BMJ Nutrition, Prevention and Health最新文献

Background: Jordan has a high prevalence of type 2 diabetes mellitus (T2DM), but it is estimated that nearly half of all cases in the Middle East and North Africa region remain undiagnosed. This study aimed to develop, validate and assess the diagnostic performance of a diabetes risk score to identify Jordanians at high risk of T2DM.

Methods: Random samples of 5000 Jordanians aged 20-79 years were simulated at different time points using an existing mathematical model describing T2DM epidemiology in Jordan. The risk score was derived through logistic regression applied to the simulated samples, using age, sex, obesity, smoking and physical inactivity as predictive variables. Cut-off values were determined based on the maximum sum of sensitivity and specificity.

Results: In 2020, the estimated area under the curve (AUC), sensitivity and specificity of the derived Jordan Diabetes Risk Score were 0.79 (95% CI: 0.77 to 0.80), 78.7% (95% CI: 77.5 to 79.8%) and 64.2% (95% CI: 62.9 to 65.6%), respectively. The positive and negative predictive values were 29.7% (95% CI: 28.4 to 31.0%) and 94.0% (95% CI: 93.3 to 94.7%), with 42.7% of Jordanians at high risk for diabetes. Similar diagnostic metrics were observed for the 2030 and 2050 risk scores, with AUCs of 0.78 (95% CI: 0.77 to 0.80) and 0.77 (95% CI: 0.76 to 0.79), respectively. The performance of the derived model-based score was comparable to a survey-based score and demonstrated better performance within the Jordanian population compared with existing regional and international scores.

Conclusions: The Jordan Diabetes Risk Score demonstrated strong diagnostic performance, offering an effective, non-invasive and accessible tool for diabetes screening. This tool can facilitate early detection, timely intervention and increased awareness, ultimately aiming to reduce the burden of T2DM and its complications in Jordan.

Background: As the prevalence of sleep disorders has grown, studies on sleep quality are increasingly required. Recent evidence suggests that calcium intake may influence sleep quality and duration, but few studies have investigated factors associated with sleep quality. This systematic review aimed to examine and synthesise existing evidence on the association between calcium intake and sleep quality and sleep duration.

Methods: We searched randomised controlled trials, case-control studies, cohort studies and cross-sectional studies from multiple databases, including PubMed, Web of Science, Cochrane Library, Scopus and CINAHL Plus, followed by keyword search at Google Scholar and reference review of included articles.

Results: A total of seven independent studies presented in nine reports met the inclusion criteria. Six of them were cross-sectional studies. The studies suggested a positive association between calcium intake and sleep quality, although the results were not statistically significant in some cases. Studies also indicated that lower calcium intake was associated with inappropriate sleep duration. We decided not to conduct a meta-analysis because of the insufficient number of studies.

Conclusion: The findings suggest a potential positive relationship between calcium intake and sleep quality, though the quality of evidence is unsatisfactory. To test the effectiveness of calcium intake on sleep quality, a randomised controlled trial is required, including many countries from different regions.

Background: Asia is experiencing a rapid rise in the incidence of type 2 diabetes mellitus (T2DM), characterised by impaired glucose tolerance and insulin resistance. Environmental variables such as dietary habits, physical inactivity, and urbanisation, as well as genetic vulnerability, contribute to the development of T2DM. Mutations in the TCF7L2 gene, particularly rs7903146, have been extensively researched for their potential significance in disease development and metabolic abnormalities, including dyslipidaemia leading to cardiovascular disease.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 principles. We reviewed six electronic databases-PubMed, Google Scholar, ResearchGate, Scopus, ScienceDirect and Web of Science-for studies published before 21 January 2024. Eligible studies comprised cross-sectional, case-control, cohort and meta-analysis that investigated the link between the TCF7L2 rs7903146 variation and T2DM, as well as its relationship to biomarkers.

