Healthy diet: Health impact, prevalence, correlates, and interventions

The Role of Lifestyle Interventions in the Prevention and Treatment of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is one of the most common pregnancy-related endocrinopathies, affecting up to 25% of pregnancies globally. GDM increases the risk of perinatal and delivery complications, and the chance of developing type 2 diabetes mellitus and its complications, including cardiovascular diseases. This elevated risk is then passed on to the next generation, creating a cycle of metabolic dysfunction across generations. For many years, GDM preventive measures have had inconsistent results, but recent systematic reviews and meta-analyses have identified promising new preventative routes. This review aims to summarize the evidence investigating the efficacy of lifestyle treatments for the prevention of GDM and to summarize the effects of two lifestyle interventions, including physical activity and dietary interventions. Based on the present research, future studies should be conducted to investigate whether initiating lifestyle interventions during the preconception period is more beneficial in preventing GDM. In addition, research targeting pregnancy should be designed with a personalized approach. Therefore, studies should customize intervention approaches depending on the presence of modifiable and non-modifiable risk factors at the individual level.

Colorectal cancer in young patients below screening age - Demographic and socioeconomic factors associated with incidence and survival

BACKGROUND

While early onset colorectal cancer (EOCRC) has previously been defined as CRC in patients younger than age 50, recent screening guidelines have been lowered to 45. With more younger patients aged 45-50 are now being screened, incidence trend and outcomes of very early EOCRC (20-44) remains unclear.

METHOD

Surveillance, Epidemiology, and End Results database was analyzed between 2006 and 2016 using Joinpoint tool to evaluate annual percentage change (APC) in incident rates, focusing on race/ethnicity and socioeconomic status (SES). Cancer specific survival (CSS) was assessed using univariate and multivariate analysis.

RESULTS

41,815 EOCRC patients met inclusion criteria. Incidence has increased significantly in both age groups (APC in age group 20-44 = 1.21 and 45-49 = 1.06). Increase incidence of very early EOCRC was observed in White and Hispanic racial/ethnic groups (ACP 1.68 and 2.63), as well as population from counties with high poverty, unemployment, language barrier, foreign born resident, and high school dropout rates (ACP 2.07, 1.87, 1.21, 1.28 and 2.02 respectively). Further, the 5-year CSS was worse in Black patients, and patients from counties with high poverty, unemployment and high school dropouts rates (Age group 20-44, 63.11%, 66.39%, 67.48% and 66.95% respectively). On multivariate analysis, living in high poverty counties was an independent risk factor for poorer CSS for very early EOCRC (HR 1.20, 95% CI 1.07-1.34, p = 0.002). Multivariate analysis was adjusted by sex, pathology type, site of disease, disease extension and surgical treatment history.

CONCLUSION

Very early EOCRC incidence increases in White, Hispanic and poor patients, and outcomes are worse for minority and low-income patients. Further study on very early EOCRC is needed among those patients.

Social Environmental Predictors of Lapse in Dietary Behavior: An Ecological Momentary Assessment Study Amongst Dutch Adults Trying to Lose Weight

BACKGROUND

When losing weight, most individuals find it difficult to maintain a healthy diet. Social environmental conditions are of pivotal importance in determining dietary behavior. To prevent individuals from lapsing, insight in social environmental predictors of lapse in dietary behavior is needed.

PURPOSE

Identify social environmental predictors of lapse in dietary behavior, using ecological momentary assessment (EMA) amongst Dutch adults trying to lose weight.

METHODS

Adults (N = 81) participated in two 7-day EMA weeks. Six times a day semi-random prompts were sent. At each prompt, participants indicated whether a lapse had occurred and responded to questions assessing social support, descriptive norm, injunctive norm, social pressure, presence of others, and current location. Generalized estimating equations were used to examine associations with lapse.

RESULTS

Injunctive norm (OR = 1.07, 95% CI = 1.03-1.11), descriptive norm (OR = 1.04, 95% CI = 1.02-1.07), and social pressure (OR = 1.09, 95% CI = 1.05-1.14), all toward diverting from diet plans, predicted lapses. Social support toward sticking to diet plans and presence of others did not predict lapses. When controlling for a prior lapse, all other associations became nonsignificant. Lapses occurred most often at home and gradually occurred more often during the day.

CONCLUSIONS

Traditional public health perspectives have mainly focused on individual choice and responsibility for overweight related unhealthy lifestyles. This study shows that there may be opportunities to enhance intervention programs by also focusing on social norms and social pressure. The involvement of partners or housemates may create more awareness of the impact of (unintentional) social pressure on risk of lapsing, and reduce the level of exerted social pressure.

Healthy Aging at Family Mealtimes: Associations of Clean Cooking, Protein Intake, and Dining Together with Mental Health of Chinese Older Adults amid COVID-19 Pandemic

The present study aims to examine whether multiple dietary factors affect the mental health of older adults amid the COVID-19 pandemic. It proposes an integrative dietary framework that highlights environmental, nutritional, and social aspects of diet for healthy aging. Based on a sample of 7858 Chinese older adults, the associations between diet and depressive symptoms, along with the rural-urban divide, were examined using zero-inflated negative binomial regression. Overall, protein intake (incidence-rate ratio [IRR] = 0.89, p < 0.001), frequency of family dining together (IRR = 0.98, p < 0.001), and using tap water for cooking (IRR = 0.92, p < 0.01) were associated with lower incidence rates of depressive symptoms among older adults. Among rural older adults, frequency of family dining together (IRR = 0.97, p < 0.001) and tap water use (IRR = 0.89, p < 0.001) were associated with fewer depressive symptoms. However, urban residents who had a higher frequency of family dining together (IRR = 0.98, p < 0.05) and protein intake (IRR = 0.81, p < 0.001) exhibited fewer depressive symptoms. The findings revealed multifaceted dietary pathways towards healthy aging, which call for policies and interventions that improve diet quality for community-dwelling older adults.

Changes in Adults' Eating Behaviors During the Initial Months of the COVID-19 Pandemic: A Narrative Review

Factors such as regulations and health concerns shifted daily habits, including eating behaviors, during the early months of the coronavirus disease 2019 (COVID-19) pandemic. This comprehensive narrative review synthesizes research on eating behavior changes during the early months of the pandemic (February to June 2020), including changes in amount, rate, and timing of food consumption, types and healthfulness of foods consumed, the occurrence of other specified eating behaviors (eg, restrained eating or binging), and reasons for eating (eg, stress or cravings), among adults. A literature search using three EBSCOhost databases and Google Scholar was conducted to identify relevant articles made available in 2020. A total of 71 articles representing 250,715 individuals from more than 30 countries were reviewed. Findings show eating behaviors changed little during the early COVID-19 pandemic for most participants. Among those whose eating behaviors changed, increases in both intake and frequency of eating meals and snacks were more common than decreases. Findings on timing of eating and healthfulness of food consumed showed mixed results. However, when changes occurred in the type of food consumed, increases were more common for snacks, homemade pastries, white bread/pasta, legumes, and fruits/vegetables; decreases were more common for meats, seafood/fish, frozen foods, fast food, dark breads/grains, and dark leafy green vegetables. During the pandemic, binging, uncontrolled eating, and overeating increased, meal skipping decreased, and restrictive eating had mixed findings. Changes in factors such as emotions and mood (eg, depression), cravings, and environmental factors (eg, food insecurity) were related to changes in eating behaviors. Findings can inform clinical practitioners in efforts to mitigate disruptions to normal, healthy eating patterns among adults both in and outside of global health catastrophes.

