Public Health Nutrition最新文献

Objective: To analyze the global cancer burden associated with dietary factors across 204 countries and regions from 1990 to 2019.

Design: A population-based study.

Setting: Global Burden of Disease Study.

Participants: Using data from the 2019 global burden of disease, we calculated Population Attributable Fractions (PAFs), death and disability-adjusted life years (DALYs). A comparative risk assessment framework was employed, along with estimated annual percentage changes (EAPCs).

Results: In 2019, approximately 6.01% of cancer mortality and 5.50% of DALY rates can be attributed to dietary risk factors, particularly low intake of whole grains, milk, and fruits and vegetables. The High Socio-Demographic Index (SDI) region had the highest cancer mortality and DALY PAFs, mainly due to high consumption of red and processed meats, while the Low SDI region showed the highest PAFs from low fruit and vegetable consumption. In 2019, the High-middle SDI region had the highest age-standardized death rate (ASDR) and DALY rate attributable to dietary factors. Among geographic regions, Southern Latin America had the highest ASDR, and Central Europe had the highest age-standardized DALY rate. At the country level, Mongolia exhibited the highest rates for both ASDR and DALYs attributable to dietary risks. From 1990 to 2019, the largest increase in ASDR was observed in Western Sub-Saharan Africa, with Bulgaria showing the largest country-specific increase. Similarly, the largest increase in the age-standardized DALY rate was seen in Western Sub-Saharan Africa, with Lesotho experiencing the highest increase at the country level.

Conclusions: Our findings underscored the importance of increasing the consumption of whole grains, milk, and calcium, which can inform global dietary guidelines and cancer prevention strategies.

Objective: We qualitatively examine the grocery shopping behaviours and fruit and vegetable consumption of low-income families participating in the Brighter Bites program in Houston, Texas.

Design: We used a single-group observational study design. We used (1) purposive sampling of schools and (2) convenience sampling of parents/caregivers to recruit participants. Research staff conducted three face-to-face qualitative focus groups in Spanish and English. Transcripts were coded using deductive and inductive reasoning.

Setting: Three elementary schools serving low-income families in Houston, Texas, in February-May of 2022.

Participants: Brighter Bites parents/caregivers from the 2021-2022 school year.

Results: Three primary themes emerged: (1) child involvement in grocery shopping - most parents/caregivers shop with their children. Children sometimes bring their own grocery lists, select their produce or help by counting produce; (2) the importance of balancing quality and affordability of fruits and vegetables purchased - both when selecting stores and choosing produce; (3) exposure to new varieties and higher quality of fruits and vegetables through Brighter Bites programming - parents/caregivers reported purchasing new fruits and vegetables as a result of participating in Brighter Bites.

Conclusion: Findings can inform nutrition education programming and policies targeting fruit and vegetable consumption for low-income families. Child involvement may be a good target for nutrition-based behaviour change programs. Nutrition programs and policies should consider both produce affordability and quality. Exposure and opportunities to try new fruits and vegetables can lead to future purchases of new produce. Findings can also inform grocery stores' efforts to understand low-income families' purchasing habits, preferences and priorities.

Objective: This systematic review investigates the characteristics, effectiveness and acceptability of interventions to encourage healthier eating in small, independent restaurants and takeaways.

Design: We searched five databases (CENTRAL, MEDLINE, Embase, CINAHL and Science Citation Index and Social Science Citation Index) in June 2022. Eligible studies had to measure changes in sales, availability, nutritional quality, portion sizes or dietary intake of interventions targeting customer behaviour or restaurant environments. We evaluated study quality using the Mixed Methods Appraisal Tool. Results are synthesised narratively, and interventions' impact on personal autonomy is assessed using the Nuffield intervention ladder.

Setting: Small, independent or local restaurants or hot food takeaway outlets, with no restrictions by year or country.

Participants: Anyone selling or purchasing food in intervention settings (e.g. restaurant staff/owners, customers).

Results: We screened 4624 records and included 12 studies describing 13 interventions in 351 businesses. Most studies were of poor quality. Customer-level intervention components mostly operated on the lower rungs of the Nuffield ladder, and most had limited positive effects on increasing demand, measured as sales or orders of healthy options. Whilst rare, most interventions measuring business outcomes operated on higher ladder rungs and showed small positive results. There was insufficient evidence to investigate differences in impact by intervention intrusiveness. Acceptability was greater for interventions that were low-effort, inexpensive and perceived as not negatively impacting on customer satisfaction.

