Identifying leading anti-inflammatory dietary determinants of depression and loneliness in older adults

Objectives

The study aims to explore the association between anti-inflammatory dietary variables and prevalence of depression and loneliness in older adults.

Design

A cross-sectional secondary data analysis was performed using data from the English Longitudinal Study of Ageing (ELSA), targeting adults aged 50 and over.

Method

Data from wave 9 of ELSA were utilised. Binary logistic regression was employed to estimate the Odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between participants' intake of fruits, vegetables, fish, nuts and seeds, legumes, and wholegrains, and the prevalence of depression and loneliness. Two sets of regressions were conducted: the first set examined each dietary component individually, while the second considered all variables simultaneously. Both models were tested with and without adjusting for covariates, including age, gender, ethnicity, self-rated weight, marital status, education, socio-economic status, and activity-limiting long-standing illnesses.

Results

Of 4254 participants included in the analysis, 355 participants (8 %) had depression, and 623 (15 %) reported experiencing loneliness. An association was observed between higher intakes of fruits and lower prevalence of depression (OR = 0.89, 95 % CI: 0.79-1.00, p = 0.05), and between higher intakes of vegetables and lower prevalence of loneliness (OR = 0.91, 95 % CI: 0.83-1.00, p = 0.05). However, these associations lost statistical significance after adjustment for confounders. Similarly, the second model, which included all anti-inflammatory dietary variables, failed to show a significant association with depression and loneliness.

Conclusions

The study does not support the hypothesis that anti-inflammatory variables are associated with prevalence of depression and loneliness in older adults.

Addressing nutritional issues and eating behaviours among university students: a narrative review

University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.

Determinants of life satisfaction in older adults with diabetes in China: a national cross-sectional study

Background

The life satisfaction (LS) of individuals among older adults with diabetes should not be neglected. However, current research provides limited insight into the LS of older adults with diabetes in China. Therefore, the primary objective of this study is to assess the current life satisfaction status of older adults with diabetes in China, to delve into the factors influencing it, and to identify the key factors.

Methods

This study selected 1,304 patients with diabetes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database for analysis. A multivariate logistic regression model was used to analyze the factors influencing life satisfaction among diabetic patients, and a random forest model was further utilized to rank the importance of significant influencing factors.

Results

30.14% of older adults with diabetes were dissatisfied with their lives. Multivariate Logistic regression analysis shows that self-assessed health status, self-assessed economic status, depressive symptoms, exercise, living arrangements, hearing impairment, and cognitive impairment all significantly affect the life satisfaction of older adults with diabetics. The OR values for self-assessed health and self-assessed economic status are relatively high, patients with fair and poor self-assessed health was 5.03 times and 9.72 times higher risk of life dissatisfaction compared to those with good self-assessed health (fair: OR = 5.03, 95% CI: 3.46-7.31; poor: OR = 9.72, 95% CI: 6.20-15.26). The risk of feeling dissatisfied with life was 7.69 times higher in patients with poor self-assessed economic status than in those with good self-assessed economic status (OR = 7.69, 95%CI: 4.25-13.89). The random forest results showed that the order of importance from highest to lowest was self-assessed health status, self-assessed economic status, depressive symptoms, exercise, living arrangements, hearing impairment, and cognitive impairment.

Conclusion

Our study reveals that the current rate of life satisfaction among older adults with diabetes is significantly high. Therefore, it is essential to implement measures from multiple perspectives for effective prevention and intervention. Among these factors, priority should be given to interventions focusing on economic support and health management, as these measures may serve as crucial protective factors in enhancing the well-being of older adults with diabetes.

Dietary status and the relationship between dietary competencies, cooking skills, and nutrition quotient of middle-aged adults living alone in Korea

BACKGROUND/OBJECTIVES

Living alone has a bearing on unhealthy lifestyle choices, such as skipping meals, unbalanced diets, smoking, and drinking, raising concerns about health problems. This study aimed to examine the dietary habits, competencies, and cooking skills of adults living alone and their relationship with the nutritional quotient (NQ).

SUBJECTS/METHODS

We conducted an online survey spanning April 20-26, 2023 that was administered to 500 adults aged 35-64 yrs who were living alone in Korea. The questionnaire included questions regarding general information, eating habits, cooking environment, dietary competencies, cooking skills, and NQ. The results were stratified according to sex and age.

RESULTS

Middle-aged adults who were living alone responded that the main reason they skipped meals when eating alone was "because meal preparation is a hassle." Middle-aged adults living alone consumed fewer vegetables, fruits, and milk than the recommended levels. The dietary competencies of the participants were 3.14 out of 5.0, and their cooking skills were 3.77 out of 5.0. Female had significantly higher scores for most items than male (P < 0.05). In addition, after adjusting for confounding factors, the odds of a high NQ score in the group with high dietary competencies was 3.75 (95% confidence interval [CI], 2.15-6.55; P for trend < 0.001), and the odds of a high NQ score for participants with higher cooking skills were 3.99 (95% CI, 2.27-7.02).

CONCLUSION

These findings provide fundamental data for developing tailored nutrition education programs for adults aged 35-64 yrs living alone, considering age and sex differences.

Partnership and marriage and risk of type 2 diabetes: a narrative review

In this review, we discuss how partnership and marriage influence cardiometabolic risk factors and risk of type 2 diabetes, and how couple-based approaches to type 2 diabetes prevention might complement individual-focused prevention efforts. There is some evidence that being married per se has a small positive effect on type 2 diabetes risk. Moreover, there is spousal concordance for many type 2 diabetes risk factors due to assortative mating and convergence during partnership, with weak to moderate correlations found for anthropometric measures, blood pressure, lipid concentrations, smoking, alcohol consumption and physical activity level. A meta-analysis shows that people have a higher risk of type 2 diabetes if their spouse has diabetes (OR 1.72, 95% CI 1.47, 2.02). However, despite some evidence, there is still a lack of research on similar associations in relation to progression to type 2 diabetes and diabetes complications. Several studies have suggested that behaviour changes, for example smoking cessation or weight loss, in one partner increase the likelihood that the other partner will make the same changes. Subsequent studies of couple-based interventions that focus on both partners have shown that people are more likely to adhere to a diabetes prevention programme if their partners are also involved in the programme. However, the effect of the quality of marriage on the outcome of an intervention is still unclear. Couple-based interventions are promising, but there is a lack of RCTs comparing couple-based interventions with individual-centred interventions.

Predictors for Emergency Admission Among Homeless Metastatic Cancer Patients and Association of Social Determinants of Health with Negative Health Outcomes

BACKGROUND/OBJECTIVES

Social determinants of health (SDOHs) are especially impactful with respect to emergency reliance among patients with cancer.

METHODS

To better predict the extent to which SDOHs affect emergency admissions in homeless patients with metastatic disease, we employed machine learning models, Lasso, ridge, random forest (RF), and elastic net (EN) regression. We also examined prostate cancer (PC), breast cancer (BC), lung (LC) cancer, and cancers of the lip, oral cavity, and pharynx (CLOP) for association between key SDOH variables-homelessness and living alone-and clinical outcomes. For this, we utilized generalized linear models to assess the association while controlling for patient and clinical characteristics. We used the United States National Inpatient Sample database for this study.

RESULTS

There were 2635 (weighted) metastatic cancer patients with homelessness. Transfer from another facility or not, elective admission or not, deficiency anemia, alcohol dependence, weekend admission or not, and blood loss anemia were the important predictors of emergency admission. C-statistics were associated with Lasso (train AUC-0.85; test AUC-0.86), ridge (85, 88), RF (0.96, 0.85), and EN (0.83, 0.80), respectively. In the adjusted analysis, PC homelessness was significantly associated with anxiety and depression (5.15, 95% CI: 3.17-8.35) and a longer LOS (1.96; 95% CI: 1.03-3.74). Findings were comparable in the BC, LC, and CLOP cohorts. Cancer patients with poor SDOHs presented with the worst clinical outcomes.

CONCLUSIONS

Cancer patients with poor SDOH presented with worst clinical outcomes. The findings of this study highlight a vacuum in the cancer literature, and the recommendations stress the value of social support in achieving a better prognosis and Quality of life.

Lifestyle, Environmental, Occupational, and Dietary Risk Factors in Small-Cell vs. Non-Small-Cell Advanced Lung Cancer Patients: Is There a Connection?

OBJECTIVES

(i) To evaluate the possible exposure of newly diagnosed lung cancer patients to selected lifestyle, environmental, occupational, and dietary risk factors and (ii) to assess the differences in exposures of small-cell (SCLC) and non-small-cell (NSCLC) lung cancer patients to those risk factors.

METHODS

In this study, 205 newly diagnosed patients with IIIB/IV stage of either SCLC or NSCLC (111 men vs. 94 women) from Vojvodina, Serbia, were surveyed for selected demographic characteristics, dietary and lifestyle habits, and environmental factors.

RESULTS

Most patients were long-term heavy smokers. The body mass index values of SCLC patients were higher than those of NSCLC patients. Women reported higher stress levels compared to men. Women diagnosed with lung adenocarcinoma were more often exposed to traffic pollution compared to men. Individual indoor coal combustion systems were more often used by SCLC patients of both sexes compared to other cancer types. Men were more frequent consumers of canned foods, which are potential sources of endocrine disruptors. Occupational exposure to lung cancer risk factors, in addition to tobacco smoking, may be crucial in lung cancer development with specific occupations.

