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Armitage RM, Iatridi V, Sladekova M, Yeomans MR. Comparing body composition between the sweet-liking phenotypes: experimental data, systematic review and individual participant data meta-analysis. Int J Obes (Lond) 2024; 48:764-777. [PMID: 38467727 PMCID: PMC11129949 DOI: 10.1038/s41366-024-01494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Legislation aimed at reducing sugar intake assumes that sweet-liking drives overconsumption. However, evidence that a greater liking for sweet taste is associated with unhealthier body size is mixed and complicated by relatively small samples, an overreliance on body mass index (BMI) and lack of classification using sweet-liking phenotypes. METHODS We first examined body size data in two larger samples with sweet-liking phenotyping: extreme sweet-likers, moderate sweet-likers and sweet-dislikers. Adults (18-34yrs), attended a two-session lab-based experiment involving phenotyping for sweet-liking status and a bioelectrical impedance body composition measurement (Experiment One: N = 200; Experiment Two: N = 314). Secondly, we conducted an individual participant data (IPD) meta-analysis: systematic searches across four databases identified 5736 potential articles. Of these, 53 papers met our search criteria: a taste assessment that measured liking using sucrose (>13.7% w/v), which allowed sweet-liking phenotyping and included either BMI, body fat percentage (BF%), fat-free mass (FFM) or waist-circumference. RESULTS A significant effect of sweet-liking phenotype on FFM was found in both Experiment One and Two, with extreme sweet-likers having significantly higher FFM than sweet-dislikers. In Experiment One, sweet-dislikers had a significantly higher BF% than extreme sweet-likers and moderate sweet-likers. However, as these data are from one research group in a young, predominantly westernised population, and the results did not perfectly replicate, we conducted the IPD meta-analyses to further clarify the findings. Robust one-stage IPD meta-analyses of 15 studies controlling for sex revealed no significant differences in BF% (n = 1836) or waist-circumference (n = 706). For BMI (n = 2368), moderate sweet-likers had slightly lower BMI than extreme sweet-likers, who had the highest overall BMI. Most interestingly, for FFM (n = 768), moderate sweet-likers and sweet-dislikers showed significantly lower FFM than extreme sweet-likers. CONCLUSION The higher BMI often seen in sweet-likers may be due to a larger FFM and questions the simple model where sweet liking alone is a risk factor for obesity.
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Affiliation(s)
| | - Vasiliki Iatridi
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
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Sambasivam R, Abdin E, AshaRani PV, Roystonn K, Devi F, Wang P, Lee ES, Sum CF, Subramaniam M. Public awareness of war on diabetes campaign and its association with behavioural outcomes. HEALTH EDUCATION RESEARCH 2024; 39:284-295. [PMID: 38394480 DOI: 10.1093/her/cyae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour ≥7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores (β = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.