Determination of vitamin D, iron and n-3 fatty acids in adolescents with different eating habits

OBJECTIVES

Proper eating habits ensure human health, so it is important to eat a balanced diet and learn the basics of proper eating from an early age. Adolescence is considered very important period for maintaining good health in terms of nutrition.

METHODS

In the study, we monitored the eating habits of 182 adolescents aged 14-19 years with different eating habits (73 vegetarians and 109 nonvegetarians) using a questionnaire on nutrition and determination of selected blood parameters - vitamin D, iron and n-3fatty acids.

RESULTS

Insufficient levels of vitamin D were determined in the whole group of adolescents, regardless of eating habits. Low iron concentrations negatively affect the biosynthesis of long-chain n-3 fatty acids, which was also reflected in our adolescents with alternative diets.

CONCLUSIONS

Based on the obtained results, it is necessary to place emphasis on the composition of the diet in adolescent age.

Intuitive Eating Intervention and Diet Quality in Adults: A Systematic Literature Review

INTRODUCTION

Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality.

METHOD

PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively.

RESULTS

Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed.

DISCUSSION

Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.

Lifestyle interventions in pregnancy targeting GDM prevention: looking ahead to precision medicine

Gestational diabetes mellitus (GDM) is the most prevalent pregnancy-related endocrinopathy, affecting up to 25% of pregnancies worldwide. Pregnant individuals who develop GDM have an increased risk of complications during pregnancy and birth, as well as future development of type 2 diabetes mellitus and CVD. This increased risk is subsequently passed along to the offspring, perpetuating a cycle of metabolic dysfunction across generations. GDM prevention strategies have had mixed results for many years, but more recent systematic reviews and meta-analyses have suggested potential new avenues of prevention. The objective of this review is to summarise the literature examining the efficacy of lifestyle interventions for the prevention of GDM and to uncover if specific individual-level characteristics influence this outcome. Based on the present literature, we determined that future trials should be designed to understand if initiation of lifestyle intervention in the preconception period is more effective to reduce GDM. Furthermore, trials initiated during pregnancy should be developed through the lens of precision prevention. That is, trials should tailor intervention approaches based on individual-level risk defined by the presence of modifiable and non-modifiable risk factors. Finally, future interventions might also benefit from just-in-time adaptive intervention designs, which allow for interventions to be modified in real-time based on objective assessments of an individual's response.

Effects of the COVID-19 pandemic on diet and physical activity and the possible influence factors among Saudi in Riyadh

Background/Aim

The COVID-19 pandemic has been spreading throughout the world, having a significant impact on people’s lifestyles and health through social isolation and home confinement. The purpose of this study is to look into the impact of COVID-19 on diet and physical activity, as well as the possible influence factors, among ≥ 13-year-olds in Riyadh, Saudi Arabia.

Materials and methods

In the present study data were collected from 2,649 participants via an online survey. The Google online questionnaire was available from April 23 to May 6, 2020. During the COVID-19 lockdown, the survey asked respondents about their demographic characteristics (gender, age, education, economic income, and occupation), anthropometric data, physical activity, and diet habits.

Results

The study included 2,649 respondents, with 23.3% being male and 76.7% female. The majority of them were in good health and ranged in age from 21 to 29 years. 31% of those polled were overweight, and 14.3% were obese. The majority of respondents have a bachelor’s degree, diploma, or the equivalent, and a monthly family income of ≤ 25.000 SR. Those who were following a healthy diet (32.3%) were unable to maintain it during confinement, with males being affected more than females (42.7%, 29.3%, respectively, P = 0.004), and those most impacted were aged 21–29 years (38.0%, P = 0.046). Furthermore, 59.5% of males significantly failed to continue exercising during confinement compared to females who exercised consistently (P = 0.01). In terms of age, females aged less than 40 increased their exercise rate by about 23.4%, while males aged 40 and up decreased their exercise rate by 25.7% (P = 0.000). Moreover, 40.5% of the subjects’ weight increased, according to the findings. However, there was no significant effect on body mass index, despite the fact that 51% of participants were overweight or obese.

Conclusion

The data showed that the COVID-19 lockdown had a negative impact on maintaining a healthy diet (p = 0.023*) and physical activity (p = 0.000^**).

Development of HPTLC method for the simultaneous estimation of quercetin, curcumin, and ascorbic acid in herbal formulations

Antioxidants can scavenge free radicals in the human body and have been associated with a protective effect on the human body against a variety of diseases. As a part of normal cellular function, free radical production occurs continuously within the body at a cellular level. Excess-free radical production from endogenous or exogenous sources may result in a variety of diseases. Vitamins (A, C, and E), carotenoids, polyphenols, and flavonoids are some examples of common natural antioxidants. Among the different antioxidants quercetin, curcumin, and ascorbic acids have been extensively studied, and numerous reports on their antioxidant activity are available in the literature. Antioxidants are regarded as a key player in the current pandemic situation, and they play a key role as a preventive and controlling tool. There are a variety of herbal formulations and immune booster therapies available, many of which claim to contain various antioxidants and are effective against covid-19. Numerous herbal formulations and immune booster therapies are available and claimed to have different antioxidants and other constituents. In the present study simple, rapid, accurate, precise, and sensitive high-performance thin-layer chromatographic analytical method was developed for simultaneous estimation of quercetin, curcumin, and ascorbic acid. The developed method can effectively employ for different polyherbal formulations. The developed method was validated according to ICH guidelines. In the present study, an aluminum plate precoated with 60F 254 silica gel was used as a stationary phase whereas chloroform: ethyl acetate: formic acid (6:6:2.5 v/v/v) was used as a mobile phase. Chromatographic detection was performed with a Camag TLC scanner at 265 nm. The linearity range for the proposed method was found to be 500–1000 ng/band for all three analytes. The antioxidant potentiality of selected antioxidants was evaluated by an optimized UV visible spectroscopic-reducing power method. The reducing power method was optimized for the concentration and volume of reagent, incubation temperature, and time. The results of the study revealed that quercetin is having the best antioxidant potential compared to curcumin and ascorbic acid.

Nutrition Knowledge, Dietary Habits, and Food Labels Use-A Representative Cross-Sectional Survey among Adults in Poland

An unhealthy diet is an important risk factor for disability and premature death. This study aimed to assess nutrition knowledge, dietary habits, and food label use among adults in Poland as well as to identify factors associated with diet-related behaviors. A cross-sectional survey was carried out in July 2020 on a non-probability quota-based sample of 1070 adult citizens of Poland. The most common sources of nutrition knowledge were news websites (41.8%) or family/friends (32.4%). Over one-quarter of adults in Poland were on a diet (28.7%). Over one-tenth of respondents (11.9%) consumed less than three meals per day. Half of the respondents (50.3%) declared that they use food labels when shopping, and 15.4% checked the nutrition information on restaurant menus. Female gender (OR:1.70; 95%CI:1.26-2.29; p < 0.001), presence of chronic diseases (OR:1.83; 95%CI:1.37-2.44; p < 0.001), regular physical activity (p < 0.001), and being a non-smoker (OR:1.45; 95%CI:1.02-2.06; p = 0.04) were significantly associated with higher odds of being on a diet. Females (OR:1.63; 95%CI:1.24-2.15; p < 0.001), respondents with higher education (OR:1.53; 95%CI:1.17-2.01; p = 0.002), those who had never been married (OR:1.49; 95%CI:1.07-2.07; p = 0.02), respondents with chronic diseases (OR:1.73; 95%CI:1.30-2.31; p < 0.001), those with regular physical activity (p < 0.05), as well as non-smokers (OR:1.42; 95%CI:1.04-1.95; p = 0.03) had higher odds of checking the food labels. This study showed a significant gap in nutrition knowledge among adults in Poland.

