BMJ Nutrition, Prevention and Health最新文献

Background: Malnutrition is a global emergency, creating an overlapping burden on individual, public and economic health. The double burden of malnutrition affects approximately 2.3 billion adults worldwide. Following 3 years of capacity building work in Kolkata, with assistance of local volunteers and organisations, we established an empowering nutrition education model in the form of a 'mobile teaching kitchen (MTK)' with the aim of creating culinary health educators from lay slum-dwelling women.

Aims: To evaluate the piloting of a novel MTK nutrition education platform and its effects on the participants, alongside data collection feasibility.

Methods: Over 6 months, marginalised (RG Kar and Chetla slums) women underwent nutrition training using the MTK supported by dietitians, doctors and volunteers. Preintervention and postintervention assessments of knowledge, attitudes and practices (KAP), as well as anthropometric and clinical nutritional status of both the women and their children were recorded. The education was delivered by a 'See One, Do One, Teach One' approach with a final assessment of teaching delivery performed in the final session.

Results: Twelve women were trained in total, six from each slum. Statistically significant improvements were noted in sections of KAP, with improvements in nutrition knowledge (+4.8) and practices (+0.8). In addition, statistically significant positive changes were seen in 'understanding of healthy nutrition for their children' (p=0.02), 'sources of protein rich food' (p=0.02) and 'not skipping meals if a child is ill' (p≤0.001).

Conclusion: The MTK as a public health intervention managed to educate, empower and upskill two groups of lay marginalised women into MTK Champions from the urban slums of Kolkata, India. Improvements in their nutrition KAP demonstrate just some of the effects of this programme. By the provision of healthy meals and nutritional messages, the MTK Champions are key drivers nudging improvements in nutrition and health related awareness with a ripple effect across the communities that they serve. There is potential to upscale and adapt this programme to other settings, or developing into a microenterprise model, that can help future MTK Champions earn a stable income.

Background: Children and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity rate in the USA.

Methods: We developed a microsimulation model to project the effect of reducing UPF consumption in children's diet on reducing the prevalence of overweight or obesity among US youth. The model incorporated nationally representative data on body mass index (BMI) percentile and dietary intake of 5804 children and adolescents aged 7-18 years from the National Health and Nutrition Examination Survey 2011-2016, and the effect of reducing UPF consumption on calorie intake from a recent randomised controlled trial. Uncertainties of model inputs were incorporated using probabilistic sensitivity analysis with 1000 simulations.

Results: Reducing UPFs in children's diet was estimated to result in a median of -2.09 kg/m² (95% uncertainty interval -3.21 to -0.80) reduction in BMI among children and adolescents aged 7-18 years. The median prevalence of overweight (BMI percentile ≥85th) and obesity (BMI percentile ≥95th percentile) was reduced from 37.0% (35.9%, 38.1%) to 20.9% (15.1%, 29.9%) and from 20.1% (19.2%, 21.0%) to 11.0% (7.86%, 15.8%), respectively. Larger BMI and weight reductions were seen among boys than girls, adolescents than children, non-Hispanic black and Hispanic youth than non-Hispanic white youth, and those with lower levels of parental education and family income.

Conclusions: Reducing UPF consumption in children's diet has the potential to substantially reduce childhood obesity rate among children and adolescents in the USA.

Background: Maternal malnutrition is a major source of regional health inequity and contributes to maternal and infant morbidity and mortality. Bihar, a state in eastern India adjacent to Jharkhand and West Bengal, has relatively high neonatal mortality rates because a large portion of infants are born to young mothers. Bihar has the second-highest proportion of underweight children under 3 in India, with infant mortality rates of 48 per 1000 live births. Maternal malnutrition remains a major threat to perinatal health in Bihar, where 58.3% of pregnant women are anaemic.

Methods: We examined dietary beliefs and practices among mothers, mothers-in-law and community members, including Accredited Social Health Activists (ASHAs), using focus group discussions (n=40 groups, 213 participants), key informant interviews (n=50 participants) and quantitative surveys (n=1200 recent mothers and 400 community health workers). We report foods that are added/avoided during the perinatal period, along with stated reasons underlying food choice. We summarise the content of the diet based on responses to the quantitative survey and identify influencers of food choice and stated explanations for adding and avoiding foods.

