Public Health Nutrition最新文献

Objectives: To assess changes in (1) Na content of processed foods in the Canadian food supply and (2) the proportion of products meeting Health Canada's voluntary Na reduction targets (SRT) between 2010 and 2020.

Design: This repeated, cross-sectional study used foods from the 2010 (n 6929), 2013 (n 9366), 2017 (n 10 324) and 2020 (n 15 797) collections of the University of Toronto's Food Label Information and Price database, categorised into Health Canada's Na categories. Quantile regression was used to assess changes in Na content. Firth's bias-reduced logistic regression was used to evaluate changes in the proportion of foods meeting the SRT, and trends were assessed with Cochran-Armitage tests.

Setting: Canada.

Participants: Processed foods.

Results: Between 2010 and 2020, 54 % (7/13) of major categories had a left shift (reduction) in their Na distribution, 15 % (2/13) had a right shift (increase), 15 % (2/13) had both a left and right shift and 15 % (2/13) did not change. The proportion of products meeting the average targets and maximum levels increased 6 % and 4 % from 2010 to 2013 and 4 % and 3 % from 2013 to 2017, then decreased 3 % and 1 % between 2017 and 2020, with trends for improvement over time (P-trend < 0·001).

Conclusions: Although many categories decreased in Na, some did not change or increased in Na and improvements in the proportion of products meeting the SRT were modest and occurred early on. Further actions, such as implementing accountability initiatives that promote industry adherence to voluntary SRT or introducing mandatory measures, alongside frequent and transparent monitoring are needed to reduce Na in processed foods in Canada.

Objectives: This study aimed to determine the prevalence of Lebanese adults living with underweight, overweight or obesity, assess and compare the cost of the Mediterranean Diet (MD) with that of the current dietary consumption pattern and explore diet cost as a determinant of living with underweight, overweight or obesity.

Design: Data for this nationally representative cross-sectional study were collected through sociodemographic questionnaires, anthropometric measurements, the Arab Family Food Security Scale and dietary assessments using a validated FFQ and 24-h recalls. Diet costs were calculated based on 2023 market prices using purchasing power parity. Logistic regression was used to assess associations with BMI.

Setting: Lebanon, using data representative of the Lebanese adults' population.

Participants: 444 Lebanese residents aged 18-64 years.

Results: Overall, 66·2 % of the participants were living with underweight (4·3 %), overweight (37·8 %) or obesity (24·1 %). On average, the cost of following MD ranged from Intl.$ 23·36 to Intl.$ 26·49/person/d, whereas a Lebanese adult spent Intl.$ 20·46 on consumption. Only 31·1 % of participants spent an amount equal to or greater than the minimum MD cost (Intl. $23·36/d). Participants who meet or exceed this threshold were 1·59 times more likely to be living with a healthy weight (aOR = 1·59, p = 0·043).

Conclusions: The high prevalence of Lebanese adults living with underweight, overweight or obesity is compounded by the unaffordability of a healthy MD. Improving the affordability of nutritious foods is crucial to promoting healthier dietary patterns and achieving better weight outcomes. Public health strategies should include economic, behavioural and policy-level interventions to enhance diet quality and affordability in crisis-affected populations.

Objective: This study used the Trials of Improved Practices (TIPs) approach to explore complementary feeding practices among caregivers of children under two and assess the acceptance of new nutritional supplements by providing Microbiota-Directed Supplementary Food (MDSF), Ready-to-Use Supplementary Food (RUSF), and Locally Available Food (LAF) among moderately malnourished children.

Design: The study was conducted between May and October 2022 in preparation for a larger trial. The first phase focused on complementary feeding, hygiene, breastfeeding, and responsive feeding practices using in-depth interviews and observations. The second phase involved counseling sessions and providing food supplements for 45 participants. Follow-up visits evaluated acceptability and challenges faced during this period.

Setting: Bauniabadh slum, Mirpur, Dhaka.

Participants: 65 children aged 6-24 months with moderate wasting and their caregivers.

Results: Findings from IDIs and observations revealed poor handwashing practices, with most caregivers washing only with water, and inconsistent use of soap. Only a minority boiled drinking water or cleaned utensils with soap. Responsive feeding practices were also limited, with frequent mobile phone use during feeding and lack of attention to the child. Among the three food interventions, LAF received the highest hedonic ratings across all sensory attributes, with a mean taste score of 5.7±1.4, compared to MDSF (4.8±1.9) and RUSF (4.7±1.6), although median consumption was similar across all supplements (75%).

