Public Health Nutrition最新文献

Objective: To investigate the extent to which the associations of socioeconomic position (SEP) with stunting and wasting are mediated by minimum acceptable diet (MAD) and a family care indicator (FCI) in Sri Lanka.

Design: Secondary data analysis of children from the 2016 Sri Lanka Demographic and Health Survey. The outcomes were stunting and wasting, the exposure was a composite measure combining maternal education and household wealth, and the mediators were binary MAD and FCI variables (adequate vs inadequate). Analyses were performed using counterfactual mediation models adjusted for age, sex and residence place.

Setting: A nationally representative sample of children from Sri Lanka.

Participants: Mothers/caregivers of children under 36 months (4,325).

Results: Twenty percent of children were stunted and 14% were wasted. Lower SEP was associated with higher odds of stunting and wasting, and inadequate MAD and FCI. Inadequate FCI was associated with higher odds of stunting (OR=1.47, 95%CI= 1.24, 1.74) but not wasting (OR=1.14, 95%CI= 0.94, 1.38), whereas MAD was not associated with stunting or wasting. Neither MAD nor FCI significantly mediated the relationship between SEP and stunting and wasting. All mediation estimates were statistically non-significant at the 5% level. For example, the proportion mediated by FCI on the association between the lowest composite SEP and stunting was 13% (Mean Difference=0.13, 95%CI= -0.64, 0.90).

Conclusion: We did not find consistent or strong evidence that the associations of SEP with childhood stunting and wasting in Sri Lanka are mediated by MAD and FCI. Research with larger samples is needed for more precise estimates.

Research shows that understanding the nutritional status and eating habits of people with disabilities is essential for creating effective preventive healthcare strategies. Communication barriers in healthcare settings, low health literacy, and socioeconomic inequities are among the challenges this community faces. These difficulties can lead to poor nutritional knowledge, food insecurity, and chronic diseases. Deaf individuals also experience higher rates of undernutrition, obesity, and micronutrient deficiencies, primarily due to limited access to linguistically appropriate nutrition education. This commentary aims to explore the nutritional problems in the Deaf community, their determinants and risks, and to offer inclusive solutions and preventive strategies at the individual, community, and policy levels to ensure equitable nutrition and health for all Deaf individuals.

Objective: To examine the efficacy of a food-based intervention on preschool children's (3-5 years) FV consumption, as measured by skin carotenoid status (SCS) using the Veggie Meter®.

Design: Quasi-experimental intervention with baseline (T1), pre-intervention (T2), and post-intervention (T3) assessments of children's SCS. Intervention classrooms (ICs) received the program, which featured food-based learning and gardening. Comparison classrooms (CC) received a standard curriculum. Child and Adult Care Food Program (CACFP) aligned menus were identical across all centers. Intervention teachers participated in semi-structured interviews to contextualize quantitative findings.

Setting: Head Start centers (n=7) across three counties in North Carolina.

Participants: 183 Head Start children (n=88 IC; n=95 CC).

Results: During the intervention period (T2-T3), significant SCS increases were observed in both groups: IC (T2=253.7, SD=77.7; T3=299.0, SD=77.4) and CC (T2=226.6, SD=77.5; T3=255.9, SD=79.9). The IC demonstrated a greater gain in SCS (17.8% gain) than the CC (12.9% gain). However, additional analyses revealed no significant difference in the SCS rate of change over time (p=0.33). Teachers reported that the intervention improved children's willingness to try fruits and vegetables and encouraged positive feeding practices beyond the mealtime setting.

Conclusions: The findings suggest that increased access to FVs through CACFP-supported meals and snacks may influence children's overall improved FV consumption. However, improved food access paired with FBL may also support higher gains in FV consumption.

Objective: This study aimed to assess the understanding, perceptions, and preferences of different front-of-pack labeling (FOPL) formats among Thai consumers.

Design: We conducted a mixed-methods study comprising a cross-sectional online survey and semi-structured interviews between February -March 2022. The survey assessed comprehension and preferences for six FOPL formats (Guideline Daily Amounts (GDA), Healthier Choice logo (HCL), Warning Labels (WLs), Nutri-Score, Health Star Rating (HSR), and Traffic Light labels (TLL)). Quantitative data were analyzed using descriptive statistics, chi-square tests, and multiple logistic regression. Qualitative data underwent thematic analysis.

