Correlates of dietary behavior in adults: an umbrella review

Adherence to 24-h movement guidelines and its associations with dietary behavior and mental health among university students from five ASEAN countries

OBJECTIVE

Despite growing evidence linking 24-h movement behaviors to health outcomes, there is limited research examining these relationships among university students in Southeast Asia. Therefore, the purpose of this study was to examine the prevalence and associations of adherence to 24-h movement guidelines (HMG) with dietary behaviour and mental health among university students in ASEAN.

METHODS

A multi-center cross-sectional survey was conducted in 2015 included 3223 university students from five ASEAN nations-Indonesia, Malaysia, Myanmar, Thailand, and Vietnam-aged 18 to 30 years, selected by stratified random sampling. Established measures included demographics, social support, perceived stress, self-rated health status, body mass index, six dietary behaviours, eight mental health outcomes, and adherence to 24-h movement guidelines (24-HMG) was assessed based on self-reported physical activity (≥ 150 min/week), sedentary time (≤ 480 min/day), screen time (≤ 180 min/day), and sleep duration (7-9 h). The relationship between dietary behaviours, mental health indicators and meeting the 24-HMG number was investigated using logistic regression models, adjusted for relevant confounders.

RESULTS

Among 3,223 participants, 11.7% met all three 24-h movement guidelines, while 13.1% met none, and 37.6% met either one or two guidelines. Adherence to all guidelines was higher among males, participants aged 22-30 years, and those from lower-income countries (Indonesia, Myanmar, and Vietnam). Multiple logistic regression analyses, adjusted for relevant confounders, revealed that meeting more movement guidelines was associated with: Increased odds of healthy dietary behaviors (fruit and vegetable intake: Adjusted Odds Ratio-AOR: 1.96, 95% Confidence intervals-CI: 1.35-2.83; breakfast intake: AOR: 2.48, 95% CI: 1.84-3.34; meal frequency: AOR: 1.83, 95% CI: 1.36-2.45; low soft drink intake: AOR: 2.20, 95% CI: 1.54-3.14; high sugared coffee or tea intake: AOR: 0.39, 95% CI: 0.24-0.61; low fast food intake: AOR: 1.46, 95% CI: 1.08-1.96; and low snacking: AOR: 2.71, 95% CI: 2.00-3.66), and Decreased odds of mental health issues (depressive symptoms: AOR: 0.43, 95% CI: 0.26-0.70; suicidal behaviour: AOR: 0.66, 95% CI: 0.47-0.93; pathological internet use: AOR: 0.60, 95% CI: 0.45-0.81; hazardous or harmful alcohol use: AOR: 0.44, 95% CI: 0.29-0.66; illicit drug use: AOR: 0.38, 95% CI: 0.20-0.73; and had poorer sleep quality: AOR: 0.33, 95% CI: 0.16-0.68). No significant associations were found between guideline adherence and PTSD symptoms or tobacco use (p > 0.05).

CONCLUSIONS

This is the first study to look at the prevalence, correlates, and relationships between 24-HMG adherence and dietary behaviour and mental health outcomes among university students in ASEAN. This pioneering study among ASEAN university students demonstrates that adherence to 24-h movement guidelines is associated with better dietary behaviours and mental health outcomes in a dose-response manner. Future university health policies should incorporate 24-h movement guidelines into existing health promotion strategies, particularly in resource-limited settings.

Contextual factors influence food intake at eating occasions in young adults: A mixed effect analysis

Understanding eating behaviours of young adults is crucial for developing strategies to improve their diet quality. Factors that influence eating behaviours are often multifaceted and highly contextual, with little research focused on young adults. This study examined contextual factors influencing food intake at eating occasions among young adults. Participants (n = 675, 18-30 years) recorded dietary intake and contextual characteristics at eating occasions (n = 27,513) using a smartphone food diary ("FoodNow") over three to four non-consecutive days. Food and beverage intakes were classified into six groups according to the Australian Dietary Guidelines. Eating occasion-level contextual factors, such as consumption location, purchase location, activity, and social context, were recorded via the app, while person-level contextual factors were collected through an online survey. Generalised mixed models with random intercepts were used to investigate effects of contextual factors on food group consumption at meals and snacks. Eating location was associated with vegetable and discretionary food intake; meals that were eaten while in transit were 0.59 serves lower in vegetables (95% CI: -0.93, -0.38; p < 0.001) and 0.31 serves higher in discretionary foods (95% CI: 0.03, 0.54; p = 0.014), compared meals eaten at home. Higher intakes of discretionary foods were observed when friends were present at meals and snacks (0.66 and 0.57 serves, 95% CI: 0.56, 0.88; 0.36, 0.77, p < 0.001). Meals purchased from convenience stores were higher in grain and discretionary foods than meals from other locations (p < 0.001). Majority of person-level factors showed minimal effects on food group consumption. Addressing factors such as purchase location and social contexts during meals and snacks may improve food choices, as small changes at eating occasions can significantly impact overall diet quality over time.

Barriers, facilitators, and other factors associated with health behaviors in childhood, adolescent, and young adult cancer survivors: A systematic review

BACKGROUND

Healthy behaviors are paramount in preventing long-term adverse health outcomes in childhood, adolescent, and young adult (CAYA) cancer survivors. We systematically reviewed and synthesized existing literature on barriers, facilitators, and other factors associated with health behaviors in this population.

METHODS

MEDLINE and PsycInfo were searched for qualitative and quantitative studies including survivors aged 16-50 years at study, a cancer diagnosis ≤25 years and ≥2 years post diagnosis. Health behaviors included physical activity, smoking, diet, alcohol consumption, sun exposure, and a combination of these behaviors (defined as health behaviors in general).

RESULTS

Barriers, facilitators, and other factors reported in ≥2 two studies were considered relevant. Out of 4529 studies, 27 were included (n = 31,905 participants). Physical activity was the most frequently examined behavior (n = 12 studies), followed by smoking (n = 7), diet (n = 7), alcohol (n = 4), sun exposure (n = 4), and health behavior in general (n = 4). Relevant barriers to physical activity were fatigue, lack of motivation, time constraints, and current smoking. Relevant facilitators were perceived health benefits and motivation. Influence of the social environment and poor mental health were associated with more smoking, while increased energy was associated with less smoking. No relevant barriers and facilitators were identified for diet, alcohol consumption, and sun exposure. Barriers to healthy behavior in general were unmet information needs and time constraints whereas lifestyle advice, information, and discussions with a healthcare professional facilitated healthy behavior in general. Concerning other factors, women were more likely to be physically inactive, but less likely to drink alcohol and more likely to comply with sun protection recommendations than men. Higher education was associated with more physical activity, and lower education with more smoking.

CONCLUSION

This knowledge can be used as a starting point to develop health behavior interventions, inform lifestyle coaches, and increase awareness among healthcare providers regarding which survivors are most at risk of unhealthy behaviors.

Social capital and healthy eating among two ethnic minority groups in Yunnan Province, Southwest China: the mediating role of social support and nutrition knowledge

Background

Although social capital has been linked to dietary intake particularly in disadvantaged populations, little is known about the mechanisms. This study aimed to investigate whether social support (SS) and nutrition knowledge (NK) mediate the association between social capital and healthy eating habits.

Methods

A probability sample of two ethnic minority groups in Yunnan Province, Southwest China were included (n = 1,033, mean age 47.5 ± 14.7 years). Bonding and bridging social capital (BOC and BRC) were assessed with the Personal Social Capital Scale (PSCS-16). Dietary data were evaluated with the Chinese Healthy Eating Index (CHEI), a measure of diet quality which reflects adherence to the Chinese Dietary Guidelines. NK and SS were measured with a validated questionnaire and scale, respectively. Structural Equation Modeling was used to calculate the direct, indirect and total effects of social capital on CHEI scores.

Results

The mean score of CHEI was 57.4 ± 9.8, which was significantly lower in men and older people. Low adherence to dietary guidelines were to observed in the consumption of dairy, beans, nuts, animal-source food vegetables and fruits. BOC and BRC were positively associated with CHEI score (β = 0.37 and 0.38, all p < 0.05). Social support and nutrition knowledge mediated 45.9 and 39.5% of the total effect of social capital on CHEI score, respectively.

Conclusion

Social capital appears to enhance adherence to dietary guidelines by improving nutrition knowledge and social support. Nutrition promotion programs therefore should consider incorporating strategies that foster social capital development, particularly in disadvantaged populations.

Profiles of Cultural Adaptation and Parenting Approach for Childhood Obesity in Lifestyle Interventions for Families With Young Children: A Systematic Review

BACKGROUND AND OBJECTIVES

Various interventions aim to reduce obesity and promote healthy lifestyles among different cultural groups.