CONCLUSIONS

Further research on environmental and occupational risk factors for lung cancer is urgent in order to unveil the etiopathogenesis of specific lung cancer types.

The Association of Oral Processing Factors and Nutrient Intake in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

CONTEXT

Oral health and food oral-processing issues emerge with functional decline in the older adult population, potentially increasing the risk of malnutrition. Impairment of oral health is associated with poorer nutrition status; however, the relationship between oral factors and the intake of each nutrient remains poorly understood.

OBJECTIVE

The associations between different oral factors and nutrient intakes among community-dwelling older adults were investigated.

DATA SOURCES

A literature search from 5 databases (Web of Science, Scopus, Cochrane Library, Ovid [MEDLINE and Embase], and CINAHL) was completed on February 1, 2022. The search was limited to peer-reviewed articles published between the years 2012 and 2022.

DATA EXTRACTION

Six cross-sectional studies were included in the meta-analysis. Two authors independently completed the data extraction and summarized the study characteristics, factors adjusted for in the statistical analysis, the outcome, and summary statistics of the results.

DATA ANALYSIS

Meta-analyses showed evidence of a significant association between compromised oral factors (namely, denture status, chewing ability, and the number of teeth) with lower energy (weighted mean difference [WMD], -107 kcal d-1 (95% CI, -132 to -81), protein (WMD, -5.2 g d-1; 95% CI, -6.6 to -3.8), fat (WMD, -4.6 g d-1; 95% CI, -6.7 to -2.6), carbohydrate (WMD, -8.8 g d-1; 95% CI, -13.9 to -3.7), and vitamin C intakes (WMD, -12.9 mg d-1; 95% CI, -16.6 to -9.2) in older adults.

CONCLUSION

Oral health can be an indicator of compromised daily energy, protein, fat, carbohydrate, and vitamin C intakes in older adults. However, the small sample size of the studies included in this review and the heterogeneity among macronutrient studies should be considered. Because of the lack of studies covering all aspects of food oral processing (eg, salivary flow rate, tongue pressure), the associations between oral processing and nutrient intake were not thoroughly explored.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022308823.

Nutrition literacy and its relationship with diet quality and quality of life among white-collar employees: a study from Türkiye

BACKGROUND

Nutrition literacy is an important component of health and healthy eating behaviors. The aim of this study was to determine the nutrition literacy (NL) status of white-collar employees and its relationship with adherence to the Mediterranean diet, anthropometric measurements, and lifestyle behaviors, including eating habits, dietary intake, and physical activity level.

METHODS

This cross-sectional study was conducted with 3459 white-collar employees aged 18-65 who lived in Türkiye. A questionnaire prepared by the researchers was used to obtain information about the demographic characteristics and anthropometric measurements of the participants. Evaluation Instrument of Nutrition Literacy on Adults (EINLA) was used to assess NL, the Mediterranean Diet Adherence Screener (MEDAS) was used to assess diet quality, and the Quality of Life Test Short Form-36 (SF-36) was used to determine quality of life. Data analysis was conducted using the IBM SPSS Statistics 21.0 program.

RESULTS

With an average age of 24.3 ± 10.5 years and 50.7% women, women presented higher nutrition literacy than men did (p < 0.001). Most participants held university or postgraduate degrees with medium to high income levels and the majority demonstrated sufficient NL. Compared with other participants, those with adequate NL had significantly higher Mediterranean diet adherence, and SF-36 physical (77.27 ± 16.26), and mental (65.45 ± 17.00) scores (p < 0.001). Negative correlations were found between the EINLA score and BMI (r=-0.082), waist circumference (r=-0.072), hip circumference (r=-0.036), waist/hip ratio (r=-0.074), and waist/height ratio (r=-0.056) (p < 0.05). Additionally, weak positive correlations were observed between the EINLA score and the SF-36 physical (r = 0.158) and mental scores (r = 0.088), as well as the metabolic equivalent of task (MET) score (r = 0.042) (p < 0.05).

CONCLUSIONS

The results of this study demonstrated that NL is a significant predictor of anthropometric measurements and healthy lifestyle behaviors including dietary habits, and quality of life among adults. Nutrition literacy can enable individuals to make informed choices and thus contribute to the prevention of many noncommunicable chronic diseases.

Exploring the multiple dimensions of perceived food access in the local food environment in Flanders: Perceptions of adults in socioeconomically disadvantaged situations

Persons in socioeconomically disadvantaged situations are more susceptible and disproportionally exposed to unhealthy food environments, which results in limited access to healthy foods and poorer dietary outcomes. This qualitative paper examines the various dimensions of perceived food access to healthy and unhealthy foods (i.e., availability, affordability, accessibility, accommodation, desirability, convenience and acceptability) within the local food environment among persons in socioeconomically disadvantaged situations. A total of 23 participants in socioeconomically disadvantaged situations expressed their perceptions of food access within their local food environment and its role in their eating behaviour through participant-driven photo-elicitation in a focus group context (n = 7) and researcher-driven photo-elicitation interviews (n = 16). Reflexive thematic analysis has been used to analyse our data through an access framework. Four overarching themes were constructed. The first two themes concern barriers to perceived food access in respectively the home and community food environment - including the importance of kitchen infrastructure, household composition and transport options. The third theme encompasses the interaction of perceived food access with the sociocultural environment, highlighting its dual role as facilitator (e.g., through food sharing practices) and barrier (e.g., through social stigma and shame). The fourth theme concerns awareness and the ability to navigate within the information food environment, which has also been proposed as a novel dimension of food access. This study emphasizes the complexity of food access and the need for a multifaceted approach that integrates perceptions to ensure equitable access to healthy foods.

Hazardous alcohol use is associated with food insecurity in adults living alone: Findings from a nationwide study in Korea

Food insecurity has emerged as a major public health issue. This cross-sectional study explored the association between hazardous alcohol use and food insecurity and how this association varies according to household composition. A nationally representative sample of 31,971 adults from the two separate wave of the Korea National Health and Nutrition Examination Surveys was analyzed. Hazardous alcohol use was measured using the four-item version of the Alcohol Use Disorders Identification Test (AUDIT-4). The outcome variable was food insecurity, as measured using the 18-item Household Food Security Survey. Household composition was classified into three categories: single-person households (individuals living alone), multi-person households without children, and multi-person households with children. Logistic regression was employed to evaluate the association between a 1-standard deviation (SD) increase in AUDIT-4 scores and food insecurity, estimating the odds ratio (OR) and the corresponding 95% confidence interval (CI). Among the participants, 9.4% lived alone, 55.8% lived within multi-person households without children, and 34.8% lived within multi-person households with children. While hazardous alcohol use showed no clear association with food insecurity in the overall sample (OR: 1.01; 95% CI: 0.94-1.08), there was positive interaction between the AUDIT-4 and living alone an on the odds of experiencing food insecurity (P < 0.001). Hazardous alcohol use and a 1-SD increase in AUDIT-4 score were associated with 1.52-fold (95% CI: 1.13-2.05) and 1.22-fold (95% CI: 1.06-1.40) increases in the odds of food insecurity among those living alone. Additionally, consuming ≥10 drinks on a single occasion (OR: 1.93, 95% CI: 1.14-3.26) and experience of concerns by others about drinking (OR: 2.02, 95% CI: 1.28-3.19) were positively associated with food insecurity among those living alone. Hazardous alcohol use is associated with food insecurity, only among individuals living alone. Therefore, targeted policy efforts are necessary to mitigate hazardous alcohol use and food insecurity.

All-cause and cause-specific mortality risks in individuals with diabetes living alone: A large-scale population-based cohort study

AIMS

The rise in one-person households is a global trend. We aimed to investigate mortality risk in individuals with diabetes living alone (IDLA) using a large-scale population-based database.

METHODS

A total of 2,447,557 adults with type 2 diabetes were identified from the Korean National Health Information Database. One-person households were defined based on the number of registered family members. The risks of all-cause and cause-specific mortalities were estimated using a multivariable Cox proportional hazards regression model.

RESULTS

During a median follow-up period of 6.0 years, 191,084 deaths (7.8 %) occurred. IDLA had a higher risk of mortality compared to those not living alone after adjusting for potential confounders (HR 1.20, 95 % CI: 1.18-1.22). This association was more prominent in younger individuals, men, and those with low income, and it was dependent on the duration of living alone. The risks of cause-specific mortality were all significantly higher in the IDLA group compared with the non-IDLA group. Adherence to favorable lifestyle behaviors was associated with a significant reduction in all-cause mortality, particularly in IDLA.

CONCLUSIONS

The elevated risk of mortality in IDLA highlights the need for tailored medical interventions and social assistance, particularly for those with unhealthy lifestyles or low income.

