BMJ Nutrition, Prevention and Health最新文献

Front-of-pack labelling (FoPL) aims to promote healthier diets by altering consumer food purchasing behaviour. We quantify the impact of the voluntary Health Star Rating (HSR) FoPL adopted by New Zealand (NZ) in 2014, on (i) the quantity of foods purchased by HSR scores and food groups and (ii) the quantities of different nutrients purchased. We used Nielsen HomeScan household purchasing panel data over 2013-2019, linked to Nutritrack packaged food composition data. Fixed effects analyses were used to estimate the association of HSR with product and nutrient purchasing. We controlled for NZ-wide purchasing trends and potential confounding at the household and product level. In 2019, HSR-labelled products accounted for 24% (2890) of 12 040 products in the dataset and 32% of purchasing volume. Of HSR-labelled products, 1339 (46%) displayed a rating of 4.0-5.0 stars and 556 (19%) displayed a rating of 0.5-2.0 stars. We found little or no association between HSR labelling and the quantities of different foods purchased. Introduction of HSR was, however, associated with lower sodium (-9%, 95% CI -13% to -5%), lower protein (-3%, 95% CI -5% to 0%) and higher fibre (5%, 95% CI 2% to 7%) purchases when purchased products carrying an HSR were compared with the same products prior to introduction of the programme. Robust evidence of HSR labelling changing consumer purchasing behaviour was not observed. The positive effect on nutrient purchasing of HSR-labelled foods likely arises from reformulation of products to achieve a better HSR label.

Background: Daily intake of 57 g Jarlsberg cheese has been shown to increase the total serum osteocalcin (tOC). Is this a general cheese effect or specific for Jarlsberg containing vitamin K₂ and 1,4-dihydroxy-2naphtoic acid (DHNA)?

Methods: 66 healthy female volunteers (HV) were recruited. By skewed randomisation (3:2), 41 HV were allocated to daily intake of 57 g Jarlsberg (J-group) and 25-50 g Camembert (C-group) in 6 weeks. After 6 weeks the C-group was switched to Jarlsberg. The study duration was 12 weeks with clinical investigations every 6 weeks. The main variables were procollagen type 1 N-terminal propeptide (PINP), tOC, carboxylated osteocalcin (cOC) and the osteocalcin ratio (R_O) defined as the ratio between cOC and undercarboxylated osteocalcin (ucOC). Serum cross-linked C-telopeptide type I collagen (CTX), vitamin K₂, lipids and clinical chemistry were used as secondary variables.

Results: PINP, tOC, cOC, R_O and vitamin K₂ increased significantly (p<0.01) after 6 weeks in the J-group. PINP remained unchanged in the C-group. The other variables decreased slightly in the C-group but increased significantly (p≤0.05) after switching to Jarlsberg. No CTX-changes detected in neither of the groups.Serum lipids increased slightly in both groups. Switching to Jarlsberg, total cholesterol and low-density lipoprotein-cholesterol were significantly reduced (p≤0.05). Glycated haemoglobin (HbA1c), Ca⁺⁺ and Mg⁺⁺ were significantly reduced in the J-group, but unchanged in the C-group. Switching to Jarlsberg, HbA1c and Ca⁺⁺ decreased significantly.

Conclusion: The effect of daily Jarlsberg intake on increased s-osteocalcin level is not a general cheese effect. Jarlsberg contain vitamin K₂ and DHNA which increases PINP, tOC, cOC and R_O and decreases Ca⁺⁺, Mg⁺⁺ and HbA1c. These effects reflect increased bone anabolism and a possible reduced risk of adverse metabolic outcomes.

Trial registration number: NCT04189796.

Background: The COVID-19 pandemic may have contributed to poorer self-management (ie, diet, physical activity and sleep) of diabetes mellitus (DM), which might predispose individuals to more severe COVID-19 outcomes.

Objective: The first objective was to capture perceived changes in diet, physical activity and sleeping during the COVID-19 pandemic in adults with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in the UK. A second objective was to explore differences between individuals with DM compared with 'no' or 'other' health conditions.

Methods: Participants aged >18 years were selected by convenience. Individuals subscribed to the Diabetes.co.uk community were sent a web-based survey including questions about demographics and health, followed by 5-point Likert-type scale questions relating to lifestyle-related behaviours during the COVID-19 pandemic. Individuals were grouped by diagnosis of DM, 'other' or 'no' health condition and responses were compared.

Results: 4764 individuals responded, with 2434 (51.3%) being female and 1550 (32.6%) aged 55-64 years. T2DM (2974; 62.7%), hypertension (2147; 45.2%) and T1DM (1299; 27.4%) were most frequently reported. Compared with T1DM, 'no' or 'other' health conditions, respondents with T2DM reported making a less conscious effort to get outside and exercise daily (p<0.001) and spending no time outdoors (p=0.001). Weight loss was more frequently reported in respondents with T2DM (p=0.005). More individuals with T2DM reported consuming convenience foods (p=0.012) and sugary foods (p=0.021), yet eating more fresh foods (p=0.001) and drinking less alcohol than normal (p<0.001). More individuals with T1DM and T2DM reported worse sleep quality (p=0.004).

