Public Health Nutrition最新文献

Objective: To evaluate the relationship between the food environment in favelas and the presence of arterial hypertension and diabetes among women in the context of social vulnerability.

Design: A cross-sectional and partially ecological population-based study was conducted in a Brazilian capital city. The healthiness and availability of ultra-processed foods in the food environment were assessed through retailer audits using the AUDITNOVA instrument. The presence of diabetes and arterial hypertension was evaluated based on self-reported prior medical diagnosis. Logistic regression models were applied using generalized estimating equations, adjusted for age, education, race/skin color, and poverty status.

Participants: 1,882 adult women of reproductive age (20 to 44 years).

Results: It was found that 10.9% of women were hypertensive, and 3.2% had diabetes. The likelihood of having diabetes and arterial hypertension decreases with higher levels of healthiness in the food environment (Diabetes [OR: 0.25; 95% CI: 0.07, 0.97]/Arterial hypertension [OR: 0.45; 95% CI: 0.24, 0.81]) and increases with greater availability of ultra-processed foods in their living area (Diabetes [OR: 2.18; 95% CI: 1.13, 4.21]/Arterial hypertension [OR: 1.64; 95% CI: 1.09, 2.47]).

Conclusions: These results suggest that characteristics of the consumer food environment have a significant effect on the occurrence of chronic diseases among socially vulnerable women, adding to the existing evidence in the literature and highlighting the need for integrated health care.

Objective: To characterise children's lunchbox contents for food, waste, and packaging.

Design: A cross-sectional study was conducted. Lunchboxes were photographed at two time points on the same day: before first morning break to capture food and packaging and post-lunch break to capture food waste. Contents were coded using an audit tool developed using REDCap.

Setting: 23 sites across metropolitan Adelaide, South Australia including 14 preschools and 9 primary schools in low (n=8), medium (n=7), and high (n=8) socioeconomic areas.

Participants: Preschool (3-5 years) to Grade 7 (6-13 years) school students.

Results: 673 lunchboxes were analysed. Grain foods dominated (with at least half of them being discretionary varieties), with 92% of lunchboxes having at least one item from that category, followed by fruits (78%), snacks (62%), dairy (32%), and vegetables (26%). Lunchboxes of preschool children contained more fruits (92% vs 65%; χ2(1)=73.3, P<0.01), vegetables (36% vs 16%; χ2(1)=34.0, P<0.01), and dairy items (45% vs 19%; χ2(1)=53.6, P<0.01), compared to lunchboxes of primary school children. Snack foods were more prevalent in primary school (68%) than preschool (55%; χ2(1)=11.2, P<0.01). Discretionary foods appeared more frequently, and single-use packaging accounted for half (53%) of all packaging in lunchboxes, primarily from snacks and grain foods. Preschool children had less single-use packaging but more food waste. Vegetables were the most wasted food group.

Conclusions: Sandwiches, fruits, and various snacks are typical lunchbox foods, often accompanied by single-use packaging. Considering both health and environmental factors in lunchbox choices could benefit children and sustainability efforts in schools.

Objective: To investigate the concordance between Australian government guidelines for classifying the healthiness of foods across various public settings.

Design: Commonly available products in Australian food service settings across 8 food categories were classified according to each of the 17 Australian state and territory food classification guidelines applying to public schools, workplaces, and healthcare settings. Product nutrition information was retrieved from online sources. The level of concordance between each pair of guidelines was determined by the proportion of products rated at the same level of healthiness.

Setting: Australia.

Participants: No human participants.

Results: Approximately half (56%) of the 967 food and drink products assessed were classified as the same level of healthiness across all 15 'traffic light'-based systems. Within each setting type (e.g., schools), pairwise concordance in product classifications between guidelines ranged from 74% to 100%. 'Vegetables' (100%) and 'sweet snacks and desserts' (78%) had the highest concordance across guidelines while 'cold ready-to-eat foods' (0%) and 'savoury snacks' (23%) had the lowest concordance. In addition to differences in classification criteria, discrepancies between guidelines arose from different approaches to grouping of products. The largest proportion of discrepancies (58%) were attributed to whether products were classified as 'Red' (least healthy) or 'Amber' (moderately healthy).

Conclusions: Results indicate only moderate concordance between all guidelines. National coordination to create evidence-based consistency between guidelines would help provide clarity for food businesses, which are often national, on how to better support community health through product development and reformulation.

Objective: To characterize food group consumption, assess the contribution of food groups to energy and micronutrient intake, and estimate usual nutrient intake among adults in rural Sri Lanka.

Design: A baseline survey (Dec 2020-Feb 2021) was conducted as part of an agriculture-based, nutrition-sensitive resilience program evaluation. Dietary intake was assessed using telephone-based 24-hour recalls (n=1283), with repeat recalls from 769 participants. Mean daily intake of food groups and their contribution to energy and nutrient intakes were calculated. The National Cancer Institute method was used to estimate usual intakes and the prevalence of adequate micronutrient intake (PAI). Differences by sex, district, and wealth were assessed using t-tests and ANOVA.