Impact of the COVID-19 Pandemic on Lifestyle Behavior and Clinical Care Pathway Management in Type 2 Diabetes: A Retrospective Cross-Sectional Study

Background and Objectives: In Italy, as in the rest of the world, government restrictions aimed at containing the spread of COVID-19 primarily imposed limitations on social relationships and personal behavior. This situation significantly affected the management of chronic illnesses, including type 2 diabetes (T2D). The objective was to evaluate the perceptions of patients with T2D regarding the quality of care received during the COVID-19 pandemic and the impact on dietary and physical activity behaviors. Materials and Methods: We conducted a retrospective cross-sectional survey. Data were collected from June to July 2023 using the convenience sampling of patients with T2D, and the Patient Assessment of Chronic Illness Care (PACIC) and Medi-Lite questionnaires were administered. Results: During the research period, out of the 130 subjects who met all enrollment criteria, 103 patients were included in this study (79.23%). The results of the administered questionnaires were heterogeneous. The average scores from the PACIC Questionnaire for each question displayed significant variability, indicating a range of experiences in the quality of care. In the Medi-Lite survey, fruit, cereals, and olive oil showed the highest adherence levels, with mean scores ranging from 2.58 (SD ± 1.18) for fruit to 1.89 (SD ± 0.34) for olive oil and 1.97 (SD ± 0.17) for cereals. Patients who reported increased food intake during the lockdown attributed it to having more time to prepare meals. Physical activity levels remained unchanged for 48 patients, decreased for 45 patients, and only 9 patients managed to exercise more during the COVID-19 restrictions. Conclusions: Healthcare systems must prioritize comprehensive care plans for T2D that address not only physical health, but also emotional and social well-being. Post-pandemic, promoting healthier lifestyles and empowering patients to manage their condition is crucial. A multidisciplinary and multidimensional approach could support the care of vulnerable individuals, such as patients with T2D, especially during crises like pandemics or other dramatic events.

Influence of restricted mastication on swallowing function

BACKGROUND

Oral food processing is an important part of daily food intake. A major part of this process is mastication, which prepares a bolus of food for swallowing by mechanically crushing and grinding ingested food between the teeth using rhythmic movements. Masticatory dysfunction is common in the elderly and in some neurological disorders and can have serious negative health consequences.

OBJECTIVE

This study investigated the effect of restricted mastication, achieved by experimentally reducing the duration of mastication, on masticatory patterns and subsequent swallowing function.

METHODS

Thirty healthy men (25 ± 3 years old) were instructed to chew gum jelly with a free mastication duration (G100), a half and a quarter duration of G100. Masseter and digastric electromyographic (EMG) activity was recorded to assess mastication and swallowing activity, respectively. In addition, the acceleration of the thyroid cartilage ridge was measured with an accelerometer. The root mean square (RMS) of muscle EMG activity in the masseter and digastric muscles, the number of masseter EMG bursts, time to peak and total duration of each masseter EMG burst, swallowing duration and laryngeal elevation latency were analysed.

RESULTS

Restricting masticatory duration reduced the number of mastication cycles (p < .001), prolonged the time to peak (p < .001) and total duration of masseter EMG bursts (p < .001) and resulted in an overall increased RMS score of masseter muscle activity (p = .017). Furthermore, restricted masticatory duration led to a decrease in both swallowing duration (p = .001) and laryngeal elevation latency (p = .012), with a significant increase in the RMS score of digastric muscle activity (p < .001).

CONCLUSIONS

Under the experimental conditions of restricted mastication, several adaptation features were observed, including changes in masticatory cycle characteristics and swallowing duration. Thus, although the overall masticatory efficiency was reduced, these adaptations allowed healthy individuals to still swallow safely.

Physical activity and nutrient intake levels according to grip strength among single-household elderly in Korea: data from 2014 and 2019 Korea National Health and Nutrition Examination Survey (KNHANES)

PURPOSE

We analyzed the differences in physical activity (PA) levels and nutrient intake based on grip strength among elderly men and women in single-person households (ESH) in Korea.

METHODS

Data were obtained from 1,581 ESH individuals (aged ≥65 years) from the Korean National Health and Nutrition Examination Survey (2014-2019). PA levels (occupational and recreational moderate-intensity activities, travel to and from places, walking, and strength training) and nutrient intake (including, total energy, carbohydrates, protein, and fat) were analyzed.

RESULTS

Men exhibited no differences in PA related to grip strength, except for the number of strength training days (p=0.000). Women with higher grip strength engaged more in recreational activities, travel, and strength training (all, p=0.000). Men with higher grip strength consumed more protein, while women consumed greater amounts of total fat (p=0.030), monounsaturated fatty acids (MUFA) (p=0.024), and polyunsaturated fatty acids (PUFA) (p=0.011). Both sexes had increased Vitamin C intake (men: p=0.023, women: p=0.020).

CONCLUSION

Sex-related differences in PA levels and nutrient intake based on grip strength were observed among older individuals in ESH. Women require programs to enhance diverse PA and balance fat intake, while men need interventions focused on strength training and protein intake.

The influencing factors of health status among low-income individuals living alone in Wuxi, China

This study aimed to understand the health status of low-income individuals living alone and to identify influencing factors. Using systematic random sampling methods, low-income individuals living alone were randomly selected. Via telephone interviews, we gathered information about their general health status. A logistic regression model was used to analyze relevant factors about the physical health of this population. The study included 1583 low-income individuals living alone. The prevalence rate of all kinds of diseases in low-income living alone in this survey was 88.63%. The multifactorial logistic regression analysis revealed that the risk factors for illness in this population were age ≥ 60 (OR 1.842, 95% CI 1.135-2.926, P = 0.006), self-rated poor mental health (OR 2.538, 95% CI 1.128-3.828, P = 0.005), and self-rated poor hearing status (OR 2.781, 95% CI 1.586-3.647, P = 0.001). Being female (OR 0.469, 95% CI 0.178-0.821, P = 0.033) was identified as a protective factor. Low-income individuals living alone are a unique group who lack familial care and economic and social support, and are thus in a disadvantaged social position. Therefore, this population requires increased attention, especially regarding their physical health. Implementing targeted assistance policies to improve their health status and enhance their quality of life is essential.

Identifying the barriers and facilitators to fruit and vegetable consumption in rural Australian adults: a mixed methods analysis

BACKGROUND

Low fruit and vegetable consumption is a leading contributor to non-communicable disease risk. However, understanding of barriers and facilitators to fruit and vegetable intake in rural settings is limited. This study used a mixed methods approach to determine the barriers and facilitators to increasing fruit and vegetable intake in rural Australian adults and to identify if these varied by gender.

METHODS

Quantitative and qualitative data were used from the 2019 Active Living Census, completed by adults living in north-west Victoria, Australia. Data were collected on fruit and vegetable intakes and barriers and facilitators to meeting fruit and vegetable recommendations. Multivariate logistic regression analyses were used to investigate the association between facilitators, classified using the socio-ecological framework, and meeting recommendations. Machine learning was used to automate content analysis of open ended information on barriers.

RESULTS

A total of 13,464 adults were included in the quantitative analysis (51% female; mean age 48 [SE 0.17] years) with 48% and 19% of participants consuming the recommended two serves of fruit and five serves of vegetables daily, respectively. Strongest facilitators to fruit consumption were at the individual level: never smoked (OR: 2.12 95% CI: 1.83-2.45) and not drinking alcohol (OR: 1.47 95% CI: 1.31-1.64). Strongest facilitators for vegetable consumption were found at all levels; i.e., individual level: used to smoke (OR: 1.48 95% CI: 1.21-1.80), social-environmental level: living with three or more people (OR: 1.41 95% CI: 1.22-1.63), and physical-environmental level: use community gardens (OR: 1.20 95% CI: 1.07-1.34). Qualitative analyses (fruit n = 5,919; vegetable n = 9,601) showed that barriers to fruit consumption included a preference for other snacks and desire to limit sugar content, whilst lack of time and unachievable guidelines were barriers for vegetables. Barriers and facilitators differed by gender; females experienced barriers due to having a more varied diet while males reported a dislike of the taste.

CONCLUSIONS

Barriers and facilitators to fruit and vegetable consumption among rural Australian adults were identified across all levels of the socio-ecological framework and varied between fruit and vegetables and by gender. Strategies that address individual, social, and physical-level barriers are required to improve consumption.

Modern vs traditional indigenous diet preference in Gauteng region, South Africa: A public health concern?

The prevalence of non-communicable diseases still represents a public health concern in South Africa, of which eating habits are some of the main risk factors. A modern diet consisting of the consumption of highly processed foods high in fat, salt and caloric sweeteners and low in fibre is recognised as unhealthy. This study was conducted to assess the penchant of the population for these types of foods rather than traditional indigenous foods known to be healthier. This research was undertaken in the Gauteng region, which is the most urbanized province in the country. This study consisted of a quantitative research survey conducted in 2019 with 1527 participants (Asians, Black, Coloured, Indians and White) aged 18 and above who had lived in the province for at least two years. The results revealed that 30-40 % were neutral on the issue. Despite half (54.4 %) indicating that it was good to mix traditional and modern foods, a clear preference for modern food was noticed for 35.7 % of respondents, with 32.2 % reporting not being concerned that traditional foods have been replaced by modern foods. The traditional indigenous food consumption (TIFC) appeared to depend on monthly total household income, residential area, and settlement category. Participants with specific economic comfort consumed less. Race and number of people in the participants' households also significantly affected the TIFC (p < 0.05). Participants of white ethnicity and those living in a household of a maximum of 02 people displayed the lowest TIFC. In comparison to those who strongly disagree, participants with a neutral opinion about the idea of mixing eating habits were also the most neutral concerning preference for a modern diet (OR: 10.95, 95 % CI 7.00-17.12) and nutrition transition (OR: 14.66, 95 % CI 9.09-23.64). Sensitisation about healthy eating habits among the identified at-risk and target groups is undoubtedly a need in the region to avoid a resurgence of modern diet-related diseases.