Results: A total of 22 articles were included. Among these, 17 studies showed a significant association of the rs7903146 polymorphism in the TCF7L2 gene with T2DM, while 5 studies did not. Based on 14 eligible studies of Asian populations, a forest plot was established, most of the studies showing ORs greater than 1.0 and association with T2DM. The significant result was discovered in a Chinese study (OR=1.98, 95% CI: 1.13 to 3.49), and the pooled trend was suggestive for a higher risk of T2DM for the T allele carriers. Effect size estimates were heterogeneous, and some margins of East Asian genetic variants were non-significant. Furthermore, TCF7L2 variants have been associated with a variety of biomedical markers, including lipid profiles, glucose, triglycerides and total cholesterol; however, the results from different investigations are conflicting.

Conclusions: The TCF7L2 rs7903146 variation has been systematically linked to an increased risk of T2DM, indicating its potential as a genetic risk marker. However, the diversity in its relationship with biomarkers implies that additional factors, such as gene-environment interactions and population-specific genetic backgrounds, play important roles in disease development. A comprehensive understanding of this variation may benefit in T2DM prevention and individualised treatment approaches.

Introduction: Vitamin A supplementation (VAS) is strongly recommended for children aged 6-59 months to reduce vitamin A deficiency and consequent morbidity and mortality. So, understanding country-specific and regional inequalities in VAS is crucial for targeting high-risk populations in the region. Therefore, we aimed to examine the socioeconomic inequalities in receiving VAS among children aged 6-59 months within and between 11 South and Southeast Asian countries.

Methods: We used population-representative cross-sectional data from the demographic and health surveys conducted between 2003 and 2022 for 11 South and Southeast Asian countries (Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor-Leste). We conducted an analysis using the slope index of inequality (SII) and relative index of inequality to measure absolute and relative inequalities in VAS coverage over time.

Results: The prevalence of receiving VAS among children varied from 15.66% in India in 2006 to 87.52% in Nepal in 2006. In most countries, the coverage of VAS disproportionately affected the population with the poorest wealth status and no formal education. Meta-analysis revealed a similar pooled prevalence of receiving VAS in South Asia (66.27%) and Southeast Asia (66.33%). The highest wealth-driven inequality was observed in the Philippines in 2003 (SII 29.26, 95% CI 28.75, 29.76), followed by Indonesia in 2007 (SII 25.30, 95% CI 10.72, 39.88). The highest education-based inequality was manifested in Maldives in 2009 (SII -29.28, 95% CI -33.98, -24.59), followed by Timor-Leste in 2016 (SII 29.26, 95% CI 28.75, 29.76). Overall, most countries' absolute and relative measures of inequalities fluctuated over time.

Conclusion: Significant geographical and socioeconomic inequalities in receiving VAS persist in South and Southeast Asian countries, particularly among those with the lowest wealth and without formal education. Using only descriptive analysis limits causal interpretation, and future research should explore underlying drivers using multivariable or longitudinal approaches. VAS programmes should be better tailored to address equity gaps in high-risk groups.

Background: Poor diet is a leading cause of mortality and morbidity globally. Given their frequent engagement with the community, medical and healthcare professionals can support improved dietary behaviours, as key brokers of nutritional knowledge. Yet, medical and healthcare professionals report receiving suboptimal nutrition education to support practice.

Objective: This project aimed to identify the nutrition education content provided across tertiary medicine and health degree programmes at an Australian university.

Methods: A list of programmes and core courses was compiled using publicly available information in 2023. Learning objectives of core courses were compared against a Nutrition Competency Framework for Australian Medical Training to identify the nutrition education provided.

Results: A total of 13 programmes and 176 core courses were included. No programme made reference to all competencies from the Nutrition Competency Framework for Medicine. The Master of Dietetics Studies programme made the greatest number of references to nutrition (n=39), followed by the Bachelor of Physiotherapy (Hons) (n=36) and the Bachelor of Nursing and Midwifery (n=31). The Master of Organisational Psychology programme made the least number of references to nutrition (n=2), followed by the Master of Psychology (n=5) and Master of Clinical Psychology (n=8). Programmes most frequently included foundational (knowledge-based) nutrition competencies (n=103, 51%), with limited application to clinical practice.