Setting: Forty-five rural villages throughout Sri Lanka.

Participants: Men and women from households in the program evaluation study area.

Results: On average, grains and coconut milk provided 56% and 12% of energy, respectively. Rice, fish, dairy, and pulses were the primary sources of micronutrients. Participants consumed 118±117g vegetables and 71±243g fruit per day. PAI was <25% for calcium; zinc; niacin; folate; and vitamins B6, B12, and C, reflecting low consumption of animal-source foods (ASF; 80 g/day), whole grains, fruits, and vegetables (F&V). Significant differences in food group consumption by sociodemographic subgroup were observed among districts and wealth quintiles.

Conclusions: We observed high consumption of rice and coconut milk and low prevalence of micronutrient adequacy. We recommend increasing ASF, whole grain, and F&V consumption to close nutrient gaps, as well as research to identify effective solutions to increase micronutrient intake.

Objective: Early childhood obesity (ECO) significantly increased in the United States. ECO interventions lack focus on the prevention of ECO for infants under two. Caregiver's feeding styles (CFS) has shown to affect ECO development, but studies on CFS are limited. This study examined socioecological factors associated with CFS for infants under two in Nevada.

Design: This cross-sectional study utilizing a survey, examined the five CFS-constructs: Responsive (RP), Non-Responsive (NRP) laissez-faire, NRP-pressuring, NRP-restrictive, and NRP-indulgent. Descriptive analysis and logistic regression following a hierarchical modeling approach were used to determine the associations between the CFS-constructs and socioecological factors (e.g., household, maternal mental health, and infant feeding).

Setting: Clark County, Nevada.

Participants: 304 caregivers with infants under two.

Results: NRP feeding styles were associated with low-income households (e.g., NRP-restrictive (AOR=2.60, 95% CI [1.01-6.71])), water insecurity (e.g., NRP-pressuring (AOR=2.46, 95% CI [1.00-6.06]), young mothers (e.g., NRP-laissez-faire (AOR=2.39, 95% CI [1.00-5.84])), lower maternal education (e.g., RP (AOR=0.58, 95% CI [0.33-1.00])), mild risk for depression (e.g., NRP-restrictive (AOR=0.50, 95% CI [0.28-0.90])) and a moderate to severe risk for anxiety (e.g., NRP-pressuring (AOR=0.32, 95% CI [0.14-0.74])). There were no associations between infant feeding factors and RP feeding.

Conclusion: Our study identified socioecological factors associated with dissimilarities in CFS in Nevada. These findings can be used to tailor educational approaches to address disparities in early childhood obesity.

Objective: While fast-food is typically considered highly processed, an analysis to demonstrate this has yet to be conducted. Therefore, the objective of this research was to examine the menu items and ingredients from six fast-food restaurant menus using the NOVA Classification.

Design: Cross-sectional study.

Setting: Data were collected from the top six highest selling United States restaurants, per each food category, identified using the Quick Service and Fast Casual Restaurants (QSR) 2020 Report.

Participants: A total of 740 menu items were identified and classified according to their degree of processing based on ingredient lists using the NOVA Classification: Minimally Processed (MPF), Culinary Processed Ingredient (CPF), Processed (PRF), or Ultra-processed (UPF). In addition, individual ingredients that appeared on at least three menus were classified into NOVA groups, and the 20 most common ingredients were identified based on frequency of appearance in ingredient lists.

Results: Across all menus, 85% (Range: 70-94%) of items were UPFs with only 11% (Range: 6-25%) being MPF (p<0.001). Additionally, 46% of the ingredients that appeared on at least three menus were ultra-processed ingredients. Three ultra-processed ingredients appeared on all six menus: natural flavors, xanthan gum, and citric acid.

Conclusions: These findings show that the vast majority of menu items from major fast-food restaurants are UPFs and there are few options for MPFs. Fast-food companies should consider reformulation or the addition of MPF to the menu to increase healthful food options for their patrons.

Objective: To investigate the relationship between US containment measures during the COVID-19 pandemic and household food insecurity.

Design: To investigate these relationships, we developed a framework linking COVID-19-related containment policies with different domains of food security and then used multilevel random effects models to examine associations between state-level containment policies and household food security. Our framework depicts theorised linkages between stringency policies and five domains of food security (availability, physical access, economic access, acceptability in meeting preferences and agency, which includes both self-efficacy and infrastructure). We used US national data from a representative survey data from the National Food Access and COVID research Team that was fielded in July-August 2020 and April 2021. Containment policy measures came from the Oxford Stringency Index and included policies such as stay-at-home orders, closing of public transit and workplace closures.