Evidence of weight loss in junior female judo athletes affects their development

Purpose

The facile manipulation of body weight in junior athletes has the potential to pose significant risks to their lifelong health. In judo, which is a weight class sport, pre-competition weight loss is widespread even among juniors, but information on the current situation is scarce, especially for female athletes, for whom it is important to provide adequate nutrition and enhance bone mass during the growth period, and the details of the current situation are not clear. Therefore, the purpose of this study was to determine the actual weight loss during the growth period in junior female judo athletes and its subsequent impact on their health.

Methods

The survey was a cross-sectional survey of junior female judo athletes in Japan using a questionnaire. Participants were asked to respond via an online questionnaire about their weight, height, weight loss experience, menstruation, competition results, and other lifestyle.

Results

51.8% of subjects experienced weight loss for competition during their junior high school years (ages 12-15). Those who experienced weight loss during secondary sexual characteristics were found to be significantly shorter in current height than those who did not (p < 0.05). Weight loss during secondary sexual characteristics did not affect current menstrual cycle. There was no significant difference in competition results due to the experience of weight loss during junior high school (χ 2 = 4.485, df = 3, n.s.).

Conclusions

These findings suggest that weight loss during the growth spurt phase may adversely impact normal development. It also suggested that weight loss during the junior high school years may not be a strategy to bring about better competition results. These observations indicate the need for education on appropriate class selection and weight control for junior athletes in weight class competitions.

Healthy eating among people on opioid agonist therapy: a qualitative study of patients' experiences and perspectives

People with substance use disorders often have unhealthy diets, high in sweets and processed foods but low in nutritious items like fruits and vegetables, increasing noncommunicable disease risks. This study investigates healthy eating perceptions and barriers among individuals with opioid use disorder undergoing opioid agonist therapy. Interviews with 14 participants at opioid agonist therapy clinics in Western Norway, using a semi-structured guide and systematic text condensation for analysis, reveal that most participants view their diet as inadequate and express a desire to improve for better health. Barriers to healthy eating included oral health problems, smoking habits, and limited social relations, while economic factors were less of a concern for the participants. Participants did find healthy eating easier when they were in social settings. This study underscores the importance of understanding and addressing these barriers and facilitators to foster healthier eating patterns in this population, potentially enhancing overall health and well-being.

Associations between Shokuiku during School Years, Well-Balanced Diets, and Eating and Lifestyle Behaviours in Japanese Females Enrolled in a University Registered Dietitian Course

This study comprehensively examined the associations between shokuiku (food and nutrition education) during school years, current well-balanced diets, and current eating and lifestyle behaviours of Japanese female university students. A hypothetical model was developed using factors potentially associated with well-balanced diets. A simultaneous multipopulational analysis was performed according to the living arrangements of 148 female Japanese students (48.6% living alone) from a registered dietitian course. The analysis showed acceptable goodness of fit and a significant positive path from shokuiku during school years (living alone: standardised estimate 0.29, p = 0.004; with family: 0.32, p = 0.006) and a negative path from eating out frequency (-0.19, p = 0.039; -0.24, p = 0.017) towards a well-balanced diet. A significant negative path was identified from late bedtimes (-0.45, p < 0.001) and home meal replacement use frequency (-0.24, p = 0.010) in those living alone and from late-night snacking frequency (-0.27, p = 0.007) in those living with family. Well-balanced diets in female university students may be positively associated with shokuiku during school years and limited by a late bedtime, eating out, and home meal replacement use in those living alone, and by late-night snacking and eating out in those living with family.

Prevalence of body mass index categories among adults living alone in China: Observational study

BACKGROUND

Adults living alone represent a growing population group in China. Understanding the prevalence of body mass index (BMI) categories and their associations with demographic and lifestyle factors among this group is essential for informing targeted interventions and public health policies.

METHODS

In this population-based cross-sectional study, we used individual-level data from the 2011-2021 China General Social Survey. Main outcomes were prevalence of BMI categories adjusted for gender and age, using logistic regression and model-predicted marginal prevalence to estimate BMI categories prevalence.

RESULTS

We analyzed 9,077 single-living Chinese adult participants. The primary-adjusted prevalence of BMI categories varied across different genders and age groups. Underweight was more prevalent in females (12.73%; 95% CI: 12.31% - 13.14%) than in males (7.54%; 95% CI: 7.19% - 7.88%), while overweight and obesity were higher in males. Primary-adjusted underweight prevalence was highest among the 18-24 years age group (22.09%; 95% CI: 20.17% - 24.01%) and decreased with age. Primary-adjusted overweight prevalence increased with age, peaking in the 45-54 years age group (41.94%; 95% CI: 40.96% - 42.93%). Primary-adjusted obesity prevalence exhibited a fluctuating pattern across age groups, with the highest prevalence observed in the 45-54 years age group (9.81%; 95% CI: 9.19% - 10.44%).

CONCLUSION

Our findings reveal significant associations between BMI categories and demographic and lifestyle factors among adults living alone in China. These results can inform targeted interventions and public health policies aimed at promoting healthy weight management and addressing the unique health challenges faced by single-living individuals in China.

Living alone increases the risk of developing type 2 diabetes mellitus: A systematic review and meta-analysis based on longitudinal studies

BACKGROUND

Living alone is a prevalent psychological issue that has been found to have significant implications for lifestyle and health status. While considerable research has been conducted to explore the relationship between living alone and the risk of developing type 2 diabetes mellitus (T2DM), the majority of studies have been cross-sectional, leaving direct correlations elusive. Therefore, this study aims to analyze data from longitudinal studies to determine whether living alone increases the risk of T2DM.

METHODS

A comprehensive search was conducted in the PubMed, Cochrane, and Embase databases to identify studies examining the association between living alone and T2DM risk. The search encompassed studies published until September 2023. Pooled analysis utilized the random-effects model with inverse variance and included adjusted hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs).

RESULTS

The meta-analysis comprised a total of 8 studies, which consisted of 5 prospective cohort studies and 3 retrospective cohort studies. The total population under consideration included 11,686,677 individuals without T2DM, of whom 54.3% were female. Among this population, 396,368 individuals developed T2DM. To account for heterogeneity, a random-effects model was employed. Overall, the pooled data demonstrated a significant association between living alone and an increased risk of T2DM when compared to living with others (HR 1.24, 95% CI 1.06-1.46). Subgroup analysis revealed that this risk was not statistically significant for either males (HR 1.28, 95% CI 0.93-1.76) or females (HR 1.06, 95% CI 0.84-1.33), nor in prospective cohort studies (HR 1.26, 95% CI 0.91-1.74) or retrospective cohort studies (HR 1.26, 95% CI 0.91-1.74).

CONCLUSION

Individuals living alone faced a significantly higher risk of developing diabetes compared to those who did not live alone. However, no significant difference in this risk was observed between genders and study types. Further high-quality studies are necessary in the future to elucidate this causal association.

Association of living alone and living alone time with hypertension among Chinese men aged 80 years and older: a cohort study

Objective

There is little evidence of the influence of living alone on hypertension risk among men 80 years or older. Additionally, the influence of living alone duration on hypertension risk lacks thorough investigation. Hence, this cohort study examines living alone and its duration's link to hypertension risk in this specific group.

Methods

We included 2009 older men aged ≥80 years without hypertension from the Chinese Longitudinal Healthy Longevity Survey in the 2008 wave. Follow-up was conducted in the 2011 wave. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) to assess hypertension risk related to living alone and living alone time.

Results

We included 2,009 older men, with a mean age of 90.7 years (standard deviation: 6.8). Over a median follow-up of 2.9 (1.3-3.0) years, 573 participants (28.5%) developed hypertension. Living alone was significantly associated with a higher hypertension risk than living with family (HR: 1.42; 95% CI 1.11-1.80). When compared to living with family, the hypertension risk was increased in the first quartile of living alone time (0-6.1 years) (HR: 1.76; 95% CI 1.16-2.66), the second quartile (6.1-10.6 years) (HR: 1.56; 95% CI 1.07-2.29), and the third quartile (10.6-19.3 years) (HR: 1.66; 95% CI 1.08-2.55). Surprisingly, no significant association was found in the fourth quartile (≥19.3 years) with hypertension risk. Stratified and Interaction analyses indicated no significant interaction effects between subgroups. Sensitivity analyses yielded consistent results.

Conclusion

Living alone was independently associated with an increased risk of hypertension in older men. The highest risk was found in those with the least time alone. These findings imply that social isolation and lack of companionship could be pivotal in hypertension development. Furthermore, the study highlights the need to consider living alone duration when assessing its impact on health outcomes.

Association between living alone and all-cause mortality of young and middle-aged patients with acute myocardial infarction: analysis of the China Acute Myocardial Infarction (CAMI) registry

BACKGROUND

Lack of social support is a known predictor of the prognosis after acute myocardial infarction (AMI). Although as a common factor associated with social support, there are limited data on long-term prognostic impact of living status in young and middle-aged patients with AMI.