Easy Nitrite Analysis of Processed Meat with Colorimetric Polymer Sensors and a Smartphone App

We have developed an in situ methodology for determining nitrite concentration in processed meats that can also be used by unskilled personnel. It is based on a colorimetric film-shaped sensory polymer that changes its color upon contacting the meat and a mobile app that automatically calculates the manufacturing and residual nitrite concentration by only taking digital photographs of sensory films and analyzing digital color parameters. The film-shaped polymer sensor detects nitrite anions by an azo-coupling reaction, since they activate this reaction between two of the four monomers that the copolymer is based on. The sensory polymer is complemented with an app, which analyzes the color in two different digital color spaces (RGB and HSV) and performs a set of 32 data fittings representing the concentration of nitrite versus eight different variables, finally providing the nitrite concentration of the test samples using the best fitting curve. The calculated concentration of nitrite correlates with a validated method (ISO 2918: 1975) usually used to determine nitrite, and no statistically significant difference between these methods and our proposed one has been found in our study (26 meat samples, 8 prepared, and 18 commercial). Our method represents a great advance in terms of analysis time, simplicity, and orientation to use by average citizens.

"Expert persuasion" can decrease willingness to pay for sugar-containing food

Recent studies have revealed types of eating nudges that can steer consumers toward choosing healthier options. However, most of the previously studied interventions target individual decisions and are not directed to changing consumers’ underlying perception of unhealthy food. Here, we investigate how a healthy eating call—first-person narrative by a health expert—affects individuals’ willingness to pay (WTP) for sugar-free and sugar-containing food products. Participants performed two blocks of a bidding task, in which they had to bid on sweets labeled either as “sugar- free” or as “sugar-containing.” In-between the two blocks, half of the participants listened to a narrative by a dietary specialist emphasizing the health risks of sugar consumption, whereas the remaining participants listened to a control narrative irrelevant to food choices. We demonstrate that the health expert’s narrative decreased individuals’ WTP for sugar-containing food, but did not modulate their WTP for sugar- free food. Overall, our findings confirm that consumers may conform to healthy eating calls by rather devaluating unhealthy food products than by increasing the value of healthy ones. This paves the way for an avenue of innovative marketing strategies to support individuals in their food choices.

Environmental and public health co-benefits of consumer switches to immunity-supporting food

During COVID-19, there has been a surge in public interest for information on immunity-boosting foods. There is little scientific support for immunity-supporting properties of specific foods, but strong evidence for food choice impacts on other health outcomes (e.g. risk of non-communicable disease) and environmental sustainability. Here, we relate online recommendations for "immunity-boosting" foods across five continents to their environmental and human health impacts. More frequently recommended food items and groups are plant based and have lower land use and greenhouse gas emission impacts plus more positive health outcomes (reducing relative risks of mortality or chronic diet-related diseases) per serving of food. We identify trade-offs between environmental outcomes of increasing consumption of recommended food items, with aquatic environment impacts increasing with food recommendation frequency. People's reliance on the Internet for health information creates an opportunity to consolidate behaviour change towards consuming foods with multiple co-benefits. Our study identifies win-win options for nudging online information-seeking behaviour towards more sustainable choices for terrestrial biodiversity conservation and human health.

Acceptability of policies to reduce consumption of red and processed meat: A population-based survey experiment

Policies to reduce meat consumption are needed to help achieve climate change targets, and could also improve population health. Public acceptability can affect the likelihood of policy implementation. This study estimated the acceptability of policies to reduce red and processed meat consumption, and whether acceptability differed when policies were framed as benefitting health or the environment. In an online experiment, 2215 UK adults rated the acceptability of six policies, presented in a randomised order. Prior to rating policies, participants were randomised to one of two framing conditions, with policy outcomes described either as benefitting health or the environment. Regression models examined differences in the primary outcome - policy acceptability (rated on a 7-point scale) - by framing. Labels were the most accepted policy (48% support), followed by a media campaign (45%), reduced availability (40%) and providing incentives (38%). Increasing price (27%) and banning advertising (26%) were the least accepted. A substantial proportion of participants neither supported nor opposed most policies (26-33%), although this fell to 16% for increasing price. There was no evidence that framing policy benefits from a health or environment perspective influenced acceptability (-0.06, 95%CIs: 0.18,0.07). Fewer than half of the UK sample expressed support for any of six policies to reduce meat consumption, regardless of framing measures as benefitting health or the environment. Conversely, fewer than half expressed opposition, with the exception of price, suggesting considerable scope to influence public opinion in support of meat reduction measures to meet environmental and health goals.

The variability of emotions, physical complaints, intention, and self-efficacy: an ecological momentary assessment study in older adults

Background

Many theoretical frameworks have been used in order to understand health behaviors such as physical activity, sufficient sleep, healthy eating habits, etc. In most research studies, determinants within these frameworks are assessed only once and thus are considered as stable over time, which leads to rather 'static' health behavior change interventions. However, in real-life, individual-level determinants probably vary over time (within days and from day to day), but currently, not much is known about these time-dependent fluctuations in determinants. In order to personalize health behavior change interventions in a more dynamic manner, such information is urgently needed.

Objective

The purpose of this study was to explore the time-dependent variability of emotions, physical complaints, intention, and self-efficacy in older adults (65+) using Ecological Momentary Assessment (EMA).

Methods

Observational data were collected in 64 healthy older adults (56.3% men; mean age 72.1 ± 5.6 years) using EMA. Participants answered questions regarding emotions (i.e., cheerfulness, relaxation, enthusiasm, satisfaction, insecurity, anxiousness, irritation, feeling down), physical complaints (i.e., fatigue, pain, dizziness, stiffness, shortness of breath), intention, and self-efficacy six times a day for seven consecutive days using a smartphone-based questionnaire. Generalized linear mixed models were used to assess the fluctuations of individual determinants within subjects and over days.

Results

A low variability is present for the negative emotions (i.e., insecurity, anxiousness, irritation, feeling down) and physical complaints of dizziness and shortness of breath. The majority of the variance for relaxation, satisfaction, insecurity, anxiousness, irritation, feeling down, fatigue, dizziness, intention, and self-efficacy is explained by the within subjects and within days variance (42.9% to 65.8%). Hence, these determinants mainly differed within the same subject and within the same day. The between subjects variance explained the majority of the variance for cheerfulness, enthusiasm, pain, stiffness, and shortness of breath (50.2% to 67.3%). Hence, these determinants mainly differed between different subjects.

Conclusions

This study reveals that multiple individual-level determinants are time-dependent, and are better considered as 'dynamic' or unstable behavior determinants. This study provides us with important insights concerning the development of dynamic health behavior change interventions, anticipating real-time dynamics of determinants instead of considering determinants as stable within individuals.

