Public Health Nutrition最新文献

Objective: This study aimed to assess the association between emotional attitudes towards diabetes, eating behaviour styles and glycaemic control in outpatients with type 2 diabetes.

Design: Observational study.

Setting: Endocrinology Division of Hospital de Clínicas de Porto Alegre, Brazil.

Participants: Ninety-one outpatients diagnosed with type 2 diabetes. Baseline assessments included data on clinical parameters, lifestyle factors, laboratory results, eating behaviour styles and emotional attitudes. All patients received nutritional counseling following diabetes recommendations. A follow-up visit was scheduled approximately 90 days later to evaluate changes in weight, medication dosages and glycated Hb (HbA1c) values. Patients were categorised based on their emotional attitude scores towards diabetes (positive or negative), and their characteristics were compared using appropriate statistical tests.

Results: At baseline, no differences were observed in the proportion of patients with good glycaemic control, eating behaviour styles and emotional attitudes. However, patients with a positive attitude towards the disease exhibited a significantly better response in glycaemic control compared with the reference group (OR = 3·47; 95 % CI = 1·12, 10·75), after adjusting for diabetes duration, sex and medication effect score. However, when BMI was included in the model, the association did not reach statistical significance. Therefore, these results should be interpreted with caution.

Conclusions: Patients with a positive attitude towards diabetes showed a greater reduction in HbA1c levels following nutritional counseling. However, baseline BMI could be a potential confounding factor.

Objective: Provide an in-depth examination of consumers' food safety beliefs and practices to draw implications for interventions to improve nutrition and food safety in Ethiopia.

Design: Adapted Focused Ethnographic Study approach using in-person semi-structured interviews and free-listing exercises, in two iterative phases.

Setting: A traditional food market in Hawassa, a mid-sized city.

Participants: Forty-six market shoppers, selected randomly in line with quotas for age and gender.

Results: Consumers did not clearly differentiate between quality and safety, seeing them through connected concepts such as 'freshness'. While most respondents had some understanding of the causes of unsafe food, they did not generally worry about becoming ill themselves and felt food safety risks were easily mitigated through in-home behaviours. Thus, food safety practices were not a main motivator of market or vendor choice. There was no evidence that food safety concerns led consumers to prefer packaged, processed food or to avoid consuming fresh foods.

Conclusions: The study offers novel depth and detail on a topic of strong policy relevance. While building on an encouraging base of understanding of food safety, there remains considerable scope for increasing knowledge, particularly with regard to the need to procure safe food as opposed to expecting household-level practices to mitigate all safety risks. Motivating customers to give food safety factors more consideration when making food purchasing decisions, such as by leveraging emotion-based communication from trusted messengers to elevate the issue's salience in their minds, may contribute to improvements in food safety in low-income countries such as Ethiopia.

Objective: (1) To develop a new regression equation for estimating fat mass percentage (%FM) from anthropometric measurements in a heterogeneous Caucasian population and (2) to compare it with the Durnin and Womersley equation, which is one of the most used anthropometric equations for FM assessment.

Design: Body mass, stature and four skinfolds (biceps, triceps, subscapular and supracrestal) were assessed by an accredited anthropometrist, according to the International Society for Advancement in Kinanthropometry. Participants completed a dual-energy X-ray absorptiometry (DXA) whole-body scan to determine their %FM. A new anthropometric equation to estimate %FM was developed using multiple forward regression analyses with DXA as the reference method. Tests for the accuracy of the different equations included mean differences, coefficient of determination, SE of the estimate (SEE), concordance correlation coefficient (CCC) and Bland-Altman plots.

Setting: Spain.

Participants: Two hundred and eighteen healthy Caucasian participants aged 18-65 years participated in this cross-sectional study.

Results: Our proposed equation explained 89·9 % of the variance in the DXA-derived %FM, with a low random error (SEE = 3·00 %), a very strong agreement (CCC = 0·93), no fixed or proportional bias and a relatively low individual variability (5·84 %). However, the Durnin and Womersley equations obtained a fixed bias of -3·65 % when compared with DXA and a greater individual variability (6·74 %).

Conclusions: The proposed equation can accurately estimate %FM in a heterogeneous Caucasian population with a wide age range (18-65 years). Additionally, the Durnin and Womersley equation was inadequate when applied to our participants.

Objective: Behaviour Change Communication (BCC) intervention programmes often lack documentation of successful processes. This manuscript aims to describe the development of Program Impact Pathway (PIP) using Theory of Change (ToC) approach for a mHealth BCC intervention titled 'Mobile Solutions Aiding Knowledge for Health Improvement (M-SAKHI)' aimed at reducing stunting in infants at 18 months of age.