Conclusions: Our study highlighted important differences in lifestyle by individuals with T1DM, T2DM, other and no health conditions in relation to the COVID-19 pandemic. Establishing surveillance systems and conducting repeated assessments are required to analyse how the situation shifted over time and whether adverse collateral effects of the pandemic were sustained in those with chronic health conditions.

Background: The COVID-19 pandemic lockdown in 2020 resulted in school closures with eventual suspension of the mid-day meal programme, biannual deworming and iron-folic acid supplements. One year into the lockdown, we evaluated the impact of the withdrawal of these programmes on the nutritional status of rural primary-school children, aged 6-12 years, in Karnataka, India.

Methods: Anthropometry, haemoglobin, serum ferritin and C reactive protein were measured in 290 children at two time points, 1 year apart, starting from just before the lockdown (February 2020 to February 2021).

Results: The prevalence of anaemia doubled from 21% to 40% (p<0.0001) with more pronounced changes in older girls (10%-53%); however, the prevalence of iron deficiency did not change (48.8%-51.9%), despite cessation of deworming and iron/folic acid supplements.

Conclusion: The increase in anaemia was due to limiting intakes of other erythropoietic nutrients, possibly due to a lower dietary diversity. The mid-day lunch meal at school (MDM) is an important part of daily food intake in rural school children, and it is important to maintain dietary diversity through the delivery of MDM for such vulnerable groups.

Objective: To investigate the association between intake of sucrose-sweetened beverages (SSBs) and risk of developing pharmacologically treated hypertension in a population of Norwegian mothers followed up to 10 years after delivery.

Design: Women without hypertension at baseline in the Norwegian Mother, Father and Child Cohort Study (n=60 027) who delivered between 2004 and 2009 were linked to the Norwegian Prescription Database to ascertain antihypertensive medication use after the first 90 days following delivery. Diet was assessed by a validated semiquantitative Food Frequency Questionnaire in mid pregnancy. Cox proportional hazard analyses evaluated HRs for the development of hypertension associated with SSB consumption as percent energy by quintiles in multivariable models. Supplemental analyses were stratified by gestational hypertension and by a low versus high sodium-to-potassium intake ratio (<0.78 compared with ≥0.78).

Results: A total of 1480 women developed hypertension within 10 years of follow-up. The highest relative to the lowest quintile of SSB intake was associated with an elevated risk for hypertension after adjusting for numerous covariates in adjusted models (HR: 1.20 (95% CI: 1.02 to 1.42)). Consistency in results was observed in sensitivity analyses. In stratified analyses, the high SSB intake quintile associated with elevated hypertension risk among women who were normotensive during pregnancy (HR: 1.25 (95% CI: 1.03 to 1.52)), who had normal body mass index (HR: 1.49 (95% CI: 1.13 to 1.93)) and among women with low sodium to potassium ratio (HR: 1.33 (95% CI: 1.04 to 1.70)).

Conclusions: This study provides strong evidence that SSB intake is associated with an increased risk of hypertension in women.

Introduction: In China, salt intake is among the highest in the world (~11 g/day) and cardiovascular disease (CVD) accounts for 40% of deaths. We estimated the potential impact of reducing salt intake on CVD events in China, via systolic blood pressure (SBP).

Methods: To develop our model, we extracted the effect of salt reduction on SBP from a meta-regression of randomised trials and a population study, and that of SBP on CVD risk from pooled cohort studies.

Results: Reducing population salt intake in China by 1 g/day could lower the risk for ischaemic heart disease by about 4% (95% uncertainty interval 1.8%-7.7%) and the risk for stroke by about 6% (2.4%-9.3%). Should this reduced salt level be sustained until 2030,~9 million (M) (7M-10.8M) CVD events could be prevented, of which ~4M (3.1M-4.9M) would have been fatal. Greater and gradual salt intake reductions, to achieve WHO's target of 30% reduction by 2025 or the Chinese government's target of ≤5 g/day by 2030, could prevent ~1.5 or 2 times more CVD events and deaths, respectively. Should the prolonged effect of salt reduction over several years be accounted for, all estimates of CVD events and deaths prevented would be 25% greater on average.

Conclusion: Bringing down the high salt intake levels in China could result in large reductions in CVD. An easily achievable reduction of 1 g/day could prevent ~9M CVD events by 2030. Urgent action must be taken to reduce salt intake in China.