Conclusion: The TIPs approach identified context-specific caregiver behaviours and feeding preferences. These findings will guide the upcoming trial and assist policymakers and program planners in developing culturally tailored interventions to address childhood malnutrition in urban slums.

Objective: To monitor the influence of international trade and investment agreements on the food environment and population nutrition in Canada.

Design: Implementation of a revised version of the INFORMAS trade and investment monitoring protocol to guide descriptive analysis of quantitative trade and investment data over the period 1994 to 2020 as well as qualitative review of policy documents related to nutrition regulations and trade concerns.

Setting: Canada, which has 15 trade and investment agreements in force with 51 countries as of 2024.

Results: Extensive tariff reductions occurred in 1995 with the introduction of the World Trade Organization, with minimal tariff reductions since that time. Tariff rates were generally highest on ultra-processed focus foods, though many countries gained tariff-free access over the study period. There were large surges in imports of dairy, meats, sugars, and soft drinks after joining the WTO, while exports of grains, dairy, sugars, processed meats, ready-meals, and sauces saw substantial growth. FDI into Canada's food manufacturing sector increased consistently, reaching $32.6 billion in 2020-2022. Canada has raised several specific trade concerns at the WTO over other countries' nutrition labelling policies and some of the challenged policies have subsequently been abandoned, modified, or delayed.

Conclusions: Increased trade and investment openness in Canada appears linked to changes in food imports, exports, and foreign investment that may impact the nutritional quality of food environments. Monitoring how trade agreements shape national food supplies is critical to developing trade policies that improve nutrition in alignment with public health goals at home and abroad.

Objectives: This study examines aspects of women's empowerment related to the nutritional status of under-five children in Bangladesh, including their age-appropriate food intake and access to healthcare during acute respiratory tract infection (ARI).

Design: Three waves of the Bangladesh Demographic Health Survey (BDHS) data (2011, 2014 and 2017-2018) were pulled and utilised to construct three domains of the Survey-Based Women's Empowerment Index, such as social independence, intrinsic agency and instrumental agency. The height-for-age Z (HAZ), weight-for-age Z (WAZ) and weight-for-height Z (WHZ) scores were used to measure the nutritional status of offspring. Two variables were generated to measure age-appropriate food intake and treatment-seeking from medically trained providers (MTP) at the commencement of ARI. Generalised structural equation modelling was performed to develop pathways between women's empowerment and children's nutritional status.

Settings: Data were collected from eight administrative divisions in Bangladesh.

Participants: A total of 18 706 married women aged 15-45 years residing with their husbands and having at least one under-five child.

Results: Women's social independence was positively associated with HAZ (0·25 (95 % CI: 0·22, 0·28)), WAZ (0·21 (0·18, 0·24)) and WHZ (0·06 (0·02, 0·09)). Intrinsic agency positively influenced HAZ (0·03 (0·02, 0·04)) and WAZ (0·02 (0·01, 0·02)). Both social independence and intrinsic agency promoted appropriate feeding, while instrumental agency had a negative effect on food consumption (-0·0026 (-0·005, -0·0002)). Both age-appropriate food intake and seeking treatment from MTP during recent ARI episodes improved nutritional outcomes of offspring.

Conclusion: Maternal social independence and intrinsic agency enhance the nutritional status, food consumption and healthcare access of offspring in Bangladesh.

Objective: The Spanish agricultural sector depends on seasonal agricultural migrant workers. This study aimed to examine the associations among dietary patterns, sociodemographic factors and food security among seasonal agricultural workers.

Design: A cross-sectional multicentre study. The dietary pattern was evaluated according to the Spanish Society of Community Nutrition recommendations for the adult population. Descriptive analysis was disaggregated according to sex. Multi-adjusted logistic models were used to assess the association between dietary patterns and explanatory variables.

Setting: Work sites and temporary accommodations in four Spanish provinces: North Spain: Lleida and La Rioja, and South Spain: Almeria and Huelva.

Participants: Male and Female Seasonal Agricultural Migrant Workers (n 623).

Results: The final sample consisted of 609 migrant agricultural workers. Of these, 36 % were female, and 61 % were classified as North African. Overall, 40 % of the participants adhered to the evaluated dietary pattern. Adherence was positively associated with North African nationality, being married or cohabiting and low socio-economic status. Not skipping meals due to economic constraints and receiving food aid emerged as key factors contributing to greater adherence to the assessed dietary pattern.

