Biobehavioral Factors That Shape Nutrition in Low-Income Populations: A Narrative Review

Local-scale deprivation is associated with the spatial distribution of poor diet quality in adults: A cross-sectional population-based study in Switzerland

Poor diet quality is linked to non-communicable diseases and mortality. Area deprivation is an important determinant of diet. Whether small area deprivation influences the spatial distribution of diet quality remains unknown. We aimed to assess the spatial dependence of diet quality and its association with local-scale deprivation in adults. We used data from the 2016-2019 waves of the population-based Bus Santé Study in Geneva (n = 4453). We assessed diet quality through the Alternate Healthy Eating Index (AHEI), and its spatial dependence through the Local Indicators of Spatial Association (LISA or Local Moran's I). Bivariate LISA analyses and Geographically Weighted Regression models were used to assess associations with sociodemographic variables and small-area deprivation. We used regression models of diet and metabolic health variables to confirm the validity of the low diet quality spatial clustering. We included 4248 participants (mean age 47 ± 14, 50·7% women). We found a mean AHEI score of 35·2 (SD 10·8). 40% of the participants fell into a low diet quality category. Diet quality was spatially patterned across the Canton of Geneva, with identified clusters of lower diet quality (mean AHEI score 27·8 ± 6·24) and higher diet quality (mean AHEI score 43·8 ± 6·8). Clusters of low diet quality persisted after adjusting for individual-level variables. The largest low diet quality cluster was associated with higher local deprivation. Our study sheds light on the role of local-scale deprivation as an independent contextual determinant of diet in a high-income European city.

Determinants of Multimorbidity in a Low-Resource Setting: A Population-Based Cross-Sectional Study in Bangladesh

Multimorbidity is a complex and highly prevalent health condition characterised by the coexistence of two or more chronic diseases within an individual. It is a growing public health issue worldwide, predominantly in low-resource countries like Bangladesh. Therefore, this study aimed to determine the prevalence and associated factors of multimorbidity among the adult population in Bangladesh. A cross-sectional study was carried out among 504 respondents who were 18 years or older. The generalised linear mixed model was used to identify the risk factors. Among the respondents, 65.3% (95% confidence interval [CI]: 61.0 to 69.3) had multimorbidity. The most common chronic conditions were allergic disorder (34%, 95% CI: 30 to 39), gastritis (31%, 95% CI: 27 to 35), low back pain (28.4%, 95% CI: 24.6 to 32.5), oral diseases (27%, 95% CI: 23 to 29) and arthritis (21%, 95% CI: 18 to 25). Middle-aged adults (adjusted odds ratio [AOR] = 7.97; 95% CI: 3.35 to 18.92) and older adults (AOR = 8.44; 95% CI: 1.90 to 36.64) had significantly higher odds of multimorbidity than young adults. Employed respondents had an 86% (AOR = 0.14; 95% CI: 0.07 to 0.36) lower odds of multimorbidity than non-working individuals. Higher sleeping duration (6 to 8 h: AOR = 0.44; 95% CI: 0.25 to 0.80; 8 to 10 h: AOR = 0.26; 95% CI: 0.11 to 0.60), regular vegetable consumption (AOR = 0.42; 95% CI: 0.22 to 0.80) and adequate water intake (AOR = 0.48; 95% CI: 0.29 to 0.79) were protective factors against multimorbidity, whereas obesity increased the odds (AOR = 3.32; 95% CI: 1.06 to 10.43). These findings emphasise the need to promote healthy lifestyle habits, such as maintaining a balanced diet, staying hydrated and engaging in regular physical exercise, to reduce the burden of multimorbidity in low-resource settings.

Impacts of temperature and solar radiation changes in northern Europe on key population health behaviors: a scoping review of reviews

AIM

Climate change threatens health directly as well as indirectly through impacts on health-related behaviors. Physical activity, nutrition and sleep are key health-related behaviors for population health. We aimed at elucidating the impacts of climate change which emerge gradually on these three key health-related behaviors, particularly focusing on scenarios and projections relevant to people living in the northern Europe.

METHODS

We conducted a systematic literature search in three different databases in January 2023 to identify English language review articles summarizing the effects of climate change on either physical activity, nutrition, sleep, or their combination.

RESULTS

We identified 15 review articles on the topic. Data on climate change impacts on nutrition and sleep were sparse, and those on physical activity were heterogeneous. The climate in northern Europe will become warmer and sunnier in summer as well as warmer and darker in winter, which will probably increase the level of physical activity, but decrease the consumption of fruits and vegetables, as well as increase the occurrence of sleep disturbances in a population.

CONCLUSIONS

The anticipated changes in physical activity, nutrition and sleep driven by climate change influence population health and call for grass-roots action plans for adaptation.

Sleep Duration is Associated with Fruit and Vegetable Intake in Lower Income Adults from the San Francisco Bay Area: A Cross-Sectional Analysis

Background: Few studies have examined whether sleep is related to dietary intake in aging adults. To address this gap, this study investigated (1) the associations between sleep duration and sleep quality with fruits and vegetables (FV), fiber, and fat intake in lower-income midlife and older adults and (2) sex differences in these relationships. Methods: Baseline data from 163 ethnically diverse, lower-income midlife and older adults in the NIH-funded Steps for Change trial were analyzed. Dietary intake was assessed using the Block Fruit/Vegetable/Fiber and Fat Intake Screeners, operationalized as weekly servings. Sleep duration (hours per night) and quality were self-reported via the Stanford WELL for Life Scale. Linear regression models assessed the association between sleep duration and FV, fiber, and fat intake, adjusting for potential confounding covariates with separate models for sleep quality. Sex differences were tested using interaction terms, with stratified models also used to explore differences. Results: The sample was 73.2% female, with a mean age of 70.5 (SD = 9.7) years (range: 41-99). The mean sleep duration was 6.8 (1.2) hours per night, with 79.2% reporting fairly or very good sleep quality. Mean weekly servings were 24 for FV, 7 for fiber, and 18 for fat. Sleep duration was positively associated with FV intake (β = 2.2; p = 0.02). The interaction between duration and sex was marginally significant (p = 0.08), with a positive association in males (β = 5.5; p = 0.02) but not in females (β = 0.9; p = 0.41). No significant associations were found between sleep duration and fiber or fat intake or between sleep quality and any dietary intake outcomes. Conclusions: This study found that longer sleep duration was associated with higher FV intake in males but not in females. These findings suggest the possibility of sex differences in the sleep-diet relationship among aging populations that merit further exploration in longitudinal studies.

Evaluation of a Trauma-Informed Nutrition Curriculum for Women With Children Living in Transitional Housing

OBJECTIVE

This study describes the implementation of a 6-week nutrition and culinary education curriculum at a transitional housing facility for single mothers in Tulsa, Oklahoma, United States.

METHODS

Using a novel, trauma-informed approach to nutrition education, we delivered the Around the Table: Nourishing Families curriculum across three, small group cohorts (n = 15) over a period of 2 years. Lessons emphasized small group dialogue and group-directed learning on the topics of toxic stress, food as nourishment and family resilience combined with hands-on recipe preparation by the group. We evaluated process measures of participation and attrition and outcome measures of self-reported food skills, dietary intake, emotional well-being, and other indicators of nutrition self-care using a pre-post design.

RESULTS

Food skills significantly improved post-curriculum (p = 0.026) with additional improvement in several areas of dietary intake, mindful eating, nutrition self-care and greater use of healthy foods at family mealtimes.

CONCLUSIONS

Hands-on, participatory nutrition and cooking education that emphasizes mind-body connections to food can be a feasible strategy for teaching introductory food skills and may also support socioemotional healing in this population.

Food insecurity and ultra-processed food consumption in the Health and Retirement Study: Cross-sectional analysis

BACKGROUND

Higher ultra-processed foods (UPF), attributed to more than half of daily intake in the US, have been associated with impaired health outcomes. Documented evidence highlights disparities in UPF consumption due to food insecurity, which is a public health challenge among older adults in the US.

OBJECTIVES

The study examined the link between food insecurity and UPF consumption. The potential of participants' sex, age, and race and Supplemental Nutrition Assistance Program (SNAP) participation in modifying the association were explored.

METHOD

The analytical sample comprised 6295 US adults, aged 52 - 101 years, enrolled in the longitudinal Health and Retirement Study (HRS), a nationally representative study of aging. Food insecurity was evaluated in the 2013 HRS Health Care and Nutrition Study using the six-item Short Form Food Security Survey Module. Dietary intake was assessed using a food frequency questionnaire, and UPFs, quantified using the NOVA food classification system, were expressed as a percentage of total energy intake. The association between food insecurity and UPFs was examined using linear regression models, adjusted for sociodemographic characteristics.