Formulation and characterization of physicochemical, functional, morphological, and antioxidant properties of cassava-based rice analogue

This study aimed to develop a cassava-based rice analogue with improved nutritional value as an alternative to commercial white rice. The rice analogue formulations (RAFs) were developed by the substitution of modified cassava flour (MOCAF) with rice flour at different ratios as 1:0, 7:3, 5:5, 3:7, and 0:1, followed by the addition of cassava leaves (0, 10, and 20 wt%). The developed rice analogues were evaluated for physicochemical, functional, morphological, and antioxidant properties. The rice analogue containing a 5:5 ratio of rice flour to MOCAF (RAF 2) added with 20% cassava leaves presented the most desirable nutritional composition and functional properties. However, RAF 4 (100% MOCAF with 20% cassava leaves) showed the highest total polyphenol content (TPC) (198.8 mg gallic acid equivalent (GAE)/100 g), total chlorophyll content (TCC) (198 mg/ml), 2,2-diphenyl-1-picrylhydrazyl (DPPH) inhibition (79%), and ferric reducing antioxidant power (FRAP) inhibition (85%). Hence, the addition of MOCAF and cassava leaves improved the nutritional value of cassava-based rice analogues, which could be a healthy alternative to commercial rice in the daily diet.

Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers

Purpose of Review

Assessing and addressing the mental and behavioral health concerns of individuals with SCI during rehabilitation is crucial, as untreated mental health distress can lead to reduced gains in rehabilitation and poor overall health. This review provides an overview of the latest research on prevalence rates of common mental and behavioral health concerns in the SCI population, highlighting disability-specific factors that may impact traditional assessment and treatment of mental health concerns.

Recent Findings

While those with SCI are at a heightened risk for experiencing mental health distress, overall, the majority of those with SCI adapt well, and live a full and meaningful life.

Summary

Rehabilitation psychologists are a vital aspect of rehabilitation teams, as they can address behavioral health and mental health concerns that may impede patients achieving their rehabilitation goals.

The Psychosocial Antecedents of the Adherence to the Mediterranean Diet

OBJECTIVE

Most previous research on the antecedents of healthy food choice has not investigated the links between these antecedents and has focused on specific food choice rather than on an overall diet. In the present study, we tested the plausibility of an integrated theoretical model aiming to explain the role of different psychosocial factors in increasing the intention to adhere to the Mediterranean Diet (MeDiet).

DESIGN AND PARTICIPANTS

A sample of 1940 Italian adults participated in an online survey that measured their attitude and perceived behavioral control (i.e., rational antecedents), subjective norm (i.e., social antecedent), positive and negative anticipated emotions (i.e., emotional antecedents), food choice health and mood motives (i.e., motivational antecedents), past adherence to the MeDiet (i.e., behavioral antecedent), and the intention to adhere to the MeDiet.

RESULTS

Structural Equation Modelling (SEM) analyses confirmed the plausibility of the proposed model. Perceived behavioral control was the strongest rational antecedent of intention, followed by the emotional (i.e., anticipated emotions) and the social (i.e., subjective norm) antecedents. Mediation analysis showed that motivational antecedents had only an indirect impact on intention via emotional antecedents. Finally, multigroup SEM analysis highlighted that past adherence to the MeDiet moderated the hypothesized paths among all the study variables.

CONCLUSIONS

The above findings advance our comprehension of which antecedents public communication might leverage to promote an increase in the adherence to the MeDiet.

Effects of Environmental Worry on Fruit and Vegetable Intake

BACKGROUND

Environmental worry, a response to environmental pollution, is a well-established predictor of pro-environmental behaviors. However, its relationship with health-promoting behaviors, such as fruit and vegetable intake (FVI), is unclear. In three studies, we explored the associations between environmental worry, behavioral intention, and FVI.

METHOD

Study 1, enrolling 358 company trainees who provided their data at Time 1 (T1) and Time 2 (T2; a 2-month follow-up), examined the relationship between environmental worry and FVI. Study 2, enrolling 226 employees providing their data at T1 and T2 (a 2-month follow-up), examined the mediating effects of intention in the relationship between environmental worry and FVI using a cross-lagged design. In study 3, data from 217 participants were collected three times over a period of 4 months. We re-examined the mediating effect of intention and further explored the moderating effect of future focus.

RESULTS

Environmental worry predicted beneficial changes in FVI (studies 1, 2, and 3). Environmental worry predicted FVI through intention (studies 2 and 3). The mediating effect of intention on the relationship between environmental worry and FVI was moderated by future focus: individuals with high environmental worry formed stronger intention when they also reported a strong future focus (study 3).

CONCLUSIONS

Our findings provide novel evidence for the direct and indirect links between environmental worry and health-promoting behavior (i.e., FVI).

Exploration of the definition and components of food and nutrition literacy among junior secondary school students: a qualitative study

Background

Food and nutrition literacy (FANLit) has been proposed to promote healthy diet behaviour and is believed to decrease the prevalence of overweight, obesity and chronic disease. However, the perspective of junior secondary school students, aged 12–15 years and stakeholders towards FANLit is not well-defined. Thus, this study aims to explore the definition and components of FANLit.

Methods

This qualitative study was carried out in Health region 2 including Phitsanulok, Sukhothai, Tak, Uttradit and Pethchboon. 49 participants from national and regional levels of Thailand were recruited. Data were collected by in-depth interview and focus group discussion using semi-structured questionnaire. Interview data were transcribed verbatim and analysed using thematic analysis.

Results

FANLit is defined as an individual’s level of knowledge and skills (fundamental, interactive and critical) that relates to food and nutrition for appropriate selection of food and nutrient. Four themes of FANLit were identified as follows: 1) food and nutrition knowledge (Subthemes: food knowledge, food understanding, nutrition knowledge and nutrition understanding), 2) functional food and nutrition literacy (Subthemes: accessing to food and nutrition information, food selection, food preparation, daily food and nutrition planning and management), 3) interactive food and nutrition literacy (Subthemes: communication with others, sharing and discussion), and 4) critical food and nutrition literacy (Subthemes: information used in decision making, healthy food selection and effective budgeting).

Conclusion

The results presented beneficial information regarding FANLit definition which is the initial stage to develop the assessing instrument and the intervention to improve FANlit in the adolescent group.

Clustering of motivational constructs based on self-determination theory for diet and physical activity and their associations with behaviour: a cross-sectional study

The present study explored whether motivational constructs for diet and physical activity (PA) cluster and how these motivational constructs relate to dietary and PA behaviour. Data of 1142 participants were used from a randomised controlled trial examining the effects of a web-based diet and PA promotion intervention based on self-determination theory and motivational interviewing. Motivation was assessed using the Treatment Self-Regulation Questionnaire and Behavioural Regulation in Exercise Questionnaire. The dietary outcomes were measured using an adapted Food Frequency Questionnaire. PA was assessed using the Short QUestionnaire to ASsess Health. Spearman rank-order correlations showed large correlation coefficients (r_s ≥ 0⋅63) between similar motivational constructs between the two lifestyle domains, except for intrinsic motivation where a medium correlation coefficient was found (r_s = 0⋅41). Furthermore, the exploratory factor analysis illustrated that more self-determined forms of motivation seem to be more domain-specific. In contrast, non-self-determined forms of motivation seem to be domain-independent. Last, regression analyses demonstrated that intrinsic motivation towards PA was the only motivational construct significantly positively associated with all PA sub-behaviours (standardised regression coefficients ranging from 0⋅17 to 0⋅28, all P < 0⋅0125). Intrinsic motivation to eat healthily was significantly positively associated with fruits, vegetables and fish intake (standardised regression coefficients ranging from 0⋅11 to 0⋅16, all P < 0⋅0125), but not with unhealthy snacks. Insight of this exploratory study is useful for understanding the interrelationships of motivational induced behaviours, the development of interventions targeting multiple behaviours, and the construction of questionnaires.