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Affiliation(s)
- Rajeswari Sambasivam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - P V AshaRani
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Kumarasan Roystonn
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, 3 Fusionopolis Link , Singapore 138543, Singapore
| | - Chee Fang Sum
- Khoo Teck Puat Hospital, Diabetes Centre, 90 Yishun Central, Singapore 768828, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
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Busse KR, Lee Mayol NR, Ammerman AS, Avery CL, Martin SL, Adair LS. Ultraprocessed Food Intake during the Transition to Adulthood Varies According to Sociodemographic Characteristics and Maternal Intake in Cebu, Philippines. J Nutr 2024:S0022-3166(24)00235-9. [PMID: 38697516 DOI: 10.1016/j.tjnut.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Ultraprocessed foods (UPFs) are associated with elevated risk of noncommunicable disease, but little is known about UPF intake and the individual-, household-, and community-level factors associated with it among adolescents in low- or middle-income countries. OBJECTIVES We estimated the association of UPF intake across adolescence with sociodemographic characteristics and maternal UPF intake in a Filipino cohort. METHODS Data were from 4 waves (1994-2005) of the Cebu Longitudinal Health and Nutrition Survey (n = 2068); participants were aged 11, 15, 18, and 21 y. Foods from 24-h recalls were classified using NOVA. We used two-part multilevel models to estimate time-varying associations of the odds and amount (percentage daily kilocalories) of UPF intake with sociodemographic characteristics and maternal UPF intake (none, below median among UPF-consuming mothers ["low"], at or above median ["high"]). RESULTS Median UPF intake (interquartile range [IQR]) among adolescents was 7.3% (IQR: 0, 17.2%) of daily kilocalories at age 11 y and 10.6% (IQR: 3.6, 19.6%) at 21 y. The odds and amount of adolescent UPF intake were positively associated with female sex, years of schooling, and household wealth and inversely associated with household size. The odds-but not amount-of adolescent UPF intake was positively associated with maternal education and urbanicity and inversely associated with the distance from a household's primary store/market. The association between odds of adolescent UPF intake and school enrollment was positive in adolescence but disappeared in early adulthood. Compared with offspring whose mothers did not consume UPFs, the odds of UPF intake among those whose mothers had low or high UPF intake was greater in adolescence, but there was no association once offspring became adults. At all ages, maternal UPF intake was positively associated with the amount of offspring intake. CONCLUSIONS Adolescent UPF intake varied across sociodemographic characteristics and was positively associated with maternal UPF intake, but not after adolescents entered adulthood.
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Affiliation(s)
- Kyle R Busse
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States.
| | - Nanette R Lee Mayol
- USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Christy L Avery
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
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Norov B, Cristobal-Maramag C, Van Minh H, Long KQ, Huse O, Nkoroi A, Luvsanjamba M, Phuong DH, Kupka R, Lobstein T, Jewell J, Castro MC, Oliver N, Watson F. Prevention of childhood overweight and obesity in Mongolia, the Philippines and Vietnam: identifying priority actions. Health Promot Int 2023; 38:daad187. [PMID: 38156876 PMCID: PMC10756053 DOI: 10.1093/heapro/daad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Low- and middle-income countries are increasingly faced with a triple burden of malnutrition: endemic underweight, micronutrient deficiencies and rising prevalence of overweight. This study aimed to address existing knowledge gaps and to identify priority policy options in Mongolia, the Philippines and Vietnam. A landscape analysis approach was adopted using methods set out in a UNICEF global toolkit. Quantitative and qualitative data were compiled from a range of global and national sources on childhood overweight and obesity, risk factors and policy responses. Key informant interviews and validation workshops were undertaken with key food and nutrition stakeholders from government and non-government organizations to identify priority policy options for the prevention of overweight and obesity among children. Overweight and obesity among children are increasing in all three countries. Associated risk factors are related to maternal nutrition, birthweight, breastfeeding, as well as diets and physical activity shaped by increasingly obesogenic environments. Key informants identified undefined policy approaches, poor community understanding and food and beverage industry influence as barriers to addressing overweight and obesity. Key policy priorities include restricting the marketing of unhealthy food and beverages, unhealthy food and beverage taxation, introduction of front-of-pack nutrition labels and improving school nutrition environments. Mongolia, the Philippines and Vietnam are all facing an increasing burden of childhood overweight and obesity. Despite differing national contexts, similar environmental factors are driving this rise. A suite of evidence-based policies can effectively be introduced to address obesogenic environments.