RESULTS

The prevalence of food insecurity was 15%. Mean UPFs% (95% confidence intervals) were 49.1 (47.8, 50.3), 48.5 (46.6, 50.4), and 52.3 (50.4, 54.3) among adults with food security, low food security, and very low food security, respectively (P-trend = 0.0156). Race modifies the association between food insecurity and UPFs (P-interaction = 0.0033). A positive linear trend was detected among Whites (P-trend = 0.0036), but an inverse linear trend was found among African Americans (P-trend = 0.0007). There was no evidence for heterogeneity by age, sex, or SNAP participation.

CONCLUSION

Food insecurity was positively correlated with UPF consumption among adults in the US. Race modifies the association with a positive linear trend among Whites and an inverse linear trend among African Americans. Further efforts are needed to promote healthy aging via improving diet quality among food-insecure older adults.

Socioeconomic and behavioural factors that contribute to the co-occurrence of risk factors for noncommunicable diseases

It is observed that the global burden of diseases had shifted from infectious diseases to Non-Communicable Diseases (NCDs), with an accumulative trend in developing countries. NCDs share key modifiable behavioral risk factors like unhealthy diet and lack of physical activity that are typically established during adolescence or young adulthood and will set the stage for NCDs development later in life. Therefore, this paper aimed to explore factors contributing to the co-occurrence of risk factors for NCDs among persons aged 30 years and above in selected urban areas of Namibia. Specifically, the paper focused on examining the social, economic and behavior characteristics of people living with NCDs and how they contribute to the relative risk of the co-occurrence of NCDs. The study is based on secondary data and analysis is based on a total sample of 1527 which was successfully interviewed. The dependent variable was co-occurrence of NCD risk factors per respondent with the following groups: No co-occurrence, at most two risk factors, 3-4 risk factors, and 5-6 risk factors. The risk factors included excessive alcohol consumption, smoking of tobacco, insufficient physical activeness, insufficient intake of fruits, and insufficient intake of vegetable and unhealthy dietary pattern. Descriptive statistics were obtained using frequencies and averages. Pearson Chi-square was used to assess the association between co-occurrence of risk factors and socio-economic and behavioural variables using cross-tabulation. A multinomial regression model was also used to predict the effects of factors contributing to the co-occurrence of risk factors. The significance of variables was tested using 5% level. The results showed that overall, co-occurrence of risks was more prevalent among respondents with HBP than those with diabetes or HRD. Notably, age and education level positively contribute to co-occurrence of risk factors of NCDs. Increased co-occurrence of risks was also relatively high among respondents with NCD who did not take medication and those who did not go for follow up. The paper concluded that taking medication, regular check-up and following healthy diet significantly reduce the risk of co-occurrence of NCD risk factors. The study recommends for infrastructural developments in urban areas that promotes health lifestyles including provision for cycling, walking paths and participation in urban agriculture.

Impact of Climate Change on Cardiovascular Health

PURPOSE OF REVIEW

Climate change is profoundly impacting cardiovascular disease through rising temperatures, more extreme weather events, and worsening air pollution. This review analyzes how these factors affect cardiovascular health.

RECENT FINDINGS

Extreme heat and cold cause physiological changes, including increasing the risk of blood clots, faster heart rates, and inflammation. Air pollution and wildfire smoke lead to oxidative stress and systemic inflammation, leading to heightened cardiovascular risk. Extreme weather disrupts healthcare access, complicating chronic condition management and negatively impacts people from lower socioeconomic communities. Climate-related stressors also affect mental health, which in turn impacts cardiovascular health. Long-term changes, such as food insecurity and migration, further strain heart health due to poor diets and psychological stress. Cardiologists must understand these risks to better support and treat patients in our changing climate.

Socioeconomic Inequalities in Intakes of Ultraprocessed and Minimally Processed Foods in Nationally Representative Samples of Adults in Canada: An Analysis of Trends between 2004 and 2015

BACKGROUND

Individuals with a lower socioeconomic position (SEP) often have higher intakes of ultraprocessed food (UPF) and lower intakes of minimally processed food (MPF); however, studies have not examined trends in absolute and relative gaps and gradients in UPF and MPF intake using multiple indicators of SEP.

OBJECTIVES

We examined within-year absolute and relative gaps and gradients in UPF and MPF intake and trends between 2004 and 2015 according to 6 indicators of SEP among nationally representative samples of adults in Canada.

METHODS

Adults (≥18 y) in the Canadian Community Health Survey-Nutrition 2004 (n = 20,880) or 2015 (n = 13,970) reported SEP (individual and household education, household income adequacy, household food insecurity, neighborhood material and social deprivation) and completed a 24-h dietary recall. Multivariable linear regression assessed within-year absolute and relative gaps and gradients in the proportion of energy from UPF and MPF and trends between 2004 and 2015.

RESULTS

The largest and most consistent within-year inequities in UPF and MPF intake were for individual and household educational attainment. Overall and among males, higher SEP groups had more favorable intakes over time based on trends in absolute and relative gaps and gradients in UPF and MPF intake by household food insecurity [for example, the absolute gap in UPF intake declined from -1.2% (95% confidence interval: -5.3%, 2.9%) to -7.9% of energy (95% confidence interval: -11.2%, -4.5%) in the overall population]. Overall and among males, lower SEP groups had more favorable intakes over time based on trends in absolute and relative gaps in UPF and MPF intake by neighborhood material deprivation.

CONCLUSIONS

Socioeconomic inequalities in UPF and MPF intake were most pronounced for individual and household education. Between 2004 and 2015, several inequalities in UPF and MPF intake emerged according to household food insecurity (favoring higher SEP groups) and neighborhood material deprivation (favoring lower SEP groups).

Sleep duration, overweight status, and the modifying role of food insecurity in a sample of 10- to 14-year-old Mexican early adolescents

OBJECTIVES

Short sleep duration has been associated with an increased risk of childhood overweight and obesity in high-income countries, but data from low- and middle-income countries are scarce. Independently, short sleep and food insecurity may increase the risk of overweight/obesity, but it is unknown whether they concurrently affect it.

METHODS

We included 3350 adolescents aged 10-14 from the 2012 and 2016 Mexican National Health and Nutrition Survey. Short sleep was categorized as less than 9 hours for ages 10-12 and less than 8 hours for ages 13-14. Overweight/obesity was assessed via anthropometry. Modified Poisson regression models assessed prevalence ratios between short sleep and overweight, examining effect modification by food security status.

RESULTS

86% met sleep duration recommendations. Short sleep was associated with an increased prevalence of overweight/obesity (prevalence ratio, 1.16; 95% CI, 1.05, 1.31). Multiplicative interaction was found between low and very low food security status and short sleep: adolescents in low food secure households with short sleep had 1.38 (95% CI: 1.10, 1.75) times the prevalence of overweight/obesity compared to adequate sleepers. Very low food secure households had 1.16 (95% CI: 1.14, 1.31) times the prevalence compared to adequate sleepers. This association was not significant in fully or marginally food secure households.

CONCLUSIONS

Short sleep is associated with an increased obesity risk among Mexican adolescents 10-14years, particularly in the context of low and very low food security. These findings highlight the importance of addressing both sleep hygiene and food security in strategies to reduce obesity risk.

Food inequity and insecurity and MASLD: burden, challenges, and interventions

Liver disease prevalence, severity, outcomes and hepatic risk factors (for example, unhealthy diet) are heavily affected by socioeconomic status and food insecurity. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally and is likely to co-occur with other liver diseases associated with food insecurity. Though weight reduction and adopting a healthy diet can reverse the course of MASLD, gaps between recommendations and practice transcend individual responsibility and preference. Broader sociocultural determinants of food choices (social nutrition) include food insecurity, community and social norms and the local environment, including commercial pressures that target people experiencing poverty, ethnic minorities and children. Food insecurity is a barrier to a healthy diet, as a low-quality diet is often less expensive than a healthy one. Consequently, food insecurity is an 'upstream' risk factor for MASLD, advanced fibrosis and greater all-cause mortality among patients with liver disease. Intervening on food insecurity at four major levels (environment, policy, community and health care) can reduce the burden of liver disease, thereby reducing social and health inequities. In this Review, we report on the current research in the field, the need for implementing proven interventions, and the role liver specialists can have.