Oral Habits during the Lockdown from the SARS-CoV-2 Pandemic in the Romanian Population

Background and Objectives: The SARS-CoV-2 pandemic led to changes in population daily patterns. In order to adapt oral health promotion measures for future similar conditions, the main objective of the study was to assess changes in dental hygiene and eating and smoking habits during the government lockdown in Romania. Materials and Methods: The cross-sectional study was conducted immediately after the end of the lockdown and consisted of 800 adult subjects. Data collection was done via an online survey. Participants were divided into two groups: non-medical/dental practitioners (N-M/D group) and medical/dental practitioners (M/D group). Results: An increased use of dental floss from 27% (pre-lockdown) to 30.5% (during lockdown) was identified in the M/D group, while the manual toothbrush usage increased to 64.8% (during lockdown) from 61.7% (pre-lockdown) in the N-MD/group. No significant differences regarding toothbrushing frequency were observed in either group. A change in the number of daily snacks was identified in both groups (3–4 snacks per day: from 11% to 20.2% in the N-M/D group, from 13.1% to 22.2% in the M/D group). The consumption of sweets as a preferred snack was also noticed. A decrease of tobacco consumers was assessed in the lockdown period (from 66.6% to 60.4% in the M/D group, from 68.5% to 61.9% in the N-/M/D group). Conclusions: Oral habits were changed during the pandemic lockdown through the increase in the frequency of the consumption of snacks and sweets and the decrease in frequency of smokers. Only minor changes were observed in oral hygiene.

Health anxiety During COVID-19: Predictive Roles of Health Promoting Behaviors and Sensory Processing Sensitivity

OBJECTIVE

The emergence of the COVID-19 pandemic resulted in major changes in daily life and economic conditions while heightening physical and mental health problems, including health anxiety. Health authorities and elected officials have encouraged individuals to engage in health behaviors. Perceptions of and reactions to these changes could be subject to individual differences. In this line, the current study investigated the predictive roles of health promoting behaviors, sensory processing sensitivity, and their interactions with health anxiety.Design and measures: In this cross-sectional study, 355 participants (73% female, 25.9% male) whose ages range from 19 to 72 (M = 25.91, SD = 9.80) filled out self-reported measures on health promoting behaviors, sensory processing sensitivity, and health anxiety via an online platform between April and May 2020.

RESULTS

It was revealed that caring for a healthy diet, taking responsibility for health and sensory processing sensitivity, but not physical activity and stress management, were associated with health anxiety. Diagnoses and perceptions of physical and mental health problems also contributed to health anxiety during the COVID-19 pandemic.

CONCLUSION

Individuals with higher levels of sensory processing sensitivity and health responsibility were more likely to experience higher levels of health anxiety, while typical physical activities and stress management behaviors were less likely to have an impact during the COVID-19 pandemic. These results highlight the importance of having a healthy diet and the need for pandemic-specific interventions for stress management and sport activities.

Children's Perceived Barriers to a Healthy Diet: The Influence of Child and Community-Related Factors

A healthy diet influences the promotion and maintenance of health throughout an individual’s life. Many individuals struggle to have a healthy diet, despite it being mainly under their control. The current study aims to explore children’s perceived barriers to a healthy diet. A qualitative study with the open-ended question, “Please identify the top 5 barriers to a healthy diet”, was undertaken between January–June 2019 in which 274 students from the 5–6th grades wrote down their answers to the open-ended question. Content analysis was used to analyze responses with a codebook based on the Six C’s Model. Five categories were identified: Child, Clan, Community, Country, and Culture-related barriers. Findings showed that the barriers most highlighted were in the Child sphere (e.g., dietary intake) and the Community sphere (e.g., peer food choices). Children seldom referred to barriers from the Clan sphere, i.e., related to family (e.g., food available at home). Additionally, it seems that girls emphasize more barriers from the Child sphere, while boys emphasize more barriers from the Community sphere. Due to the qualitative nature of this study, interpretation of the data should take into account the specific characteristics and context of the sample. Nevertheless, the current data are helpful in identifying implications for practice, for example, the need to empower children with tools (e.g., self-regulation-based interventions) likely to help them overcome perceived barriers. Finally, advocacy groups may help set environmental and structural changes in the community likely to facilitate children’s healthy choices.

Effects of Perceived Benefit on Vitamin D Supplementation Intention: A Theory of Planned Behaviour Perspective

There are many factors that affect vitamin D supplementation, including those from the theory of planned behaviour (TPB); however, how the perceived benefit acts in the model remains unknown. In the current study, we tested the efficacy of the TPB and the impacts of the perceived benefit (PBE) in the model. The subjects were 287 customers who purchased vitD from pharmacies in major cities in Taiwan. A structured questionnaire was used to collect the data. t-tests, analysis of variance (ANOVA), regression analyses, and path analysis via SPSS and AMOS were used to analyse the data. The original TPB model explained 47.5% of the variance of intention with the three variables of attitude (β = 0.261), perceived behavioural control (β = 0.183), and subjective norms (β = 0.169). The model that incorporated PBE increased the explained variance to 59.7%, and PBE became the strongest predictor (β = 0.310) and a significant mediator linking attitude, subjective norms, perceived control (ANC) with supplementation intention. PBE and attitude were the two most important variables in predicting vitD supplementation intention. We suggest that updated information regarding dietary sources of vitD and its benefits should be included in health- or nutrition-related courses in education programs for the overall health of the nation.

Alteration of dietary habits and lifestyle pattern during COVID-19 pandemic associated lockdown: An online survey study

Background & aim

A few population-based studies have looked at how the Corona virus disease (COVID-19) pandemic and outbreak-related lockdown has impacted people's daily eating habits and lifestyles. Due to the emergence of the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), continuous lockdown or social isolation can alter dietary consumption patterns and lifestyle routines, resulting in significant negative health consequences. Focused on the COVID-19 and disease related lockdown effects, this study aims to reflect the evolving trend in dietary habits and lifestyle status during the COVID-19 lockdown in West Bengal through a population mediated retrospective survey distributed via social media platforms.

Methods

This survey was conducted using Google form via online platform from July 7 to July 31, 2020, with 1059 participants reported their eating habits and lifestyle preferences, as well as basic socio-demographic details. Entire variables were qualitatively examined and uttered as frequency (f) and percentage (%). The Chi-square test was performed to conclude whether categorical variables differed.