Setting: Bangkok and metropolitan areas.

Participants: Thai residents aged 12-78 years (n=410).

Results: While awareness of existing labels was high (GDA: 95.4%, HCL: 82.4%), only 23.9% regularly read GDA labels. WLs and Nutri-Score were the most effective at providing information to consumers in a format that translated into choosing healthier products. WLs demonstrated the highest effectiveness in guiding healthier choices. HCL received the highest agreement across multiple attributes, including packaging inclusion preference (59.8%), visibility (58.5%), and visual appeal (57.3%), although effectiveness was not tested. Qualitative findings revealed preferences for color-coded systems but identified barriers including time constraints, small font sizes, and difficulty interpreting numerical information.

Conclusions: While interpretive labels, particularly warning labels, are most effective for guiding consumers to healthier choices, successful implementation requires consideration of both consumer preferences and real-world usage constraints. Findings support replacing the current GDA system with an interpretive design, accompanied by comprehensive public education campaigns. These results provide evidence-based recommendations for FOPL policy development in Thailand.

Educational attainment is a key determinant of diet quality. The overarching pathways (i.e. theories and mechanisms) through which educational attainment shapes diet quality remain largely unexplored in the nutrition literature, and the most salient pathways likely differ across time, populations and socio-economic and political contexts. This commentary proposes a research agenda and outlines methodological considerations that are intended to better illuminate the educational attainment-diet quality relationship. From an extensive review of the literature, which led to two publications pertinent to the topic, we identified three major research gaps that should be addressed to better understand how educational attainment stratifies diet quality to guide interventions and inform equity-enhancing policies: (1) interrogating the construct of educational attainment; (2) comparative population-level and subgroup studies; and (3) root cause analyses and structural reforms. We also discuss methodological considerations needed to inform future studies of associations between educational attainment and diet quality.

Objective: To discuss the growing challenge of the double burden of malnutrition (DBM), the co-existence of undernutrition and obesity, and the associated clinical and policy complexities in low- and middle-income countries (LMIC).

Design: This commentary synthesises evidence from recent multi-country and country-specific studies in sub-Saharan Africa and other LMIC. Many LMIC are typified by food insecurity, socio-economic inequalities and fragile health systems which drive DBM patterns, as well as informal community structures such as rotating savings groups which influence access to healthier diets.

Results: Evidence indicates that DBM disproportionately affects disadvantaged households and complicates obesity management. Current clinical guidelines remain obesity-centric and often overlook contexts where individuals with obesity may also experience stunting or micronutrient deficiencies.

Conclusions: This commentary aligns with global frameworks including WHO’s double-duty actions for nutrition, the UN Decade of Action on Nutrition (2016–2025) and the FAO-WFP food systems agenda. To achieve health equity, a coordinated approach is needed: clinical practice must improve diagnosis of co-existing undernutrition and obesity, while public policy must ensure that efforts to manage obesity are supported by food systems that provide equitable access to affordable, nutritious diets.

Objective: To map the spread of research on legumes, including beans, peas, and other pulses; to identify research gaps and opportunities relating to the use of legumes for improved human nutrition, health and environmental outcomes; and to develop a novel method for clarifying research priorities.

Design: Prospective mapping review, identifying and mapping ongoing research (2019-2023) across the value chain.

Setting: UK.

Participants/sample: Academic research studies in three databases.

Results: 50 ongoing research projects were identified, revealing a focus on the two ends of the value chain: production (21 projects) and consumption (21 projects). Only four projects encompassed the entire value chain from producer to consumer. Research on production includes the role of legumes in crop rotations for soil health and reduced fertiliser use, productivity interventions, and improved breeds. Research on consumption includes dietary and health outcomes, predominantly cardiometabolic impacts, and legumes as an alternative protein source. Few projects focused on the middle of the value chain (four projects on product development) with none focused on processing, food service or retail.

Conclusions: Further interdisciplinary projects, linking producers to consumers and with a greater focus on middle chain actors, are needed. The food processing/manufacturing, food service and retail sectors hold significant power in food systems practice and governance. They play a crucial role in transitioning to a healthier and more sustainable food system. Understanding the drivers and barriers for these food systems actors in increasing production and consumption of beans, peas and pulses is required to inform future food policy and practice.