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Affiliation(s)
- Bolormaa Norov
- Nutrition Department, National Center for Public Health, Peace Ave 46, Ulaanbaatar 13381, Mongolia
| | - Cherry Cristobal-Maramag
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Hoang Van Minh
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Khương Quỳnh Long
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Oliver Huse
- Deakin University, Geelong Australia, Global Obesity Centre for Preventive Health and Nutrition, Institute for Health Transformation, 1 Gheringhap St 3220
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Alice Nkoroi
- Philippines Country Office, UNICEF, 14th Floor, North Tower, Rockwell Business Center Sheridan, Sheridan Street corner United Street, Highway Hills, Mandaluyong City 1550, Philippines
| | - Munkhjargal Luvsanjamba
- Mongolia Country Office, UNICEF, UN House, United Nations street-14, Ulaanbaatar 14201, Mongolia
| | - Do Hong Phuong
- Vietnam Country Office, UNICEF, The Green One UN House, 304 Kim Ma, Ba Dinh District, Hanoi, Vietnam
| | - Roland Kupka
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Tim Lobstein
- Policy Section, World Obesity Federation, 5th Floor, 38 Chancery Lane, London, WC2A 1EN, UK
- The Boden Initiative, University of Sydney, John Hopkins Dr, Camperdown, Sydney, 2050, NSW, Australia
| | - Jo Jewell
- Nutrition Section, UNICEF, 3 United Nations Plaza, New York, NY 10017, USA
| | - Mary Christine Castro
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Nikka Oliver
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Fiona Watson
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
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Bankole E, Harris N, Rutherford S, Wiseman N. A systematic review of the adolescent-directed marketing strategies of transnational fast food companies in low- and middle-income countries. Obes Sci Pract 2023; 9:670-680. [PMID: 38090687 PMCID: PMC10712404 DOI: 10.1002/osp4.676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Fast food consumption is associated with excessive intake of energy-dense foods; a major determinant of childhood obesity. The lack of data on the marketing strategies used to promote fast food to adolescents in low and middle-income countries (LMICs) acts as a barrier to global efforts to reduce the marketing of unhealthy foods to young people around the world. OBJECTIVES This systematic review aimed to identify the adolescent-directed marketing strategies of transnational fast food corporations in LMICs. METHODS A systematic search of eight scientific databases (PubMed, CINAHL, Medline, Embase, ProQuest, PsycInfo, Scopus and Google Scholar) was conducted. Following PRISMA guidelines, primary research articles written in English were included if they were published between 1 January 2010 and 30 December 2022, and reported any adolescent-directed marketing activity undertaken by a transnational fast food company operating in a LMIC. Articles were excluded if they were not peer reviewed. The quality of the included articles was assessed using a condensed version of the Consolidated Criteria for Reporting Qualitative Research tool. RESULTS Twelve articles met the eligibility criteria and were included in this review. A narrative synthesis of these articles revealed that the most documented strategies used to promote fast food to adolescents in LMICs were the use of incentives or premium offers, product appeals, promotional characters and brand familiarity. These strategies were mostly observed on social media, suggesting that there are serious concerns about adolescent exposure to fast food via social media in developing settings, especially as contextual differences in the nature of such marketing were identified. DISCUSSION The promotion of fast food to adolescents in LMICs is contextual in nature, with the nature of marketing strategies employed by transnational fast food corporations varying greatly across cultural and socio-economic contexts. These findings are crucial for the development of guidelines and regulations restricting the marketing of fast food to adolescents in lower income settings, contributing to global efforts to reduce adolescent exposure to unhealthy food promotion.