Setting: The USA.

Participants: 3071 adult individuals from the National Food Access and COVID research Team survey.

Results: We found no significant associations between state-level containment policies and overall food insecurity at the state level or any of the individual domains of food insecurity.

Conclusions: This research suggests that while food insecurity across all domains was a significant problem during the studied phases of the pandemic, it was not associated with these containment measures. Therefore, impacts may have been successfully mitigated, likely through a suite of policies aimed at maintaining food security, including the declaration of food workers as essential and the expansion of federal nutrition programmes.

Objective: To develop and evaluate the validity and reliability of the Street Food and Beverage Tool (SFBT).

Design: This methodological study contains two phases: a) tool development, which involves conducting a systematic review followed by expert evaluation of the items, the creation of a Nutritional Healthfulness Index (NH), and pilot testing; and b) evaluation of the Tool's Validity and Reliability: Content validity was judged by an external technical group, which evaluated the adequacy and pertinence of each tool item. Construct validity was evaluated around schools by testing the hypothesis: In high-income areas, there will be greater availability of healthy food and beverages at street food outlets (SFOs), as measured by the NH-index. Inter-rater and test-retest reliability were assessed outside subway stations. Pearson's correlation, Cohen's kappa, and Content validity Indexes were used for reliability and validation. A multinomial regression model was used to estimate construct validity.

Setting: Mexico City, Mexico.

Subjects: 80 SFOs at subway station exits and 1,066 around schools from diverse income areas.

Results: The SFBT content validity index was satisfactory. The construct validity of the NH-index indicated higher values in higher-SDI areas. The NH-index showed a positive linear correlation between raters and across the first and second evaluations. The majority of item availability (>60%) showed moderate to strong kappa values for inter-rater and test-retest reliability.

Conclusions: The SFBT is a reliable and valid tool for assessing the availability of foods and beverages. Compared to other tools, it can measure the nutritional quality of SFOs expressed as an NH-index.

Objectives: To design and develop a new, innovative and valid School Menu Healthiness Assessment Tool that is suitable for the quantitative and qualitative analysis of school food and drink provision. Second, to analyse primary and secondary school menus and price lists pan-Wales to ascertain their healthiness and whether free school meal (FSM) eligible pupils can afford to access healthy, nutritious food across the school day.

Design: Codable items and categories of school food and drink provision were operationalised before the tool underwent iterative development and testing. Then, cross-sectional content analysis of publicly available documents detailing school food provision (i.e. menus and price lists) was done.

Setting: Primary and secondary schools in Wales, UK.

Participants: In total, 82 canteen menus were sourced online. This comprised local authority catering for primary (n 22) and secondary (n 19) schools and school-organised catering for primary (n 5) and secondary (n 36) schools.

Results: Intercoder reliability testing found high agreeability between coders, demonstrating that the tool and data interpretation are reproducible and trustworthy. The FSM allowance is not wholly sufficient for all secondary school pupils to purchase a healthy meal from the school canteen. Moreover, the tool identified that oily fish and wholegrain provision were lacking across many menus.

Conclusions: A valuable tool was created, useful for researchers and other health professionals (i.e. dietitians) who are required to analyse the healthiness of school food provision in line with the latest nutritional requirements. This study provides insight into the current school food and drink landscape pan-Wales.

Objective: Explore the relationship between water insecurity (WI) and food security and their covariates in Mexican households.

Design: A cross-sectional study with nationally representative data from the National Health and Nutrition Survey-Continuous 2021 (in Spanish, ENSANUT-Continua 2021), collected data from 12 619 households.

Setting: WI was measured using the Household Water Insecurity Experiences (HWISE) Scale in Spanish and adapted to the Mexican context. Food security was measured using the Latin American and Caribbean Food Security Scale. A generalised path model was used to produce two simultaneous logistical regression equations - WI (HWISE ≥ 12) and moderate-to-severe food insecurity (FI) - to understand key covariates as well as the contribution of WI to FI.

Participants: The head of the household, an adult of >18 years of age, consented to participate in the survey.

Results: Households experiencing WI were more likely to experience moderate-to-severe FI (OR = 2·35; 95 % CI: 2·02, 2·72). The odds of WI were lower in households with medium (OR = 0·74; 95 % CI: 0·61, 0·9) to high (OR = 0·45; 95 % CI: 0·37, 0·55) asset scores. WI also depended on the region of Mexico. FI is more prevalent in indigenous people (OR = 1·29; 95 % CI: 1·05, 1·59) and rural households (OR = 0·42; 95 % CI: 1·16, 1·73). Notably, wealth and household size did not contribute directly to FI but did so indirectly through the mediating factor of WI.

Conclusions: Our study shows that there are structural factors that form part of the varied determinants of WI, which in turn is closely linked to FI.