The association between COVID-19 related income loss and diet quality: The mediating role of distress

The COVID-19 lockdowns saw many individuals lose income, experience distress and increase intake of foods that would typically be considered less 'healthy' (more processed and less fresh produce). Establishing whether there are direct and indirect links between these variables would be of benefit in preparing for similar future events but also has implications for the current global financial climate, where many are experiencing relative decreases in income. Adults in two locations (UK and Australia) (N = 917) completed online questionnaires to explore the impact of the first COVID-19 lockdown on their change in income, emotional wellbeing (depression, anxiety, stress, loneliness), resilience and diet quality. A structural equation model revealed that income loss was indirectly associated with diet quality via distress. As such, the greater the loss of income experienced, the more distress reported; distress was then directly associated with a less nutritious diet. This pattern of results existed when data from both countries were combined but also when they were modelled individually. Our findings indicate that where individuals experience a sudden reduction of income there are likely to be negative consequences for both mental and physical health. It is plausible that these findings would extend to other circumstances in which sudden loss of income may be experienced such as reductions in state social care, rising inflation and interest rates and sudden increases to the general cost of living.

A narrative review of lifestyle management guidelines for metabolic dysfunction-associated steatotic liver disease

BACKGROUND AND AIMS

Metabolic dysfunction-associated steatotic liver disease management guidelines have been published worldwide; we aimed to summarize, categorize, and compare their lifestyle intervention recommendations.

APPROACH AND RESULTS

We searched metabolic dysfunction-associated steatotic liver disease/NAFLD management guidelines published between January 1, 2013, and June 31, 2024, through databases including PubMed/MEDLINE, Cochrane, and CINAHL. In total, 35 qualifying guidelines were included in the final analysis. Guideline recommendations were categorized into 5 domains (ie, weight reduction goals, physical activity, nutrition, alcohol, and tobacco smoking) and were ranked based on how frequently they appeared. A recommendation was defined as widely adopted if recommended in ≥24 (≥66.6%) of the guidelines. These included increasing physical activity; reducing body weight by 7%-10% to improve steatohepatitis and/or fibrosis; restricting caloric intake; undertaking 150-300 or 75-150 minutes/week of moderate or vigorous-intensity physical activity, respectively; and decreasing consumption of commercially produced fructose. The least mentioned topics, in ≤9 of the guidelines, evaluated environmental determinants of health, mental health, referring patients for psychological or cognitive behavioral therapy, using digital health interventions, and assessing patients' social determinants of health.

CONCLUSIONS

Most guidelines recommend weight reduction through physical activity and improving nutrition, as these have proven positive effects on health outcomes when sustained. However, gaps regarding mental health and the social and environmental determinants of metabolic dysfunction-associated steatotic liver disease were found. To optimize behavioral modifications and treatment, we recommend carrying out studies that will provide further evidence on social support, environmental factors, and mental health, as well as further exploring digital health interventions.

Dietary practice and nutritional status of low-income earners in a rural adult population in Delta State, Nigeria: a cross-sectional study

Introduction

due to the inability of low-income populations to access nutritious foods or basic education, these groups usually consume unhealthy diets, which frequently lead to nutrition issues like obesity, malnutrition, and other health morbidities. The purpose of the study was to evaluate the nutritional knowledge, dietary practices, nutritional status, and factors influencing the dietary habits of low-income persons living in a rural constituency in Southern Nigeria.

Methods

a cross-sectional study was carried out on 419 consenting low-income adults (18 years and older) using a simple random technique, in order to collect data on their socio-demographic traits, nutritional knowledge, dietary practices, and nutritional status. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyze the data generated.

Results

the respondents´ the average age was 40.9 ± 15.68 years while 224 (53.5%) of those surveyed were females. The proportion of responders with a secondary education was highest 279 (66.6%). The most common occupation among respondents was farming 151 (36.1%) and petty trading 135 (32.2%). Overall, 314 (74.9%) of low-income adults had poor dietary habits, and 245 (60.6%) had poor nutrition knowledge. Occupation and gender were significantly associated with nutritional status P<0.05. The majority of respondents 56.2% (235) were overweight or obese, and multivariate logistic regression analysis shows that respondents with concern about gaining weight were more likely to be overweight or obese (OR=1.065, 95% CI=0.832-1.363).

Conclusion

the findings from the study indicate that inadequate nutritional knowledge and poor dietary habits, reflected in respondents' body weight are likely to increase the risk of non-communicable diseases, necessitating the need for nutritional education among rural populations.

Cyclic Formula Feeding Among Infants Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND

Low-income households often experience a cyclic pattern in food availability, with acute food shortages at month end. Variations in the monthly feeding of infant formula are understudied.

OBJECTIVES

This study aimed to compare the amount and frequency of formula consumed at the beginning and end of the monthly Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance cycle and test associations with total energy intake and other feeding practices among infants aged 7-11 mo.

METHODS

This study was conducted between May 2020 and April 2021 in the southeastern United States and involved mothers of infants participating in WIC's fully formula package. Mothers were interviewed and 24-h feeding recalls were conducted at the beginning and end of the month. We defined month beginning as 5 d following the first WIC formula purchase and month end as 5 d before the next monthly cycle. Fifty mother-infant dyads participated in single or multiple monthly cycles, totaling 98 monthly cycles. Generalized linear mixed-effects modeling was used to test differences in formula feeding at month beginning and end.

RESULTS

Most participants (84%) were African American or Latino and >90% purchased all formula within 2-3 d of the WIC issuance. The energy intake from formula at month beginning was significantly higher than at month end (67.63% and 57.85%, respectively; P = 0.002), with no differences in total energy intake. The odds of infants being fed cow milk and fruit juices/drinks increased from month beginning to end (P < 0.05).

CONCLUSIONS

Infants in low-income households are at risk of experiencing a cyclic feeding pattern characterized by higher formula feeding at month beginning and an increase in feeding of nonrecommended drinks at month end. The WIC program policy could review educational and distribution options to reduce cyclic formula feeding and clarify caregivers' understanding of infants' formula needs. Household-level investigations into formula management and determinants of cyclic feeding are warranted.

Relationships between Food Insecurity, Self-Efficacy, and Changes in Body Mass Index among the Youth in Taiwan: Analysis from a Longitudinal Cohort Survey

BACKGROUND

Food insecurity is a heightened concern among economically disadvantaged youth, and it may contribute to the atypical body mass index (BMI) patterns frequently observed in this group. Self-efficacy seems to intervene in the negative impacts of contextual restraints. This study investigated the relationship between food insecurity, self-efficacy, and BMI trajectory among economically disadvantaged Taiwanese youth.

METHODS

We utilized three-wave longitudinal data from the Taiwan Database of Children and Youth in Poverty. The Food Insecurity Score (FIS) assessed food insecurity with a 4-item scale measuring reduced meal frequency, hunger, skipping meals, and economic constraints. Moreover, the General Self-Efficacy Scale (GSES) assessed self-efficacy, showcasing the ability to handle stress effectively and envision success scenarios, contributing to positive outcomes. By employing latent growth modeling, we were able to delineate the impacts of baseline food insecurity and self-efficacy on initial BMI and its subsequent growth trajectory.

RESULTS

Elevated baseline FIS significantly predicted higher initial BMI (coefficient = 0.420, p = 0.042). Baseline GSES was negatively associated with initial BMI (coefficient = -0.093, p < 0.001) but positively predicted the BMI growth rate (coefficient = 0.023, p = 0.011).

CONCLUSION

Enhancing self-efficacy may be an effective multidisciplinary intervention to address psychosocial and socioeconomic factors when tackling weight problems in vulnerable youth groups.

The impact of the cost of living crisis and food insecurity on food purchasing behaviours and food preparation practices in people living with obesity

Lower income households are at greater risk of food insecurity and poor diet quality than higher income households. In high-income countries, food insecurity is associated with high levels of obesity, and in the UK specifically, the cost of living crisis (i.e., where the cost of everyday essentials has increased quicker than wages) is likely to have exacerbated existing dietary inequalities. There is currently a lack of understanding of the impact of the current UK cost of living crisis on food purchasing and food preparation practices of people living with obesity (PLWO) and food insecurity, however this knowledge is critical in order to develop effective prevention and treatment approaches to reducing dietary inequalities. Using an online survey (N = 583) of adults residing in England or Scotland with a body mass index (BMI) of ≥30 kg/m2, participants self-reported on food insecurity, diet quality, perceived impact of the cost of living crisis, and their responses to this in terms of food purchasing behaviours and food preparation practices. Regression analyses found that participants adversely impacted by the cost of living crisis reported experiencing food insecurity. Additionally, food insecurity was associated with use of specific purchasing behaviours (i.e., use of budgeting, use of supermarket offers) and food preparation practices (i.e., use of energy-saving appliances, use of resourcefulness). Exploratory analyses indicated that participants adversely impacted by the cost of living crisis and who used budgeting had low diet quality, whereas use of meal planning was associated with high diet quality. These findings highlight the fragility of food budgets and the coping strategies used by PLWO and food insecurity during the cost of living crisis. Policy measures and interventions are urgently needed that address the underlying economic factors contributing to food insecurity, to improve access to and affordability of healthier foods for all.