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Affiliation(s)
- Elijah Bankole
- Public HealthSchool of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Neil Harris
- Public HealthSchool of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Shannon Rutherford
- Public HealthSchool of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Nicola Wiseman
- Public HealthSchool of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
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Huse O, Backholer K, Nguyen P, Calibo A, Guirindola M, Desnacido JP, Sacks G, Bell AC, Peeters A, Angeles-Agdeppa I, Ananthapavan J. A comparative analysis of the cost-utility of the Philippine tax on sweetened beverages as proposed and as implemented. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 41:100912. [PMID: 37780636 PMCID: PMC10534259 DOI: 10.1016/j.lanwpc.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/01/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023]
Abstract
Background In response to increasing overweight and obesity, the Philippine government introduced a tax on sweetened beverages (SBs) in 2018. Evidence suggests that the beverage industry influenced the final tax design, making it more favourable for industry than the initially proposed bill. This study aimed to compare the relative health and economic benefits of the proposed SB tax with the implemented SB tax. Methods Philippine dietary consumption data were combined with price elasticity data from Mexico and data from Australia adapted to the Philippine context to estimate reductions in SB purchases and changes in body mass index (BMI) following the implementation of the tax. A multi-state, multiple-cohort Markov model was used to estimate the change in health-adjusted life years (HALYs) due to reduction in the epidemiology of obesity-related diseases, healthcare cost savings and government taxation revenue, resulting from both the proposed and implemented tax policies, over the lifetime of the 2018 Philippine population. Findings The proposed and implemented taxes were modelled to be dominant (cost-saving and improving health). Intervention costs were modelled to be PHP305.2 million (M) (approximately US$6M). Compared to the proposed tax, the implemented tax was modelled to result in a 43.0% smaller reduction in targeted beverage intake (51.1 ml/person/day vs. 89.7 ml/person/day), a 43.5% smaller reduction in BMI (0.35 kg/m2 vs. 0.62 kg/m2), 39.7% fewer HALYs gained (2,503,118 vs. 4,149,030), 39.9% fewer healthcare cost savings (PHP16.4 billion (B) vs. PHP27.3B), and 27.7% less government taxation revenue (PHP426.3B vs. PHP589.4B). Interpretation While the implemented tax in the Philippines will benefit population health, it is likely to yield less benefit than the proposed tax. The influence of the food and beverage industry on policy processes has the potential to lessen the benefits of population NCD prevention policies. Funding OH was supported to conduct this research by an Australian Government Research Training Program Stipend Scholarship. The funding body had no role in data collection and analysis, or manuscript preparation.
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Affiliation(s)
- Oliver Huse
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anthony Calibo
- Child Health Division, Department of Health, Medical Specialist IV, Disease Prevention and Control Bureau, Manila (2011-2020), Philippines
- Institute of Pediatrics and Child Health, St. Luke's Medical Center, Quezon City, Philippines
| | - Mildred Guirindola
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Josie P. Desnacido
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Gary Sacks
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Andrew Colin Bell
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Jaithri Ananthapavan
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Disdier AC, Etilé F, Rotunno L. The international diffusion of food innovations and the nutrition transition: retrospective longitudinal evidence from country-level data, 1970-2010. BMJ Glob Health 2023; 8:e012062. [PMID: 37967902 PMCID: PMC10660632 DOI: 10.1136/bmjgh-2023-012062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/10/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION There is a lack of quantitative evidence on the role of food innovations-new food ingredients and processing techniques-in the nutrition transition. OBJECTIVE Document the distribution of food innovations across 67 high-income (HIC) and middle-income (MIC) countries between 1970 and 2010, and its association with the nutritional composition of food supply. METHODS We used all available data on food patents, as compiled by the European Patent Office, to measure food innovations. We considered innovations directly received by countries from inventors seeking protection in their territories, and those embedded in processed food imports. Food and Agricultural Organization data were used to estimate the associations between international diffusion of food innovations and trends in total food supply and its macronutrient composition, after adjusting for confounding trends in demand-side factors. We identified the role of trade by simulating the changes in average diet due to innovations embedded in food imports. RESULTS Trends in food innovations were positively and significantly associated with changes in daily per capita calorie supply available for human consumption in MIC between 1990 and 2010 (elasticity of 0.027, 95% CI 0.019 to 0.036). Food innovations were positively correlated with the share of animal and free fats in total food supply (elasticities of 0.044, 95% CI 0.030 to 0.058 for MIC between 1970 and 1989 and 0.023, 95% CI 0.003 to 0.043 for HIC between 1990 and 2010). Food innovations were associated with substitutions from complex carbohydrates towards sugars in total food supply for MIC after 1990 (elasticities of -0.037, 95% CI -0.045 to -0.029 for complex carbs, 0.082, 95% CI 0.066 to 0.098 for sugars). For these countries, the trade channel capturing access to innovations through imports of processed food played a key role. CONCLUSION Policy-makers should consider the impacts of the international diffusion of food innovations in assessing the costs and benefits of international trade regulations.