METHODS

We analyzed data from the China Acute Myocardial Infarction (CAMI) Registry, consecutive AMI young and middle-aged patients admitted at 108 hospitals in China between January 2013 and September 2014 were included. Eligible patients were assigned to living alone and not living alone groups based on their living status. The primary endpoint was 2-year all-cause mortality. The secondary endpoints included in-hospital mortality and 2-year major adverse cardiac and cerebrovascular events (MACCEs; a composite of all-cause mortality, MI, or stroke). Multilevel logistic and multilevel Cox regression models were used to evaluate the effect of living status on short-term and long-term outcomes.

RESULTS

A total of 8307 consecutive AMI young and middle-aged patients were included, 192 (2.3%) patients were living alone. Of the analyzed patients, living alone was associated with 2-year all-cause mortality and MACCEs among all analyzed patients after multivariate adjustment (adjusted hazard ratio [HR] = 2.171 [1.210-3.895], P = 0.009; adjusted HR = 2.169 [1.395-3.370], P = 0.001), but not with poorer in-hospital mortality.

CONCLUSIONS

The analysis suggested that living alone was associated with both 2-year all-cause mortality and MACCEs in AMI young and middle-aged patients but did not show an extra effect on the in-hospital mortality after covariate adjustment.

TRIAL REGISTRATION

Trial registration number: NCT01874691; Registered 31 October 2012.

Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working-age adults

BACKGROUND

Previous studies have shown an association between living alone and cancer mortality; however, findings by sex and race/ethnicity have generally been inconsistent, and data by socioeconomic status are sparse. The association between living alone and cancer mortality by sex, race/ethnicity, and socioeconomic status in a nationally representative US cohort was examined.

METHODS

Pooled 1998-2019 data for adults aged 18-64 years at enrollment from the National Health Interview Survey linked to the National Death Index (N = 473,648) with up to 22 years of follow-up were used to calculate hazard ratios (HRs) for the association between living alone and cancer mortality.

RESULTS

Compared to adults living with others, adults living alone were at a higher risk of cancer death in the age-adjusted model (HR, 1.32; 95% CI, 1.25-1.39) and after additional adjustments for multiple sociodemographic characteristics and cancer risk factors (HR, 1.10; 95% CI, 1.04-1.16). Age-adjusted models stratified by sex, poverty level, and educational attainment showed similar associations between living alone and cancer mortality, but the association was stronger among non-Hispanic White adults (HR, 1.33; 95% CI, 1.25-1.42) than non-Hispanic Black adults (HR, 1.18; 95% CI, 1.05-1.32; p value for difference < .05) and did not exist in other racial/ethnic groups. These associations were attenuated but persisted in fully adjusted models among men (HR, 1.13; 95% CI, 1.05-1.23), women (HR, 1.09; 95% CI, 1.01-1.18), non-Hispanic White adults (HR, 1.13; 95% CI, 1.05-1.20), and adults with a college degree (HR, 1.22; 95% CI, 1.07-1.39).

CONCLUSIONS

In this nationally representative study in the United States, adults living alone were at a higher risk of cancer death in several sociodemographic groups.

The association between loneliness or social isolation and food and eating behaviours: A scoping review

Loneliness or social isolation and food/eating behaviours have important health consequences and there are rationales for why they could interact. Loneliness and dietary behaviours are recognised as health determinants and targets for interventions at individual, group and population levels. However, there are currently no research reviews investigating associations between these areas. This scoping review synthesized evidence investigating loneliness or social isolation and food/eating behaviours in people aged over 16 years in high-income countries. A systematic search of five databases from 2000 was conducted using predetermined search terms. Dissertation database and backwards citation searches were also conducted. Full text screening of 254 articles/theses resulted in inclusion of three qualitative and 26 quantitative studies, with eight conducted in COVID-19 lockdowns. Almost all studies reported a relationship between loneliness/social isolation and eating behaviours usually considered harmful such as low fruit and vegetable intake and lower diet quality. Qualitative research also supports the detrimental influence of loneliness or social isolation on eating. Study quality was considered, and interpretation and comparison of results was complicated by use of varying methods. Better awareness and understanding of the relationship between these complex aspects of health is needed to inform the development of interventions and practice of nutrition and mental health practitioners, policymakers, researchers and end-users.

BMI categories across different living arrangements

INTRODUCTION

Research on the prevalence of body mass index (BMI) categories across different living arrangements remains limited. We aimed to quantify the prevalence of BMI categories among those living alone (LA) and those not living alone (NLA).

METHODS

In this population-based cross-sectional study, we used individual-level data from the 2011-2021 Behavioral Risk Factor Surveillance System. Main outcomes were prevalence of BMI categories in LA and NLA, adjusted for age, gender, and race/ethnicity, and socioeconomic status, using logistic regression and model-predicted marginal prevalence to estimate BMI categories prevalence.

RESULTS

Between 2011 and 2021, we quantified BMI categories prevalence in 4,195,414 adults in the BRFSS, with 1,197,787 (28.5%) adults LA and 2,997,627 (71.5%) adults NLA. In comparison to NLA, LA consistently demonstrates lower adjusted obesity prevalence across genders and age groups, with the highest prevalence observed in the 45-64 age range, particularly within the 45-54 group (LA: 37.4%, 95% CI: 37.1-37.8%; NLA: 34.3%, 95% CI: 33.8-34.7%). Additionally, LA displays an overall lower adjusted prevalence of overweight compared to NLA, notably in the 18-34 and >64 age groups.

CONCLUSIONS

Heterogeneity in BMI categories prevalence exists between LA and NLA. Future studies and public health efforts should consider this heterogeneity.

Knowledge and attitude toward oral health behavior of overseas students during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has impacted overseas students, including their oral health. Due to movement restrictions, limited living allowances, dental treatment costs, and health insurance fees, overseas students might be more concerned about their oral health. The objective of the present study was to determine the association of knowledge and attitude toward oral healthcare behavior of overseas university students staying in Thailand between January 2020 to July 2022 and explore the experiences of their oral health problems.

METHODS

A cross-sectional study was conducted using an online survey in English operated through the Google platform by convenience sampling among overseas Chulalongkorn University students. A newly developed self-administered questionnaire on knowledge and attitude toward oral health-related behavior and experiences in oral health problems was completed voluntarily. Descriptive statistics, Chi-square test, t-test, ANOVA, and Pearson correlations were employed using IBM SPSS version 29.

RESULTS

Of 311 overseas students, 55.6% were male. The average age of students was 27.5 ± 4.5 years. 68.81% of students were from ASEAN countries, and 73.31% studied in non-health science programs. The study fields, health and non-health sciences, were associated with knowledge score (p < 0.001) and attitude score (p = 0.004), whereas the type of health insurance had an association with behavior score (p = 0.014) and the student's perspective about dental visits (p = 0.014). Three hundred fifty-nine cases of oral health problems were experienced by 47.3% of overseas students. These problems consisted primarily of tooth hypersensitivity (21.2%), gingivitis (15.3%), caries (14%), cracked or broken tooth (10%), severe toothache (9%), fallen out filling (8%), and wisdom tooth pain (7.8%). There was an association between oral healthcare behavior and oral health problems (p < 0.001), and a negative correlation was found between behavior score and the number of oral health problems (p < 0.001, r=-0.204).

CONCLUSION

The oral healthcare habits of overseas university students correlated positively with knowledge and attitude. A negative correlation was observed between behavior and the number of oral health problems. Furthermore, studying in health science programs impacted students' knowledge and attitude toward oral health, while dental treatment coverage insurance affected decisions for dental visits.

Association between Living Conditions and the Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults

Objective In recent decades, living conditions have changed drastically. However, there are few data regarding the interaction between living conditions and the risk of ischemic stroke (IS) in young adults. The present study explored the association between living conditions or marital status and the risk factors, etiology, and outcome of IS in young adults. Methods We prospectively enrolled patients with incident IS who were 20-49 years old from 37 clinical stroke centers. We collected the demographic data, living conditions, marital status, vascular risk factors, disease etiology, treatment, and outcomes at discharge. A comparison group was established using the official statistics of Japan. We categorized patients into the two groups based on living conditions: solitary group and cohabiting group. Clinical characteristics were then compared between living conditions. Results In total, 303 patients were enrolled (224 men; median age at the onset: 44 years old). Significant factors associated with the incidence of IS were as follows: solitary status, body mass index >30 kg/m2, current smoking, heavy alcohol consumption, hypertension, diabetes mellitus, and dyslipidemia. Furthermore, in the solitary group, the proportions of men, unmarried individuals, and current smokers were significantly higher than in the cohabiting group. In addition, poor outcomes (modified Rankin Scale ≥4) of IS were more common in the solitary group than in the cohabiting group. Conclusion Our study showed that not only conventional vascular risk factors but also living conditions, especially living alone while unmarried, were independent risk factors for IS in young adults.