Caregiver perceptions of a pediatric produce prescription program during the COVID-19 pandemic

Introduction

Produce prescription programs are rapidly expanding as a type of Food is Medicine intervention with prospects for mitigating food insecurity and reducing diet-related health disparities. Gaining insight into participant perspectives on program logistics and perceived impacts is crucial to program success and improvements.

Methods

Between May and June 2021, we conducted individual and small group interviews with 23 caregivers with children aged 1-5 years who participated in a produce prescription program from 2020 to 2021 in Texas, U.S. They were provided with a gift card to a major national grocery retailer to purchase fresh produce. The card was reloaded $60 monthly for 8 months with automatic roll-over of unused funds to the next month. Participants also received nutrition education in the form of two videos. A deductive analysis approach was employed, and NVivo qualitative data analysis software was used to perform coding and to assist with subsequent analyses.

Results

All 23 participants were female, with an average age of 37.5 years, and the majority identified as Hispanic/Latino (83%). About 43% of the families had three or more children. Six themes were generated from interviews. Three of these themes were related to program logistics: (1) ease of program use; (2) participant satisfaction with the incentive; and (3) desire for additional store options. The remaining main themes pertained to program impact: (1) the enhanced ability to purchase produce; (2) the usefulness of the nutrition education; and (3) persistent challenges encountered when preparing the produce for picky eaters and young children.

Conclusion

A pediatric produce prescription program was perceived as logistically easy and a helpful source of financial support for accessing fresh produce. Program features such as card-based incentive system and partnership with major grocery retailer were favored by participants. For future program design, it may be beneficial to consider collaborating with multiple grocery outlets and enhancing the intensity and targeting of nutrition education.

Tunneling, cognitive load and time orientation and their relations with dietary behavior of people experiencing financial scarcity - an AI-assisted scoping review elaborating on scarcity theory

BACKGROUND

The concept of a financial scarcity mindset has raised much attention as an explanation for poor decision-making and dysfunctional behavior. It has been suggested that financial scarcity could also impair dietary behavior, through a decline in self-control. Underlying cognitive mechanisms of tunneling (directing attention to financial issues and neglecting other demands), cognitive load (a tax on mental bandwidth interfering with executive functioning) and time orientation (a shift towards a present time horizon, versus a future time horizon) may explain the association between financial scarcity and self-control related dietary behavior. The current scoping review gathers recent evidence on how these mechanisms affect dietary behavior of people experiencing financial scarcity. It builds on a theoretical framework based on insights from behavioral economics and health psychology.

METHODS

A literature search was executed in six online databases, which resulted in 9.975 papers. Search terms were tunneling, cognitive load and time orientation, financial scarcity, and dietary behavior. Screening was performed with ASReview, an AI-ranking tool. In total, 14 papers were included in the scoping review. We used PRISMA-ScR guidelines for reporting.

RESULTS

Limited evidence indicates that a scarcity mindset could increase tunneling, through attentional narrowing on costs of food, which then directly impacts dietary behavior. A scarcity mindset involves experiencing financial stress, which can be understood as cognitive load. Cognitive load decreases attentional capacity, which could impair self-control in dietary choices. Financial scarcity is related to a present time orientation, which affects dietary choices by shifting priorities and decreasing motivation for healthy dietary behavior.

CONCLUSIONS

A scarcity mindset affects dietary behavior in different ways. Tunneling and a shift in time orientation are indicative of an attentional redirection, which can be seen as more adaptive to the situation. These may be processes indirectly affecting self-control capacity. Cognitive load could decrease self-control capacity needed for healthy dietary behavior because it consumes mental bandwidth. How a changing time orientation when experiencing financial scarcity relates to motivation for self-control in dietary behavior is a promising theme for further inquiry.

The hidden threat: Environmental toxins and their effects on gut microbiota

The human gut microbiota (GM), which consists of a complex and diverse ecosystem of bacteria, plays a vital role in overall wellness. However, the delicate balance of this intricate system is being compromised by the widespread presence of environmental toxins. The intricate connection between contaminants in the environment and human well-being has garnered significant attention in recent times. Although many environmental pollutants and their toxicity have been identified and studied in laboratory settings and animal models, there is insufficient data concerning their relevance to human physiology. Consequently, research on the toxicity of environmental toxins in GM has gained prominence in recent years. Various factors, such as air pollution, chemicals, heavy metals, and pesticides, have a detrimental impact on the composition and functioning of the GM. This comprehensive review aims to comprehend the toxic effects of numerous environmental pollutants, including antibiotics, endocrine-disrupting chemicals, heavy metals, and pesticides, on GM by examining recent research findings. The current analysis concludes that different types of environmental toxins can lead to GM dysbiosis and have various potential adverse effects on the well-being of animals. We investigate the alterations to the GM composition induced by contaminants and their impact on overall well-being, providing a fresh perspective on research related to pollutant exposure.

Food Insecurity is Associated With COPD Morbidity and Perceived Stress

Background

Low socioeconomic status (SES) has been associated with worse clinical outcomes in chronic obstructive pulmonary disease (COPD). Food insecurity is more common among individuals with low SES and has been associated with poor outcomes in other chronic illnesses, but its impact on COPD has not been studied.

Methods

Former smokers with spirometry-confirmed COPD were recruited from low-income areas of Baltimore, Maryland, and followed for 9 months as part of a cohort study of diet and indoor air pollution. Food insecurity and respiratory outcomes, including COPD exacerbations and patient-reported outcomes, were assessed at regular intervals. The association between food insecurity and COPD outcomes was analyzed using generalized linear mixed models. Additional analyses examined the association of COPD morbidity with subdomains of food insecurity and the association of food insecurity with psychological well-being measures.

Results

Ninety-nine participants had available data on food insecurity and COPD outcomes. A total of 26.3% of participants were food insecure at 1 or more times during the study. After adjusting for individual SES, neighborhood poverty, and low healthy food access, food insecurity was associated with a higher incidence rate of moderate and severe exacerbations and worse dyspnea, COPD health status, and respiratory-specific quality of life. Subdomains of food insecurity were independently associated with worse patient-reported outcomes. Food insecurity was additionally associated with higher perceived stress.

Discussion

Among former smokers with COPD, food insecurity was associated with a higher incidence of exacerbations, worse patient-reported outcomes, and higher perceived stress. Subdomains of food insecurity were independently associated with worse patient-reported outcomes.

A Randomized Trial to Address Food Insecurity and Promote Smoking Cessation Among Low-Income Adults

Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke.

Food Insecurity Predicts Magnitude of Early BMI Change in a Pediatric Weight Management Intervention

OBJECTIVE

The aim of this study was to estimate the prevalence of food insecurity among children with overweight/obesity presenting for weight management treatment and examine whether food insecurity predicts early change in body mass index (BMI), expressed as a percentage of the 95th percentile (%BMIp95).

METHOD

Children (N = 69; ages 3-18 years) presenting to a hospital-based pediatric weight management intervention and 1 parent/guardian per child (N = 69) were included. At the first appointment, parents/guardians completed the US Household Food Security Survey Module: Six-item Short Form and a demographics questionnaire. Height and weight of the children were measured at the first and third appointments to calculate %BMIp95.

RESULTS

Among participating families, 29.0% reported experiencing food insecurity. Controlling for the ratio of income to poverty, 11.4% of the variance in %BMIp95 change from the first to third appointments was accounted for by food insecurity, ▵F (1, 66) = 8.46, p = 0.01. Children with greater food insecurity demonstrated a smaller magnitude of %BMIp95 decrease, representing a small-to-medium effect size within the context of the regression model (f2 = 0.13).

CONCLUSION

A high proportion of families with children receiving weight management treatment reported experiencing food insecurity in comparison with US households with children. There may be unique characteristics of food insecurity, as opposed to household income alone, that explain the smaller magnitude of BMI decrease observed early in treatment. Future research should explore complex associations among food insecurity, income, BMI, and race over time.

Association Between Temporary Employment and Gradient Health Outcomes Among Chinese Workers

Temporary workers' health problems in China have raised concerns recently. This study aimed to assess the relationship between temporary employment and three health outcomes with gradient severity and explore mediating mechanisms. Data was obtained from a national cross-sectional survey (China General Social Survey 2018). Compared with regular workers, temporary workers reported more frequent mood disorders (β = 0.197) and disturbance of daily activities (β = 0.132), however, there was no significant difference in serious health risks (inpatient treatment) between temporary and regular workers. Income poverty, subjective social status, and family relative socioeconomic status were significant mediators. The results suggest that temporary workers have higher general health risks, and economic deprivation is the main mechanism. Therefore, Chinese policymakers should provide more inclusive preventive health services beyond the existing health care system focused on critical illness to reduce the general health risks of grassroots workers.

Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study

BACKGROUND

Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms.

OBJECTIVE

The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population-African American women.

METHODS

We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load.

RESULTS

This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023.

CONCLUSIONS

We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52193.

Participation in the Georgia Food for Health programme and CVD risk factors: a longitudinal observational study

OBJECTIVE

To assess the relationship between programme attendance in a produce prescription (PRx) programme and changes in cardiovascular risk factors.

DESIGN

The Georgia Food for Health (GF4H) programme provided six monthly nutrition education sessions, six weekly cooking classes and weekly produce vouchers. Participants became programme graduates attending at least 4 of the 6 of both the weekly cooking classes and monthly education sessions. We used a longitudinal, single-arm approach to estimate the association between the number of monthly programme visits attended and changes in health indicators.

SETTING

GF4H was implemented in partnership with a large safety-net health system in Atlanta, GA.

PARTICIPANTS

Three hundred thirty-one participants living with or at-risk of chronic disease and food insecurity were recruited from primary care clinics. Over three years, 282 participants graduated from the programme.

RESULTS

After adjusting for programme site, year, participant sex, age, race and ethnicity, Supplemental Nutrition Assistance Program participation and household size, we estimated that each additional programme visit attended beyond four visits was associated with a 0·06 kg/m2 reduction in BMI (95 % CI -0·12, -0·01; P = 0·02), a 0·37 inch reduction in waist circumference (95 % CI -0·48, -0·27; P < 0·001), a 1·01 mmHg reduction in systolic blood pressure (95 % CI -1·45, -0·57; P < 0·001) and a 0·43 mmHg reduction in diastolic blood pressure (95 % CI -0·69, -0·17; P = 0·001).

CONCLUSIONS

Each additional cooking and nutrition education visit attended beyond the graduation threshold was associated with modest but significant improvements in CVD risk factors, suggesting that increased engagement in educational components of a PRx programme improves health outcomes.

Social supermarkets, nutritional implications and healthy eating: exploration of members and their views

BACKGROUND

The Covid-19 pandemic has increased the need for food support but simultaneously enabled substantial innovation in food support provision, including the evolution of social supermarkets (SSM). These allow consumers to choose from a range of low-cost products, minimise stigma and reduce food waste. Data from members of two Sussex SSM were gathered for their perspectives and experiences, as well as potential nutritional implications of the SSM.

METHODS

Questionnaires administered face-to-face during site visits and optional telephone interviews were used. Data were collected during three site visits; 111 participants completed questionnaires, and an additional 25 detailed interviews with members of the SSM were completed. All data were gathered between December 2021 and May 2022.

RESULTS

Overall, the SSMs were valued by their members. Social, economic and nutritional benefits were identified. SSM increased consumer choice and reduced stigma. Most members visited regularly, using SSM to supplement other food purchases. They valued the opportunity to choose their own foods and opportunities to socialise, in addition to the range of food and household items offered. The majority agreed that healthy eating was important but time and cost were barriers especially for younger members. SSM introduced members to novel foods and dishes, potentially diversifying dietary intakes. Challenges included restrictions on the amounts of food available, depending on the timing of visits. This was a greater challenge for those more reliant on SSM for household needs.

CONCLUSIONS

SSM represent an innovative and less stigmatising model of food support. Greater variety of food offered suggests their potential to diversify and improve dietary intakes. Challenges include ensuring stability of food supply and reducing stigma further.

Food Insecurity and Diet Quality Among Adults on Medicaid With and Without a Mental Illness Diagnosis

BACKGROUND

Adults with mental illnesses are more likely to have low income and diet-related chronic diseases.

OBJECTIVE

This study examined associations of mental illness diagnosis status with food insecurity and diet quality and whether the relationship between food security status and diet quality differed by mental illness diagnosis status in adult Medicaid beneficiaries.

DESIGN

This was a secondary cross-sectional analysis of baseline (2019-2020) data collected as part of the LiveWell study, a longitudinal study evaluating a Medicaid food and housing program.

PARTICIPANTS/SETTING

Participants were 846 adult Medicaid beneficiaries from an eastern Massachusetts health system.

MAIN OUTCOME MEASURES

Food security was measured with the 10-item US Adult Food Security survey module (0 = high food security, 1-2 = marginal food security, 3-10 = low/very low food security). Mental illness diagnoses included health record-documented anxiety, depression, or serious mental illness (eg, schizophrenia, bipolar disorder). Healthy Eating Index (HEI-2015) scores were calculated from 24-hour dietary recalls.

STATISTICAL ANALYSES

Multivariable regression analyses adjusted for demographics, income, and survey date.

RESULTS

Participants' mean (standard deviation) age was 43.1 (11.3) years, and 75% were female, 54% Hispanic, 33% non-Hispanic White, and 9% non-Hispanic Black. Fewer than half (43%) of participants reported high food security, with almost one third (32%) reporting low or very low food security. The 341 (40%) participants with one or more mental illness diagnosis had greater odds of low/very low food security (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.38-2.70) and had similar mean HEI-2015 scores (53.1 vs 56.0; P = 0.12) compared with participants with no mental illness diagnosis. Mean adjusted HEI-2015 scores did not significantly differ by high vs low/very low food security for those without a mental illness diagnosis (57.9 vs 54.9; P = 0.052) or those with a mental illness diagnosis (53.0 vs 52.9; P = 0.99).

CONCLUSION

In a cohort of adults with Medicaid, those with mental illness diagnoses had higher odds of experiencing food insecurity. Overall, diet quality among adults in this sample was low but did not differ by mental illness diagnosis or food security status. These results highlight the importance of augmenting efforts to improve both food security and diet quality among all Medicaid participants.

Cultural Influences on African Migrant Pregnant and Postnatal Women's Dietary Behaviours and Nutrition Support Needs in the UK

Black women in the UK face significantly higher risks of overweight and obesity and adverse pregnancy outcomes compared to women from other ethnic groups. Maternal nutrition plays a pivotal role in influencing the health outcomes of women and their children, especially during preconception and pregnancy. Cultural and environmental factors significantly influence the dietary experiences of African women after migration. This study explored the unique nutrition-related challenges faced by African migrant pregnant and postnatal women in the UK, and their nutrition support needs. Interviews were conducted with 23 African migrant women living in the UK, who were either pregnant or had a pregnancy within the past 3 years. These were analysed thematically, resulting in five overarching themes: food rituals and beliefs, pregnancy cravings, limited access to culturally appropriate food, limited access to culturally appropriate and evidence-based nutritional guidance, and the focus on healthy weight. The study identified challenges that African migrant women face in balancing their cultural heritage with the UK food environment and dietary recommendations, including potential implications on their health and pregnancy outcomes. It emphasised the importance of addressing these challenges through culturally sensitive approaches and tailored interventions, to enable informed decision making and enhance health outcomes for these women.

Food insecurity is associated with glycemic markers, and socioeconomic status and low-cost diets are associated with lipid metabolism in Mexican mothers

The association between socioeconomic status (SES) and chronic disease has recently become more evident in middle- and low-income countries. We hypothesized that poor socioeconomic conditions, such as food insecurity, low educational level, or low SES, may restrict access to a healthy diet and may be associated with cardiometabolic risk independently of body fat. This study examined the relation between socioeconomic indicators, body fat, and cardiometabolic disease risk markers in a random sample of mothers living in Queretaro, Mexico. Young and middle-aged mothers (n = 321) answered validated questionnaires to determine SES, food insecurity, and educational level and a semiquantitative food frequency questionnaire to determine dietary patterns and the cost of individual diet. Clinical measurements included anthropometry, blood pressure, lipids profile, glucose, and insulin. Obesity was present in 29% of the participants. Women with moderate food insecurity had higher waist circumference, glucose, insulin, and homeostasis model assessment of insulin resistance than women with food security. High triglyceride concentration and lower levels of high-density lipoprotein and low-density lipoprotein cholesterol were associated with lower SES and lower educational level. Women who consumed a lower carbohydrate diet had higher SES, higher education, and better cardiovascular risk markers. The higher carbohydrate diet profile was the least expensive diet. There was an inverse association between the cost and energy-density of foods. In conclusion, food insecurity was associated with glycemic control markers, and lower SES and education were related to a low-cost, higher carbohydrate diet and to a greater cardiovascular risk. The influence of the social environment on obesity and cardiovascular diseases needs to be further explored.

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

Determinants of Nutritional Risk among Community-Dwelling Older Adults with Social Support

BACKGROUND

It is well established that older adults are at risk for malnutrition due to several social and non-social determinants, namely physiological, psychosocial, dietary and environmental determinants. The progression to malnutrition is often insidious and undetected. Thus, nutritional assessment should consider a complex web of factors that can impact nutritional status (NS). The primary objective of this study was to assess the NS of older adults attending senior centres (SCs) and to identify its predictors.