Conclusions: Despite some evidence of small positive effects of healthy eating interventions on healthier purchases or restaurant/hot food takeaway practices, a weak evidence base hinders robust inference.

Objective: Free school meals (FSM) are a crucial form of support for families. This study aimed to investigate whether the FSM allowance can provide what is perceived to be, healthy, sustainable and satisfying food.

Design: A mixed methods study incorporating co-production, citizen science and participatory approaches was conducted. Citizen scientists were given a daily budget equivalent to the FSM allowance and asked to purchase a 'tasty, healthy and sustainable' school lunch for a week. Alongside keeping records of available and purchased foods, young people engaged in focus groups to capture information on perceptions of food offered and FSM allowance adequacy.

Setting: Secondary schools in Yorkshire, UK.

Participants: Citizen scientists (n 42) aged 11-15 years across seven schools.

Results: Obstacles were faced in obtaining sustainable and healthful meals when restricted to an FSM allowance. Reasons included restrictions in what could be purchased due to costs, limitations in the use of allowances that restricted breaktime purchases leading to hunger, inadequate portion sizes, systemic barriers like hurried lunch breaks that encourage 'grab and go' options and broken water fountains that led students to purchase bottled drinks. Findings were reinforced by descriptive food record data.

Conclusions: Our findings suggest that schools would benefit from national policies to address the lack of funding, infrastructure issues and capacity to support optimal provision of food to those on FSM as well as provide greater flexibility in how pupils use their allowance. Young people verified these findings, which they presented to policymakers at a parliamentary event.

Objective: The aim of this study is to analyse complementary feeding practices, to assess the extent to which minimum dietary diversity (MDD) recommendations are being met in the population studied and to study factors that influence the achievement of MDD.

Design: We pooled individual level data form the Demographic and Health Surveys (DHS) and Multi Indicator Cluster Surveys (MICS). We apply methods from poverty measurement to identify individual gaps towards achieving MDD. We further identify food groups that separate children who achieve MDD from those who do not.

Setting: West and Central Africa.

Participants: 62 257 children aged between 6 and 23 months.

Results: 82·0 per cent of children do not achieve MDD and on average are lacking 2·5 out of five required food groups. For 19·0 per cent of children, the gap to MDD is one food group and for 23·7 per cent of children the gap is two food groups. Consumption of eggs, other fruits and vegetables as well as legumes and nuts is particularly low among children who are not achieving MDD. More than 90·0 per cent of children who do not achieve MDD do not consume these food groups compared to around half of children who achieve MDD.

Conclusions: Overall MDD is low, but there is large potential for improving MDD achievement if food consumption can be increased by one or two food groups. Available, affordable and culturally accepted food groups are identified that could be prioritised in interventions to close this gap.

Objective: Humanitarian aid, including food aid, has increasingly shifted towards the provision of cash assistance over in-kind benefits. This paper examines whether food security mediates the relationship between receipt of humanitarian cash transfers and subjective wellbeing among Syrian refugee youth in Jordan.

Design: Secondary analysis of the 2020-21 Survey of Young People in Jordan, which is nationally representative of Syrian youth aged 16-30. We employ stepwise model building and structural equation models.

Setting: Jordan.

Participants: Syrian refugee youth aged 16-30 (n 1572).

Results: While 92 % of Syrian households with youth received cash transfers from a UN agency, 78 % of households were food insecure using the Food Insecurity Experience Scale. Fifty-one percent of youth suffered from poor wellbeing using the WHO-5 subjective wellbeing scale. Household food insecurity was associated with poorer youth wellbeing. Receiving larger cash transfer amounts was associated with better wellbeing among Syrian youth in unadjusted models. The relationship between receipt of cash transfers and youth wellbeing was not mediated by food security.

Conclusion: We do not find support for the hypothesis that food security is a mediator of the association between cash transfers and subjective wellbeing for this population.

Objective: The South East Asian Nutrition Survey II Indonesia aimed to provide up-to-date data on dietary intake, nutritional and biochemical status of children aged 0·5-12 years in Indonesia 2019-2020.