METHODS

We have conducted a systematic literature review, following PRISMA guidelines (registered at https://doi.org/10.17605/OSF.IO/HB9AX), to explore profiles of cultural adaptation and parenting approach of lifestyle interventions for families with young children (1-4 years).

RESULTS

Our search (in CINAHL, ERIC, PsycINFO, PubMed, Scopus, and SSCI) yielded 41 studies reporting 31 interventions. Drawing on Intervention Mapping, we applied a newly developed framework with various indicators of cultural adaptation and a parenting approach to analyze interventions. Our review shows clear differences in the level of cultural adaptation. A categorical principal component analysis revealed 6 different empirical profiles of cultural adaptation.

CONCLUSIONS

Based on our profiles, we discuss how cultural adaptation can be strengthened in the design of future early interventions aimed at promoting a healthy lifestyle.

Achieving high diet quality at eating occasions: findings from a nationally representative study of Australian adults

This study examined differences in food groups consumed at eating occasions by the level of adherence to dietary guidelines in Australian adults (≤19 years) and whether consumption differed with respect to age, sex and education levels. Secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey (n 9054) was performed, using one 24-h dietary recall with self-reported eating occasions. Dietary Guideline Index scores were used to assess adherence to the 2013 Australian Dietary Guidelines. Mean differences (95 % CI) in servings of the five food groups and discretionary foods at eating occasions were estimated for adults with higher and lower diet quality, stratified by sex, age group and education. Using survey-based t-tests, differences of at least half a serving with P values < 0·05 were considered meaningful. Compared with adults with lower diet quality, women and men aged 19-50 years with higher diet quality consumed more serves of vegetables at dinner (mean difference (95 % CI), women; 1·0; 95 % CI (0·7, 1·2); men: 0·9; 95 % CI (0·6, 1·3)) and fewer serves of discretionary foods at snacks (women: -0·7; 95 % CI (-0·9, -0·5); men: -1·0; 95 % CI (-1·4, -0·7). Other food groups, such as grains, dairy products and alternatives, meats and alternatives, were not significantly different between adults with lower and higher diet quality, across any eating occasions and age groups. Discretionary food intake at lunch, dinner and snacks was consistently greater among adults with lower diet quality, regardless of education level. Our findings identify dinner and snacks as opportunities to increase vegetable intake and reduce discretionary food intake, respectively.

Different sedentary behavior domains present distinct associations with eating-related indicators

BACKGROUND

Unhealthful dietary patterns have been consistently associated with low levels of physical activity (PA), but studies dedicated to sedentary behavior (SB) are scarce, especially in adults. The few studies that investigated the association between SB and dietary patterns focused mostly on specific types of SB, such as TV-watching or screen time. SB can be accumulated in distinct domains (i.e., work, transport, and leisure-time), thus, it is key to investigate in depth the impact that different domains of SB can have on eating-related indicators. We aimed to investigate the associations between different SB domains and eating-related indicators, in a sample of adults.

METHODS

Cross-sectional data from students, teachers, and staff from a Portuguese University was collected in November/2021 through an anonymous online survey. Data analyses were performed using the IBM SPSS software (version 28.0) and included descriptive statistics, partial correlations, and group comparisons using one-way ANOVA. Daily average SB at work/study, transport, and in leisure-time were self-reported and eating-related indicators were measured with several items from the Mediterranean Diet Score. Specific eating-related behaviors reflecting a protective eating pattern (e.g., eating breakfast regularly), and eating behavior traits (e.g., external eating) were also assessed. Body mass index (BMI) was calculated as weight (kg)/height(m)2. The International Physical Activity Questionnaire/Short-Form was used to assess PA.

RESULTS

The sample included 301 adults (60.1% women), with a mean age of 34.5 years. Overall, leisure-time SB was inversely associated with adherence to the Mediterranean diet (r = -0.20; p < 0.001) and with a protective eating profile (r = -0.31; p < 0.001). Higher transport SB was also related to lower adherence to the Mediterranean diet (r = -0.20; p < 0.001) and to an unhealthier eating profile (r = -0.22; p < 0.001), but no associations were found for work-related SB (p > 0.05). These results persisted after the adjustment for BMI, sex, and self-reported PA. These results were impacted by the age tertile.

CONCLUSIONS

Our findings suggest that adults with higher levels of SB in leisure-time and transport domains tend to report less healthy eating-related behaviors, irrespective of BMI, sex, and PA level. However, some differences in these associations were found according to the age tertile. This information may assist public health authorities in focusing their efforts in augmenting literacy on SB, namely on how SB can be accumulated via different settings. Furthermore, public health literacy efforts need to extend besides the more known deleterious effects of SB on health (e.g., diabetes, cardiovascular disease), to also include the interplay with eating indicators. Strategies to reduce SB and unhealthy eating should be particularly focused on promoting physically active forms of commuting and reducing SB in the leisure setting.

One Health Determinants of Escherichia coli Antimicrobial Resistance in Humans in the Community: An Umbrella Review

To date, the scientific literature on health variables for Escherichia coli antimicrobial resistance (AMR) has been investigated throughout several systematic reviews, often with a focus on only one aspect of the One Health variables: human, animal, or environment. The aim of this umbrella review is to conduct a systematic synthesis of existing evidence on Escherichia coli AMR in humans in the community from a One Health perspective. PubMed, EMBASE, and CINAHL were searched on "antibiotic resistance" and "systematic review" from inception until 25 March 2022 (PROSPERO: CRD42022316431). The methodological quality was assessed, and the importance of identified variables was tabulated across all included reviews. Twenty-three reviews were included in this study, covering 860 primary studies. All reviews were of (critically) low quality. Most reviews focused on humans (20), 3 on animals, and 1 on both human and environmental variables. Antibiotic use, urinary tract infections, diabetes, and international travel were identified as the most important human variables. Poultry farms and swimming in freshwater were identified as potential sources for AMR transmission from the animal and environmental perspectives. This umbrella review highlights a gap in high-quality literature investigating the time between variable exposure, AMR testing, and animal and environmental AMR variables.

Correlates of Dietary Behaviors Among Young Emirati Males Completing Compulsory Military Service

INTRODUCTION

It is important to understand the correlates of different dietary behaviors in a military context in the United Arab Emirates (UAE) to guide intervention development to prevent and treat obesity as it has a significant impact at the country and regional level. This study aimed to assess different dietary behaviors and their association with potential correlates including age, marital status, educational level, smoking status, screen time, dietary knowledge, eating self-efficacy, and general self-efficacy.

MATERIALS AND METHODS

The study used a cross-sectional design and included 153 (M = 25.9 years, SD = ± 3.2) military recruits completing their basic training at a single military camp in the UAE. Dietary behaviors of these recruits were measured using the Arab Teens Lifestyle Study. Other potential correlates included dietary knowledge, general self-efficacy, and eating efficacy. The ethical approval was obtained from the research ethics committee in the UAE university.

RESULTS

Daily intake of fruits, vegetables, and breakfast was reported by 14.4%, 25.5%, and 22.9% of the military recruits, respectively. Almost half of the recruits (46.4%) consumed sugar-sweetened drinks more than 3 times a week, 39.2% consumed fast food more than 3 times a week, and 37.3% consumed sweets/chocolates more than 3 times a week. Bivariate regression analyses revealed that eating self-efficacy was positively associated with breakfast and dairy food consumption, although it was inversely associated with sugar, fast-food, and French fries intake. Age was significantly and inversely associated with sugar, fast-food, and energy drink intake. Moreover, nutrition knowledge was significantly and positively correlated with vegetable intake and negatively correlated with energy drink consumption. Multiple regressions showed that lower age and lower eating self-efficacy were found to be the main predictors for sugar-sweetened drinks (adjusted R2 = 0.112) and fast-food intake (adjusted R2 = 0.084). Also, a higher dietary knowledge score was a predictor of vegetable intake (adjusted R2 = 0.093), although age and smoking predict energy drink intake (adjusted R2 = 0.225).

CONCLUSIONS

The results show that unhealthy eating patterns are common among new recruits in the UAE military. The study suggests that age, eating self-efficacy, and nutrition knowledge are the main correlates of selected dietary behaviors. Interventions are advised to target these correlates to achieve healthier dietary habits inside the military.

Predictors of Food and Physical Activity Tracking Among Young Adults

BACKGROUND

Monitoring food intake and physical activity (PA) using tracking applications may support behavior change. However, few longitudinal studies identify the characteristics of young adults who track their behavior, findings that could be useful in designing tracking-related interventions. Our objective was to identify predictors of past-year food and PA tracking among young adults.