METHODS

This cross-sectional study enrolled a sample of community-dwelling older adults in Lisbon. NS was assessed using Mini Nutritional Assessment (MNA^®). Malnutrition or malnutrition risk (recategorised into a single group) was predicted using binary logistic regression models, considering those participants classified as having a normal NS as the reference group. Data were collected through face-to-face interviews and anthropometric indices were measured according to Isak procedures.

RESULTS

A sample of 337 older adults, with an average age of 78.4 years old (range 66-99), mostly women (n = 210; 62.3%), were enrolled. Older adults at risk of malnutrition accounted for 40.7% of the sample. Being older (OR = 1.045, CI 95% [1.003-1.089], p = 0.037), having a worse perception of health status (OR = 3.395, CI 95% [1.182-9.746], p = 0.023), having or having had depression (OR = 5.138, CI 95% [2.869-9.201], p < 0.001), and not having or having had respiratory tract problems (OR = 0.477, CI 95% [0.246-0.925], p = 0.028) were independent predictors of malnutrition or malnutrition risk. An intermediate time of SC attendance was associated with a lower probability of malnutrition or risk (OR = 0.367, CI 95% [0.191-0.705], p = 0.003).

CONCLUSIONS

NS among older adults has a multifactorial aetiology, with a strongly social component and is related to health circumstances. Further research is needed to timely identify and understand nutritional risk among this population.

A conceptual framework for nutritional evaluation, screening, and monitoring of pregnant women: Evidence from a Brazilian cohort of nulliparous women

The present review comes from five previous studies of a multicenter cohort of nulliparous pregnant women from different regions of Brazil. The first study showed a wide difference in consumption of industrialized foods among women from the south and southeast regions compared with northeastern women who chose to eat a healthier diet with fresh natural food. The second investigation intended to understand maternal eating habits, where five dietary patterns were identified: two considered healthy and three with excess protein, ultra-processed foods, fats, and sweets. Considering some barriers to classifying nutrition status during prenatal care, when data on pre-pregnancy weight is unknown, the third study developed a tool to identify three levels of risk for each gestational age range, assessed by measuring arm circumference. Applying those new tools, the associations between maternal nutrition and pregnancy outcomes were investigated: prematurity, pre-eclampsia, gestational diabetes mellitus, and small-for-gestational-age infants. From these analyses, a predictive model was developed indicating that obesity, non-white color, and dietary pattern with excess protein consumption were associated with a greater probability of adverse pregnancy outcomes. Moreover, the potential of the intergenerational influence of head circumference as a proxy for maternal nutrition was analyzed. Using a Path Analysis method, the model was evidenced by different socioeconomic variables. Finally, understanding the complexity of the nutritional assessment, the present conceptual framework was proposed for nutritional assessment, and tracking and monitoring of pregnant women.

Food security and diet quality in a racially diverse cohort of postpartum women in the USA

Food insecurity has been associated with poor diet, but few studies focused on the postpartum period - an important time for women's health. We examined associations between food security and diet quality in postpartum women and assessed whether participation in federal food assistance programmes modified this potential relation. Using longitudinal data, we analysed the association between food security at 3 months postpartum and a modified Alternate Healthy Eating Index-2010 (AHEI) at 6 months postpartum (excluding alcohol). We conducted multivariable linear regressions examining associations between food security and AHEI. We assessed two food assistance programmes as potential effect modifiers. The sample included 363 postpartum women from the Nurture study, located in the Southeastern USA (2013-2017). Among women, 64·4 % were Black and 45·7 % had a high school diploma or less. We found no evidence of an interaction between food security and two federal food assistance programmes. In adjusted models, marginal, low and very low food security were not associated with AHEI. However, low (β: -0·64; 95 % CI -1·15, -0·13; P = 0·01) and very low (β: -0·57; 95 % CI -1·02, -0·13; P = 0·01) food security were associated with greater trans fat intake. Food security status was not associated with overall diet quality but was associated with higher trans fat (low and very low) and more moderate alcohol (marginal) intake. Future studies should assess the consistency and generalisability of these findings.

Nutrient density and cost of commonly consumed foods: a South African perspective

Food-based dietary guidelines promote consumption of a variety of nutritious foods for optimal health and prevention of chronic disease. However, adherence to these guidelines is challenging because of high food costs. The present study aimed to determine the nutrient density of foods relative to cost in South Africa, with the aim to identify foods within food groups with the best nutritional value per cost. A checklist of 116 food items was developed to record the type, unit, brand and cost of foods. Food prices were obtained from the websites of three national supermarkets and the average cost per 100 g edible portion was used to calculate cost per 100 kcal (418 kJ) for each food item. Nutrient content of the food items was obtained from the South African Food Composition Tables. Nutrient density was calculated using the Nutrient Rich Food (NRF9.3) Index. Nutrient density relative to cost was calculated as NRF9.3/price per 100 kcal. Vegetables and fruits had the highest NRF9.3 score and cost per 100 kcal. Overall, pulses had the highest nutritional value per cost. Fortified maizemeal porridge and bread had the best nutritional value per cost within the starchy food group. Foods with the least nutritional value per cost were fats, oils, foods high in fat and sugar, and foods and drinks high in sugar. Analysis of nutrient density and cost of foods can be used to develop tools to guide low-income consumers to make healthier food choices by identifying foods with the best nutritional value per cost.

Changes in dietary habits and eating behaviors during COVID-19 induced confinement: A study from Jordan

Objective

This study aimed to evaluate dietary habits (DH) and eating behaviors (EB) among adults during confinement induced by COVID-19 in Jordan.

Method

In this cross-sectional study, an online survey designed to assess the change in DH and EB during April and May 2020 was distributed using various social media platforms.

Results

The survey was completed by a total of 1844 adult (18-72 years) participants from the public in Jordan. The results indicated an increase (42.5-61.8%) in most of the DH and EB examined in the current study in the majority of participants. Among these changes, they have increased (p < 0.05) the prevalence of fruit and vegetable, immune boosters, water, and hot beverage consumption, as well as decreased (p < 0.05) eating in restaurants and fatty food consumption, indicating a positive change. Conversely, a larger (p < 0.05) proportion of participants reported increased consumption of high-calorie food and late-night eating, indicating a risky behavior for obesity and subsequent chronic complications. Additionally, age, sex, obesity, education, income, and type of job appeared to contribute (p < 0.05) to changes in DH and EB. Overall, confinement caused by COVID-19 appears to compel adults to adopt a specific DH and EB. Although most of these changes were positive, some were negative.

Conclusion

This study provides essential information for designing subpopulation recommendations and developmental programs for adults under such conditions.

Cannabis Use Is Inversely Associated with Overweight and Obesity in Hepatitis B Virus-Infected Patients (ANRS CO22 Hepather Cohort)

Background: Chronic hepatitis B virus (HBV) infection may evolve into cirrhosis and hepatocellular carcinoma, and this progression may be accelerated by specific risk factors, including overweight and obesity. Although evidence for a protective effect of cannabis use on elevated body weight has been found for other populations, no data are available for HBV-infected patients. Aims: We aimed to identify risk factors (including cannabis use) for overweight and obesity in patients with HBV chronic infection. Methods: Using baseline data from the French ANRS CO22 Hepather cohort, we performed two separate analyses, one using "central obesity" (based on waist circumference) and the other "overweight" and "obesity" (based on body mass index) as outcomes. Logistic and multinomial regressions were used to model central obesity and overweight/obesity, respectively. Results: Among the 3706 patients in the study population, 50.8% had central obesity, 34.7% overweight, and 14.4% obesity. After multivariable adjustment, current cannabis use was associated with a 59% lower risk of central obesity compared with no lifetime use (adjusted odds ratio [95% CI]: 0.41 [0.24 to 0.70]). It was also associated with a 54% and 84% lower risk of overweight (adjusted relative risk ratio [95% CI]: 0.46 [0.27 to 0.76]) and obesity (0.16 [0.04 to 0.67]), respectively. Conclusions: Cannabis use was associated with lower risks of overweight and obesity in patients with HBV chronic infection. Future studies should test whether these potential benefits of cannabis and cannabinoid use translate into reduced liver disease progression in this high-risk population.

The Perception of Overweight and Obesity among South African Adults: Implications for Intervention Strategies

Obesity is a public health problem, affecting more than half of the global population. Perceptions and beliefs play a significant role in preventing and managing overweight and obesity. Thus, the paper explores own perception of overweight and obesity on personal health among South African adults. This was a qualitative study in which the participants (n = 24) were interviewed in-depth on their perception of obesity and health. Thematic analysis was used in data assessment. The results revealed four main themes: perceived causes of obesity, self-perception of being obese, perception of obesity, health, and cultural beliefs. Environmental and personal factors were perceived as the leading cause of overweight and obesity. The findings further showed that body weight preference was personal and differed from individual to individual. The study provided insight into perceptions of obesity from individuals' perspectives. The misperceptions of overweight and obesity are helpful in the design of impactful intervention programmes that can be used to prevent and manage obesity in South Africa.

