI and child health outcomes using statistical methods.

Setting: High-income English-speaking countries.

Participants: Child (3-10 years) and adolescent populations (11-24 years) and their parents, if appropriate.

Results: Eight studies reported on the mechanisms by which HFI is related to child health outcomes, suggesting that maternal mental health and parenting stress play mediating roles between HFI and child/adolescent mental health, behaviour and child weight status. Sixty studies reported on associations between HFI and various child health outcomes. HFI had a significant impact on diet and mental health, which appeared to be interrelated. Sociodemographic factors were identified as determinants of HFI and moderated the relationship between HFI and child/adolescent health outcomes.

Conclusions: There is a gap in the evidence explaining the mechanistic role of diet quality between HFI and child weight status, as well as the interplay between diet, eating behaviours and mental health on physical child health outcomes. The conceptual map highlights opportunities for intervention and policy evaluations using complex systems approaches.

Objective: Multiple sclerosis (MS) is a chronic, auto-immune, neurodegenerative condition with increasing global prevalence. People living with MS (plwMS) have reported limited guidance relating to nutrition information. Paired with varied health literacy levels, this makes plwMS susceptible to nutrition misinformation.

Design: A cross-sectional online social network analysis (SNA) examining nutrition information for MS.

Setting: A systematic SNA using Twitter/X and YouTube platforms using NodeXL to summarise metrics. Quality was assessed using the QUEST tool. Content analysis of YouTube videos was synthesised into themes for misinformation.

Participants: Online publicly available social media user posts and video content.

Results: Twitter/X SNA revealed keywords used most by an account representing 72·8 % of the user network with common diet mentions including Wahls (57 times), paleo (15 times) and ketogenic (11 times). 'Favourite count' metrics were strongly correlated with 'repost count' (r = 0·83, P = 0·000). Videos which endorsed a diet were more likely to have a lower QUEST score. User engagement metrics were higher for lower quality videos. The quality of online nutrition information relating to MS was moderate (61 %). Physicians were the most likely source of nutrition information endorsing a diet for MS. The content analysis identified a knowledge gap for both medical professionals and plwMS.

Conclusions: Nutrition misinformation for MS occurs on social media and information quality is variable. Audiences need to be cautioned about users with large followings and evaluate the credibility of all information. This study reiterates the importance of evidence-based information for the MS community.