BMJ Nutrition, Prevention and Health最新文献

Background: A healthier diet is associated with lower chronic disease burden, but the impact of neighbourhood food environments on disability and death in older adults is not known.

Methods: In the Cardiovascular Health Study, a cohort study of adults aged 65+, we calculated study years until death (years of life (YOL)), study years without activities of daily living (ADL) difficulty (years of able life; YoAL) and percent of study years without ADL difficulty (compression of disability). Linear regression quantified associations of food establishments within 5 km of baseline home address (as a z-score) with each outcome, adjusted for sociodemographic characteristics. Sensitivity analyses considered adjustment for risk factors and comorbidities, multiple imputation, alternate neighbourhood definitions (1-km radial buffer, census tract) and restriction on residential stability.

Results: We included 4298 participants followed for up to 26 years. All food retail establishments were associated with 6 months higher YoAL per SD in the main model (beta, 0.50 years; 95% CI 0.01, 0.98; p=0.046), with similar findings across sensitivity analyses except when restricting on residential stability. Supermarkets and produce markets were associated with compression of disability (beta, 2.31; 95% CI, 0.04, 4.57) and when using 1-km buffers with YOL (beta, 0.23 years; 95% CI 0.03, 0.43) and YoAL (beta, 0.21 years; 95% CI 0.01, 0.41). Non-supermarket food stores were associated with YoAL (beta, 0.67 years; 95% CI, 0.07, 1.27) and compression of disability (beta, 3.03; 95% CI 0.44, 5.62), but significance was not consistent across sensitivity analyses. Fast-food restaurants did not reach statistical significance in any model.

Conclusion: All food retail was associated with YOL without impairment. Neighbourhood food retail access and type may both have roles in extending YOL and years of able life among older adults, but the findings were sensitive to decisions made during measurement and modelling.

Background: Non-communicable diseases (NCDs), known as chronic diseases, significantly impact patients' quality of life (QoL) and increase medical expenses. The majority of risk factors are modifiable, and metabolomics has been suggested as a promising strategy for their evaluation, though real-world data are scarce. This study evaluated the QoL improvement and cost-effectiveness of a metabolomics-based treatment for NCDs, aiming to restore metabolic dysfunctions and nutritional deficiencies.

Methods: We performed a pre-post intervention analysis using clinical, metabolomics, QoL and economic data obtained from the electronic health records of 765 patients visiting a private practice. The intervention consisted of personalised treatment to restore metabolic dysfunctions and nutritional deficiencies identified by metabolomics alongside the standard treatment for their condition. The mean intervention duration was 401 days.

Results: Significant improvement was identified in energy levels, sleep quality, gastrointestinal function and physical activity (p<0.001). 67.9% of participants reported significant improvement in the overall QoL, and the average quality-adjusted life-years (QALYs) increased by 0.064 (95% uncertainty interval 0.050 to 0.078) post-treatment. The incremental cost-effectiveness ratio was estimated at €49.774/QALY (95% CI €40.110 to €61.433). Metabolic profiling demonstrated that 16/35 organic acids and 11/24 total fatty acids were significantly changed post-treatment (p<0.001), participating in key pathways such as energy metabolism, microbiome and neurotransmitter turnover. Vitamin D and 5-methyltetrahydrofolate insufficiency was significantly restored (p=0.036).

Conclusion: This is the first study providing evidence that the integration of metabolomics in clinical practice can have a clinical benefit for patients' QoL and may be a cost-effective method.

Introduction: The coverage of vitamin A supplementation (VAS) is still short of the target set by the government to reach 90% coverage of VAS in Bangladesh. The present study aims to examine the socioeconomic and geographical inequalities in receiving VAS among children aged 6-59 months in Bangladesh from 2004 to 2017.

Methods: The Bangladesh Demographic and Health Surveys for the years 2004-2017 were accessed through the WHO's Health Equity Assessment Toolkit. Inequalities were explored from socioeconomic and geographical perspectives. Specifically, it considered wealth quintile and education as socioeconomic dimensions and place of residence as geographical dimensions. We calculated difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio as summary measures and their associated 95% CIs to quantify and assess the extent of health disparities.

Results: The study revealed a fluctuating trend over the years in the prevalence of receiving VAS among children in Bangladesh. The prevalence shifted from 78.68% in 2004 to a low of 62.09% in 2011, subsequently increasing to 79.29% in 2017. The PAF in 2017 for the variable wealth was 4.61 (95% CI 2.38 to 6.85), highlighting the extent of the disparity that favoured wealthier individuals. The study also detected inequalities based on educational levels; in 2017, the difference measure of inequality was 9.24 (95% CI 3.69 to 14.79), indicating a notable advantage for children from the higher educated group. Children from urban areas were also observed to have a higher likelihood of receiving VAS compared with their rural counterparts.