Associations between cooking self-efficacy, attitude, and behaviors among people living alone: A cross-sectional survey analysis

Cooking-related literacy and attitudes may play important roles in preventing and reducing diet-related chronic diseases and nutrition disparities. People living alone are an under-researched but growing population who face above average food insecurity rates. This study's objectives were to 1) test how cooking self-efficacy and attitude are stratified demographically among a sample of people living alone, focusing on variations across gender, age, and food security, and 2) examine how cooking self-efficacy and attitude are associated with two indicators of cooking behavior - cooking frequency and convenience orientation. We draw from a cross-sectional survey analysis of 493 adults living alone in Illinois, USA with validated measures for cooking self-efficacy, attitude, frequency, convenience orientation, and demographic characteristics. Hierarchical linear regression models were used to examine demographic factors explaining variation in self-efficacy and attitude, with attention to interactions between gender, food insecurity, and age. Poisson and OLS linear regression models were used to examine associations between self-efficacy and attitude and cooking frequency and convenience orientation. We find cooking-related self-efficacy and attitude showed strong but distinct associations with cooking frequency and convenience orientation. Overall, food insecure groups had lower self-efficacy than those who were food secure; however, food insecure women had higher self-efficacy than men in similar positions, apart from older-adult women who held particularly low efficacy. Cooking attitudes varied in small ways, notably with food insecure younger and older women possessing more negative cooking attitudes than middle-aged women. This research highlights the importance of understanding the cooking-related orientations of single-living people, while demonstrating that this group's ability to prevent and manage food insecurity is not uniform. These results can inform targeted interventions around food and nutrition insecurity, cooking attitudes, and self-efficacy among single-living populations.

Evaluation on the Nutrition Quotient Scores of Elderly People Living Alone in Korea

As the Korean society is aging rapidly, the issues on physical, social, economic, and mental disabilities of single-person households aged 65 years or older has also increased. This study aimed to investigate the nutrition-related dietary conditions of elderly people living alone and determine their dietary behavior by calculating the nutrition quotient for elderly (NQ-E). One hundred and three elderly people living alone who were basic living recipients were recruited from six senior welfare centers in Seoul, and the data were collected using a questionnaire from 19 July 2016 to 17 August 2016, with a 1:1 in-depth interview using the modified version of the NQ-E questionnaire. The data were analyzed using SPSS 27.0 for Mac (IBM Corp., Armonk, NY, USA); a p value of <0.05 was considered significant. The nutrition-related dietary conditions of the elderly living alone were limited, and many of them received support from the government, which helped improve their diet. The nutrition quotient score of the elderly living alone was 50.14, which was lower than the NQ-E mean score (57.6) of the Korean elderly and the NQ-E (62 points), which is the top 25% of the national survey subjects according to the criteria value presented by the Korean Nutrition Society. Elderly people living alone often have poor dietary habits and nutritional status. The NQ-E presented in this study can be used to evaluate the dietary conditions of the elderly and is expected to be used as an indicator for developing community programs for health promotion and evaluating their effectiveness.

Dietary behaviours and related lifestyles according to the presence or absence of skipping breakfast in Japanese adults: the JPHC-NEXT study

OBJECTIVE

To assess dietary behaviours and related lifestyles according to the presence or absence of skipping breakfast.

DESIGN

We analysed the cross-sectional data from a baseline survey of a large-scale population-based cohort study in Japan conducted in 2011-2016. Participants provided information on dietary behaviours and lifestyles through a self-administered questionnaire. Skipping breakfast was defined as not eating breakfast at least once a week and was classified according to the frequency of skipping breakfast as 1-2, 3-4 or ≥5 times/week.

SETTING

Sixteen municipalities in seven prefectural areas across Japan under the Japan Public Health Centre-based prospective study for the Next Generation.

PARTICIPANTS

112 785 residents (51 952 males and 60 833 females) aged 40-74 years.

RESULTS

After adjustment for age, socio-demographic status, drinking status and smoking status, individuals who skipped breakfast at least once a week, compared with those who ate breakfast every day, were more likely to have adverse dietary behaviours such as frequent eating out (multivariable OR = 2·08, 95 % CI (1·96, 2·21) in males and 2·15, 95 % CI (1·99, 2·33) in females), frequent eating instant foods (1·89, 95 % CI (1·77, 2·01) in males and 1·72, 95 % CI (1·56, 1·89) in females). They had late bedtime (1·85, 95 % CI (1·75, 1·95) in males and 1·98, 95 % CI (1·86, 2·11) in females) and living alone (2·37, 95 % CI (2·17, 2·58) in males and 2·02, 95 % CI (1·83, 2·21) in females), using the logistic regression model.

CONCLUSIONS

Both adult males and females who skipped breakfast were likely to eat out, to have a dietary habit of eating instant foods and have lifestyles such as late bedtime and living alone than those who ate breakfast.

Exploring Living Arrangements as a Predictor of Canadians' Illicit Drug Use: Quantitative Findings From the Canadian Community Health Survey

Objectives: About four percent of Canadians used illegal drugs in 2019, but it remains unknown whether their living arrangements are a relevant factor. Methods: We use the public version of the 2015-2016 Canadian Community Health Survey Annual Component. The binary logit model and complementary log-log model are applied to investigate to what extent living arrangements predict Canadians' recent illicit drug use. Results: Living alone is significantly associated with Canadians' illicit drug use. For young and older Canadians, those living with spouses/partners, children, or both are less likely to use illicit drugs than their solo-living counterparts. Middle-aged Canadians who lived with spouses/partners only or with children have significantly lower likelihoods of using illicit drugs compared to those living alone. Additionally, differences between men and women have been found. Spouses/partners and children play more positive roles for young and middle-aged women than for men. Conclusion: Our findings suggest that living with core families is a type of collectivity that may have positive effects on Canadians' health behaviours compared to those living alone, who, therefore, need more attention from health officials.

Association of Sociodemographic, Socioeconomic and Lifestyle Characteristics with Low Protein and Energy Intake in the Healthy Swiss Population

A balanced diet has the goal of providing adequate amounts of different nutrients to promote and maintain physical and psychological health. Our aim was to study the association between different sociodemographic, socioeconomic and lifestyle factors and low energy or protein intake among the Swiss population. This is a cross-sectional cohort study based on the national nutritional survey "MenuCH", which is the first representative, detailed assessment of dietary habits in the adult Swiss population conducted in 2014/2015. We compared the mean protein and caloric intake based on two 24 h recall nutritional assessments with current recommendations based on resting metabolic rate calculation and DACH guidelines. A total of 1919 participants with a median age of 46 years and 53% females were included. Overall, 10.9% and 20.2% of participants had an energy and protein intake, respectively, below the dietary reference values. However, a high income (>9000 CHF per month) reduced the risk of low energy intake (OR 0.49 [0.26-0.94], p = 0.032), obesity (OR 6.55 [3.77-11.38], p < 0.01), and living in a household with children (OR 2.1 [1.15-3.85], p = 0.016) was associated with higher risk. Regarding low protein intake, the most important risk factors were an age group of 65-75 years (OR 2.94 [1.57-5.52], p = 0.001) and female gender (OR 1.73 [1.15-2.6], p = 0.008). Regular meat consumption reduced the risk of low protein intake (OR of 0.23 (0.1-0.53), p = 0.001). Within this survey, several socio-economic and lifestyle factors were associated with low energy and protein intake in the healthy Swiss population. A bunderstanding of these factors may help to reduce the risk of malnutrition.

Culinary Nutrition Education Programs in Community-Dwelling Older Adults: A Scoping Review

BACKGROUND

Culinary nutrition education programs are increasingly used as a public health intervention for older adults. These programs often integrate nutrition education in addition to interactive cooking workshops or displays to create programs suitable for older adults' needs, ability and behaviour change. Synthesising the existing literature on nutrition education and interactive cooking programs for older adults is important to guide future program development to support healthy ageing.

OBJECTIVES

To determine the extent of published literature and report the characteristics and outcomes of interactive culinary nutrition education programs for older adults (> 51 years).

DESIGN

This scoping review followed the PRISMA-ScR guidelines recommended for reporting and conducting a scoping review.

METHODS

Five databases were searched of relevant papers published to May 2022 using a structured search strategy. Inclusion criteria included: older adults (≥ 51 years), intervention had both an interactive culinary element and nutrition education and reported dietary outcome. Titles and abstracts were screened by two reviewers, followed by full-text retrieval. Data were charted regarding the characteristics of the program and outcomes assessed.

RESULTS

A total of 39 articles met the full inclusion criteria. The majority of these studies (n= 23) were inclusive of a range of age groups where older adults were the majority but did not target older adults exclusively. There were large variations in the design of the programs such as the number of classes (1 to 20), duration of programs (2 weeks to 2 years), session topics, and whether a theoretical model was used or not and which model. All programs were face-to-face (n= 39) with only two programs including alternatives or additional delivery approaches beside face-to-face settings. The most common outcomes assessed were dietary behaviour, dietary intake and anthropometrics.

CONCLUSION

Culinary nutrition education programs provide an environment to improve dietary habits and health literacy of older adults. However, our review found that only a small number of programs were intentionally designed for older adults. This review provides a summary to inform researchers and policy makers on current culinary nutrition education programs for older adults. It also recommends providing face-to-face alternatives that will be accessible to a wider group of older adults with fewer restrictions.

Physical activity levels and energy intake according to the presence of metabolic syndrome among single-household elderly in Korea: Korean National Health and Nutrition Examination Survey 2016-2018

Background

Exercise and dietary and nutritional intake affect the risk and prevalence of metabolic syndrome (MetS) in elderly people, effects that may differ according to sex in elderly single households (ESH). This study aimed to analyze the differences in physical activity (PA) levels and energy intake according to sex and prevalence of MetS among elderly people in Korea to investigate the relationships between these factors.