Key findings: Analyses for all methodologies included gathering frequency counts and running descriptive statistics by food item, recommendation to eat or avoid, pregnancy or post partum, food group and health promoting or risk avoiding. During pregnancy, commonly added foods were generally nutritious (milk, pulses) with explanations for consuming these foods related to promoting health. Commonly avoided foods during pregnancy were also nutritious (wood apples, eggplant) with explanations for avoiding these foods related to miscarriage, newborn appearance and issues with digestion. Post partum, commonly added foods included sweets because they ease digestion whereas commonly avoided foods included eggplants and oily or spicy foods. Family, friends, relatives or neighbours influenced food choice for both mothers and ASHAs more than ASHAs and other health workers.Perinatal dietary beliefs and behaviours are shaped by local gastroecologies or systems of knowledge and practice that surround and inform dietary choices, as well as how those choices are explained and influenced. Our data provide novel insight into how health influencers operating within traditional and biomedical health systems shape the perinatal dietary beliefs of both mothers and community health workers.

Background: All over the world, the COVID-19 pandemic, not unlikely other epidemics, has hit harder people in low socioeconomic conditions.In Western countries, undocumented migrants are a growing component of this disadvantaged segment of the population.Their health conditions are frequently burdened by a number of chronic conditions, and they experience many difficulties in accessing public health services. Frequently, the only medical assistance they can get is provided by non-governmental organisations.

Methods: We studied the medical records (including pharmacological treatments) of all patients attending the outpatient clinics of Opera San Francesco (OSF; a big charity in Milano, Italy), in the first 5 months of 2020. These comprise the outbreak of the pandemic and the lockdown period. The 1914 patients (1814 undocumented migrants and 100 Italians) seen during the lockdown were compared with those seen in the same period of 2019 and with those seen in the preceding months of 2020. We especially focused on three chronic conditions: cardiovascular diseases, diabetes and psychiatric disorders.

Results: The number of consultations during the first 5 months of 2020 was much smaller than that of the same period of 2019. During the lockdown, we found 4048 consultations for 1914 patients, while they were 8051 in the same period of 2019 and 5681 in the first 2 months of 2020.The quantity of medicines dispensed by OSF showed a marked decrease in the period of the study and mainly during the lockdown.The decrease in consultations and dispensation of medicines was most evident for psychiatric patients and almost not existent for patients with diabetes. Female patients suffered a more pronounced reduction.

Conclusions: Western countries need strategies to better assist the very poor during epidemics.Differences among different groups of disadvantaged persons should be taken into account when designing recovery plans.

Background: Metabolomics analysis of human stool samples is of great interest for a broad range of applications in biomedical research including early detection of colorectal neoplasms. However, due to the complexity of metabolites there is no consensus on how to process samples for stool metabolomics measurements to obtain a broad coverage of hydrophilic and hydrophobic substances.

Methods: We used frozen stool samples (50 mg) from healthy study participants. Stool samples were processed after thawing using eight different processing protocols and different solvents (solvents such as phosphate-buffered saline, isopropanol, methanol, ethanol, acetonitrile and solvent mixtures with or without following evaporation and concentration steps). Metabolites were measured afterwards using the MxP Quant 500 kit (Biocrates). The best performing protocol was subsequently applied to compare stool samples of participants with different dietary habits.

Results: In this study, we were able to determine up to 340 metabolites of various chemical classes extracted from stool samples of healthy study participants with eight different protocols. Polar metabolites such as amino acids could be measured with each method while other metabolite classes, particular lipid species (better with isopropanol and ethanol or methanol following a drying step), are more dependent on the solvent or combination of solvents used. Only a small number of triglycerides or acylcarnitines were detected in human faeces. Extraction efficiency was higher for protocols using isopropanol (131 metabolites>limit of detection (LOD)) or those using ethanol or methanol and methyl tert-butyl ether (MTBE) including an evaporation and concentration step (303 and 342 metabolites>LOD, respectively) than for other protocols. We detected significant faecal metabolite differences between vegetarians, semivegetarians and non-vegetarians.

Conclusion: For the evaluation of metabolites in faecal samples, we found protocols using solvents like isopropanol and those using ethanol or methanol, and MTBE including an evaporation and concentration step to be superior regarding the number of detected metabolites of different chemical classes over others tested in this study.

Background: The association between intake of fruit and vegetables and their subtypes, and the risk of type 2 diabetes has been investigated in several studies, but the results have been inconsistent.

Objective: We conducted an updated systematic review and dose-response meta-analysis of prospective studies on intakes of fruit and vegetables and fruit and vegetable subtypes and the risk of type 2 diabetes.

Design: PubMed and Embase databases were searched up to 20 October 2020. Prospective cohort studies of fruit and vegetable consumption and type 2 diabetes mellitus were included. Summary relative risks (RRs) and 95% CIs were estimated using a random effects model.