METHODS

Data were available for 676 young adults participating in the ongoing longitudinal Nicotine Dependence in Teens Study. Potential predictors were measured in 2017-2020 at age 31, and past-year food and PA tracking were measured in 2021-2022 at age 34. Each potential predictor was studied in a separate multivariable logistic regression model controlling for age, sex, and educational attainment.

RESULTS

One third (37%) of participants reported past-year PA tracking; 14% reported past-year food, and 10% reported both. Nine and 11 of 41 potential predictors were associated with food and PA tracking, respectively. Compensatory behaviors after overeating, trying to lose weight, self-report overweight, reporting a wide variety of exercise behaviors, and pressure to lose weight predicted both food and PA tracking.

CONCLUSION

Food and PA tracking are relatively common among young adults. If the associations observed herein between compensatory behavior after overeating and tracking (among other observed associations) are replicated and found to be causal, caution may need to be exercised in making "blanket" recommendations to track food intake and/or PA to all young adults seeking behavior change.

Association between adverse childhood experiences and fruit and vegetable intake among a national sample of U.S. adults

Few studies have examined the role adverse childhood experiences (ACEs) have on specific diet patterns. This study assessed the association between ACEs and daily fruit and vegetable intake (FVI). Data were derived from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) which surveys 50 states and three U.S. territories. Participants who completed the ACEs module were included in the analyses (N = 106,967). Total ACEs included the summed responses from the domains of abuse, household challenges, and neglect. FVI was reported by number of times consumed per day. The two fruit items included fruit (fresh, frozen, and canned) and fruit juice. The four vegetable items included leafy greens, fried potatoes, non-fried potatoes, and other vegetables. All fruit and vegetable items were analyzed separately to see which specific items drove the relationship between total ACEs and total FVI, equaling a total of 8 regression models. Every model controlled for poor mental health days, sex, age, ethnicity, income, body mass index, and physical activity. Total ACEs were positively associated with daily intake of fried potatoes (β = 0.008, p =.025), other potatoes (β = 0.008, p =.049), and other vegetables (β = 0.024, p <.001). Total ACEs were negatively associated with daily intake of fruit (β = -0.016, p <.001). ACEs had non-significant relationships with leafy greens and fruit juice. Findings suggests that those with increased ACEs scores report increased consumption of fried potatoes, non-fried potatoes, and other vegetables, and less of fruit. Findings highlight the need for understanding food context and preparation when analyzing the relationship between ACEs and diet intake.

Risk and safety profile of electronic nicotine delivery systems (ENDS): an umbrella review to inform ENDS health communication strategies

OBJECTIVES

This umbrella review aims to summarise the evidence about electronic nicotine delivery systems' (ENDS) risk and safety health profile to inform ENDS health communication strategies.

DATA SOURCES AND STUDY SELECTION

Six databases were searched for systematic reviews presenting evidence on ENDS-related health effects. Ninety reviews divided into five categories were included: toxicity=20, health effects=40, role in smoking cessation=24, role in transition to combustible cigarettes (CCs)=13 and industry marketing claims=4.

DATA EXTRACTION

Findings were synthesised in narrative summaries. Meta-analyses were conducted by study type when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine's Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limited-suggestive and limited-not-conclusive.

DATA SYNTHESIS

We found high-level evidence that ENDS exposes users to toxic substances; increases the risk of respiratory disease; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CC initiation; and exposure to ENDS marketing increases its use/intention to use. Evidence was moderate for ENDS association with mental health and substance use, limited-suggestive for cardiovascular, and limited-not-conclusive for cancer, ear, ocular and oral diseases, and pregnancy outcomes.

CONCLUSIONS

As evidence is accumulating, ENDS communication can focus on high-level evidence on ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning) and anti-ENDS industry sentiment. Direct comparison between the harm of CCs and ENDS should be avoided.

PROSPERO REGISTRATION NUMBER

CRD42021241630.

Exploring the effects of added sugar labels on food purchasing behaviour in Australian parents: An online randomised controlled trial

Background

Evidence of the effects of front-of-pack added sugar labelling remains limited, especially for foods other than sugary drinks. More information is needed about which labels are likely to be most effective in reducing intended purchases of products with higher added sugar content in realistic contexts to inform policymakers’ decisions.

Objective

To determine the impact of added sugar labels on intended purchases of high sugar breakfast cereals, yoghurt, and non-alcoholic beverages.

Methods

Australian parents who were regular purchasers of relevant product categories completed an online parallel randomised controlled trial from 31 August 2020 to 13 February 2021. Participants selected their intended purchase from 10 products in each of packaged beverages, breakfast cereal, and yoghurt categories after randomisation to one of seven added sugar labelling conditions in current use or under consideration by the Australian Government. Logistic regressions assessed differences between intervention and control conditions in the odds of intended purchases of a high sugar product.

Results

2825 eligible participants were randomised with 2582 valid surveys analysed (Control n = 367; ‘Nutrition Information Panel (NIP) with Added Sugar’ n = 364; ‘Teaspoons of Sugar’ n = 369; ‘Warning’ n = 371; ‘Health Star Rating (HSR) using Total Sugar’ n = 368; ‘HSR with Added Sugar’ n = 371; ‘Sugar in the Ingredients List’ n = 372). No consistent effects were found on intended purchases of high sugar products overall or within product categories for any of the tested labels compared to controls (overall, ‘NIP with Added Sugar’: OR 1.00 [95%CI 0.83,1.20]; ‘Teaspoons of Sugar’: 0.94[0.80,1.11]; ‘Warning’: 1.10[0.93,1.30]; ‘HSR with Total Sugar’: 1.01[0.85,1.21]; ‘HSR with Added Sugar’: 1.09[0.92,1.30]; ‘Sugar in the Ingredients List’: 1.01[0.85,1.21]).

Conclusions

Findings reinforce the importance of ensuring nutrition labelling policies are introduced as part of a suite of interventions to influence both consumer and manufacturer behaviour.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12620000858998. Registered 28 August 2020, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000858998.

Prenatal exposure to ambient air pollution and adverse birth outcomes: An umbrella review of 36 systematic reviews and meta-analyses

Multiple systematic reviews and meta-analyses linked prenatal exposure to ambient air pollutants to adverse birth outcomes with mixed findings, including results indicating positive, negative, and null associations across the pregnancy periods. The objective of this study was to systematically summarise systematic reviews and meta-analyses on air pollutants and birth outcomes to assess the overall epidemiological evidence. Systematic reviews with/without meta-analyses on the association between air pollutants (NO2, CO, O3, SO2, PM2.5, and PM10) and birth outcomes (preterm birth; stillbirth; spontaneous abortion; birth weight; low birth weight, LBW; small-for-gestational-age) up to March 30, 2022 were included. We searched PubMed, CINAHL, Scopus, Medline, Embase, and the Web of Science Core Collection, systematic reviews repositories, grey literature databases, internet search engines, and references of included studies. The consistency in the directions of the effect estimates was classified as more consistent positive or negative, less consistent positive or negative, unclear, and consistently null. Next, the confidence in the direction was rated as either convincing, probable, limited-suggestive, or limited non-conclusive evidence. Final synthesis included 36 systematic reviews (21 with and 15 without meta-analyses) that contained 295 distinct primary studies. PM2.5 showed more consistent positive associations than other pollutants. The positive exposure-outcome associations based on the entire pregnancy period were more consistent than trimester-specific exposure averages. For whole pregnancy exposure, a more consistent positive association was found for PM2.5 and birth weight reductions, particulate matter and spontaneous abortion, and SO2 and LBW. Other exposure-outcome associations mostly showed less consistent positive associations and few unclear directions of associations. Almost all associations showed probable evidence. The available evidence indicates plausible causal effects of criteria air pollutants on birth outcomes. To strengthen the evidence, more high-quality studies are required, particularly from understudied settings, such as low-and-middle-income countries. However, the current evidence may warrant the adoption of the precautionary principle.