Conclusions: There is a need for increased skills-based nutrition education in medicine and health degree programmes to support the translation of knowledge to future practice. Interprofessional competencies provide an opportunity for synergy across programmes.

Objective: Dairy intake has been reported to be both pro-inflammatory and anti-inflammatory; this inconsistency has led to uncertainty in the field. We aimed to address this using genetic data to perform a causal analysis of the link between lactose intolerance, rheumatoid arthritis (RhA) and body mass index (BMI). Lactose intolerance necessarily leads to reduced dairy intake. RhA is an autoimmune disease, which has been linked to both increased and reduced dairy intake. Dairy intake has also been associated with elevated BMI, which is itself pro-inflammatory and is associated with increased risk of RhA.

Methods: We separately considered congenital lactose intolerance, and adult-onset lactose intolerance where a prolonged period of dairy intake has already occurred. We combined Mendelian randomisation (MR) and rare genetic variant association testing to determine the relationship between genetic liability to lactose intolerance, risk of RhA and BMI. As a positive control to optimise instruments for measurement of lactose intolerance, we used the causal link between lactose intolerance and osteoporosis. Rare variant analysis was performed under a recessive model. Conditional analysis of the effect of lactose intolerance on the risk of RhA via BMI used multivariable MR.

Results: We observed an opposite effect of congenital and adult-onset lactose intolerance on RhA risk. Congenital lactose intolerance increases the risk of RhA, but adult-onset lactose intolerance reduces the risk of RhA. The protective effect of adult-onset lactose intolerance on RhA is conditional on reduced BMI.

Discussion: We conclude that dairy intake is anti-inflammatory, which explains why congenital lactose intolerance and lifetime avoidance of dairy foods increases the risk of RhA. However, adult-onset lactose intolerance can reduce the risk of RhA because of an association with reduced BMI, which is also anti-inflammatory.

Background: The Mediterranean diet has been associated with improved metabolic health among adults. This meta-analysis aimed to evaluate the association between adherence to a Mediterranean diet and metabolic syndrome among children and adolescents.

Methods: A systematic review of the literature was conducted by searching PubMed, the Excerpta Medica Database (Embase, via OvidSP), Scopus and Web of Science, covering publications from inception to April 2024. Studies were included if they evaluated the association between adherence to a Mediterranean diet and metabolic syndrome among children and adolescents. A random-effects model was used to estimate the summary effect size.

Results: A total of eight studies involving children and adolescents aged 6 to 19 years were included in the meta-analysis (n=6562, 50% girls). Low adherence to the Mediterranean diet was associated with greater odds of metabolic syndrome than was medium/high adherence (odds ratio [OR] = 2.18, 95% confidence interval [CI] 1.45 to 3.28; p < 0.001; inconsistency index [I ²] = 64.15%).

Conclusion: This meta-analysis suggested that increased adherence to a Mediterranean diet is associated with lower probabilities of having cardiometabolic risk among children and adolescents. Thus, our findings suggest that public health strategies are needed to implement and promote effective actions toward healthy eating habits in children and adolescents.

Objective: To evaluate the association between a comprehensive multidimensional healthy lifestyle and the risk of pre-diabetes and glycaemic control markers, specifically glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG), and to conduct subgroup analyses to examine these associations across different populations.

Methods: A cross-sectional analysis of 9567 adults aged 20 and older was conducted using data from the National Health and Nutrition Examination Survey from 2005 to 2018 participants. A lifestyle score was created based on eight modifiable factors: diet, physical activity, smoking, alcohol consumption, sleep duration, waist circumference, depressive symptoms and marital status. Weighted logistic regression estimated ORs for pre-diabetes, and linear regression assessed associations with HbA1c and FPG.