Results

A high number of participants reported that they were consumed healthy foods and physically active during this pandemic situation. Females were more likely to be involved in exercise and consume protein-rich food, as well as the majority of them, maintain basic dietary and Ayurvedic home remedies precautions like consumption of lemon, consumption of herbs, taking warm water, etc. A majority of older participants were tried to maintain a healthy lifestyle with extra protective essential protection during the COVID-19 stage. The frequency of going to market was decreased by the participants. Females were more likely to decrease their frequency of going to market than males. In terms of hygiene and sanitization of food items after buying from the market, females were more careful than males. Participants with higher education were more likely to be careful regarding the hygiene of food preparation and eating during this situation.

Conclusion

From this study, dieticians, legislators, and public health experts can have a better understanding of the current situation of food intake and lifestyle trends in communities of West Bengal, India. It also has the potential to have a significant impact on future public health research.

Membrane technologies for sports supplementation

The important developments in membrane techniques used in the dairy industrial processes to whey manufacturing are discussed. Particular emphasis is placed on the description of membrane processes, characterization of protein products, biological issues related to bacteriophages contamination, and modeling of the processes. This choice was dictated by the observed research works and consumer trends, who increasingly appreciate healthy food and its taste qualities.

Exploring the Intersection Between Diet and Self-Identity: A Cross-Sectional Study With Australian Adults

OBJECTIVE

Diet-related self-identity, which includes components such as individuals' overall dietary pattern and food choice motivations, is a strong predictor of health behaviors. This study sought to assess the variation in dietary patterns reported by a sample of Australian adults and their associations with diet quality.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Australian adults (n = 2,010) VARIABLES MEASURED: The main outcome measure was diet quality relative to the Australian Dietary Guidelines, measured by the Healthy Diet Score survey. Other outcomes captured included dietary patterns (eg, unrestricted, vegetarian, flexitarian, or ketogenic diets), diet-related self-identity constructs (centrality, prosocial motivation, personal motivation, and strictness), and sociodemographic characteristics (eg, age, sex, and education level).

ANALYSIS

Data were analyzed descriptively, and ordinary least squares regression was performed to identify significant predictors of diet quality.

RESULTS

Eighteen unique dietary patterns were reported. These were classified into 3 categories on the basis of the degree of restriction of core food groups. Diets based on restriction of animal protein were associated with the highest diet quality, including the highest consumption of fruits, vegetables, and whole grains, whereas restriction of other foods was associated with the poorest diet quality. Unrestricted diets reported the highest consumption of discretionary food (high in saturated fat, salt, or added sugar). Finally, the regression analysis found that diet quality was significantly predicted by dietary pattern and diet-related self-identity constructs (F[8, 1974] = 54.952; P < 0.0001; adjusted R² = 0.179).

CONCLUSIONS AND IMPLICATIONS

Dietary pattern and diet-related self-identity constructs are key determinants of diet quality. This has implications for future interventions, including that programs and messages could be tailored to ensure they align with the target population's self-identity and overall dietary patterns.

How Food Insecurity and Financial Difficulty Relate to Emotional Well-Being and Social Functioning

OBJECTIVES

Medically uninsured individuals living in poverty experience poor health and face social barriers that negatively affect their health. The purpose of this study was to examine the association between social barriers, particularly healthy food availability and financial difficulty, and well-being among uninsured free clinic patients in the United States.

METHODS

Data were collected using a self-administered paper survey at a free clinic from adult patients who spoke and read English or Spanish (N = 666) from January to April 2019.

RESULTS

Better neighborhood healthy food availability is associated with better self-reported general health. Food security is related to better emotional well-being and social functioning. Having difficulty paying rent or a mortgage is linked to worse emotional well-being and social functioning.

CONCLUSIONS

Providing health education programs may not be sufficient to promote healthy eating among underserved populations because of the social barriers that they experience, such as food insecurity and financial difficulty. Future research could be performed to determine how these social factors influence those of different social and cultural backgrounds than the participants in this study.

Food Availability, Motivational-Related Factors, and Food Consumption: A Path Model Study with Children

The promotion of children’s healthy eating is a key public health priority. However, children’s food consumption is a complex phenomenon with several contributing factors, and there is a call to continue developing comprehensive models with several variables acting simultaneously. The present study aimed to examine the role different motivational-related variables (e.g., self-regulation, self-efficacy) may play in children’s consumption of healthy and unhealthy foods. To address this goal, data were collected in a sample of 242 fifth and sixth graders with access to both healthy and unhealthy foods at home. A path model was conducted to analyze networks of relationships between motivational-related variables and children’s healthy and unhealthy eating. The gender variable was included as a covariate to control its effect. The data showed that self-regulation for healthy eating mediates the relationship between the predictor variables (i.e., knowledge, attitude, and self-efficacy) and the type of food consumption (healthy and unhealthy). Current data contribute to understanding the complexity behind food consumption by providing a comprehensive model with motivational-related factors associated with both healthy and unhealthy eating. The present findings are likely to help inform the development of early preventive interventions focused on the promotion of healthy eating.

Nutraceuticals and Cancer: Potential for Natural Polyphenols

Cancer is one of the leading causes of death globally, associated with multifactorial pathophysiological components. In particular, genetic mutations, infection or inflammation, unhealthy eating habits, exposition to radiation, work stress, and/or intake of toxins have been found to contribute to the development and progression of cancer disease states. Early detection of cancer and proper treatment have been found to enhance the chances of survival and healing, but the side effects of anticancer drugs still produce detrimental responses that counteract the benefits of treatment in terms of hospitalization and survival. Recently, several natural bioactive compounds were found to possess anticancer properties, capable of killing transformed or cancerous cells without being toxic to their normal counterparts. This effect occurs when natural products are associated with conventional treatments, thereby suggesting that nutraceutical supplementation may contribute to successful anticancer therapy. This review aims to discuss the current literature on four natural bioactive extracts mostly characterized by a specific polyphenolic profile. In particular, several activities have been reported to contribute to nutraceutical support in anticancer treatment: (1) inhibition of cell proliferation, (2) antioxidant activity, and (3) anti-inflammatory activity. On the other hand, owing to their attenuation of the toxic effect of current anticancer therapies, natural antioxidants may contribute to improving the compliance of patients undergoing anticancer treatment. Thus, nutraceutical supplementation, along with current anticancer drug treatment, may be considered for better responses and compliance in patients with cancer. It should be noted, however, that when data from studies with bioactive plant preparations are discussed, it is appropriate to ensure that experiments have been conducted in accordance with accepted pharmacological research practices so as not to disclose information that is only partially correct.

Gender Differences in Nutritional, Odontological and Psychological Patterns of Adolescent Students during COVID-19 Pandemic

This research aimed to explore gender differences in nutritional, odontological and psychological patterns of adolescent students during the COVID-19 pandemic. In order to achieve the study’s aim, 127 adolescent students (17.61 ± 7.43 years) completed an online questionnaire which analysed variables regarding their psychological, nutritional, oral health, and physical activity profiles and habits during the COVID-19 crisis. Students showed a higher weekly alcohol consumption and higher levels of loneliness perception when alcohol consumption was lower. In addition, experimental avoidance and psychological inflexibility values were lower when the perception of having dry mouth or lack of saliva is higher. The results also show that males presented a more varied intake of food than females and a stronger adherence to physical activity routines. Female students presented a lower number of meals per day when beer and alcohol consumption was higher, and a higher tendency for fat- and sugar-rich foods such as fast food or bakery products than males. Regarding the oral health profile, females showed higher values in daily tooth brushing and no significant differences were found in dry mouth and gastritis variables. The results from the present study could be used by various educational institutions to implement multidisciplinary interventions to develop healthier habits.