Results: We included 23 cohort studies. The summary RR for high versus low intake and per 200 g/day were 0.93 (95% CI: 0.89 to 0.98, I²=0%, n=10 studies) and 0.98 (95% CI: 0.95 to 1.01, I²=37.8%, n=7) for fruit and vegetables combined, 0.93 (95% CI: 0.90 to 0.97, I²=9.3%, n=20) and 0.96 (95% CI: 0.92 to 1.00, I²=68.4%, n=19) for fruits and 0.95 (95% CI: 0.88 to 1.02, I²=60.4%, n=17) and 0.97 (95% CI: 0.94 to 1.01, I²=39.2%, n=16) for vegetables, respectively. Inverse associations were observed for apples, apples and pears, blueberries, grapefruit and grapes and raisins, while positive associations were observed for intakes of cantaloupe, fruit drinks, fruit juice, brussels sprouts, cauliflower and potatoes, however, most of these associations were based on few studies and need further investigation in additional studies.

Conclusions: This meta-analysis found a weak inverse association between fruit and vegetable intake and type 2 diabetes risk. There is indication of both inverse and positive associations between intake of several fruit and vegetables subtypes and type 2 diabetes risk, however, further studies are needed before firm conclusions can be made.

Introduction: The majority of Indian women have a poor dietary folate and vitamin B₁₂ intake resulting in their chronically low vitamin status, which contributes to anaemia and the high incidence of folate-responsive neural-tube defects (NTDs) in India. Although many countries have successfully deployed centrally-processed folate-fortified flour for prevention of NTDs, inherent logistical problems preclude widespread implementation of this strategy in India. Because tea-the second most common beverage worldwide (after water)-is consumed by most Indians every day, and appeared an ideal vehicle for fortification with folate and vitamin B₁₂, we determined if daily consumption of vitamin-fortified tea for 2 months could benefit young women of childbearing-age in Sangli, India.

Methods: Women (average age=20±2 SD) used teabags spiked with therapeutic doses of 1 mg folate plus either 0.1 mg vitamin B₁₂ (Group-1, n=19) or 0.5 mg vitamin B₁₂ (Group-2, n=19), or mock-fortified teabags (Group-0, n=5) to prepare a cup of tea every day for 2 months, following which their pre-intervention and post-intervention serum vitamin and haemoglobin concentrations were compared.

Results: Most women had baseline anaemia with low-normal serum folate and below-normal serum vitamin B₁₂ levels. After 2 months, women in both Group-1 and Group-2 exhibited significant increases in mean differences in pre-intervention versus post-intervention serum folate levels of 8.37 ng/mL (95% CIs 5.69 to 11.04, p<0.05) and 6.69 ng/mL (95% CI 3.93 to 9.44, p<0.05), respectively; however, Group-0 experienced an insignificant rise of 1.26 ng/mL (95% CI -4.08 to 0.16). In addition, over one-half and two-thirds of women in Group-1 and Group-2, respectively, exhibited increases in serum vitamin B₁₂ levels over 300 pg/mL. There was also a significant post-interventional increase in the mean haemoglobin concentration in Group-1 of 1.45 g/dL (95% CI 0.64 to 2.26, p=0.002) and Group-2 of 0.79 g/dL (95% CI 0.11 to 1.42, p=0.027), which reflected a bona fide clinical response.

Conclusion: Tea is an outstanding scalable vehicle for fortification with folate and vitamin B₁₂ in India, and has potential to help eliminate haematological and neurological complications arising from inadequate dietary consumption or absorption of folate and vitamin B₁₂.

Background: Smoking has been associated with poorer outcomes in relation to COVID-19. Smokers have higher risk of mortality and have a more severe clinical course. There is paucity of data available on this issue, and a definitive link between smoking and COVID-19 prognosis has yet to be established.

Methods: We included 5224 patients with COVID-19 with an available smoking history in a multicentre international registry Health Outcome Predictive Evaluation for COVID-19 (NCT04334291). Patients were included following an in-hospital admission with a COVID-19 diagnosis. We analysed the outcomes of patients with a current or prior history of smoking compared with the non-smoking group. The primary endpoint was all-cause in-hospital death.

Results: Finally, 5224 patients with COVID-19 with available smoking status were analysed. A total of 3983 (67.9%) patients were non-smokers, 934 (15.9%) were former smokers and 307 (5.2%) were active smokers. The median age was 66 years (IQR 52.0-77.0) and 58.6% were male. The most frequent comorbidities were hypertension (48.5%) and dyslipidaemia (33.0%). A relevant lung disease was present in 19.4%. In-hospital complications such sepsis (23.6%) and embolic events (4.3%) occurred more frequently in the smoker group (p<0.001 for both). All cause-death was higher among smokers (active or former smokers) compared with non-smokers (27.6 vs 18.4%, p<0.001). Following a multivariate analysis, current smoking was considered as an independent predictor of mortality (OR 1.77, 95% CI 1.11 to 2.82, p=0.017) and a combined endpoint of severe disease (OR 1.68, 95% CI 1.16 to 2.43, p=0.006).