Design: Multistage cluster sampling, stratified by geographical location.

Setting: Out of forty-six targeted districts in Indonesia, the study only covered twenty-one districts/cities in Java and Sumatera islands, Indonesia due to COVID-19 pandemic.

Participants: A total of 2475 children aged 0·5-12 years were included.

Result: The growth (weight-for-age, height-for-age, weight-for-height and BMI-for-age) of Indonesian pre-school- and school-aged children was below the WHO standards. The prevalence of stunting in Java and Sumatera islands was 20·6 and 33·4 % in urban and rural areas, respectively. Stunting was higher in the 1·0-3·9-year age group, boys and rural areas. Overall, 9-12 percent of all children were overweight -obese, with 23·7 % of urban 7-12-year-olds having the highest prevalence.Anaemia was 22·8 % in < 5-year-old and highest in < 1-year-old children. Fe, Zn, vitamins A and D insufficiency was observed in 20·3 %, 11·9 %, 1·9 % and 27·1 % of the children. Dietary intakes of energy, fibre, Ca, Fe, Zn, vitamins A, B₁, C and vitamin D below the Indonesian RDA were prevalent and observed in more than half of the children.

Conclusion: High stunting, increasing trends of overweight/ obesity, anaemia, serum vitamin D insufficiency, inadequate energy and micronutrient intake in children highlighted the triple burden of malnutrition in Java and Sumatera, Indonesia's most populous regions in 2019-2020, shortly before COVID-19 pandemic era.

Objective: This study assessed the association between baseline sociodemographic variables, body composition and 4-year changes in the intake of food groups, including sugar-sweetened beverages (SSB) among children, after the implementation of the health promotion levy.

Design: Prospective cohort study.

Setting: Ten schools in North West Province, South Africa.

Participants: 950 children aged 5-9 years at baseline and data of 672 children at follow-up. The frequency of intake from healthy and unhealthy food groups was assessed by questionnaire. Anthropometric and sociodemographic information were collected; BMI-for-age z-scores were calculated. The health promotion levy was implemented after baseline and follow-up measurements were done after 4 years. A random intercept generalised linear mixed model analysis was applied to investigate the time effect of the weekly intake of the foods adjusting for BMI-for-age z-scores and sociodemographic characteristics of the children.

Results: The weekly frequency of intake from most food groups remained unchanged at follow-up. The frequency of SSB intake decreased significantly over 4 years. Decreased intake of SSB was not linked to increased intake of healthy foods. Changes in intakes from SSB were not associated with household income, parental education or BMI-for-age z-score categories. A decreased frequency of intake from SSB was observed following the implementation of the health promotion levy after baseline, in line with reports of national decreases in SSB sales in South Africa since 2017.

Conclusions: The decreased frequency of SSB intakes following the implementation of the health promotion levy in South Africa may indicate that health policies can promote healthier dietary habits.

Objective: To explore mothers' and early childhood (EC) educators' experiences of breast-feeding/breast milk provision and breast-feeding support in child care centres (CCC) in the USA.

Design: We conducted one-time, semi-structured phone interviews with mothers and EC educators to examine perceptions of support, accommodations and barriers to breast-feeding in CCC. We administered a background survey to assess participant characteristics and quantify perceived degree of breast-feeding support in the workplace (mothers) and CCC (mothers and EC educators).

Setting: US-based CCC.

Participants: Fifty working mothers using CCC for their infants and twenty-two EC educators.

Results: Interview themes and background surveys reflected neutral feelings towards breast-feeding support received (mothers) and provided (EC educators) in CCC. Maternal expectations for breast-feeding support in CCC were generally low; workplace and social support for breast-feeding were perceived as the most important factors impacting breast-feeding. EC educators' capacity to offer breast-feeding support was constrained by CCC infant feeding regulations, inadequate breast-feeding training and time limitations. Tensions arose when mothers attempted to manage low milk supply at the CCC level by requesting EC educators to individualise feeding or milk storage practices for their infant.

Conclusions: Breast-feeding efforts of working mothers are undermined in multiple settings, including the workplace and CCC. Improving breast-feeding outcomes for this population requires structural/policy changes that: (1) maximise opportunities for continued, direct breast-feeding and maternal/infant proximity and (2) enforce evidence-based CCC feeding protocols and standards and EC educator lactation training.