Design: The PIP was developed using ToC to design the intervention and plan its implementation. Literature review and data from previous pilots helped to identify health service gaps that needed to be addressed by the PIP of this intervention.

Setting: M-SAKHI was implemented in 244 villages under governance of forty primary health centres of Nagpur and Bhandara districts of eastern Maharashtra in central India.

Participants: The study investigators and the public health stakeholders participated in developing the PIP. M-SAKHI evaluation study recruited 2501 pregnant women who were followed up through delivery until their infants were 18 months old.

Results: The PIP was developed, and it identified the following pathways for the final impact: (1) improving maternal and infant nutrition, (2) early recognition of maternal and infant danger signs, (3) improving access and utilisation to healthcare services, (4) improving hygiene, sanitation and immunisation practices, and (5) improving implementation and service delivery of community health workers through their training, monitoring and supervision in real time.

Conclusion: This paper will illustrate the significance of development of PIP for M-SAKHI. It can aid other community-based programmes to design their PIP for nutrition-based BCC interventions.

Objective: The aim of this study is to conduct a comparative analysis across nations to: (1) identify the determinants influencing knowledge and attitudes related to sodium (Na) intake and (2) to analyse the association between knowledge and attitudes related to Na intake.

Design: We utilised a secondary data from a cross-sectional study that was conducted across seven nations. Structural equation modelling (SEM) was utilised to assess the impact of socio-economic and health-related predictors on knowledge and attitudes pertaining to Na intake and further to investigate the relationship between knowledge and attitude.

Setting: Indonesia, Brazil, Thailand, Japan, France, the UK and the USA.

Participants: 7090 participants aged 15 years and above were included in the study.

Results: SEM analysis showed a strong association between knowledge about Na intake and related attitude across all countries, particularly in the UK (2·65, 95 % CI 1·48-3·82), France (2·62, 1·45-3·79) and the USA (1·97, 1·21-2·73). In Brazil, Japan and France, individuals or family members having certain health conditions such as raised blood pressure, heart diseases, strokes or other diseases exhibited a positive attitude towards reducing Na intake. Conversely, socio-economic factors like education and income demonstrated the complexity of influences on knowledge and attitudes about Na intake.

Conclusion: The study underscores the need for tailored public health interventions to reduce excessive Na consumption, considering the diverse cultural, social and economic factors. It highlights the complex determinants of knowledge and attitudes towards Na intake, calling for further research in varied populations.

Objective: Māori, the Indigenous population of Aotearoa New Zealand, face a substantial burden of nutrition-related diseases, especially obesity and type 2 diabetes. Weight loss, through dietary change, is a central component of obesity and diabetes prevention and management; however, most approaches have not been designed with or evaluated specifically for Māori. The aim of this study was to review literature on the enablers and barriers to dietary change, for Māori.

Design: Relevant literature published from January 2000 to May 2024 was identified by searches in Medline (Ovid), Embase (Ovid), Scopus, Indigenous health (informit), CINAHL (EBSCO), Web of Science and NZResearch. Studies included Māori and reflected enablers and barriers to dietary change for individuals/whānau (families). Data identifying the aims, methods, interventions, location, population studied and identified enablers and barriers to dietary change and responsiveness to Māori were extracted. Enablers and barriers to dietary change were mapped to a New Zealand indigenous health framework, the Meihana model.

Setting: Settings included studies based in Aotearoa New Zealand, where participants were free living and able to determine their dietary intake.

Participants: Studies included at least 30% Māori participants.

Results: Twenty two of 77 identified records met the inclusion criteria. Records included a diverse range of research approaches.

Conclusions: Using a relevant Indigenous model, this study highlights that multiple and diverse enablers and barriers to dietary change exist for Māori and the critical importance of developing interventions, in close partnership with Indigenous communities, grounded in Indigenous understandings of health.

Objective: This study aims to determine differences in food consumption by the NOVA food categories in South Africa and Ghana and how they relate to poverty and food supply systems.

Design: This study used a cross-sectional design to assess household food acquisition and lived poverty index.

Setting: The study was conducted in Khayelitsha and Mount Frere, urban and rural communities in South Africa, respectively, and Ahodwo and Ejuratia, urban and rural communities in Ghana, respectively.

Participant: An adult in charge of or knowledgeable about household food acquisition and consumption was selected to participate in the study.

Results: A total of 1299 households participated in the study. Supermarkets were a prominent source of ultra-processed foods for households in South Africa, while informal outlets were an important source of ultra-processed foods in Ghana. Consumption of unprocessed foods was higher among South African households (58.2%) than Ghanaian households (41.8%). In South Africa, deprivation was associated with increased odds of infrequent consumption of both unprocessed foods (OR 3.431 p<0.001) and ultra-processed foods (OR 2.656 p<0.001) compared to non-deprivation. In Ghana, no significant associations were observed between household deprivation and consumption of the NOVA food classes.