Evolving Food Choices Among the Urban Indian Middle-Class: A Qualitative Study

One of the leading risk factors for an escalating obesity burden in India is non-nutritious choices. Underpinned by the nutrition transition theory, this qualitative inquiry was designed to understand the urban middle-class Indian consumers’ views about processed foods and rapidly changing food choices. The study consisted of two phases, the first phase consisted of focus group discussions pertaining to the definition and conception of processed foods and the second phase consisted of interviews regarding the changing food environment. A convenience sample of Indian consumers aged 40–65 years were recruited from Mumbai and Kochi to participate in focus group discussions (FGD1 – nine participants and FGD2 – seven participants) and semi-structured face-to-face interviews (N = 22). Both discussions and interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the transcribed data. Features of processed foods mentioned were chemical and physical processing, prolonged shelf life and poor nutritional quality. Factors influencing food choices and consumption of processed foods reported by participants could be categorized into changes in the socio-cultural environment and changes in the food environment. Changes in the socio-cultural environment included globalization and urbanization, long work days and sedentary living, rise in income levels and decrease in household cooking. Changes in the food environment included increased availability and accessibility of processed foods, replacement of traditional Indian diet with Western food, food as indicators of status, food advertisements and convenience. These results are consistent with nutrition transition theory and provide useful direction for public health policies aimed at promoting healthy diets.

Neighborhood environment is associated with unhealthy food intake in a Brazilian urban area

Unhealthy food intake is one of the main risk factors for morbidity and mortality for non-communicable diseases (NCDs), and is associated with multiple factors, including the neighborhood environment. The present study aimed to examine the association between the neighborhood context and unhealthy food intake in adults. This is a cross-sectional study, carried out in Belo Horizonte, Brazil. This study used the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), which was georeferenced and linked to a database with information on the physical and social realities of a neighborhood context. The administrative boundary of the basic health units (ABBHU) was used as a neighborhood unit. Unhealthy food intake was assessed by the regular consumption of meat with excess fat, soft drinks, and red meat, as well as the irregular consumption of fruits and vegetables. To characterize the physical and social realities of a neighborhood, this study used georeferenced data of establishments selling foods, population density, homicide rates, health vulnerability Index, and total income. For data analysis, multilevel logistic regression was used. The sample consisted of 5783 adults. It was observed that younger, males, people with a lower-level education, who were inactive during leisure time, who had abusive alcohol consumption, and who were current smokers, were associated with a greater chance of having an unhealthy food intake. After adjusting for individual characteristics, it was observed that living in ABBHU, with a low mean income and an extremely high vulnerability, increases the individual's chances of having an unhealthy food intake. An unhealthy food intake is partially explained by demographic characteristics and socioeconomic conditions in the neighborhood. The present study can contribute to improving the understanding of the importance of the urban environment in food choices.

Perspectives of health practitioners and adults who regained weight on predictors of relapse in weight loss maintenance behaviors: a concept mapping study

Background

Preventing people from relapsing into unhealthy habits requires insight into predictors of relapse in weight loss maintenance behaviors. We aimed to explore predictors of relapse in physical activity and dietary behavior from the perspectives of health practitioners and persons who regained weight, and identify new predictors of relapse beyond existing knowledge.

Methods

We used concept mapping to collect data, by organizing eight concept mapping sessions among health practitioners (N=39, five groups) and persons who regained weight (N=21, three groups). At the start of each session, we collected participants’ ideas on potential predictors. Subsequently, participants individually sorted these ideas by relatedness and rated them on importance. We created concept maps using principal component analysis and cluster analysis.

Results

43 predictors were identified, of which the majority belonged to the individual domain rather than the environmental domain. Although the majority of predictors were mentioned by both stakeholder groups, both groups had different opinions regarding their importance. Also, some predictors were mentioned by only one of the two stakeholder groups. Practitioners indicated change in daily structure, stress, maladaptive coping skills, habitual behavior, and lack of self-efficacy regarding weight loss maintenance as most important recurrent (mentioned in all groups) predictors. Persons who regained weight indicated lifestyle imbalance or experiencing a life event, lack of perseverance, negative emotional state, abstinence violation effect, decrease in motivation and indulgence as most important recurrent predictors.

Conclusions

For several predictors associations with relapse were shown in prior research; additionally, some new predictors were identified that have not been directly associated with relapse in weight loss maintenance behaviors. Our finding that both groups differed in opinion regarding the importance of predictors or identified different predictors, may provide an opportunity to enhance lifestyle coaching by creating more awareness of these possible discrepancies and including both points of view during coaching.

Predictors of lapse and relapse in physical activity and dietary behaviour: a systematic search and review on prospective studies

OBJECTIVE

Behaviour change maintenance seems to be difficult for many people. To prevent people from relapsing, insight into determinants of relapse is needed. We synthesized the evidence on predictors of lapse and relapse in physical activity and dietary behaviour change.

DESIGN

Prospective studies in adults aged ≥18 years were identified from systematic searches in PsycINFO, PubMed and Cinahl. Methodological quality was analysed, and data were synthesized narratively.

MAIN OUTCOME MEASURES

Lapse and relapse in physical activity and dietary behaviour.

RESULTS

37 articles were included. For several predictors, evidence for an association was found, with self-efficacy as the only consistent predictor across the different outcomes, predicting both lapse and relapse in physical activity, and relapse in dietary behaviour. For most other variables, evidence for prospective relationships with lapse and relapse was insufficient.

CONCLUSION

Most predictors on lapse and relapse were not examined frequently enough to draw conclusions from; many predictors were studied only once or had inconclusive evidence. To be able to provide more substantiated conclusions, more high-quality research is needed. Practitioners and intervention programs could focus on sustainability of behaviour change, by targeting the outcome of interest and its relevant predictors by using behaviour change techniques that have proven effective.

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews

OBJECTIVE

The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance.

INTRODUCTION

A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking.

INCLUSION CRITERIA

Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included.

METHODS

We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence.

RESULTS

We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management.

CONCLUSIONS

Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018084665.

Mis-reporting of energy intake among older Australian adults: Prevalence, characteristics, and associations with quality of life

OBJECTIVES

Mis-reporting is common in dietary assessment, leading to misinterpretation of disease risk and could be important in older adults with increased chronic disease risk. This study investigated the prevalence and characteristics of mis-reporting among older adults and its association with health outcomes including quality of life (QoL).

METHODS

The study was conducted in 335 community-dwelling older adults at increased risk for cardiovascular disease, participating in the SCReening Evaluation of the Evolution of New Heart Failure Study dietary substudy. Diet was assessed using 4-day weighed food diaries, QoL measured through Short Form 36, and physical activity assessed using the European Prospective Investigation into Cancer and Nutrition physical activity questionnaire. Dietary mis-reporting was defined based on Goldberg cutoffs, using individual physical activity levels. Odds ratios were determined to establish associations between mis-reporting and health outcomes.

RESULTS

The prevalence of mis-reporting among older adults was 49.3%, with 44.5% of women mis-reporting their energy intake. The study found under-reporting of energy to be associated with body mass index, specifically being overweight (odds ratio: 3.08; 95% confidence interval [CI], 1.54-6.15) and obese (odds ratio: 6.60; 95% CI, 3.05-4.26), as well as physical inactivity (odds ratio: 0.24; 95% CI, 0.14-0.43). Only physical inactivity predicted over-reporting of dietary intake (odds ratio: 7.52; 95% CI, 1.57-36.0).

CONCLUSIONS

Dietary under-reporting was associated with being overweight, obese, and physically inactive in addition to the absence of comorbidities, reinforcing the need for further research in older adults to factor in dietary mis-reporting for meaningful diet-disease relationship analyses.

Associations between the built environment and obesity: an umbrella review

BACKGROUND

In the past two decades, the built environment emerged as a conceptually important determinant of obesity. As a result, an abundance of studies aiming to link environmental characteristics to weight-related outcomes have been published, and multiple reviews have attempted to summarise these studies under different scopes and domains. We set out to summarise the accumulated evidence across domains by conducting a review of systematic reviews on associations between any aspect of the built environment and overweight or obesity.

METHODS

Seven databases were searched for eligible publications from the year 2000 onwards. We included systematic literature reviews, meta-analyses and pooled analyses of observational studies in the form of cross-sectional, case-control, longitudinal cohort, ecological, descriptive, intervention studies and natural experiments. We assessed risk of bias and summarised results structured by built environmental themes such as food environment, physical activity environment, urban-rural disparity, socioeconomic status and air pollution.

RESULTS

From 1850 initial hits, 32 systematic reviews were included, most of which reported equivocal evidence for associations. For food- and physical activity environments, associations were generally very small or absent, although some characteristics within these domains were consistently associated with weight status such as fast-food exposure, urbanisation, land use mix and urban sprawl. Risks of bias were predominantly high.

CONCLUSIONS

Thus far, while most studies have not been able to confirm the assumed influence of built environments on weight, there is evidence for some obesogenic environmental characteristics. Registration: This umbrella review was registered on PROSPERO under ID CRD42019135857.