Conclusions: This study provides an initial insight into the dietary pattern of seasonal agricultural migrant workers in Spain. The findings indicate that external socio-economic and structural factors primarily shape their dietary habits. Policies aimed at enhancing food security, and other food coping strategies, such as access to food aid, are crucial for improving dietary adherence to a healthy dietary pattern.

Objective: Newfoundland and Labrador (NL) introduced Canada's first excise tax on sugar-sweetened beverages (SSBs) in 2022. Industry marketing practices in response to SSB taxation may affect public health impacts. We examined changes in posted beverage pricing and marketing of taxable and non-taxable beverages in NL before and after the SSB tax was implemented.

Design: Pre-/post- observational study with in-store audits of beverage prices and marketing. Changes including pricing discounts and promotions were assessed the at the individual beverage level, for years pre/post-tax implementation.

Setting: 80 food stores (grocery, convenience, drug, dollar) in NL, Canada.

Results: There was no evidence of a change in posted shelf prices between pre/post years. There was a significant increase (+2.5%, χ2=9.693, p=0.002) in proportion of discounted taxable SSBs with no change in non-taxable beverages (p=0.350). There were no significant differences in change of number of promotions for taxable SSBs (+5.2 [-0.1, 10.5], F=3.789, p=0.053) nor non-taxable beverages (+3.4 [-1.0, 7.7], F=2.268, p=0.134).

Conclusions: The lack of change in posted prices of taxable SSBs indicate that the NL SSB tax was not communicated at the point of decision-making. While some marketing changes post-tax were observed, results should be interpreted cautiously as they cannot be attributed definitively to the tax. Existing literature implies that industry may adapt marketing conduct to counteract beverage taxes. Such changes were limited in NL, suggesting retailers may have opted not to display the tax rather than attempt to actively counteract it. Lack of transparency surrounding the tax may neutralize intended behavioral effects.

Objective: To test the 'Investigate Exposure' step of the WHO's CLICK framework and to investigate 12-16-year-old children's exposure to paid-for digital food advertising in Finland.

Design: The DIGITUTKA pilot study was carried out as part of the EU Joint Action Best-ReMap project. Data on paid-for digital food advertising that children were exposed to via their phones over a two-week period were captured using the RealityMeter application, following the 'Investigate Exposure' step of the CLICK framework. Data were collected between April and June 2022 and analysed in Excel, following a protocol outlined by WHO Europe. The WHO Europe Nutrient Profile Model (v1, 2015) was used to determine marketing permission.

Setting: Four schools in Finland.

Participants: 6th-9th grade students (n 34).

Results: Out of the 17 820 captured advertisements, 2316 (13 %) were identified as food or beverage brands and products. The most commonly advertised products were ready-made and convenience foods and composite dishes (16 %, n 372) and energy drinks (9 %, n 202). The majority of the food and beverage advertisements (n 1291, 56 %) were not permitted to be marketed to children, with only one in ten (n 222, 9 %) permitted to be marketed to children. A third (35 %) of the food and beverage advertisements could not be identified due to missing information.

Conclusions: Children were exposed to a large number of food and beverage advertisements, most of which were not permitted to be marketed to children. To protect children's health and prevent obesity, marketing restrictions should be combined with broader changes to the food environment and taxation.

Objective: The objective of this study was to develop, implement, and refine a food environment survey to capture people's perceptions of their food environments in low-and middle-income countries: the Food Environment Perceptions Survey (FEPS).

Design: Identifying aspects of food environment to include: drawing from existing survey instruments; a Delphi survey with food environment experts working globally; workshops with local experts in India and Cambodia; cognitive testing of the survey items; and piloting the tools in diverse field settings in India and Cambodia.

Setting: Rural, peri-urban, and urban communities in India and Cambodia.

Participants: Global food environment experts for Delphi survey; food environment experts in India and Cambodia for workshops; convenience sample of participants in India (n=44) and Cambodia (n=60) for FEPS piloting.

Results: The FEPS underwent many iterations prior to piloting. The initial versions of the survey were long, leading us to remove questions and reconfigure the survey to streamline it. The workshop participants rated the revised survey versions relatively favorably. The final survey consists of 109 questions covering six sections: accessibility and availability (48 questions); affordability (5 questions), convenience (17 questions); quality and safety (3 questions); information, promotion, and labeling (16 questions); and an optional sustainability section (20 questions). Based on pilot data, we found significant differences in how participants interacted with different food environment types across rural, peri-urban, and urban transects.

Conclusions: The finalized FEPS is a newly developed survey instrument that can be incorporated by other researchers to characterize diverse perceptions of food environments in LMICs.