Conclusion: Different food supply systems and poverty are associated with household acquisition of the different NOVA food classes. Policies should be geared towards formal shops in South Africa and informal shops in Ghana to reduce the consumption of key obesogenic foods.

Objective: While many Asian countries undergo dietary transitions, little is known about Japan's dietary pattern changes and their impact on nutritional intake. We aimed to examine 17-year trends in dietary patterns and nutrient intakes in Japan.

Design: Principal component analysis was used to derive dietary patterns. The nutrient intake of subjects with principal component scores in the highest quartiles of each dietary pattern was assessed using the NRF9·3, which is a scale that evaluates the entire diet in terms of nutrient density.

Setting: Japan.

Participants: We used data from the National Survey 2003-2019 (67 066 women, 55 133 men).

Results: Two common dietary patterns were identified in both sexes: the 'Japanese style' and the 'bread and dairy' pattern. Additionally, two other patterns: 'meat and oil' and 'noodles', were pronounced in men. Over the 17 years, the scores of the 'Japanese style' pattern decreased while the 'meat and oil' and the 'bread and dairy' patterns increased. The nutrition assessment result showed that the highest quartiles of the 'Japanese style' pattern had higher NRF scores (women: 716·0, men: 670·5) (P < 0·001), whereas those of the 'bread and dairy' pattern had a lower score (636·9 in women, 661·2 in men) (P < 0·001).

Conclusions: Trend analysis in this study suggests the ongoing Westernisation of diet in Japan. A decreasing trend of the dietary pattern with the most preferable nutrient profile (i.e. the 'Japanese style') might indicate a potential decrease in beneficial nutrient intake and, thus, a deterioration of the nutritional status of the Japanese population.

Objective: This study develops successful ageing profiles across six low- and middle-income countries (LMIC) and examines associations with fruit and vegetable (F&V) intake.

Design: A cross-sectional analysis was conducted in mid-aged and older adults from the WHO Study of Global Ageing. Participants without chronic disease, cognitive impairment, depression or disability and with good physical, cardiovascular and respiratory function were considered to have successfully aged. Associations between F&V intake (serves/d) and successful ageing were examined using log-binomial regression adjusting for key confounders.

Setting: China, Ghana, India, Mexico, Russia and South Africa.

Participants: A total of 28 785 men and women aged 50 years and over.

Results: Successful ageing ranged from 4 % in Mexico to 15 % in China. After adjustment, only Ghana showed an association between fruit intake and successful ageing, with an inverse association identified (prevalence ratio (PR) = 0·87, 95 % CI 0·78, 0·98). An inverse association between vegetable intake and successful ageing was found in China (0·97, 0·95, 0·98) but no other country. An inverse association was shown for both China (0·98, 0·96, 0·99) and Ghana (0·92, 0·84, 1·00) when considering fruit and vegetables combined.

Conclusions: Associations between F&V intake and successful ageing are inconsistent. Further studies on LMIC countries are needed to meet the challenges of the ageing population.

Objective: To conduct a systematic review of the published peer-reviewed articles on the biochemical assessment of nutritional status of South African infants, children and adolescents in 1997-2022.

Design: Online databases (Pubmed, CINAHL, EbscoHost and SAePublications) were used to identify thirty-nine papers.

Setting: South Africa, 1997-2022.

Participants: Infants, children and adolescents.

Results: Vitamin A deficiency prevalence was 35-67 % before 2001 and mostly below 16 % after 2008. Anaemia ranged from 5·4 to 75·0 %, with 36-54 % of infants below 1 year being anaemic. Among 0- to 6-year-olds, iron deficiency (ID) was 7·2-39·4 % in rural and 16-41·9 % in urban areas. Zn deficiency remained high, especially among 0- to 6-year-olds, at 39-48 %. Iodine insufficiency (UIC < 100 µg/l) was between 0 and 28·8 %, with excessive levels in two areas. Vitamin D deficiency was 5 % for 11- to 17-year-olds in one urban study but 33-87 % in under 10-week-old infants. The 2005 national survey reported sufficient folate status among 0- to 6-year-olds, and vitamin B₁₂ deficiency was 0-21 %. Low-grade inflammation was between 5 % and 42 % depending on the biomarker and cut-offs.

Conclusions: Vitamin A status may have improved meaningfully during the last 25 years in South Africa to below 16 %, and iodine and folate deficiency appears to be low particularly among 0- to 6-year-olds. However, confirmation is needed by a national survey. Anaemia, Fe and Zn deficiencies still pose severe problems, especially among 0- to 6-year-olds. Sufficient data on vitamin D and B₁₂ status are lacking.