Effects of carbohydrate restriction on postprandial glucose metabolism, -cell function, gut hormone secretion, and satiety in patients with Type 2 diabetes

Dietary carbohydrate restriction may improve the phenotype of Type 2 diabetes (T2D) patients. We aimed to investigate 6 wk of carbohydrate restriction on postprandial glucose metabolism, pancreatic α- and β-cell function, gut hormone secretion, and satiety in T2D patients. Methods In a crossover design, 28 T2D patients (mean HbA_1c: 60 mmol/mol) were randomized to 6 wk of carbohydrate-reduced high-protein (CRHP) diet and 6 wk of conventional diabetes (CD) diet (energy-percentage carbohydrate/protein/fat: 30/30/40 vs. 50/17/33). Twenty-four-hour continuous glucose monitoring (CGM) and mixed-meal tests were undertaken and fasting intact proinsulin (IP), 32,33 split proinsulin concentrations (SP), and postprandial insulin secretion rates (ISR), insulinogenic index (IGI), β-cell sensitivity to glucose (B_up), glucagon, and gut hormones were measured. Gastric emptying was evaluated by postprandial paracetamol concentrations and satiety by visual analog scale ratings. A CRHP diet reduced postprandial glucose area under curve (net AUC) by 60% (P < 0.001), 24 h glucose by 13% (P < 0.001), fasting IP and SP concentrations (both absolute and relative to C-peptide, P < 0.05), and postprandial ISR (24%, P = 0.015), while IGI and B_up improved by 31% and 45% (both P < 0.001). The CRHP diet increased postprandial glucagon net AUC by 235% (P < 0.001), subjective satiety by 18% (P = 0.03), delayed gastric emptying by 15 min (P < 0.001), decreased gastric inhibitory polypeptide net AUC by 29% (P < 0.001), but had no significant effect on glucagon-like-peptide-1, total peptide YY, and cholecystokinin responses. A CRHP diet reduced glucose excursions and improved β-cell function, including proinsulin processing, and increased subjective satiety in patients with T2D.

The health-related determinants of eating pattern of high school athletes in Goiás, Brazil

Background

Athletes put their health at short- and long-term risk and a detailed investigation of health outcomes is important because it should allow the development of more specific interventions. This study aimed to evaluate the health-related determinants of eating pattern of high school athletes.

Methods

The study enrolled 248 Brazilian athletes aged 14–20 years. Eating pattern outcomes included skipping breakfast, vegetable and fruit consumption, and sweets consumption. The following factors were considered as independent variables: sociodemographic, economic, anthropometry, body weight control, psychosocial, sedentary behavior, sleeping time, meals, alcohol and smoking, and strength variables. Data were analyzed using Poisson regression model and the effect measure was the prevalence ratio (PR).

Results

The results showed that 45.6% of the athletes skipped breakfast, 29.8% ate sweets regularly, and only 8.9% consumed vegetables and fruit regularly. Multiple analysis revealed the following positive associations: breakfast skipping and vomiting or using laxatives to lose weight (PR, 1.12; 95% CI, 1.01–1.26); low fruit and vegetable consumption and using pills to lose weight (PR, 1.05; 95% CI, 1.02–1.07); high sweets consumption and female athletes (PR, 1.32; 95% CI, 1.12–1.55); high sweets consumption and more than 2 h spent watching TV (PR, 1.19; 95% CI, 1.02–1.39).

Conclusions

Our findings indicated that sociodemographic, body weight control and sedentary factors are determinants on eating patterns of high school athletes.

Ambient Air Pollution, Extreme Temperatures and Birth Outcomes: A Protocol for an Umbrella Review, Systematic Review and Meta-Analysis

Prenatal exposure to ambient air pollution and extreme temperatures are among the major risk factors of adverse birth outcomes and with potential long-term effects during the life course. Although low- and middle-income countries (LMICs) are most vulnerable, there is limited synthesis of evidence in such settings. This document describes a protocol for both an umbrella review (Systematic Review 1) and a focused systematic review and meta-analysis of studies from LMICs (Systematic Review 2). We will search from start date of each database to present, six major academic databases (PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid and Web of Science Core Collection), systematic reviews repositories and references of eligible studies. Additional searches in grey literature will also be conducted. Eligibility criteria include studies of pregnant women exposed to ambient air pollutants and/or extreme temperatures during pregnancy with and without adverse birth outcomes. The umbrella review (Systematic Review 1) will include only previous systematic reviews while Systematic Review 2 will include quantitative observational studies in LMICs. Searches will be restricted to English language using comprehensive search terms to consecutively screen the titles, abstracts and full-texts to select eligible studies. Two independent authors will conduct the study screening and selection, risk of bias assessment and data extraction using JBI SUMARI web-based software. Narrative and semi-quantitative syntheses will be employed for the Systematic Review 1. For Systematic Review 2, we will perform meta-analysis with two alternative meta-analytical methods (quality effect and inverse variance heterogeneity) as well as the classic random effect model. If meta-analysis is infeasible, narrative synthesis will be presented. Confidence in cumulative evidence and the strength of the evidence will be assessed. This protocol is registered with PROSPERO (CRD42020200387).

[A joint study of the multidimensional factors associated with the overall quality of adult diets in Canada]

BACKGROUND

With 26% of Canadians suffering from obesity, significant steps are needed to reduce the social and economic costs entailed by their condition. Given its major contribution to this phenomenon, the quality of diet has been at the heart of numerous previous studies. The objective of the study is to analyze, based on recent data, the association between the quality of the diet of Canadian adults (18 years old and over), and their individual characteristics as well as those of their living environment, including several new elements (prices of fruits and vegetables, food security status).

METHODS

Using data from the 2015 CCHS-Nutrition Survey and information from the 2007 Canadian Food Guide, a diet quality score (also called healthy eating index) was first calculated and then associated with different factors (identified in a literature review) through multiple linear regressions.

RESULTS

In addition to confirming its association with age, gender, overall well-being and other socio-economic factors, this study reveals that quality of adult diets is negatively correlated with the evolution of people's food insecurity status and the increase of vegetable prices in the Canadian provinces since 2002. The positive link between diabetes and the quality of diet could reflect healthier eating behaviors due to the constraints generated by this disease. While city dwellers generally have access to a more diversified food supply, they nevertheless do not have a better diet than the rural population. Finally, non-North American immigrants appear to have a better diet than non-autochthonous Canadians.

CONCLUSION

Paying more attention to food insecurity and to the affordability of vegetables are avenues to explore in view of improving the quality of nourishment in Canada. In any event, longitudinal studies shall be required to confirm the role and to measure the actual influence of these variables on the quality of individual adult diets.

Eating occasion situational factors and sugar-sweetened beverage consumption in young adults

Background

Young adulthood represents an influential transitional period marked by poor dietary habits and excess weight gain. Sugar-sweetened beverages (SSB) are a major source of excess caloric intake among young adults, yet little is known about the correlates of SSB consumption. This study examines the individual and situational correlates of SSB consumption, using real-time assessment of Australian young adults’ eating occasions.

Methods

Dietary, sociodemographic and health behaviour data were collected during the Measuring EAting in Everyday Life (MEALS) study (n = 675 adults, 18–30 y). Participants reported all foods and beverages consumed over 3–4 non-consecutive days using a real-time Smartphone food diary application (“FoodNow”). For every eating occasion, food and beverage intake was recorded along with situational characteristics (eating location, purchase location, presence of others and activities while eating). A beverage occasion was defined as any eating occasion where a beverage was consumed and a SSB occasion was defined as any eating occasion where a SSB was consumed. Multilevel logistic regression was used to examine individual and situational characteristics with SSB intake at beverage occasions (i.e. factors associated with choosing a SSB over other non-alcoholic beverages) and to examine factors associated with consuming a SSB at any occasion where food and/or beverages were consumed.

Results

Thirty-five percent of participants consumed SSBs during the recording period (n = 237). Of the 2185 beverage eating occasions reported by SSB consumers, 481 (20%) contained a SSB. SSB were rarely consumed on their own (i.e. other foods were present). Having a lower than tertiary education (odds ratio [95% confidence interval]: 1.53 [1.16, 2.01]; p < 0.01); eating in a café/restaurant, compared to at home (3.02 [1.58, 5.78]; p < 0.001), and purchasing beverages from a convenience outlet, compared to a supermarket/grocery store (4.58 [2.85, 7.38]; p < 0.001) were associated with SSB intake at beverage eating occasions. Similar associations were also found when all food and/or beverage eating occasions were examined.

Conclusion

In this study, SSB were often consumed with other foods and intake was associated with individual and situational factors. Further studies are needed to confirm these findings and explore how SSB are consumed in relation to their accompanying foods.

Factors influencing dietary behaviours in urban food environments in Africa: a systematic mapping review

Objective:

To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research.