Methods

Data from 893 elderly individuals (aged >65 years) were obtained from the Korean National Health and Nutrition Examination Survey (2016-2018). We analyzed PA levels (occupational and recreational PA and place movement) and energy intake (EI; total, carbohydrate, protein, and fat), and found that there were sex differences in both according to the presence or absence of MetS in ESH.

Results

Among both males and females, the MetS group had a significantly lower recreational moderate PA than the non-MetS group. However, total PA in males was significantly higher in the non-MetS than in the MetS group, but there was no significant difference in females. Furthermore, the EI of females did not differ in the presence or absence of MetS, except for fat intake, and in the nutritional intake of ESH in males, no difference was found in the presence or absence of MetS. We also found that in Odd ratio, "active" was associated with lowering high waist circumference (OR = 0.40, 95%CI = 0.21-0.76), and "very active" was associated with lower MetS occurrence (OR = 0.51, 95%CI = 0.33-0.81) and low high-density lipoprotein cholesterol (HDL-C) (OR = 0.55, 95%CI = 0.37-0.83).

Conclusions

Therefore, in the MetS group of ESH, there was a significant correlation of the MetS component in PA rather than EI. Male ESH require interventions that increase PA, while female ESH require nutrition interventions that increase and balance PA. Therefore, a new program is needed that promotes continuous interest and healthy lifestyles in consideration of the characteristics of ESH.

Dietary diversity and associated factors among adult cancer patients attending treatment at Black Lion Specialized Hospital, Addis Ababa, Ethiopia

Background: Cancer has become a significant public health issue around the world and an increasingly important contributor to disease burdens. In countries like Ethiopia with high nutrient demands, people with chronic diseases like cancer are at a high risk of macro and micronutrient deficiencies. Therefore, the present study attempted to assess dietary diversity and associated factors among adult cancer patients attending treatment at Black Lion Specialized Hospital, Addis Ababa, Ethiopia. Method and Materials: Hospital-based cross-sectional study was conducted from 22 April 2021 to 22 May 2021 on 416 adult cancer patients at Black Lion Specialized Hospital (BLSH). A systematic random sampling technique was applied to select study subjects. Quantitative data were collected using a structured, pretested and interviewer-administered questionnaire. The questionnaire comprised the standard dietary diversity measurement tool, which was adopted from the Food and Technical Assistance (FANTA) then data were entered into EPI INFO software and analysed using Statistical Package for the Social Sciences (SPSS) version 25. Frequency, mean and standard deviation were used to describe variables. A binary logistic regression model was fitted to elicit factors associated with the dietary diversity of cancer patients and a P-value of less than 0⋅2 was used as a cut-off for further analysis. Logistic regression analysis with a 95 % confidence interval (CI) was estimated to measure the strength of association at P < 0⋅05. Results: The present study revealed that 61⋅5 % of patients had low dietary diversity. Being from a family size of five and more (AOR = 1⋅48, 95 % CI 1⋅28, 1⋅83), having no permanent income (AOR = 1⋅31, 95 % CI 1⋅15, 1⋅67), alcohol consumption (AOR = 3⋅97, 95 % CI 1⋅20, 13⋅1), not doing regular physical exercise (AOR = 1⋅83, 95 % CI 1⋅07, 3⋅12), lack of nutritional information (AOR = 2⋅23, 95 % CI 1⋅30, 3⋅82), poor nutritional knowledge (AOR = 1⋅84, 95 % CI 1⋅05, 3⋅25) and minimum meal frequency (AOR = 10⋅7, 95 % CI 5⋅04, 22⋅7) were factors associated with inadequate dietary diversity. Conclusion: The present study showed that the majority of cancer patients had low dietary diversity, suggesting that they are highly vulnerable to micronutrient deficiencies. Therefore, efforts should be strengthened to improve patients' income level, access to nutrition information and nutritional knowledge.

Association between depressive symptoms and bone density in elderly patients with non-dialysis dependent chronic kidney disease

BACKGROUND

Depression is a disease that is commonly accompanied by elderly chronic kidney disease (CKD) patients, but when the two diseases are accompanied, etiology or combination are not well known. We aimed to evaluate the etiology of CKD and comorbid depression by investigating bone disorders that are observed in persons affected by both CKD and depression.

METHODS

We conducted a cross-sectional study with a total of 646 patients with CKD. We compared the sociodemographic factors, kidney function, markers for CKD-Mineral and Bone Disorder (CKD-MBD) and bone mineral density according to the depressive symptoms. We conducted a univariate and multivariate logistic regression analysis to calculate odd ratios (95 % confidence interval) between depressive symptoms and low bone mineral density.

RESULTS

Individuals with CKD and depressive symptoms were associated with lower level of education attained, living alone, exercising less, low 24-hour urine phosphorus, and low bone density. Depressive symptoms were significantly associated with low bone density in lowest parts (1.55 [1.06-2.29]) and in total hip (1.72 [1.17-2.53]) even after adjusting for diabetes mellitus, hypertension, kidney function, proteinuria, age, sex, smoking, and body mass index.

LIMITATIONS

A cross-sectional design was used in this study and the bone biopsy for diagnosis of CKD-MBD was not done because of invasiveness and practical difficulties.

CONCLUSION

Low bone density was associated with depressive symptoms in elderly patients with non-dialysis chronic kidney disease.

A longitudinal study of disability in activities of daily living and activity restriction‐induced fear of falling among Korean older people

AIM

This study examined the effects of the fear of falling (FOF) alone and fear-associated activity restriction (FAR) on future activities of daily living (ADL) disability and analysed predictors of ADL disability among community-dwelling older people with and without FAR.

DESIGN

This prospective study involved secondary data analysis of the Korean Longitudinal Study of Aging.

METHODS

We obtained data from 5074 community-dwelling older adults. Generalized estimating equations were used to identify the predictors of changes in ADL disability between 2008 and 2018.

RESULTS

Compared with FOF alone, FAR was significantly related to changes in ADL disability. Being older, living with others and having poor self-rated health status were associated with future ADL disability in participants without FAR. Weakened grip strength and social engagement were associated with future ADL disability in those with FAR. Nurses must consider the impact of FAR on future ADL decline and implement tailored interventions.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Living alone and all-cause mortality in community-dwelling adults: A systematic review and meta-analysis

Background

The non-causal and causal associations, possible age and sex differences between living alone and all-cause mortality among adults were unclear. We aimed to assess the association and causal relation between living alone and all-cause mortality among community-dwelling adults, addressing the certainty of evidence, possible age and sex differences.

Methods

We searched Medline, Embase, and APA PsycINFO for cohort studies examining the association between living alone and all-cause mortality on November 19, 2021. We used the GRADE approach to assess certainty of evidence, and the Instrument for the Credibility of Effect Modification Analyses (ICEMAN) to evaluate credibility of subgroup inferences and conducted a meta-analysis of measures of association between living alone and mortality. The study was registered with PROSPERO, CRD42021290895.

Findings

18 cohort studies with 62,174 adults proved eligible. Living alone was associated with mortality (relative risk (RR) = 1.15, 95% confidence interval (CI) 1.08-1.23). Both age and sex modified the association (high and moderate credibility, separately). Living alone increased the risk of dying only in younger but not older individuals (ratio of RRs = 1.59, interaction P = 0.003; younger RR 1.41, 95% CI 1.17-1.71, high certainty for prognosis, low for causation; older RR = 1.05, 95% CI 0.91-1.22, moderate certainty for prognosis, very low for causation). Living alone increased risk to a greater extent in males than females (ratio of RRs = 1.39, 95% CI 1.14-1.70; interaction P = 0.001, males RR = 1.41, 95% CI 1.17-1.71, high certainty for prognosis, low for causation; females RR = 1.15, 95% CI 0.99-1.33; moderate for prognosis factor, very low for causation).

Interpretation

Living alone is associated with increased mortality in individuals under 65 years (high certainty) but not with those over 75 years; the association may be causal (low certainty). Associations, and possibly effects, may be stronger in men than women.

Funding

None.

The Interactions of Food Security, Health, and Loneliness among Rural Older Adults before and after the Onset of COVID-19

Older adults and those living in rural areas face unique challenges to health and food security which were exacerbated during the COVID-19 pandemic. We examine the interrelationships among food security, physical health, and loneliness among rural older adults before the onset of and during the COVID-19 pandemic. Using data from a cross-sectional household survey of older adults in rural Indiana, administered May 2020 through July 2020, our results show a higher prevalence of food insecurity, poorer physical health, and increased loneliness after the onset of the pandemic. Path analyses confirmed the interrelationship between food security, health, and the absence of loneliness before and after the onset of COVID-19. Loneliness emerged as a major pathway through which the pandemic impacted quality of life, particularly affecting older women and physical health. Policy initiatives should consider the unique experiences and challenges associated with rural life among older adults and create food security initiatives that incorporate socialization while also considering the challenges associated with poor physical health in older age. Furthermore, our analysis shows that those who are vulnerable to food security, poor health, and loneliness in the absence of a global pandemic remain vulnerable during a pandemic.

