Public Health Nutrition最新文献

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: Fifty ongoing research projects were identified, revealing a focus on the two ends of the value chain: production (twenty-one projects) and consumption (twenty-one 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.

Objective: To evaluate the healthfulness of the food/beverage products featured by TikTok influencers whose audiences include millions of adolescents.

Design: In a cross-sectional study, we collected the maximum available up to 100 videos from the top 100 TikTok influencers in the USA - based on views, likes, comments and shares - in July 2022. For each video, we identified the most prominent food/beverage product featured. We used the Nutrient Profile Index (NPI) to classify food products as healthy/unhealthy. We grouped beverages by category.

Setting: TikTok.

Participants: N/A.

Results: Our sample included 8871 videos, 1360 (15·3 %) of which featured at least one food (n 755, 55·5 %), beverage (n 580, 42·6 %) or dietary supplement (n 25, 1·8 %). Mean NPI score for foods was 54·73 (sd 19·95). Most foods (58 %) were considered unhealthy, with a 20-percentage-point difference between branded (70·8 %) and unbranded (50·8 %) foods. Alcohol (n 154, 26·6 %) and energy drinks (n 149, 25·7 %) were the most featured beverages overall. Among branded beverages, energy drinks were the largest category (n 148, 38·9 %). Among unbranded beverages, alcoholic drinks were the largest category (n 73, 36·5 %).

Conclusions: More than half of the foods promoted by TikTok influencers were considered unhealthy, and most beverages featured were alcoholic and energy drinks. Many foods and a large share of alcoholic beverages were unbranded, either reflecting genuine influencer preferences or potentially masking the true extent of commercial marketing. Given the reach of influencers, including millions of adolescents, stronger regulations are needed for social media platforms, influencers and brands to protect consumers from undue harm from food/beverage marketing.

Objective: A high rate of food insecurity among college students has been documented in various studies. Knowledge gaps exist regarding food insecurity and cultural food access among international college students. We explored the demographic correlations of food insecurity and cultural food access and affordability for international college students.

Design: Cross-sectional online survey from 2 to 16 November 2022.

Setting: A public university in the southwestern USA.

Participants: Three hundred and thirty-five international undergraduate and graduate students.

Results: About 22 % of the sample reported high food security, 18 % marginal food security, 30 % low food security and 31 % very low food security. Twenty-seven percent reported that they were able to find cultural foods at the university, and 29 % reported that they were able to afford the cultural foods available on campus. Enrolment status, primary caregiver status, housing location and vehicle ownership predicted food security status. Region of origin, gender, being a primary caregiver for an adult with special needs and vehicle ownership were associated with access to cultural foods. Region of origin, being a primary caregiver for children, housing location and vehicle ownership were associated with being able to afford cultural foods on campus. The predictors differ between undergraduate and graduate international students.

Conclusion: Researchers and student services professionals who develop programmes and resources to support international students should consider differences within the group of international students, especially differences by region of origin and degree status (undergraduate v. graduate), and work to ensure students have access to reliable transportation.

Objective: Refugees are susceptible to food insecurity. In high-income countries (HIC), settlement workers (SW) provide information, including food security information resources, to newly arrived refugees. Australia has a range of resources, but their use in settlement work is unknown. This study's aims were to explore SW's resource use with refugee clients.

Design: This descriptive, qualitative study explored SW's perceptions regarding resource use. One-on-one interviews, using a semi-structured guide, were conducted. The Technology Acceptance Model's usage constructs (including Actual Use and Perceived Usefulness) informed the guide and analytical constructs. Under these constructs, emergent usage themes were identified.

Setting: Six Australian cities.

Participants: Settlement workers.

Results: Fourteen workers were interviewed. Thirteen worked for government-related departments. Most used resources as part of client welcome packs to address acute food insecurity and/or support clinical deficiency issues. Print, pictorial, translated and co-designed resources were perceived to be most useful. Less useful were resources with limited cultural tailoring, translation issues and high literacy demand. There was limited use of digital resources due to variations in clients' digital access and literacy. Opportunities for improvement include streamlining access, addressing topics such as clinical deficiencies related to food insecurity and increasing culturally nuanced translation.

Conclusions: Development of culturally appropriate resources, facilitating resource access and improved food culture information may help SW better support refugee populations with food security challenges during resettlement in HIC.

Objective: To study (1) the differences in dietary climate impact between sociodemographic groups, (2) the differences in food consumption and macronutrient intake as absolute amounts and in relation to energy intake by dietary climate impact level and (3) food groups as contributors of dietary climate impact.

Design: Food consumption and energy and macronutrient intakes were calculated based on two non-consecutive 24-hour dietary recalls. Dietary climate impact was calculated using national coefficients produced with life cycle assessment. Regression analysis was used to test the mean differences between sociodemographic groups and sex-specific dietary climate impact tertiles.

Setting: Finnish national food consumption survey FinDiet 2017.

Subjects: In total, 565 men and 682 women (age 18-74) after exclusion of energy under-reporters.

Results: The mean daily dietary climate impact was higher in men than in women (5·6 v. 4·0 kg CO₂eq) and in younger age group (18-44 years) than in older age group (65-74 years). The association of food consumption and dietary climate impact was mainly different for food consumption as absolute amounts (g/d) and in relation to energy (g/MJ). In relation to energy, the consumption of animal-based foods was higher and plant-based foods lower in the highest dietary climate impact tertile compared with the lowest tertile. Red and processed meat was a major contributor to dietary climate impact.

Conclusion: Our study emphasises the importance of considering food consumption and nutrient intake both as absolute amounts and in relation to energy intake. Our findings support the advantages of plant-based diets in being both healthier and more climate-friendly.

Objective: We examined whether point-of-sale warning posters, compared with control posters, reduced Guatemalan adolescents' purchases of sugar-sweetened beverages (SSB) at school stores.

Design: We used a difference-in-differences approach (4-week baseline and 4-week treatment). Our primary analysis compared two schools assigned to an intervention warning poster to one school that displayed a control poster. Based on purchase transaction data, the outcomes were volume of SSB, beverage kcal and sugar purchased per transaction.

Setting: Three private schools in Guatemala City, Guatemala.

Participants: Students between 12 and 18 years of age.

Results: Our primary analysis found that the warning poster decreased the overall volume of SSB (in ounces) that adolescents purchased in the warning poster intervention schools (-2·27 oz. 95 % CI = (-2·70, -1·85)) compared with the control school. This reduction was driven by a decrease in SSB purchases (OR = 0·64, 95 % CI = (0·49, 0·86)). The warning posters were associated with a significant reduction in likelihood of purchasing a beverage with kilocalories (calories) (OR = 0·68, 95 % CI = (0·49, 0·92)). These changes were associated with a significant overall decrease in sugar purchased (-5·54 g 95 % CI = (-6·69, -4·39)). The posters were associated with a significant increase in non-SSB purchases in the intervention schools compared with the control school (OR = 1·53, 95 % CI = (1·16, 2·02)).

Conclusion: Our results suggest that messages that warn adolescents about the high-sugar content in SSB may be an effective, low-cost way to modestly reduce purchases of these drinks. These findings provide evidence to support national front-of-package labelling, currently being considered in Guatemala.