Design:

We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical and macro.

Setting:

Urban food environments in Africa.

Participants:

Studies involving adolescents and adults (11–70 years, male/female).

Results:

Thirty-nine studies were included (six adolescent, fifteen adolescent/adult combined and eighteen adult). Quantitative methods were most common (twenty-eight quantitative, nine qualitative and two mixed methods). Studies were from fifteen African countries. Seventy-seven factors influencing dietary behaviours were identified, with two-thirds at the individual level (45/77). Factors in the social (11/77), physical (12/77) and macro (9/77) environments were investigated less. Individual-level factors that specifically emerged for adolescents included self-esteem, body satisfaction, dieting, spoken language, school attendance, gender, body composition, pubertal development, BMI and fat mass. Studies involving adolescents investigated social environment-level factors more, for example, sharing food with friends. The physical food environment was more commonly explored in adults, for example, convenience/availability of food. Macro-level factors associated with dietary behaviours were food/drink advertising, religion and food prices. Factors associated with dietary behaviour were broadly similar for men and women.

Conclusions:

The dominance of studies exploring individual-level factors suggests a need for research to explore how social, physical and macro-level environments drive dietary behaviours of adolescents and adults in urban Africa. More studies are needed for adolescents and men, and studies widening the geographical scope to encompass all African countries.

The Effectiveness of the Good Affordable Food Intervention for Adults with Low Socioeconomic Status and Small Incomes

Good Affordable Food (GAF) is a small-group nutrition education intervention for adults with low socioeconomic status and small incomes. It aims to empower participants to save money on groceries and consume healthier diets. This paper reports the short-term and longer-term effects on behavioural determinants and self-reported behavioural changes. A quasi-experimental control group design was applied with a baseline measurement, a post-test immediately after the intervention, and a follow-up measurement after six months. The study included 237 participants (intervention group: n = 131; control group: n = 106) at baseline, 197 at post-test, and 152 at follow-up. Data were collected by telephone, mostly using closed interview questions. Positive short-term and longer-term effects were found for attitude towards the costs of healthy foods, food label use, and the use of liquid butter or oil to prepare hot meals. Short-term intervention effects related to knowledge towards saving money on groceries, self-efficacy towards healthy eating, portion size awareness, and mindful eating. GAF was effective in changing some determinants and behaviours related to cost and food consumption, however, mostly in the short term. Thereby, it is an example of combining pricing and health information in nutrition education that developers of effective nutrition education for low-income groups can build on.

Mothers' food choices and consumption of ultra-processed foods in the Brazilian Amazon: A grounded theory study

In recent decades, an increase in consumption of ultra-processed foods (UPF), a type of product frequently associated with diet-related obesity, chronic diseases, decrease of eating traditions and loss of culinary diversity, has been observed in middle-income countries. However, there is lack of information on factors related to choosing UPF. In this study, we aimed to understand the factors promoting UPF choices and consumption among mothers living in an urban context in the Brazilian Amazon, and to present a conceptual model grounded on their experiences that illustrates the dynamics between the observed factors. For this qualitative study, we used a constructive grounded theory approach, with a theoretical sampling of 40 women, to choose mothers with high and low consumption of ultra-processed foods. Data production and the first steps of analysis were performed concomitantly, followed by four steps of coding focused on creating conceptual categories and explaining the interactions between them. Our findings highlighted the importance of context in promoting UPF choice and consumption, particularly the "food environment", physical and virtual, and the "sociocultural environment". These contextual aspects interacted with the two main personal aspects influencing participants' UPF consumption, one concerning practices, "cooking behaviors", and the other concerning preferences, "food tastes". Factors such as economic and time constraints were also important and competed to shape eating practices through interactions with participants' health valorization. Findings are discussed in relation to food choice theories, social roles and the food environment. Implications for public health initiatives include the importance of considering environmental changes, sociocultural and economic influences, the reliance on UPF, and the role of women in the home, when promoting healthy diets.

Impact of nutritional knowledge on dietary behaviors of students in Kuwait University

Increasing nutritional knowledge is an important component of broader societal efforts to address the high prevalence of nutrition-related diseases. In Kuwait, university students are a critical target group since many of their lifestyle behaviors are shaped during college and may continue throughout their life. The aim of this study was to explore the effects of nutritional knowledge on the dietary behavior of 700 undergraduate students of Kuwait University. Nutritional knowledge and dietary behavior of Kuwait University undergraduate students were evaluated using paper-based questionnaires to assess lifestyle and nutrition behavioral changes. Students who experienced better dietary habits had better nutritional knowledge. However, the strength of the association was considered weak (r=0.229). The findings suggest that nutritional knowledge can slightly assist in adopting healthier eating habits, which may reduce nutrition-related diseases. Therefore, nutrition education programs and nutritional activities in classes should be recommended among students to promote healthy lifestyles.

Associations among eating behaviour traits, diet quality and food labelling: a mediation model

OBJECTIVE

To assess the associations among eating behaviour traits, food label use and diet quality and to evaluate if the association between eating behaviour traits and diet quality is mediated by food label use.

DESIGN

Eating behaviour traits were assessed using the Three-Factor Eating Questionnaire (TFEQ), the Restraint Scale and the Intuitive Eating Scale, whereas food label use was measured with the Label Reading Survey. Diet quality (Canadian Healthy Eating Index) was assessed with an FFQ.

SETTING

Cross-sectional study.

PARTICIPANTS

Adults (n 385; mean (sd): BMI = 26·0 (4·9) kg/m2, age = 41·1 (15·0) years) involved in two previous experimental studies.

RESULTS

When controlling for potential covariates, general food label use (β = 1·18 (se 0·26), P < 0·0001) was the main determinant of diet quality, explaining 6·7 % of its variance. General food label use partly mediated the association between TFEQ-cognitive restraint and diet quality; the indirect effect (βindirect (se); 95 % CI) was stronger in men (0·32 (0·10); 0·15, 0·55) than women (0·16 (0·05); 0·08, 0·27). General food label use also partly mediated the negative association between unconditional permission to eat and diet quality; the indirect effect (βindirect (se); 95 % CI) was also stronger in men (-1·88 (0·55); -3·11, -0·96) than women (-1·03 (0·33); -1·81, -0·49).

CONCLUSIONS

General food label use was the main determinant of diet quality and partly mediated the association between eating behaviour traits and diet quality. The stronger mediating effect observed in men suggests they rely more on food labelling when attempting to restrained themselves, which translates into better diet quality.

Nutritional Qualities of Commercial Meal Kit Subscription Services in Australia

People are cooking at home less often and relying more on food prepared outside of the home, which is often of less nutritional value than home-cooked meals. The foodservice industry has endeavored to address barriers with the introduction of commercial meal kit subscription services (MKSSs). We aimed to assess and compare the nutritional qualities of MKSSs available in Australia. Average nutritional qualities per serve of 12 recipes (from four weekly boxes of three meals serving two people) were analyzed from five MKKSs (Dinnerly, HelloFresh™, MarleySpoon™, Pepper Leaf, Thomas Farms Kitchen). On average, MKSSs provided adequate serves of core foods, particularly of vegetables (2.3 ± 1.6-3.1 ± 1.8 serves per serve). Energy content ranged between 2891 ± 539 and 3904 kJ ± 890 per serve. All MKKSs were high in fat (39.5 ± 9.5-59.6 ± 11.2% of energy) and sodium (723 ± 404-1426 ± 688 mg per serve). All MKSSs met suggested dietary target level of dietary fiber for women, but none for men. If MKSS providers can modify recipes to reduce added salt and fat and increase dietary fiber, they have the potential to provide both men and women with nutritious meals that more closely align with the dietary guidelines for the prevention of chronic disease, especially if meals are used as an alternative to energy-dense nutrient-poor takeaway and convenience foods.

How and why does discretionary food consumption change when we promote fruit and vegetables? Results from the ShopSmart randomised controlled trial

OBJECTIVE

The present study aimed to identify whether discretionary food consumption declined in an intervention focused primarily on promoting fruit and vegetable consumption. We also aimed to identify potential mediators explaining intervention effects on discretionary food consumption.

DESIGN

Secondary analysis of data from the ShopSmart study, a randomised controlled trial involving a 6-month intervention promoting fruit and vegetable consumption. Linear regression models examined intervention effects on discretionary food consumption at intervention completion (T2). A half-longitudinal mediator analyses was performed to examine the potential mediating effect of personal and environmental factors on the association between the intervention effects and discretionary food consumption. Indirect (mediated) effects were tested by the product of coefficients method with bootstrapped se using Andrew Hayes' PROCESS macro for SPSS.