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Affiliation(s)
- Anne-Célia Disdier
- Paris School of Economics, Paris, France
- UMR 1393, Paris-Jourdan Sciences Economiques, INRAE, Paris, France
| | - Fabrice Etilé
- Paris School of Economics, Paris, France
- UMR 1393, Paris-Jourdan Sciences Economiques, INRAE, Paris, France
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Singh S, Vemireddy V. Transitioning diets: a mixed methods study on factors affecting inclusion of millets in the urban population. BMC Public Health 2023; 23:2003. [PMID: 37833667 PMCID: PMC10576316 DOI: 10.1186/s12889-023-16872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The increasing health challenge in urban India has led to consumers to change their diet preferences by shifting away from staple cereals and making way for healthier foods such as nutri-cereals like millets and other diverse food groups. Taking the case of millets, this study seeks to uncover the exact drivers for this shift of consumers away from a traditional cereal dense diet to a nutritionally more diverse diet that includes nutri-cereal. We also look at deterrents that dissuade consumers from shifting to millets. METHOD We use primary data by surveying respondents through interviews and focused group discussions and online questionnaires. A total of 20 personal consumer interviews and 4 focus group discussions having 8-12 members each were conducted to arrive at the measures for the study. We use logistic regression and Structural Equation Modeling for data analysis. Responses were obtained across major metropolitan cities and tier 2 cities of India thus ensuring representation of geographical, cultural and diet diversity. 875 participants' responses were analysed for results. RESULTS Health reasons and social networks are the major drivers for shift to millets while lack of awareness, lack of easy availability, high prices, lack of branded products, family being averse to switching to millets and lack of attractive promotional cashbacks and discounts are major deterrents to trying out millets. CONCLUSIONS Diet focussed interventions are urgently needed to curb rising diet related non communicable diseases. Government policies aimed at greater production of millets, running awareness campaigns on mass media and private sector initiatives aimed at generating better value added market offerings could lead the way.
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Affiliation(s)
- Suruchi Singh
- Centre for Management in Agriculture, Indian Institute of Management Ahmedabad, Ahmedabad, India.
| | - Vidya Vemireddy
- Centre for Management in Agriculture, Indian Institute of Management Ahmedabad, Ahmedabad, India
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Wells JCK. An evolutionary perspective on social inequality and health disparities: Insights from the producer-scrounger game. Evol Med Public Health 2023; 11:294-308. [PMID: 37680454 PMCID: PMC10482145 DOI: 10.1093/emph/eoad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/13/2023] [Indexed: 09/09/2023] Open
Abstract
There is growing concern with social disparities in health, whether relating to gender, ethnicity, caste, socio-economic position or other axes of inequality. Despite addressing inequality, evolutionary biologists have had surprisingly little to say on why human societies are prone to demonstrating exploitation. This article builds on a recent book, 'The Metabolic Ghetto', describing an overarching evolutionary framework for studying all forms of social inequality involving exploitation. The dynamic 'producer-scrounger' game, developed to model social foraging, assumes that some members of a social group produce food, and that others scrounge from them. An evolutionary stable strategy emerges when neither producers nor scroungers can increase their Darwinian fitness by changing strategy. This approach puts food systems central to all forms of human inequality, and provides a valuable lens through which to consider different forms of gender inequality, socio-economic inequality and racial/caste discrimination. Individuals that routinely adopt producer or scrounger tactics may develop divergent phenotypes. This approach can be linked with life history theory to understand how social dynamics drive health disparities. The framework differs from previous evolutionary perspectives on inequality, by focussing on the exploitation of foraging effort rather than inequality in ecological resources themselves. Health inequalities emerge where scroungers acquire different forms of power over producers, driving increasing exploitation. In racialized societies, symbolic categorization is used to systematically assign some individuals to low-rank producer roles, embedding exploitation in society. Efforts to reduce health inequalities must address the whole of society, altering producer-scrounger dynamics rather than simply targeting resources at exploited groups.