Sociodemographic Indicators, Household Food Security and Associations with Choline Intake in Pregnant Women: The NuEMI Study

Higher sociodemographic status is associated with adequate nutrient intake and food security. Adequate choline intake is vital during pregnancy to support fetal development. In this cross-sectional study, information was obtained from 682 pregnant women attending an ante-natal clinic in Bloemfontein, South Africa. Sociodemographic indicators that were bivariately significantly associated with a choline intake below the adequate intake level (AI) included a higher household density ratio, no access to own flush toilets at home, household not owning a refrigerator or microwave, as well as a lower level of education. Approximately one-third of participants were severely food-insecure. Logistic regression analysis, adjusted for energy intake, showed that household overcrowding increased the odds of a choline intake below the AI (OR 1.71).

Socio-economic inequalities in the consumption of fruits and vegetables in Peru between 2014 and 2019

OBJECTIVE

To estimate the prevalence and socio-economic inequalities in adequate consumption of fruits and vegetables in Peru between 2014 and 2019.

DESIGN

Analytical cross-sectional study. The outcome variable was adequate consumption of fruits and vegetables, defined as the consumption of five or more servings of fruits and vegetables per d (yes/no). We used concentration curves and Erreygers concentration index to describe socio-economic inequalities and a microeconometric approach to determine the contribution of each variable to inequality.

SETTING

Peru.

PARTICIPANTS

Data from Peruvians aged 18 years or older collected by the Demographic and Family Health Survey.

RESULTS

The prevalence of adequate fruit and vegetable consumption did not change between 2014 (10·7 %; 95 % CI (10·0, 11·4)) and 2019 (11 %; 95 % CI (10·4, 11·7)). We found socio-economic inequalities in the adequate consumption of fruits and vegetables, with wealthier individuals having a higher prevalence of adequate consumption compared to poorer individuals in 2014 (19·2 % v. 3·5 %) and 2019 (18·6 % v. 4·7 %). The decomposition analysis found that education, urban areas and being wealthy were the main factors associated with socio-economic inequality in adequate fruit and vegetable consumption, being structural problems of society.

CONCLUSION

Despite the current regulations on healthy eating in Peru, adequate consumption of fruits and vegetables remains low, and there are socio-economic inequalities between the poorest and wealthiest individuals. Our findings suggest that more efforts are needed to increase the intake and assess the disparities in adequate fruit and vegetable consumption.

Extending the Theory of Planned Behavior for Explaining Dietary Quality: The Role of Financial Scarcity and Food Insecurity Status

OBJECTIVE

To examine whether an extended Theory of Planned Behavior (TPB) that included finance-related barriers better explained dietary quality.

DESIGN

Cross-sectional survey.

PARTICIPANTS

One-thousand and thirty-three participants were included from a Dutch independent adult panel.

MAIN OUTCOME

Dietary quality.

ANALYSIS

Five TPB models were assessed: a traditional TPB, a TPB that included direct associations between attitude and subjective norm with dietary quality, a TPB that additionally included financial scarcity or food insecurity, and a TPB that additionally included financial scarcity and food insecurity simultaneously. Structural relationships among the constructs were tested to compare the explanatory power.

RESULTS

The traditional TPB showed poorest fit (χ²/degrees of freedom = 11; comparative fit index = 0.75; root mean square error of approximation [95% confidence interval], 0.10 [0.091-0.12]; standardized root mean square residual = 0.049), the most extended TPB (including both financial scarcity and food insecurity) showed best fit (χ²/degrees of freedom = 3.3; comparative fit index = 0.95; root mean square error of approximation [95% confidence interval], 0.050 [0.035-0.065]; standardized root mean square residual = 0.018). All 5 structure models explained ∼42% to 43% of the variance in intention; however, the variance in dietary quality was better explained by the extended TPB models, including food insecurity and/or financial scarcity (∼22%) compared with the traditional TBP (∼7%), indicating that these models better explained differences in dietary quality.

CONCLUSIONS AND IMPLICATIONS

These findings highlight the importance of accounting for finance-related barriers to healthy eating like financial scarcity or food insecurity to better understand individual dietary behaviors in lower socioeconomic groups.

Neighborhood Socioeconomic Disadvantage and the Neurobiology of Uncertainty in Traumatically Injured Adults

BACKGROUND

Individuals residing in more socioeconomically disadvantaged neighborhoods experience greater uncertainty through insecurity of basic needs such as food, employment, and housing, compared with more advantaged neighborhoods. Although the neurobiology of uncertainty has been less frequently examined in relation to neighborhood disadvantage, there is evidence that neighborhood disadvantage is associated with widespread neural alterations.

METHODS

Recently traumatically injured participants (n = 90) completed a picture anticipation task in the magnetic resonance imaging scanner, in which they viewed images presented in a temporally predictable or unpredictable manner. We investigated how neighborhood disadvantage (via area deprivation index [ADI]) was related to neural activation during anticipation and presentation of negative and neutral images after accounting for individual factors (i.e., age, gender, income, acute posttraumatic stress symptoms).

RESULTS

There was a significant interaction during the anticipation period such that higher ADI rankings were related to greater activation of the right anterior cingulate cortex to predictable versus unpredictable neutral stimuli. Although no other robust interactions emerged related to ADI, we note several novel simple effects of ADI during anticipation and presentation periods in the hippocampus and prefrontal, cingulate, and occipital cortices.

CONCLUSIONS

Together, these results may represent an adaptive response to predictable and/or negative stimuli, stemming from chronic exposure to socioeconomic-based uncertainties. Although effects were modest, future work should continue to examine pretrauma context on posttrauma outcomes. To better understand trauma outcomes, it is imperative that researchers consider the broader context in which trauma survivors reside.

Food insecurity, housing instability, and dietary quality among children with sickle cell disease: Assessment from a single urban center

BACKGROUND

Food insecurity and housing instability, both social determinants of health (SDoH), disproportionately affect economically unstable, under-resourced US communities in which children with sickle cell disease (SCD) live. Association between these SDoH markers and dietary quality among children with SCD is unknown.

PROCEDURES

We assessed a cross-sectional sample of dyadic parent-child patients and young adult patients up to age 21 from one pediatric SCD center. Food insecurity, housing instability, and dietary quality were measured using validated US instruments and a food frequency questionnaire. Better dietary quality was defined using US dietary guidelines. Multivariate regression assessed for associations among dietary quality and food insecurity with or without (±) housing instability and housing instability alone.

RESULTS

Of 100 enrolled participants, 53% were Black and 43% Hispanic; mean age 10.6 ± 5.6 years. Overall, 70% reported less than or equal to one economic instability: 40% housing instability alone and 30% both food insecurity and housing instability. Eighty percent received more than or equal to one federal food assistance benefit. Compared to no economic instability, food insecurity ± housing instability was significantly associated with higher intake of higher dairy and pizza, while housing instability alone was significantly associated with higher dairy intake. Food insecurity ± housing instability was significantly associated with lower intake of whole grains compared to housing instability alone.

CONCLUSIONS

Our sample reported high frequencies of both food insecurity and housing instability; having more than or equal to one SDoH was associated with elements of poorer diet quality. Screening families of children with SCD for food insecurity and housing instability may identify those with potential nutrition-related social needs.

The role of material and psychosocial resources in explaining socioeconomic inequalities in diet: A structural equation modelling approach

We examined whether material and psychosocial resources may explain socioeconomic differences in diet quality. Cross-sectional survey data from 1461 Dutch adults (42.5 (SD 13.7) years on average and 64% female) on socio-demographics, diet quality, psychosocial factors and perceptions of and objective healthiness of the food environment were used in a structural equation model to examine mediating pathways. Indicators for socioeconomic position (SEP) were income, educational, and occupational level and the 2015 Dutch Healthy Diet (DHD15) index assessed diet quality. Material resources included food expenditure, perceptions of healthy food accessibility and healthfulness of the food retail environment. Psychosocial resources were cooking skills, resilience to unhealthy food environments, insensitivity to food cues and healthy eating habits. Higher SEP was associated with better diet quality; Beducation 8.5 (95%CI 6.7; 10.3), Bincome 5.8 (95%CI 3.7; 7.8) and Boccupation 7.5 (95%CI 5.5; 9.4). Material resources did not mediate the association between SEP and diet quality and neither did the psychosocial resources insensitivity to food cues and eating habits. Cooking skills mediated between 13.3% and 19.0% and resilience to unhealthy food environments mediated between 5.9% and 8.6% of the relation between SEP and the DHD15-index. Individual-level factors such as cooking skills can only explain a small proportion of the SEP differences in diet quality. On top of other psychosocial and material resources not included in this study, it is likely that structural factors outside the individual, such as financial, work and living circumstances also play an important role.