SETTING

Women were recruited via the Coles FlyBuys loyalty card database in socio-economically disadvantaged suburbs of Melbourne, Australia.

PARTICIPANTS

Analyses included 225 women (116 intervention and 109 control).

RESULTS

Compared with controls, intervention participants consumed fewer discretionary foods at T2, after adjusting for key confounders (B = -0·194, 95 % CI -0·378, -0·010 servings/d; P = 0·039). While some mediators were associated with the outcome (taste, outcome expectancies, self-efficacy, time constraints), there was no evidence that they mediated intervention effects.

CONCLUSIONS

The study demonstrated that a behavioural intervention promoting fruit and vegetable consumption among socio-economically disadvantaged participants was effective in reducing discretionary food intake. Although specific mediators were not identified, researchers should continue searching for mechanisms by which interventions have an effect to guide future programme design.

Examining the Associations of Smoking Behavior and Obesity Among Older Adults in China: Should We Consider Food Consumption Behaviors?

Objective: This research investigates the associations between smoking frequency and body mass index (BMI) among older adults in China with and without the inclusion of food consumption behaviors. Method: Applying three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014), with 12,312 observations from 4,104 participants, gender-stratified panel ordered logistic regressions were performed. Food consumption included intake frequency and types of fruits, vegetables, staple food, cooking oil, and meat. Results: Among male older adults, more frequent smoking behavior was associated with lower BMI with the inclusion of food consumption behaviors. However, more frequent smoking behavior was not associated with BMI among female participants with the inclusion of food consumption behaviors. Former smoking status was not associated with BMI in all models. Discussion: The findings suggest the need of food consumption behaviors when researchers study the associations between smoking frequency and obesity. Gender gaps also should be considered.

Overweight and obesity among adults in the Gulf States: A systematic literature review of correlates of weight, weight-related behaviours, and interventions

Obesity has increased to an epidemic level in the Gulf States. This systematic review is the first to explore the scientific evidence on correlates and interventions for overweight (body mass index [BMI] ≥ 25) or weight-related behaviours in the region. A systematic search of peer-reviewed articles was conducted using PubMed and PsycINFO. Ninety-one studies were eligible for this review including 84 correlate studies and seven intervention studies. Correlate studies of overweight focused on sociodemographic factors, physical activity, and dietary habits. Low physical activity, sedentary behaviour, and unhealthy dietary habits were associated with overweight. The most-reported sociodemographic correlates of overweight were increased age, being married, low education, urban residence, and unemployment. Correlate studies of physical activity and dietary behaviours mostly focused on sociodemographic variables. Being female and increased age (the latter less consistently) were associated with low physical activity. Interventions were very heterogeneous with respect to the target group, intensity, and behavioural strategies used. The effectiveness of interventions was difficult to evaluate because of the chosen study design or outcome measure, the small sample size, or high attrition rate. Few studies have investigated sociocognitive and environmental determinants of weight-related behaviours. Such information is crucial to developing health promotion initiatives that target those weight-related behaviours.

Delivering in-school interventions to improve dietary behaviours amongst 11- to 16-year-olds: A systematic review

Childhood obesity is a global health concern, which has both short- and long-term health consequences for the individual, and is a potential burden on health care services and the wider economy. The school environment is a setting where changes can be applied to dietary behaviours, as schools have direct and intensive contact with children. This systematic review evaluated school-based interventions designed to improve dietary behaviours among adolescents (11- to 16-year-olds). The aims were to review types of interventions delivered, dietary behaviours targeted, and interventions' effectiveness in improving dietary behaviour and associated intervention components. Twenty-nine school-based interventional studies with this population were identified for review. The data were synthesized by identifying and comparing individual studies' results, intervention components, and characteristics. Interventions appeared more effective when they involved peers, used educational media to deliver health messages, increased availability of healthy foods in school, and incorporated computer-based individualized feedback with normative information on eating behaviours. A limitation of the review was the lack of description in certain reviewed studies and the nonfeasibility of conducting a meta-analysis owing to study heterogeneity. Future interventions with this population could consider including the aforementioned components, gender-specific feedback, and both short- and long-term follow-ups as change may not be apparent immediately and to determine if changes are sustained.

'I've worked so hard, I deserve a snack in the worksite cafeteria': A focus group study

This study obtained insight in motivation regarding food choices of Dutch employees, especially when visiting the worksite cafeteria. We also aimed to know why employees visit the worksite cafeteria. These insights are useful for intervention development to encourage healthier purchases in worksite cafeterias. We conducted seven focus groups among 45 employees of seven Dutch companies. The topics were 1) drivers and motives for food selection; 2) motives for visiting the worksite cafeteria; 3) motives for food selection in the worksite cafeteria; 4) perceptions of healthiness of products in the worksite cafeteria and 5) solutions brought up by the employees to encourage healthier eating. Thematic analyses were conducted with MAXQDA software. Qualitative analyses revealed that this group of Dutch employees mentioned 'healthiness', 'price' and 'taste' as most important drivers food selection. These employees generally visit the worksite cafeteria to have a break from their work setting. Healthiness played a less important role in visiting or making food choices in the worksite cafeteria. Reasons for buying unhealthy food items were being tempted and the feeling to 'deserve' it. In order to choose healthier foods employees suggested a bigger offer of healthy food options, providing knowledge, changing prices and prominent placing of healthy foods. This focus group study shows that drivers for food selection can differ from motives for visiting the worksite cafeteria and when choosing food there. Health is important for food choice in general, but less important in the worksite cafeteria. The results of this study could be used in the development of strategies that aim to change people's food choice behavior.

A Process Evaluation of a Multi-Component Intervention in Dutch Dietetic Treatment to Improve Portion Control Behavior and Decrease Body Mass Index in Overweight and Obese Patients

The SMARTsize intervention embeds an evidence-based portion control intervention in regular dietetic care. This intervention was evaluated to explore (1) which patients participated, (2) the implementation process, and (3) the outcomes of the intervention. The intervention was evaluated with an observational study design including measures at baseline, and three, six, and nine months after the start of the program. Data concerning the process (participation, dose delivered, dose received, satisfaction) and the outcomes (self-efficacy, intention, portion control strategies, and Body Mass Index (BMI) were collected with forms and questionnaires filled out by dietitians and patients. Descriptive analyses, comparison analyses, and cluster analyses were performed. Patients were mainly obese, moderately to highly educated women of Dutch ethnicity. Use of the intervention components varied from 50% to 100% and satisfaction with the SMARTsize intervention was sufficient to good (grades 7.2⁻8.0). Statistically significant (p < 0.001) improvements were observed for self-efficacy (+0.5), portion control strategies (+0.7), and BMI (-2.2 kg/m²), with no significant differences between patients with or without counselling. Three clusters of patients with different levels of success were identified. To conclude, implementing an evidence-based portion control intervention in real-life dietetic practice is feasible and likely to result in weight loss.

Exploring the relationship between perceived barriers to healthy eating and dietary behaviours in European adults

PURPOSE

Dietary behaviours may be influenced by perceptions of barriers to healthy eating. Using data from a large cross-European study (N = 5900), we explored associations between various perceived barriers to healthy eating and dietary behaviours among adults from urban regions in five European countries and examined whether associations differed across regions and socio-demographic backgrounds.

METHODS

Frequency of consumption of fruit, vegetables, fish, fast food, sugar-sweetened beverages, sweets, breakfast and home-cooked meals were split by the median into higher and lower consumption. We tested associations between barriers (irregular working hours; giving up preferred foods; busy lifestyle; lack of willpower; price of healthy food; taste preferences of family and friends; lack of healthy options and unappealing foods) and dietary variables using multilevel logistic regression models. We explored whether associations differed by age, sex, education, urban region, weight status, household composition or employment.

RESULTS

Respondents who perceived any barrier were less likely to report higher consumption of healthier foods and more likely to report higher consumption of fast food. 'Lack of willpower', 'time constraints' and 'taste preferences' were most consistently associated with consumption. For example, those perceiving lack of willpower ate less fruit [odds ratio (OR) 0.57; 95% confidence interval (CI) 0.50-0.64], and those with a busy lifestyle ate less vegetables (OR 0.54; 95% CI 0.47-0.62). Many associations differed in size, but not in direction, by region, sex, age and household composition.

CONCLUSION

Perceived 'lack of willpower', 'time constraints' and 'taste preferences' were barriers most strongly related to dietary behaviours, but the association between various barriers and lower intake of fruit and vegetables was somewhat more pronounced among younger participants and women.