Living alone is associated with a higher prevalence of psychiatric morbidity in a population-based cross-sectional study

Background

Living alone has been linked to poor mental health, however large-scale epidemiological studies on the association between living alone and psychiatric morbidity including depression and anxiety are lacking. The aim of this study was to investigate this issue in a large Taiwanese cohort.

Methods

In this cross-sectional study, we enrolled 121,601 volunteers from 29 community recruitment stations in Taiwan and divided them into two groups based on whether or not they lived alone. Psychiatric morbidity was defined as a Generalized Anxiety Disorder 2-item score ≥ 3, Patient Health Questionnaire 2-item score ≥ 3, or self-reported depression. Logistic regression was used to explore the associations between living alone and psychiatric morbidity.

Results

The participants who lived alone had a higher prevalence of psychiatric morbidity [odds ratio (OR) = 1.608, 95% confidence interval (CI) = 1.473 to 1.755] after adjusting for potential confounders. In a subgroup analysis, married subjects who lived alone and divorce/separation (OR = 2.013, 95% CI = 1.763 to 2.299) or widowing (OR = 1.750, 95% CI = 1.373 to 2.229) were more likely to have psychiatric morbidity than those who were married and not living alone.

Conclusions

Our findings suggest that living alone is a risk factor for psychiatric morbidity, especially for married subjects who live alone in concordance with divorce, separation, or the death of a spouse.

The Income Elasticities of Food, Calories, and Nutrients in China: A Meta-Analysis

Estimating food- and nutrient-income elasticities is important for making food and nutrition policies to combat malnutrition. There are many studies that have estimated the relationship between income growth and food/nutrient demand in China, but the results are highly heterogeneous. We conducted a meta-analysis in China to systematically review the elasticity of food, calories, and other nutrients to income. We considered a meta-sample using a collection of 64 primary studies covering 1537 food-income elasticities, 153 nutrient-income elasticities, and 147 calorie-income elasticity estimates. There are significant differences in the size of the income elasticities across food and nutrient groups. We found that food- and calorie-income elasticity appear to decline as per capita income increases, except for vitamin and aquatic products. We also found a publication bias for food and calories, and in particular, the study attributes may be important, as they can influence estimates. Given the limited study on nutrient-income elasticity, understanding the impact of income changes on nutrient intake is an important direction worthy of further research.

Association between the dietary inflammatory index and disability in Japanese older people

OBJECTIVES

To examine the demographic and lifestyle characteristics related to the dietary inflammatory index (DII™) score and to evaluate the association between DII score and disability among older people in Japan.

DESIGN

Cross-sectional design. The DII score was calculated from nutrient intake information obtained from a FFQ. Disability was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence questionnaire. Overall disability and disability in each component of everyday competence, that is, instrumental activities of daily living (IADL), intellectual activities and social participation, were assessed. Those with a deficit in one or more activities were defined as disabled.

SETTING

Five non-urban areas in Japan.

PARTICIPANTS

A total of 1642 Japanese older people aged 65 years or older.

RESULTS

Women, residents of Oga-shi, and those with a higher education and greater frequency of shopping followed a more anti-inflammatory diet, while those living alone and residents of Minamiawaji-shi had higher dietary inflammation. A pro-inflammatory diet was associated with higher odds of overall disability and disability in each component of competence: overall disability, OR (95 % CI) = 1·26 (1·16, 1·36); IADL disability, OR (95 % CI) = 1·16 (1·07, 1·26); disability in intellectual activities, OR (95 % CI): 1·30 (1·20, 1·40); and disability in social participation, OR (95 % CI) = 1·20 (1·11, 1·29).

CONCLUSIONS

Sex, living alone, education, frequency of shopping and area of residence were shown to be determinants of DII score in Japanese older people. DII score was positively associated with disability.

Health Determinants Associated with the Mediterranean Diet: A Cross-Sectional Study

INTRODUCTION

The Mediterranean diet (MD) has been shown to be a good tool for the prevention of obesity and other chronic noncommunicable diseases (NCDs) and to have a low environmental impact. The aim of the present study was to evaluate the relationship between declared morbidity, lifestyles and other sociodemographic factors with high adherence to the MD (AMD) in an adult population in southeastern Spain.

MATERIAL AND METHODS

We conducted a cross-sectional study of a sample (n = 2728) representative of a non-institutionalized population ≥16 years. The data corresponded to the 2010-11 Nutrition Survey of the Valencian Community. The AMD was assessed using the Mediterranean Diet Adherence Screener questionnaire. The association of variables and high AMD was assessed by univariate and multivariate logistic regression determining crude and adjusted odds ratios.

RESULTS

Multivariate analysis showed that age 45 years or older, living with a partner, eating between meals, and not smoking were associated with high AMD. The age groups 45-64 years and 65 years or older showed the strongest association with high AMD in both sexes.

CONCLUSION

The investigation showed a generational loss of AMD. People older than 45 years and living in company are more likely to adhere to DM, the risk group being young people living alone and smokers.

The limitations of investigating appetite through circuit manipulations: are we biting off more than we can chew?

Disordered eating can underpin a number of debilitating and prevalent chronic diseases, such as obesity. Broader advances in psychopharmacology and biology have motivated some neuroscientists to address diet-induced obesity through reductionist, pre-clinical eating investigations on the rodent brain. Specifically, chemogenetic and optogenetic methods developed in the 21st century allow neuroscientists to perform in vivo, region-specific/projection-specific/promoter-specific circuit manipulations and immediately assess the impact of these manipulations on rodent feeding. These studies are able to rigorously conclude whether a specific neuronal population regulates feeding behaviour in the hope of eventually developing a mechanistic neuroanatomical map of appetite regulation. However, an artificially stimulated/inhibited rodent neuronal population that changes feeding behaviour does not necessarily represent a pharmacological target for treating eating disorders in humans. Chemogenetic/optogenetic findings must therefore be triangulated with the array of theories that contribute to our understanding of appetite. The objective of this review is to provide a wide-ranging discussion of the limitations of chemogenetic/optogenetic circuit manipulation experiments in rodents that are used to investigate appetite. Stepping into and outside of medical science epistemologies, this paper draws on philosophy of science, nutrition, addiction biology and neurophilosophy to prompt more integrative, transdisciplinary interpretations of chemogenetic/optogenetic appetite data. Through discussing the various technical and epistemological limitations of these data, we provide both an overview of chemogenetics and optogenetics accessible to non-neuroscientist obesity researchers, as well as a resource for neuroscientists to expand the number of lenses through which they interpret their circuit manipulation findings.

Association between Healthy Eating Index and Mental Health in Middle-Aged Adults Based on Household Size in Korea

This study examined the association between dietary lifestyle and mental health outcomes among middle-aged individuals (40−60-year-olds) living alone, using the Korean Healthy Eating Index (KHEI). The participants were selected (1334 men and 2185 women) from the Korea National Health and Nutrition Examination Survey 2016−2018 and categorized into single/multi-person households. The KHEI scores were calculated based on the 24 h recall data of dietary intake. Among both sexes, single-person households had significantly lower subjective health status scores (p = 0.015 for men; p < 0.001 for women), lower EuroQol-5D index scores (p = 0.011 for men; p = 0.003 for women), and higher Patient Health Questionnaire-9 index scores (p = 0.004 for men; p < 0.001 for women), compared to multi-person households. Men had a higher risk of depression in single-person households compared to multi-person households (OR, 3.5; 95% CI, 1.2−10.1). For women, the ORs for stress perception with the first tertile group of KHEI scores in single-person and multi-person households compared to the third tertile group were 3.5 (95% CI, 1.3−9.0) and 1.4 (95% CI, 1.0−1.8), respectively. The results of this study are expected to be used as baseline data to establish nutrition, healthy eating behavior, and health policies for the middle-aged living alone.

Independent predictors of depressive symptoms and social isolation on two-year all-cause mortality among the elderly in a population-based cohort study: gender differences

OBJECTIVES

This study examined whether depressive symptoms and social isolation were independent predictors of 2-year all-cause mortality among the elderly using data from a population-based cohort study.

METHODS

In total, 1,033 participants (320 men and 713 women) older than 60 years of age participated in this study. Depressive symptoms, social isolation status, and socio-demographic and health-related covariates were assessed at baseline. The primary outcome measure was 2-year all-cause mortality. Data were collected through in-person interviews by trained interviewers. The GENMOD procedure was used to calculate relative risks (RRs).

RESULTS

Of the 1,033 participants, 102 (40 men and 62 women) died within the follow-up period of 2 years. During the 2-year follow-up period, 17.8% of depressed men and 12.3% of depressed women died, and 29.8% of socially isolated men and 14.9% of socially isolated women died. Social isolation was an independent predictor of mortality in elderly men (adjusted relative risk [aRR], 4.6, 95% confidence interval [CI], 2.0 to 10.2), while depressive symptoms were an independent predictor of mortality in elderly women (aRR, 2.0; 95% CI, 1.2 to 3.6) when controlling for potential confounding factors. However, the depressive symptoms detected using the geriatric depression scale were not associated with mortality in men, and social isolation was not associated with mortality in women.

CONCLUSIONS

The effects of depressive symptoms and social isolation on 2-year all-cause mortality within an elderly population differed according to gender. Gender-specific community-based interventions must be developed to potentially reduce 2-year all-cause mortality among the elderly.