Background: The double burden of malnutrition (DBM), which refers to the coexistence of overnutrition and undernutrition among populations, households or individuals, is a growing problem in low/middle-income countries. The Latin America and the Caribbean (LAC) region has been particularly affected by the DBM, following a nutrition transition and a rapid increase in overweight, obesity and diet-related disease, while high levels of undernutrition persist. This study aims to describe the prevalence of four different DBM definitions in mother-child pairs across nine LAC countries and investigate the socioeconomic determinants of overweight mothers with at least one stunted child (SCOM).

Methods: We used cross-sectional data from the Demographic and Health Surveys for all analyses. We used descriptive statistics to obtain prevalence rates and conducted multiple logistic regression analyses to investigate the association between SCOM households and socioeconomic determinants, including wealth index, maternal education, place of residency and whether the mother was working, adjusted for a range of variables.

Results: Overweight/obese mothers with at least one anaemic child were the most common type of DBM, with a prevalence of 19.39%, followed by SCOM with a prevalence of 10.44%. Statistically significant socioeconomic predictors of SCOM were households with a lower wealth index, lower maternal education and living in rural areas.

Conclusion: This study showed that the overall prevalence of most DBM definitions examined was high, which points to the need for urgent interventions in the LAC region. The unique set of socioeconomic predictors of SCOM identified in this study calls for future double-duty policies that simultaneously target food affordability, nutrition education and access to healthy food.

Bioelectrical impedance analysis (BIA) provides a practical method of body composition estimation for field research and weight management programmes, with devices and algorithms that have improved in recent years. We compared suitability of a commercial BIA system that uses multi-frequency-based proprietary algorithms (InBody 770, Cerritos, California, USA) and a laboratory-based validated single-frequency system (Quantum IV, RJL Systems, Clinton Township, Michigan, USA) with dual-energy X-ray absorptiometry (DXA) (iDXA, GE Lunar, Madison, Wisconsin, USA). Volunteers included fit non-obese active duty US Marines (480 men; 315 women), assessed by DXA and the two BIA systems. Both RJL and InBody BIA devices predicted DXA-based fat-free mass (FFM) (mean absolute error (MAE) 2.8 and 3.1 kg, respectively) and per cent body fat (%BF) (MAE 3.4% and 3.9%, respectively), with higher correlations from the InBody device (r²=0.96 (%BF) and 0.84 (FFM)) versus the RJL (r²=0.92 (%BF) and 0.72 (FFM)). InBody overpredicted FFM (bias +2.7, MAE 3.1 kg) and underpredicted %BF (bias -3.4 and MAE 3.9%) versus the RJL. A 3% correction factor applied to the InBody device results provided values very close to the DXA measurements. These findings support the application of modern BIA systems to body composition goals of maximum %BF and minimum lean body mass for both men and women.

Objectives: Intermittent fasting boosts some host defence mechanisms while modulating the inflammatory response. Lower-frequency fasting is associated with greater survival and lower risk from COVID-19-related comorbidities. This study evaluated associations of periodic fasting with COVID-19 severity and, secondarily, initial infection by SARS-CoV-2.

Design: Prospective longitudinal observational cohort study.

Setting: Single-centre secondary care facility in Salt Lake City, Utah, USA with follow-up across a 24-hospital integrated healthcare system.

Participants: Patients enrolled in the INSPIRE registry in 2013-2020 were studied for the primary outcome if they tested positive for SARS-CoV-2 during March 2020 to February 2021 (n=205) or, for the secondary outcome, if they had any SARS-CoV-2 test result (n=1524).

Interventions: No treatment assignments were made; individuals reported their personal history of routine periodic fasting across their life span.

Main outcome measures: A composite of mortality or hospitalisation was the primary outcome and evaluated by Cox regression through February 2021 with multivariable analyses considering 36 covariables. The secondary outcome was whether a patient tested positive for SARS-CoV-2.

Results: Subjects engaging in periodic fasting (n=73, 35.6%) did so for 40.4±20.6 years (max: 81.9 years) prior to COVID-19 diagnosis. The composite outcome occurred in 11.0% of periodic fasters and 28.8% of non-fasters (p=0.013), with HR=0.61 (95% CI 0.42 to 0.90) favouring fasting. Multivariable analyses confirmed this association. Other predictors of hospitalisation/mortality were age, Hispanic ethnicity, prior MI, prior TIA and renal failure, with trends for race, smoking, hyperlipidaemia, coronary disease, diabetes, heart failure and anxiety, but not alcohol use. In secondary analysis, COVID-19 was diagnosed in 14.3% of fasters and 13.0% of non-fasters (p=0.51).

Conclusions: Routine periodic fasting was associated with a lower risk of hospitalisation or mortality in patients with COVID-19. Fasting may be a complementary therapy to vaccination that could provide immune support and hyperinflammation control during and beyond the pandemic.

Trial registration: Clinicaltrials.gov, NCT02450006 (the INSPIRE registry).