Objective: To investigate whether taste perception of two artificial sweeteners-aspartame and neohesperidin dihydrochalcone (NHDC)-is causally associated with the risk of site-specific cancers.

Design: A two-sample Mendelian randomisation (MR) study.

Setting: Genetic instruments for taste perception (6 for aspartame; 13 for NHDC) were obtained from a genome-wide association study (GWAS) of Australian adolescents, and cancer outcome data were sourced from publicly available GWAS datasets.

Participants: Genetic data for taste perception from 1757 Australian adolescents and genetic data for cancers from large-scale GWAS cohorts, including UK Biobank (n 500 000) and FinnGen (n 500 000).

Results: A one sd increase in the genetically predicted perceived intensity of NHDC was associated with an increased risk of male genital cancer (OR = 1·11, 95 % CI: 1·04, 1·19) and prostate cancer (OR = 1·03, 95 % CI: 1·01, 1·08) based on FinnGen data. These associations persisted after multivariable MR adjustment for glucose and aspartame perception but were not replicated in the UK Biobank. A weak protective association between aspartame perception and cervical cancer (OR = 0·998, 95 % CI: 0·997, 0·999) was observed, but this attenuated to null in sensitivity analyses.

Conclusions: This study found no compelling evidence that perception of aspartame or NHDC during adolescence causally influences later-life cancer risk. The findings highlight the importance of evaluating individual artificial sweeteners separately in future research examining potential health effects.

Objective: Nutrition plays a valuable role in health promotion and disease prevention. Nutrition education for healthcare professionals (HCPs) has been widely explored globally. However, it has not been investigated extensively within Ireland. This research aimed to assess references to nutrition within education programmes, accreditation curricula standards and registration requirements of professional bodies for primary care and community HCPs in Ireland.

Design: A cross-sectional content analysis was conducted. Data collection was carried out in October 2024.

Setting: Ireland.

Participants: A sample of primary care and community HCPs was included (n 10). An online search identified education programmes (undergraduate and postgraduate), accreditation curriculum standards and registration requirements from professional bodies governing primary care and community HCPs. Relevant webpages and documentation were reviewed to determine direct references to nutrition (e.g. 'diet', 'nutrition', 'eating', 'food') and/or indirect references to nutrition (e.g. 'health promotion' and 'well-being').

Results: Out of fifty-two education programmes, 26·9 % (n 14) made direct reference to nutrition, with the majority (n 8) of these being postgraduate level. Furthermore, 20 % (n 2) of the HCP bodies referred directly to nutrition within their registration requirements (one of which was for dietitians), and 50 % (n 5) referred directly to nutrition within their accreditation standards.

Conclusions: This research demonstrates a sparsity of nutrition within key education standards for primary care and community HCPs in Ireland. Key recommendations include a call to action for formal and consistent embedding of nutrition within education for medical professionals in Ireland, in line with international best practice.

Objective: Ultra-processed foods (UPFs) are shown to promote disease. Research shows high UPF intake with food insecurity and SNAP participation. However, no research has quantitatively examined UPF acquisitions (which includes purchases) by food insecurity and SNAP status in US households. This analysis examines food insecurity and SNAP participation with UPF acquisitions for home consumption.

Design: Food insecurity was assessed through the ten-item Adult Food Security Survey. Household SNAP participation was considered affirmative if any member of the household reported receiving SNAP benefits. Household UPF acquisitions/purchases for home consumption (as a percentage of total energy acquired/purchased) were determined by the NOVA classification system. Multivariable linear regressions adjusted for household sociodemographic characteristics quantified associations between food insecurity and SNAP participation with UPF acquisitions for home consumption in US households.

Setting: The USA.

Participants: 3949 households from the National Household Food Acquisition and Purchase Survey.

Results: 15·5 % and 13·9 % of US households experienced marginal food security and food insecurity, respectively. Adjusted means for UPF acquisition for home consumption across food security and SNAP categories ranged from 53·2 % to 57·0 %. Marginal food security was associated with 3·8 % higher UPF acquisitions for home consumption (P = 0·0039) compared with households with high food security. However, there was no association with food insecurity or SNAP.

Conclusions: UPF acquisitions for home consumption were high for US households across food security and SNAP categories. Marginal food security was associated with higher UPF acquisitions for home consumption in US households. However, we observed no associations between food insecurity and SNAP participation with UPF acquisitions. More research on drivers of this association for households with marginal food security should be conducted.