Food insecurity and ultra-processed food consumption: the modifying role of participation in the Supplemental Nutrition Assistance Program (SNAP)

BACKGROUND

Ultra-processed foods contribute to risks of obesity and cardiometabolic disease, and higher intakes have been observed in low-income populations in the United States. Consumption of ultra-processed foods may be particularly higher among individuals experiencing food insecurity and participating in the Supplemental Nutrition Assistance Program (SNAP).

OBJECTIVES

Using data from the 2007-2016 NHANES, we examined the associations between food insecurity, SNAP participation, and ultra-processed food consumption.

METHODS

The study population comprised 9190 adults, aged 20-65 y, with incomes ≤300% of the federal poverty level (FPL). Food insecurity was assessed using the Household Food Security Survey Module and SNAP participation over the past 12 mo was self-reported. Dietary intake was measured from two 24-h dietary recalls. Ultra-processed food consumption (percentage of total energy intake) was defined using the NOVA food classification system. Linear regression models were used to examine the associations between food insecurity, SNAP participation, and ultra-processed food consumption, adjusting for sociodemographic and health characteristics.

RESULTS

More severe food insecurity was associated with higher intakes of ultra-processed foods (P-trend = 0.003). The adjusted means of ultra-processed food intake ranged from 52.6% for adults with high food security to 55.7% for adults with very low food security. SNAP participation was also associated with higher intakes of ultra-processed foods (adjusted mean: 54.7%), compared with income-eligible participants (adjusted mean: 53.0%). Furthermore, the association between food insecurity and ultra-processed foods was modified by SNAP participation (P-interaction = 0.02). Among income-eligible nonparticipants and income-ineligible nonparticipants, more severe food insecurity was associated with higher consumption of ultra-processed foods. Among SNAP participants, the association between food insecurity and consumption of ultra-processed foods was nonsignificant.

CONCLUSION

In a nationally representative sample of adults, food insecurity and SNAP participation were both associated with higher levels of ultra-processed food consumption.

Social determinants of health and obesity: Findings from a national study of US adults

OBJECTIVE

This study examined the association between social determinants of health (SDOH) burden and overweight/obesity in a nationally representative sample of adults in the United States.

METHODS

Data for 161,795 adults aged ≥18 years from the 2013 to 2017 National Health Interview Survey were used. A total of 38 SDOH were aggregated to create a cumulative SDOH score, which was divided into quartiles (Q1-Q4) to denote levels of SDOH burden. Prevalence of overweight and obesity was examined across SDOH quartiles in the total population and by age, sex, and race/ethnicity. Multinomial logistic regression models were used to analyze the association between SDOH quartiles and overweight/obesity, adjusting for relevant covariates.

RESULTS

There was a graded increase in obesity prevalence with increasing SDOH burden. At nearly each quartile, overweight and obesity rates were higher for middle-aged and non-Hispanic Black adults compared with their counterparts; additional differences were observed by sex. In fully adjusted models, SDOH-Q4 was associated with 15%, 50%, and 70% higher relative prevalence of overweight, obesity class 1 and 2, and obesity class 3, respectively, relative to SDOH-Q1.

CONCLUSIONS

Cumulative social disadvantage, denoted by higher SDOH burden, was associated with increased odds of obesity, independent of clinical and demographic factors.

Polyphenols and ω-3 PUFAs: Beneficial Outcomes to Obesity and Its Related Metabolic Diseases

Obesity is associated with the leading causes of death in the worldwide. On the other hand, the intake of vegetables, fruits and fish is related to the reduction of obesity and other metabolic syndromes. This review aims to highlight the role of ingestion of polyphenols and omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in reducing obesity and related metabolic diseases (RMDs). The consumption of vegetables, fish and by-products rich in polyphenols and α-linolenic acid (ALA), as well as oils rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are associated with a decrease in obesity and its RMDs in consumers. Furthermore, we discussed the adequate amount of extracts, powder, polyphenols, ω-3 PUFAs administrated in animal models and human subjects, and the relevant outcomes obtained. Thus, we appeal to the research institutions and departments of the Ministries of Health in each country to develop a food education joint project to help schools, businesses and families with the aim of reducing obesity and other metabolic diseases.

Association of Employees' Meal Skipping Patterns with Workplace Food Purchases, Dietary Quality, and Cardiometabolic Risk: A Secondary Analysis from the ChooseWell 365 Trial

BACKGROUND

Employed adults may skip meals due to time or financial constraints, challenging work schedules, or limited workplace food choices. Little is known about the relationship between employees' meal skipping patterns and workplace dietary choices and health.

OBJECTIVE

To examine whether hospital employees' meal skipping patterns were associated with workplace food purchases, dietary quality, and cardiometabolic risk factors (ie, obesity, hypertension, and prediabetes/diabetes).

DESIGN

This is a secondary cross-sectional analysis of baseline data from the ChooseWell 365 randomized controlled trial. Employees reported meal-skipping frequency in a baseline survey. The healthfulness of workplace food purchases was determined with a validated Healthy Purchasing Score (HPS) (range = 0 to 100 where higher scores = healthier purchases) calculated using sales data for participants' purchases in the 3 months before study enrollment. Dietary quality was measured with the 2015 Healthy Eating Index (range = 0 to 100 where higher score = healthier diet) from two 24-hour recalls. Cardiometabolic risk factors were ascertained from clinic measurements.

PARTICIPANTS/SETTING

Participants were 602 hospital employees who regularly visited workplace cafeterias and enrolled in ChooseWell 365, a workplace health promotion study in Boston, MA, during 2016-2018.

MAIN OUTCOME MEASURES

Primary outcomes were HPS, 2015 Healthy Eating Index, and cardiometabolic risk factors.

STATISTICAL ANALYSES

Regression analyses examined differences in HPS, 2015 Healthy Eating Index, and cardiometabolic variables by meal skipping frequency, adjusting for demographic characteristics.

RESULTS

Participants' mean (standard deviation) age was 43.6 (12.2) years and 478 (79%) were women. Overall, 45.8% skipped breakfast, 36.2% skipped lunch, and 24.9% skipped dinner ≥ 1 day/week. Employees who skipped breakfast ≥ 3 days/week (n = 102) had lower HPS (65.1 vs 70.4; P < 0.01) and 2015 Healthy Eating Index score (55.9 vs 62.8; P < 0.001) compared with those who never skipped. Skipping lunch ≥ 3 days/week and dinner ≥ 1 day/week were associated with significantly lower HPS compared with never skipping. Employees who worked nonstandard shifts skipped more meals than those who worked standard shifts. Meal skipping was not associated with obesity or other cardiometabolic variables.

CONCLUSIONS

Skipping meals was associated with less healthy food purchases at work, and skipping breakfast was associated with lower dietary quality. Future research to understand employees' reasons for skipping meals may inform how employers could support healthier dietary intake at work.

The association between housing and food insecurity among medically underserved cancer patients

PURPOSE

To assess the prevalence of socioeconomic needs and associations between housing characteristics and food insecurity among low-income cancer patients, among whom housing and food insecurity are particularly prevalent.

METHODS

Low-income cancer patients in active treatment (N = 1618) were enrolled in a comprehensive patient navigation program. Food insecurity was assessed using the 18-item US Department of Agriculture US Household Food Security Survey Module. Participants self-reported their need for assistance with housing issues/type of assistance needed, perception of overcrowding, satisfaction with living situation, and household density via a cross-sectional survey. Descriptive analyses, cross-tabulations and tests of proportions, and binary logistic regression were used in data analyses.

RESULTS

Seventy percent of patients were food insecure. Housing characteristics associated with food insecurity were homelessness or living in sheltered/supportive housing (83.3% food insecure), renting (71.9%), and homeownership (58.1%; p < .001); living situation satisfaction (not satisfied, 79.4%; somewhat satisfied, 25.6%; very satisfied, 66%; p < .001); need of housing assistance (79.2%; p < .001), and feeling crowded in their living unit (77.6%; p < .05). Associations of living unit type with food insecurity were significant in the binary logistic regression model (renters 1.68 OR, homeless/sheltered housing 2.80 OR vs homeowners).

CONCLUSION

The vulnerability to food insecurity of patients in this low-income sample was underlined by the high rates found, and clear associations with housing characteristics of homelessness, housing assistance needs, and feeling overcrowded were identified. These results could help shape priorities around screening patients for nutrition and housing needs and developing interventions to address them.