Results: A higher healthy lifestyle score was associated with a significantly lower risk of pre-diabetes and improved glycaemic markers. Compared with participants with 0-2 healthy lifestyle factors, those with 7-8 factors exhibited a 53% lower risk of pre-diabetes (OR: 0.47, 95% CI: 0.31 to 0.69; p<0.001, P for trend <0.001). The results showed significant reductions in HbA1c by 0.08 units (95% CI: -0.16 to -0.01) and in FPG by 2.74 mg/dL (95% CI: -4.47 to -1.01). Stratified analyses showed stronger associations in women, individuals without a family history of diabetes, and those aged 40-59. Sensitivity analyses confirmed the robustness of these findings.

Conclusions: The study results highlight the value of a multidimensional, modifiable healthy lifestyle in reducing pre-diabetes risk and improving glycaemic control. These results support integrated lifestyle interventions in population-level pre-diabetes prevention strategies.

Background: Breastfeeding is a cornerstone of child health. We investigated the associations of any breastfeeding initiation and duration with physical, mental and behavioural health conditions among children aged 3-5 years in the USA.

Methods: Data were derived from the 2016 to 2022 National Survey of Children's Health, which is a national, population-based, cross-sectional study. A total of 40 280 children aged 3-5 years were included. Any breastfeeding initiation and duration, physical (asthma, allergies, arthritis, cerebral palsy, diabetes, epilepsy or seizure disorder, heart conditions or severe headaches), mental (anxiety or depression) and behavioural (Tourette syndrome, attention-deficit/hyperactivity disorder or behavioural/conduct problems) health conditions were measured using parent-reported questionnaires.

Results: Any breastfeeding was significantly associated with lower odds of behavioural health conditions (OR=0.76, 95% CI: 0.58 to 0.99) and marginally with mental health conditions (OR=0.70, 95% CI: 0.48 to 1.02, p=0.067). There was a significant non-linear trend between any breastfeeding duration and having a mental or behavioural health condition (all P_non-linear<0.001). The intervals of significant associations were 7.3-23.4 months for mental condition and 6.8-24.1 months for behavioural condition (the most associated points at 15.6 and 15.3 months). There were no significant associations of any breastfeeding initiation and duration with physical health.

Conclusions: Any breastfeeding was linked to better behavioural health and marginally to mental health, with no association found for physical health among children aged 3-5 years in the USA. Any breastfeeding duration of approximately 15 months appears to have the strongest association with promoting children's mental and behavioural health.

Background and aims: In sub-Saharan Africa, a nutrition transition is driving increased consumption of ultraprocessed foods and reduced intake of vegetables and fruits. This shift contributes to high rates of diet-related non-communicable diseases like diabetes. This study aimed to identify the facilitators and barriers to consuming indigenous fruits and vegetables (IFVs) among individuals with type 2 diabetes (T2D) in Uganda.

Methods: Individuals living with T2D were recruited for focus group discussions (FGDs) based on a modified theoretical framework comprising three established theories. Purposive sampling targeted participants at a community diabetic clinic, recruited through village health workers. FGDs were audio-recorded, transcribed verbatim and analysed using inductive thematic content analysis. Recruitment continued until data saturation.

Results: Five FGDs (n=33) were conducted. Along with conventional pharmacotherapies, several indigenous vegetables and fruits were perceived as useful in maintaining normal blood glucose levels. Determinants for IFV use were identified at three ecological levels: personal, interpersonal and environmental. Major barriers included undesirable sensory attributes of IFV, lack of food processing and preservation skills, cultural and social influences, proximity to food markets, seasonality of IFV, financial constraints, unhygienic and harmful farm practices, media influence and limited accessibility to IFV. Major facilitators included fear-inspired dietary shift, attributed health benefits of IFV, presence of home gardens, literacy and budgeting skills, social and healthcare support, and skills in IFV preparation and preservation.

Conclusion: Despite acknowledging the importance of IFVs, barriers limit their consumption. Interventions should address personal obstacles, boost self-efficacy and change the food environment to promote healthy diets among Ugandan individuals living with diabetes.