Caloric Restriction Mimetics in Nutrition and Clinical Trials

The human diet and dietary patterns are closely linked to the health status. High-calorie Western-style diets have increasingly come under scrutiny as their caloric load and composition contribute to the development of non-communicable diseases, such as diabetes, cancer, obesity, and cardiovascular disorders. On the other hand, calorie-reduced and health-promoting diets have shown promising results in maintaining health and reducing disease burden throughout aging. More recently, pharmacological Caloric Restriction Mimetics (CRMs) have gained interest of the public and scientific community as promising candidates that mimic some of the myriad of effects induced by caloric restriction. Importantly, many of the CRM candidates activate autophagy, prolong life- and healthspan in model organisms and ameliorate diverse disease symptoms without the need to cut calories. Among others, glycolytic inhibitors (e.g., D-allulose, D-glucosamine), hydroxycitric acid, NAD+ precursors, polyamines (e.g., spermidine), polyphenols (e.g., resveratrol, dimethoxychalcones, curcumin, EGCG, quercetin) and salicylic acid qualify as CRM candidates, which are naturally available via foods and beverages. However, it is yet unclear how these bioactive substances contribute to the benefits of healthy diets. In this review, we thus discuss dietary sources, availability and intake levels of dietary CRMs. Finally, since translational research on CRMs has entered the clinical stage, we provide a summary of their effects in clinical trials.

Revisiting food-sourced vitamins for consumer diet and health needs: a perspective review, from vitamin classification, metabolic functions, absorption, utilization, to balancing nutritional requirements

The significant attention gained by food-sourced vitamins has provided insights into numerous current researches; for instance, the potential reversal of epigenetic age using a diet and lifestyle intervention, the balance between food and dietary supplements in the general population, the role of diet and food intake in age-related macular degeneration, and the association of dietary supplement use, nutrient intake and mortality among adults. As relevant literature about food-sourced vitamin increases, continuous synthesis is warranted. To supplement existing information, this perspective review discussed food-sourced vitamins for consumer diet and health needs, scoping from vitamin absorption, metabolic functions, utilization, to balancing nutritional requirements. Relevant literatures were identified through a search of databases like Google Scholar, Web of Science, the Interscience Online Library, ScienceDirect, and PubMed. We demonstrated that vitamins whether from plant- and animal-based sources are prerequisites for the metabolic functions of the human body. The fat- and water-soluble classification of vitamins remains consistent with their respective absorption and dissolution potentials, underpinned by numerous physiological functions. Vitamins, largely absorbed in the small intestine, have their bioavailability dependent on the food composition, its associated interactions, as well as alignment with their metabolic functions, which involves antioxidants, coenzymes, electron acceptor/donor, and hormones. Moreover, vitamin deficiencies, in every form, pose a serious threat to human health. Vitamin toxicities remain rare, but can still occur mainly from supplementation, although it appears much less in water-soluble vitamins of which some excesses get readily removed by the human body, different from the fat-soluble ones that are stored in tissues and organs. Besides discussions of absorption, transport, and cellular uptake of vitamins, this perspective review also included approaches to meeting vitamin requirements and therapeutic strategies against micronutrient deficiency and COVID-19. We have also attempted on how to strike the balance between food-sourced vitamins and dietary supplements.

Application of deep learning for image-based Chinese market food nutrients estimation

With commercialization of deep learning (DL) models, daily precision dietary record based on images from smartphones becomes possible. This study took advantage of DL techniques on visual recognition tasks and proposed a suite of big-data-driven DL models regressing from food images to their nutrient estimation. We established and publicized the first food image database from the Chinese market, named ChinaMartFood-109. It contained 10,921 images with 23 nutrient contents, covering 18 main food groups. Inception V3 was optimized using other state-of-the-art deep convolutional neural networks, achieving up to 78 % and 94 % for top-1 and top-5 accuracy, respectively. Besides, this research compared three nutrient estimation algorithms and achieved the best regression coefficient (R²) by normalization + AM compared with arithmetic mean and harmonic mean, validating applicability in practice as well as theory. These encouraging results provide further evidence supporting artificial intelligence in the field of food analysis.

Knowledge and attitude toward health and CVD risk factors among firefighters in Cape Town, South Africa

BACKGROUND

Firefighting is a hazardous occupation, and the firefighters' fitness for duty is affected by their knowledge of and attitudes toward their health and their relationship in the development of cardiovascular disease (CVD). The aim of this study was to assess knowledge and attitude toward health and CVD risk factors among firefighters in South Africa.

DESIGN AND METHODS

The study used a cross-sectional research design. A sample of 110 firefighters, males and females, aged 18 to 65 years were conveniently sampled from the City of Cape Town Fire and Rescue Service. A researcher-generated self-administered questionnaire was completed online to obtain data from firefighters. A p-value of less than 0.05 indicated statistical significance.

RESULTS

The results showed that 52.8% of firefighters had a poor knowledge of health, and 47.2% had a good knowledge of health, while 10% reported a negative attitude towards health and 90.0% had a positive attitude towards health. There was a significant difference between firefighters' knowledge of health and their attitudes toward health (p<0.05), particularly related to marital status, age, years of experience and in those with CVD risk factors (p<0.05). Significant correlations were found between knowledge of CVD and knowledge of health-risk behaviors (p<0.05).

CONCLUSION

Significant differences in health knowledge and attitudes toward health were present in married, aged and hypertensive firefighters. Overall health knowledge and health-risk behaviours were significant predictors of attitudes toward health.

E-healthy diet literacy scale and its relationship with behaviors and health outcomes in Taiwan

The study was to develop the e-healthy diet literacy (e-HDL) questionnaire based on the comprehensive health literacy (HL) conceptual framework, to examine the association among HL, e-HDL, health behaviors and outcomes. A nationwide study was conducted on 1342 adults aged 18 years and above, between April and September 2017. Multi-stage random sampling was used to recruit the participants from four regions and 19 cities and counties in Taiwan. HL and e-HDL were measured by HLS-SF12 and the e-healthy diet literacy questionnaire (e-HDLQ), respectively. Socio-demographics, behaviors (e.g. smoking, drinking and exercising) and health outcomes were also measured. Principal component analysis (PCA), linear regression models and logistic regression models were used. The mean age was 33.9 ± 11.4 years. The e-HDLQ was constructed with 11 items. A positive association between HL and e-HDL was found. In the multivariate analysis, HL and e-HDL were significantly lower in men and higher in those who used Facebook for searching information. HL was positively associated with the ability to pay for medication, and social status. The e-HDL was lower in older participants, and people who searched for healthy cooking, healthy food places or weight control, as compared with ones searched for nutritional therapies, while positively associated with education. Both HL and e-HDL were positively associated with health status and physical activities. In conclusion, the valid e-HDL survey tool was developed for general public use. The e-HDL strongly associated with HL, while both were determined by gender, online searching means and linked to health behaviors and outcomes.

Dynamics of the complex food environment underlying dietary intake in low-income groups: a systems map of associations extracted from a systematic umbrella literature review

Background

Inequalities in obesity pertain in part to differences in dietary intake in different socioeconomic groups. Examining the economic, social, physical and political food environment of low-income groups as a complex adaptive system – i.e. a system of multiple, interconnected factors exerting non-linear influence on an outcome, can enhance the development and assessment of effective policies and interventions by honouring the complexity of lived reality. We aimed to develop and apply novel causal loop diagramming methods in order to construct an evidence-based map of the underlying system of environmental factors that drives dietary intake in low-income groups.

