BMJ Nutrition, Prevention and Health最新文献

Introduction: Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied.

Methods: We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18).

Results: A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time.

Conclusion: FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.

Introduction: A higher number of ideal cardiovascular health (CVH) metrics is associated with a lower risk of cardiovascular-related and all-cause mortality. However, the change in CVH metrics has rarely been studied in sub-Saharan Africa. We investigated the level and changes of CVH metrics and their correlates among Beninese adults between 2008 and 2015.

Methods: Secondary analysis was performed on data obtained from Benin's 2008 and 2015 WHO Stepwise surveys (STEPS). In total, 3617 and 3768 participants aged 25-64 years were included from both surveys, respectively. CVH metrics were assessed using the American Heart Association definition, which categorised smoking, fruit and vegetable consumption, physical activity, body mass index (BMI), blood pressure (BP), total cholesterol (TC) and glycaemia into 'ideal', 'intermediate' and 'poor' CVH. The prevalence of ideal CVH metrics was standardised using the age and sex structure of the 2013 population census.

Results: Few participants met all seven ideal CVH metrics, and ideal CVH significantly declined between 2008 and 2015 (7.1% (95% CI 6.1% to 8.1%) and 1.2% (95% CI 0.8% to 1.5%), respectively). The level of poor smoking (8.0% (95% CI 7.1% to 8.9%) and 5.6% (95% CI 4.8% to 6.3%)) had decreased, whereas that of poor BP (25.9% (95% CI 24.5% to 27.4%) and 32.0% (95% CI 30.0% to 33.5%)), poor total cholesterol (1.5% (95% CI 1.0% to 1.9%) and 5.5% (95% CI 4.8% to 6.2%)) and poor fruit and vegetable consumption (34.2% (95% CI 32.4% to 35.9%) and 51.4% (95% CI 49.8% to 53.0%)) significantly increased. Rural residents and young adults (25-34 years) had better CVH metrics.

Conclusion: The proportion of adults with ideal CVH status was low and declined significantly between 2008 and 2015 in Benin, emphasising the need for primordial prevention targeting urban areas and older people to reduce the burden of cardiovascular disease risk factors.

Background: Obesity remains a major global public health issue, despite numerous attempts to address it. Health behaviour theories suggest that a misconception of how excess weight affects general health may be preventing individuals from taking action towards addressing it. The present study explores this relationship in European countries.

Methods: This study analysed cross-sectional secondary data collected as part of the European Health Interview Survey Wave 2 (2013-2015), with a total sample of 299 846 participants. The association between body mass index and self-perceived health was analysed using logistic regression models. Age, sex, country, degree of urbanisation and level of education were included in the model to determine excess weight's independent contribution to self-perceived health over and above these variables.

Results: The majority of the sample was in the excess weight category (52.92%; n=155 812), with only Austria and Luxembourg reporting a higher proportion of normal weight than excess weight. An analysis of self-perceived health revealed that most individuals perceived themselves to be in good health (42.88%; n=128 579). Logistic regression results show that overweight individuals were more likely to report being in poorer self-perceived health (OR=1.27, 95% CI 1.25 to 1.29) compared with normal weight individuals. The same effect was observed for individuals in the obese class I (OR=2.00, 95% CI 1.96 to 2.05), obese class II (OR=3.00, 95% CI 2.88 to 3.13) and obese class III (OR=4.38, 95% CI 4.07 to 4.71) categories. However, this study did not find a rigid pattern of association between excess weight and self-perceived health across European countries.

Conclusion: In general, a higher body mass index category is associated with poorer self-perceived health, suggesting that the majority of the study population have a correct perception of how their weight affects their health. However, in some key countries this relationship is not observed and should be further explored.

Background to issue: Future sustainable healthcare delivery and systems need reflective practitioners and critical thinkers to engage the public to achieve health policy aims and objectives. Therefore, this descriptive review introduces a generic conceptual framework, adopting a specific theme to illustrate and demonstrate a model of care or any other context. Whatever the purpose, context or philosophical stance in healthcare and health literacy, there is no standardised generic conceptual framework to structure reflection and critical thinking. This work presents a pragmatic solution focused on the one-to-one relationship of learner-mentor, patient-clinician, public health professional-public and groups.

Methods: The method is constructivist, an educational exercise, practical and the target group can be defined/viewed as student, teacher, patient, carer or member of the public in a health promotion campaign, for example. The building blocks are health and care concepts that arise clinically in practice, or for a student writing an assignment. As will be explained, concepts (including the Sustainable Development Goals) are assigned by the subject(s)-in this instance the authors-to a domain of knowledge.

Results: As two-by-two tables, the results represent the structure of the conceptual framework, framing the content in a series of four knowledge (care) domains. The contents, ultimately the Sustainable Development Goals, may then be linked and relationships discussed. Results are produced gradually, building a cognitive or mind-map. The results, it must be stressed, are therefore qualitative.

Conclusion: Drawing on educational theory and practice, the results are explored and justified using the theme of nutrition, and the often stated desirability in education of reflective practice and critical thinking abilities. Providing a series of cross-disciplinary, the reader will gain insight into the potential of Hodges' model to facilitate integrated, person-centred and care that improves parity of esteem, supporting students and qualified personnel in their learning careers.