Conclusion: This study identified a persistent regional inequality in receiving VAS in Bangladesh over time. These inequalities remained a concern, especially for children from poor wealth groups, low-educated families and rural regions. This understanding will inform the development of a comprehensive programme aimed at increasing the prevalence of VAS among all children in Bangladesh.

Introduction: Diet and lifestyle play pivotal roles in Ayurveda's preventive and therapeutic principles. The rich culinary heritage of Kerala harmoniously aligns with Ayurvedic dietetic principles. With the recent designation of 2023 as the International Year of Millets, there has been a surge of interest in integrating millets into dietary practices worldwide. Ayurveda physicians are poised to offer nutritional guidance to endorse health.

Methods: A cross-sectional online survey was conducted from 26 July to 9 August 2023 among Ayurveda practitioners in Kerala. The survey used a semi-structured questionnaire finalised through the face and content validity, comprising eight items each for knowledge, attitudes and practices (KAP) domains. A target sample size of 422 participants was determined through convenience sampling methodology. Spearman's rank correlation test was used to examine the correlations between KAP while binary logistic regression analyses were employed to identify determinants associated with favourable levels of KAP among participants.

Results: A total of 386 complete responses were used for analysis. The average scores for KAP items were 5.21, 6.36 and 5.34, respectively, (range 0-8). It was found that better Knowledge scores were associated with more favourable Attitudes towards the prescription of millet-based diet (MBD) (adjusted Odd's Ratio (AOR): 3.04) and even more positive responses towards Practice (AOR: 8.59).

Conclusion: The knowledge of Ayurveda practitioners in Kerala regarding the use of MBD is satisfactory. There is a significant relationship between Knowledge and Attitude as well as Practice. This study has underscored the importance of education and awareness in shaping favourable attitudes and practices related to MBD, aligning with Ayurvedic principles. Despite practitioners demonstrating good KAP behaviour towards MBD, gaps persist in certain aspects of contemporary knowledge and limitations in translating knowledge into practice. Addressing these gaps and barriers is essential to promote the widespread adoption and prescription of MBD.

Objective: The study aimed to explore factors influencing the implementation of food fortification regulation among corn millers in Dar es Salaam Tanzania.

Methods: This phenomenological qualitative study was conducted in Dar es Salaam, Tanzania among purposely interviewed corn millers. In-depth interviews conducted with nine corn millers were analysed using thematic analysis with the aid of N-Vivo software version 12.

Results: The implementation of food fortification regulation among corn millers is influenced by access to knowledge and the right information, lack of consumers' awareness, zero costs for the fortification of corn flour, and lack of punitive measures for non-compliance to the regulation.

Conclusion and recommendations: Laxity in implementing food fortification as an important population-wide approach in addressing micronutrient deficiency is evident in Tanzania. This is triggered by non-punitive measures for non-compliance of the regulation among micro, small and medium-scale corn millers. Strengthening efforts to identify and implement measures against non-compliers, demand creation for fortified products through educational and advocacy interventions, and supportive supervision can help reach more than 90% of the population with fortified corn flour in Tanzania.

Background: Children living in orphanages face an increased susceptibility to malnutrition due to inadequate nutrition and psychological factors, in comparison to children who stay with their parents. A considerable proportion of institutionalised children remain unreported, and there is a dearth of information regarding the nutritional status of these children in Pakistan. This study set out to evaluate the status of malnutrition in the orphanages of Social Welfare Department Punjab.

Methodology: A multicentre analytical cross-sectional study was conducted from 12 December 2021 to 30 June 2022, with 255 study participants (aged 6-18 years) in seven orphanages (4 girls, 3 boys) out of 12 orphanages of government of Punjab. Anthropometric measurements were taken using standardised measuring instruments, and data were collected using structured questionnaire. Subjects were classed as malnourished based on body mass index for age and height for age reference growth charts of WHO 2007. Binary logistic regression was used to identify potential risk factors of malnutrition in orphanages.

Results: The study identified 36.1% malnourished children, of whom, 65.2% were orphans and 34% destitute children. The study reported 9.4% moderately underweight, 2.4% severely underweight, 4.3% overweight and 1.2% obese children and adolescents. The study established 17.6% moderately stunted, and 7.1% severely stunted children. Age at admission to orphanages (9-13 years) and lack of milk and meat consumption were identified as significant predictors of malnutrition in institutionalised children of Punjab.