Conclusion: Smoking has a negative prognostic impact on patients hospitalised with COVID-19.

Objective: To compare the costs and climate impact (greenhouse gas emissions) associated with current and healthy diets and two healthy and environmentally friendly dietary patterns: flexitarian and vegan.

Design: Modelling study.

Setting: Aotearoa (New Zealand).

Main outcome measures: The distribution of the cost and climate impact (kgCO₂e/kg of food per fortnight) of 2 weekly current, healthy, vegan and flexitarian household diets was modelled using a list of commonly consumed foods, a set of quantity/serves constraints for each, and constraints for food group and nutrient intakes based on dietary guidelines (Eating and Activity Guidelines for healthy diets and EAT-Lancet reference diet for vegan and flexitarian diets) or nutrition survey data (current diets).

Results: The iterative creation of 210-237 household dietary intakes for each dietary scenario was achieved using computer software adapted for the purpose (DIETCOST). There were stepwise differences between diet scenarios (p<0.001) with the current diet having the lowest mean cost in New Zealand Dollars (NZ$584 (95% CI NZ$580 to NZ$588)) per fortnight for a family of four) but highest mean climate impact (597 kgCO₂e (95% CI 590 to 604 kgCO₂e)), followed by the healthy diet (NZ$637 (95% CI NZ$632 to NZ$642), 452 kgCO₂e (95% CI 446 to 458 kgCO₂e)), the flexitarian diet (NZ$728 (95% CI NZ$723 to NZ$734), 263 kgCO₂e (95% CI 261 to 265 kgCO₂e)) and the vegan diet, which had the highest mean cost and lowest mean climate impact (NZ$789, (95% CI NZ$784 to NZ$794), 203 kgCO₂e (95% CI 201 to 204 kgCO₂e)). There was a negative relationship between cost and climate impact across diets and a positive relationship within diets.

Conclusions: Moving from current diets towards sustainable healthy diets (SHDs) will reduce climate impact but generally at a higher cost to households. The results reflect trade-offs, with the larger constraints placed on diets, the greater cost and factors such as nutritional adequacy, variety, cost and low-emissions foods being considered. Further monitoring and policies are needed to support population transitions that are country specific from current diets to SHD.

Background: Malnutrition in children is widely prevalent around the world. It has been observed that malnourished children with multiple anthropometric deficits have higher mortality. However, adequate studies are not available on the outcome and recovery of these children.Nandurbar, a tribal district from Maharashtra, India, shows high prevalence of all three forms of malnutrition, often occurring simultaneously. A project previously undertaken in Nandurbar from July 2014 to June 2016 studied the effect of various therapeutic feeds in treatment of children with uncomplicated severe acute malnutrition (SAM). In this study, we analyse secondary data from it to correlate effects of stunting, wasting and underweight on treatment recovery.

Methods: Analysis was done on 5979 children with SAM using linear and logistic regression on R software for recovery rates and weight gain in children with SAM with single versus multiple anthropometric deficits, their relation to age, sex, and recovery from severe stunting by gain in height.

Results: The mean age of children was 35 months and 53.1% of the children were males. 2346 (39.2%) children recovered at the end of the 8-week treatment. 454 (7.6%) had single anthropometric deficit (SAM only), 3164 (52.9%) had two anthropometric deficits (SAM and severe underweight (SUW)) and 2355 (39.4%) children had three anthropometric deficits (SAM, SUW and severe stunting). Out of the 5979 children with SAM, only 52 (0.9%) of children were not underweight (severe or moderate).44.94% of children with SAM who were severely stunted recovered, compared with 35.52% of children who were not (p<0.001). After controlling for confounders, severe stunting was found to increase the odds of recovery by 1.49. Severely stunted children with SAM also showed faster recovery and weight gain by 1.93 days (p<0.012) and 0.29 g/kg/day (p<0.001), respectively. Recovery was higher in females and younger age group. Recovery was also found to depend on the therapeutic feed, with children receiving medical nutrition therapy showing better recovery for severely stunted children.

Conclusion: Our findings corroborate previous literature that stunting is a way for the body to deal with chronic stress of nutritional deprivation and provides a survival advantage to a child.