Pre-eclampsia affects 3%-5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia. Several nutrients and dietary factors previously believed to be implicated in the risk of pre-eclampsia have now been shown to have no effect on risk; these include vitamins C and E, magnesium, salt, ω-3 long-chain polyunsaturated fatty acids (fish oils) and zinc. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain. The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25-30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk. Our recommendations are summarised in a table of guidance for women at particular risk of developing pre-eclampsia.

Background: This study investigated the cost-effectiveness of vitamin D₃ supplementation in older adults in Ireland, with year-round vitamin D deficiency (serum 25-hydroxyvitamin D concentration <30 nmol/L) (13% of Irish adults), from the perspective of the Health Service Executive.

Methods: Three age groups were investigated: (1) ≥50 years, (2) ≥60 years and (3) ≥70 years. Based on the clinical literature, vitamin D₃ supplementation may: (1) decrease all-cause mortality by 7% and (2) reduce hip fractures by 16% and non-hip fractures by 20%. A discount rate of 4% was applied to life years and quality-adjusted life years (QALYs) gained, and healthcare costs. The annual healthcare costs per patient used in the model are based on the average annual health resource use over the 5-year time horizon of the model.

Results: The cost/QALY estimates in all three age groups are below the usually acceptable cost-effectiveness threshold of €20 000/QALY. The most cost-effective and least costly intervention was in adults ≥70 years. For this age group, the average annual costs and outcomes would be approximately €5.6 million, 1044 QALYs gained, with a cost/QALY of approximately €5400. The results are most sensitive to the mortality risk reduction following vitamin D₃ supplementation.

Conclusion: The cost-effectiveness of vitamin D₃ supplementation is most robust in adults ≥70 years. Clinical uncertainty in the magnitude of the benefits of vitamin D₃ supplementation could be further addressed by means of: (1) performing a clinical research study or (2) conducting a pilot/regional study, prior to reaching a decision to invest in a nationwide programme.

Objective: The objective of this study is to assess changes in the dimensions of the food system and consumption associated with body weight variations during the first month's lockdown in Peruvian adults in Metropolitan Lima.

Methods: A cross-sectional study conducted during the first months of lockdowns in Peru. 694 adults completed a web-based survey about changes experienced in the process of acquiring food during lockdown, changes in their intake and self-perceived body weight. A multinomial logistic regression analysis was conducted to evaluate the factors associated with changes in body weight.

Results: Weight gain was perceived in 38% of the participants and 22.8% perceived weight loss. 39.2% did not perceive changes in their weight. Risk factors for body weight gain were increased alcohol consumption (OR=4.510, 95% CI 1.764 to 11.531) and decreased fruit consumption (OR=2.129, 95% CI 1.290 to 3.515), while decreasing cereal intake (OR=0.498, 95% CI 0.269 to 0.922) and choosing nutritious food as a driver for purchase (OR=0.512, 95% CI 0.320 to 0.821) were found to be protective against gaining weight. Decreasing food intake during the pandemic (OR=2.188, 95% CI 1.348 to 3.550) and having to miss important foods (OR=2.354, 95% CI 1.393 to 3.978), were associated with weight loss.

Conclusions: During confinement, weight gain was mostly associated with food consumption and personal food system factors. Meanwhile, weight loss was associated with external food system factors.

Objective: To assess weight loss maintenance, diabetes status, mortality and morbidity 15 years after a very low calorie diet programme (VLCD) in patients with obesity.

Design: General practice data bases were interrogated for subjects coded for group therapy with VLCD in the 1990s. Causes of death, occurrence of vascular disease and remission or development of diabetes were ascertained from patient records and national stroke and cardiovascular disease data bases.

Results: 325 subjects engaged in the programme and had sufficient data for analysis. Baseline characteristics were: age 47.8±12. 8 years; body mass index (BMI) 36.1±6.8 kg/m²; 79.1% female/20.9% male; 13.5% had type 2 diabetes. After 15±4 years weight had changed from 97.9±19 kg at baseline to 100±20.8 kg. 10 with diabetes at baseline were in remission at 3 months, but only two remained in remission at 5 years. 50 new cases of type 2 diabetes and 11 of impaired fasting glucose developed during follow-up. Only 5.9% who remained healthy at follow-up had maintained >10% body weight reduction. Neither diabetes incidence nor diabetes free survival were related to percentage body weight lost during VLCD. Only baseline BMI was related to development of new impaired fasting glucose or diabetes by 15 years (p=0.007). 37 subjects had a cardiovascular event. Age (p=0.000002) and degree of weight loss after VLCD (p=0.03) were significantly associated with subsequent vascular events.

Conclusion: Long-term maintenance of weight loss after VLCD was rare in this single centre retrospective study 15 years later. Glucose intolerance developed in 21.4%. Lasting remission of type 2 diabetes or prevention of later glucose intolerance were not achieved. Vascular events were more frequent in those who lost most weight. Risk management during weight regain should be studied in future to assess potential for reduction in adverse cardiovascular outcomes.