Conclusion: Central Punjab had the highest malnutrition rate compared to North and South Punjab. Micronutrient deficiencies were more pronounced in South Punjab orphanages. Effective prevention of malnutrition requires early assessment of malnutritional risk in Pakistani orphanages.

Background: The effects of multiple early adverse psychosocial and biological factors on child development at preschool age in deprived settings are not fully understood.

Methods: The 'Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development' (MAL-ED) project followed children from eight countries, recording sociodemographic, nutritional, illness, enteroinfection biomarkers and scores for quality of home environment (Home Observation for Measurement of the Environment (HOME)), development (Bayley) and maternal depression during the first year of life. In the Pakistan cohort, we investigated associations of these early factors with Z-scores (derived from the eight participating countries) of three developmental outcomes at 5 years: Executive Functions (Z-EF), the Wechsler Preschool and Primary Scale for Intelligence (Z-WPPSI) and the externalising behaviours component of the Strength and Difficulties test (Z-externalising behaviours).

Results: Most children had 5-year development measurements below other MAL-ED countries (Z-EF<0, 80.3%, Z-WPPSI<0, 69.3%) and 45.6% had Z-externalising behaviours>0. Higher Z-EF was associated with higher HOME (coeff: 0.03 (95% CI 0.005, 0.05), p=0.017) and Bayley scores (0.01 (0.002, 0.01), p=0.010). Higher Z-WPPSI was associated with more household assets (0.02 (0.01, 0.03), p=0.003), but with lower alpha-1 antitrypsin (µmol/L, protein-losing enteropathy) (-0.01 (-0.02, -0.005), p=0.003). Lower externalising behaviour was associated with female sex (-0.30 (-0.53, -0.08), p=0.009), higher soluble-transferrin-receptors (mg/L) (-0.07 (-0.14, -0.01), p=0.024) and initiation of solids/semisolids≥6 months (-0.16 (-0.31, -0.01), p=0.033), but higher externalising behaviour was associated with underweight (0.35 (0.07, 0.62), p=0.014), more diarrhoeal episodes (0.03 (0.004, 0.06), p=0.022) and higher Maternal Depression Score (0.04 (0.01, 0.07), p=0.003) in the first year.

Conclusion: Adverse environmental, nutrition and infectious factors, and indicators of deprived early development in the first year of life have a negative association with developmental scores at 5 years. Addressing early stressors, improving diet, infections and environment stimulation early in life could positively impact child development in resource-constrained settings.

Objective: In humans, haptoglobin (Hp) exists in two allelic forms, Hp1 and Hp2, that differ significantly in their ability to protect the organism from oxidative stress. It has been proposed that in patients with diabetes mellitus carriers of the Hp2-2 genotype may benefit from vitamin E supplementation. Aim of our study was to investigate if there is evidence regarding a potential interaction between the Hp polymorphism and vitamin E with regard to mortality in individuals at medium-to-high cardiovascular risk with and without diabetes mellitus.

Research design and methods: Data from 3176 participants of the Ludwigshafen Risk and Cardiovascular Health study, a monocentric hospital-based study of patients referred for coronary angiography, were analysed using Cox proportional hazard regression.

Results: Participants with the Hp2-2 genotype demonstrated significantly lower Hp levels, while carriers of at least one Hp-2 allele displayed elevated levels of the inflammatory markers high-sensitive C reactive protein and serum amyloid A. No notable differences in comorbidities were observed among the various HP genotype groups. While the HP genotype showed no direct association with mortality, a borderline significant correlation between α-tocopherol plasma concentration and overall mortality was noted. An interaction between vitamin E status and the HP genotype regarding mortality risk was evident, particularly among patients with diabetes mellitus, with a p value of 0.021 for the interaction term. In restricted cubic splice analysis, patients with diabetes mellitus who are carriers of the Hp2-2 genotype seem to benefit from higher γ-tocopherol concentrations whereas for the other genotype groups there was a direct association with mortality risk.

Conclusion: Particularly in patients with diabetes mellitus we could show a significant interaction of γ-tocopherol plasma concentration and HP genotype. Carriers of the Hp2-2 genotype seemed to benefit from higher plasma concentrations of γ-tocopherol. Further research is warranted to elucidate the underlying mechanisms and potential therapeutic implications in cardiovascular disease management.