Augmented Reality Applied in Dietary Monitoring

Recent advances in augmented reality (AR) have attracted much attention in nutrition and healthcare education. In the context of obtaining dietary knowledge, a mobile AR system was developed for learning and exploration, which allowed students to scan food images, receive information about nutrient content and record as well as accumulate daily nutrient intake. Students could also access learning materials provided in the system to achieve the learning objectives. Their learning outcomes were gathered at the close, with reactions to the learning experiences also assessed via a set of questionnaire items (using a 5 point Likert scale) in various criteria. Both qualitative and quantitative data were gathered, showing that most students achieved the learning objectives and were positive about exploring with AR. The results of this study indicated that students with high levels of monitoring had better learning outcomes (p<0.05) and were more positive about the varied criteria in their responses, including: visual interest and learning enjoyment, functional use, personal relevance and learning of knowledge (p<0.05). The effect of the self-participatory aspect of AR on learning is emphasized.

Socio-economic determinants of physical activity across the life course: A "DEterminants of DIet and Physical ACtivity" (DEDIPAC) umbrella literature review

Background

To date, the scientific literature on socioeconomic correlates and determinants of physical activity behaviours has been dispersed throughout a number of systematic reviews, often focusing on one factor (e.g. education or parental income) in one specific age group (e.g. pre-school children or adults). The aim of this umbrella review is to provide a comprehensive and systematic overview of the scientific literature from previously conducted research by summarising and synthesising the importance and strength of the evidence related to socioeconomic correlates and determinants of PA behaviours across the life course.

Methods

Medline, Embase, ISI Web of Science, Scopus and SPORTDiscus were searched for systematic literature reviews and meta-analyses of observational studies investigating the association between socioeconomic determinants of PA and PA itself (from January 2004 to September 2017). Data extraction evaluated the importance of determinants, strength of evidence, and methodological quality of the selected papers. The full protocol is available from PROSPERO (PROSPERO2014:CRD42015010616).

Results

Nineteen reviews were included. Moderate methodological quality emerged. For adults, convincing evidence supports a relationship between PA and socioeconomic status (SES), especially in relation to leisure time (positive relationship) and occupational PA (negative relationship). Conversely, no association between PA and SES or parental SES was found for pre-school, school-aged children and adolescents.

Conclusions

Available evidence on the socioeconomic determinants of PA behaviour across the life course is probable (shows fairly consistent associations) at best. While some evidence is available for adults, less was available for youth. This is mainly due to a limited quantity of primary studies, weak research designs and lack of accuracy in the PA and SES assessment methods employed. Further PA domain specific studies using longitudinal design and clear measures of SES and PA assessment are required.

Healthy Eating and Leisure-Time Activity: Cross-Sectional Analysis of that Role of Work Environments in the U.S

OBJECTIVE

The aim of this study was to evaluate relationships between work context and two health behaviors, healthy eating and leisure-time physical activity (LTPA), in U.S. adults.

METHODS

Using data from the 2010 National Health Interview Survey (NHIS) and Occupational Information Network (N = 14,863), we estimated a regression model to predict the marginal and joint probabilities of healthy eating and adhering to recommended exercise guidelines.

RESULTS

Decision-making freedom was positively related to healthy eating and both behaviors jointly. Higher physical load was associated with a lower marginal probability of LTPA, healthy eating, and both behaviors jointly. Smoke and vapor exposures were negatively related to healthy eating and both behaviors. Chemical exposure was positively related to LTPA and both behaviors. Characteristics associated with marginal probabilities were not always predictive of joint outcomes.

CONCLUSION

On the basis of nationwide occupation-specific evidence, workplace characteristics are important for healthy eating and LTPA.

Factors influencing self-management in adults with diabetes: an umbrella review protocol

REVIEW OBJECTIVES

The aim of this umbrella review is to identify and describe factors influencing diabetes self-management (DSM) in adults with diabetes. More specifically, we will address DSM-related factors and their relationships, considering both qualitative and quantitative components of available literature.The review question for the qualitative component of the umbrella review is:The review questions for the quantitative component of the umbrella review are:An additional question will be applied to both the qualitative and quantitative components of the overview.

Comparison of food recommendations varying in sustainability: Impact on dietary intake and motivation to follow recommendations

Food recommendations increasingly focus on sustainability in addition to nutritional value. By providing participants with standard versus sustainable (plant-based) dietary recommendations for 3 weeks, the present research tested the impact of recommendations on dietary compliance. Furthermore, predictors of food intake were tested across food categories. Participants in the sustainable diet condition complied less with recommendations as compared to those in the standard diet condition and were less motivated to continue complying after the intervention. Taste was the main predictor of intake across food categories. Together, this stresses the importance of considering factors stimulating consumers' compliance when formulating food recommendations.

Determinants of eating patterns and nutrient intake among adolescent athletes: a systematic review

Background

This review aims to update the influences of sport modalities, sport performance, and non-exercise-related determinant, on eating patterns and nutrient intake outcomes among adolescent competitive athletes.

Methods

The PubMed and Scopus databases were searched for the last 20 years. Observational and intervention studies of all languages on eating patterns and nutrient intake in adolescent (10- to 19-year-old) competitive athletes were included. Study quality and risk of bias were assessed using a Downs and Black instrument. Moreover, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) evidence system was used to assess the strength of the body of evidence.

Results

Regarding outcomes of 21 included articles, 95.2% of studies focused on nutrient analysis, whereas few of the included articles reported eating patterns. As determinants, most studies analyzed the influences of sport-related (n = 10) and demographic factors (n = 8), among which only sport modalities were significantly associated with nutrient intake. Age and sex were not significantly associated with nutrient intake. All studies were observational, and most were cross-sectional (n = 17) and conducted in developed countries such as the United States and European nations. Most studies evaluated boys, and the sport that received the most attention was soccer.

Conclusions

Athletes do not adjust their nutrient intake or food choice to the demands of the training load or different training sessions, while sport modalities significantly influenced nutrient intake. Moreover, results concerning demographic determinants were inconsistent and thus remain inconclusive.

Trial registration

Prospero CRD42016043310.

Electronic supplementary material

The online version of this article (doi:10.1186/s12937-017-0267-0) contains supplementary material, which is available to authorized users.

Using Temporal Self-Regulation Theory to understand healthy and unhealthy eating intentions and behaviour

OBJECTIVES

The present research investigated whether Temporal Self-Regulation Theory (TST) can be used to help understand healthy and unhealthy eating intentions and behaviour.

DESIGN

A prospective design with two waves of data collection one week apart.

METHOD

An online survey measured the key components of TST (i.e., connectedness, timing and valence beliefs, intentions, past behaviour, habit strength, perceived environmental cues, and self-control) with respect to eating fruit and vegetables (F&V; N = 133) or unhealthy snacks (N = 125). Eating behaviour was assessed one week later.

RESULTS

The components of TST explained significant amounts of the variance in intentions and behaviour for intake of F&Vs (22% and 64%, respectively) and unhealthy snacks (18% and 35%, respectively). Beliefs about positive and negative short-term outcomes significantly predicted intentions to perform both behaviours. Intentions and past behaviour significantly predicted consumption of F&Vs, and past behaviour moderated the relationship between intention and behaviour which became stronger as past behaviour increased. Past behaviour and habit strength significantly predicted unhealthy snacking.

CONCLUSIONS

The findings suggest that TST may be a useful framework for understanding eating intentions and behaviour. However, research did not find support for all of the hypothesised relationships (e.g., self-regulatory capacity did not significantly predict eating behaviour and also failed to moderate the relationships between intentions and behaviour). Research using alternative measures of self-regulatory capacity, along with experimental manipulations of TST variables, may be needed to further understand eating intentions and behaviour.

The DONE framework: Creation, evaluation, and updating of an interdisciplinary, dynamic framework 2.0 of determinants of nutrition and eating

The question of which factors drive human eating and nutrition is a key issue in many branches of science. We describe the creation, evaluation, and updating of an interdisciplinary, interactive, and evolving “framework 2.0” of Determinants Of Nutrition and Eating (DONE). The DONE framework was created by an interdisciplinary workgroup in a multiphase, multimethod process. Modifiability, relationship strength, and population-level effect of the determinants were rated to identify areas of priority for research and interventions. External experts positively evaluated the usefulness, comprehensiveness, and quality of the DONE framework. An approach to continue updating the framework with the help of experts was piloted. The DONE framework can be freely accessed (http://uni-konstanz.de/DONE) and used in a highly flexible manner: determinants can be sorted, filtered and visualized for both very specific research questions as well as more general queries. The dynamic nature of the framework allows it to evolve as experts can continually add new determinants and ratings. We anticipate this framework will be useful for research prioritization and intervention development.