Methods

A systematic umbrella review was conducted on literature examining determinants of dietary intake and food environments in low-income youths and adults in high/upper-middle income countries. Information on the determinants and associations between determinants was extracted from reviews of quantitative and qualitative studies. Determinants were organised using the Determinants of Nutrition and Eating (DONE) framework. Associations were synthesised into causal loop diagrams that were subsequently used to interpret the dynamics underlying the food environment and dietary intake. The map was reviewed by an expert panel and systems-based analysis identified the system paradigm, structure, feedback loops and goals.

Results

Findings from forty-three reviews and expert consensus were synthesised in an evidence-based map of the complex adaptive system underlying the food environment influencing dietary intake in low-income groups. The system was interpreted as operating within a supply-and-demand, economic paradigm. Five sub-systems (‘geographical accessibility’, ‘household finances’, ‘household resources’, ‘individual influences’, ‘social and cultural influences’) were presented as causal loop diagrams comprising 60 variables, conveying goals which undermine healthy dietary intake.

Conclusions

Our findings reveal how poor dietary intake in low-income groups can be presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods. In order to reshape system dynamics driving unhealthy food environments, simultaneous, diverse and innovative strategies are needed to facilitate longer-term management of household finances and socially-oriented practices around healthy food production, supply and intake. Ultimately, such strategies must be supported by a system paradigm which prioritises health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01164-1.

"More Than Buying Extra Fruits and Veggies, Please Hide the Fats and Sugars": Children's Diet Latent Profiles and Family-Related Factors

Promoting children’s healthy diets is a key public health priority. Family can play a relevant role in children’s eating patterns. The goals of the current research were to identify different latent diet profiles in children based on their food consumption and to assess the relationship between profiles and family-related factors. A total of 678 school-aged children from the fifth and sixth grades participated. The study design was cross-sectional and questionnaire based. Research assessed healthy (fruit and vegetables) and unhealthy (fast food, sugar-sweetened beverages, and candies) food consumption and family-related factors. A latent profile analysis and multivariate data analysis were developed. Four diet profiles were identified: Combined Diet, Mainly Healthy Diet, Mainly Unhealthy Diet, and Very Unhealthy Diet. Nearly half of the children (45.22%) showed a Combined Diet profile, meaning that they reported eating nearly the same amount of healthy and unhealthy types of foods. Associations between the diet profiles, family income, and food availability were found. For example, the Mainly Healthy Diet profile was statistically associated with a higher family income and less access to unhealthy foods. The present study reinforces the idea that profiling diets can allow for a tailored healthy eating intervention model according to the specific needs of each diet profile.

The peak of health: The vertical representation of healthy food

As expressed by the "Healthy is Up" metaphor, conceptual metaphor theory argues that the representation of health is commonly associated with high verticality because, typically, people stay upright when they are healthy whereas illness may force them to lie down. Along this line of argument, this research is the first to empirically explore the metaphorical representation of healthy food in terms of verticality. Across five experiments (N = 714), this article first demonstrates that people are faster to pair healthy food with up than down in an implicit association test (Study 1, supporting a metaphorical congruency effect). Then, it shows that people associate healthy food with high verticality and unhealthy food with low verticality by placing healthy food up high and unhealthy food low down along the vertical axis, and by preferring a food pyramid that depicts healthy food at the top rather than at the bottom (Studies 2a, 2b and 3, supporting an abstract-to-concrete effect). Last, this research finds that people judge a food product as healthier when it is pictured from an upward-looking angle than when it is pictured from a downward-looking angle (Study 4, supporting a concrete-to-abstract effect). Further analyses test the interaction between individual differences in self-control and the effects of the "Healthy is Up" metaphor in Studies 2a, 2b, 3 and 4. The article concludes with a discussion of the theoretical and practical implications of this research.

General self-efficacy in individuals with visual impairment compared with the general population

BACKGROUND

Knowledge about self-efficacy and its significance for the quality of life of people with visual impairment is lacking. The aims of the study were to compare general self-efficacy in individuals with visual impairment with the general population, and to investigate the association between self-efficacy and life satisfaction.

METHODS

A telephone-based cross-sectional survey was conducted between January and May 2017 in a probability sample of adults who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about their sociodemographic characteristics, characteristics of vision loss, general self-efficacy (General Self-efficacy Scale), and life satisfaction (Cantril's Ladder of Life Satisfaction). We obtained norm data from a representative survey of the general Norwegian population (N = 1792; mean age 53.2 years; 52.5% females).

RESULTS

People with visual impairment had higher levels of general self-efficacy than people in the general population (Mean: 31.5 versus 29.0, p < .001). Results from linear regression analyses of the visual impairment population showed that higher education and residential in an urban municipality were associated with higher self-efficacy. Having additional impairments and a previous history of physical or sexual assaults were associated with lower self-efficacy. A linear dose-response relationship was found between self-efficacy and life satisfaction, in the visual impairment population as well as in the general population.

CONCLUSIONS

People with visual impairment have higher self-efficacy than people in the general population, possibly due to extensive mastery experience in how to handle life as visually impaired. Self-efficacy seems to be important in achieving the best possible life.

Students' Knowledge of Healthy Food and Their Actual Eating Habits: A Case Study on the University of Granada (Spain)

This article focuses on an analysis of the discourses produced during 34 semi-structured interviews (17 men and 17 women) conducted at the University of Granada (Spain) with undergraduate, Master, and Ph.D. students. The interviewees were between 20 and 44 years old. It was observed that the fact of having a high educational level did not prevent University students from eating unhealthily. There is a gap between the fact that 97.1% of 34 students interviewed (that is, 33 of them) know what healthy food is and their self-perception about whether or not what they are eating is healthy, since in 41.2% of them said self-perception is negative. This gap narrows as the interviewees' age increases and their socio-economic and vital situation is stabilizing which favors that their eating habits become more regular and healthier. Thus, all the interviewees aged 27 or over self-perceived that they were eating healthily. But the biggest differences are those that have to do with the gender of interviewees. Thus, while 23.5% of women interviewed perceived that they were not eating healthy, 76.5% of them felt that they were eating healthy. However, among the men interviewed, these percentages were somehow reversed, in such a way that 58.8% of them believed that they were not eating healthy, compared to 41.2% of them who indicated that they were eating healthy. Therefore, the investigation revealed that women tend to have the best chances of assuming healthy eating habits. Male students living outside the family home or without female partners exhibited greater feeding problems, while females living under similar conditions tended to display healthier eating habits. This is related to the fact that women have traditionally been in charge of acquiring and preparing food. So, women's food education has not been restricted to the mere transmission to them of knowledge about what healthy food is, but from their childhood they were food trained through their active involvement in practical experiences. Obviously, the solution proposed to this male disadvantage is to not perpetuate macho gender stereotypes that assign women the role of home caregivers, but to seek that both women and men have the opportunity and the duty to experience equally those practical experiences that involve the tasks of the acquisition and preparation of food. Working to achieve a situation like this, not only promotes progress in gender equality, but also helps to overcome the lower training of men to perform the tasks inherent in their diet.