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Le Goff D, Aerts N, Odorico M, Guillou-Landreat M, Perraud G, Bastiaens H, Musinguzi G, Le Reste JY, Barais M. Practical dietary interventions to prevent cardiovascular disease suitable for implementation in primary care: an ADAPTE-guided systematic review of international clinical guidelines. Int J Behav Nutr Phys Act 2023; 20:93. [PMID: 37507692 PMCID: PMC10385931 DOI: 10.1186/s12966-023-01463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/03/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Cardiovascular diseases (CVD) are the leading cause of death globally. The current model of care for high-income countries involves preventive medication and highly trained healthcare professionals, which is expensive and not transposable to low-income countries. An innovative, effective approach adapted to limited human, technical, and financial resources is required. Measures to reduce CVD risk factors, including diet, are proven to be effective. The survey "Scaling-up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and Sub-Saharan Africa" aims to develop non-pharmacological cardiovascular prevention and control programs in primary care and community settings in high, middle, and low-income countries. This review aims to identify the existing, validated dietary interventions for primary CVD prevention from national and international clinical guidelines that can be implemented in primary care and communities. METHODS A systematic review of CVD prevention guidelines was conducted between September 2017 and March 2023 using the Turning Research Into Practice medical database, the Guidelines International Network, and a purposive search. The ADAPTE procedure was followed. Two researchers independently conducted the searches and appraisals. Guidelines published after 01/01/2012 addressing non-pharmacological, dietary interventions for primary CVD prevention or CVD risk factor management, in the adult general population in primary care or in community settings were included and appraised using the Appraisal of Guidelines Research and Evaluation II score. Individual dietary recommendations and the studies supporting them were extracted. Then supporting data about each specific dietary intervention were extracted into a matrix. RESULTS In total, 1375 guidelines were identified, of which 39 were included. From these, 383 recommendations, covering 10 CVD prevention themes were identified. From these recommendations, 165 studies for effective dietary interventions for CVD prevention were found. Among these, the DASH diet was the most effective on multiple CVD risk factors. Combining diet with other interventions such as exercise and smoking cessation increased efficacy. No guidelines provided detailed implementation strategies. CONCLUSION The DASH diet combined with other interventions was the most effective on an individual basis. However, expansion in the wider population seems difficult, without government support to implement regulations such as reducing salt content in processed food. TRIAL REGISTRATION Clinical Trials NCT03886064.
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Affiliation(s)
- Delphine Le Goff
- Department of General Practice, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France.
- ER 7479 SPURBO, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France.
| | - Naomi Aerts
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, 2610, Belgium
| | - Michele Odorico
- Department of General Practice, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
- ER 7479 SPURBO, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
| | - Morgane Guillou-Landreat
- ER 7479 SPURBO, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
| | - Gabriel Perraud
- Department of General Practice, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
- ER 7479 SPURBO, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, 2610, Belgium
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, 2610, Belgium
| | - Geofrey Musinguzi
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, 2610, Belgium
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Jean-Yves Le Reste
- Department of General Practice, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
- ER 7479 SPURBO, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
| | - Marie Barais
- Department of General Practice, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
- ER 7479 SPURBO, University of Western Brittany, 22, Av. Camille Desmoulins, Brest, 29238, France
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Russell C, Baker P, Grimes C, Lindberg R, Lawrence MA. Global trends in added sugars and non-nutritive sweetener use in the packaged food supply: drivers and implications for public health. Public Health Nutr 2023; 26:952-964. [PMID: 35899782 PMCID: PMC10346066 DOI: 10.1017/s1368980022001598] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The health implications of excessive added sugar intakes have led to national policy actions to limit their consumption. Subsequently, non-nutritive sweeteners (NNS) may be used to maintain product sweetness. We aimed to assess trends in quantities of added sugars and NNS sold in packaged food and beverages worldwide, and the association between these trends and the number of national policy actions across regions to reduce added sugar consumption. DESIGN (i) Longitudinal analysis of Euromonitor sales data (2007-2019) to assess the quantity of added sugars (kg) and NNS (g) sold in packaged foods and beverages globally, across regions, and across country income categories; (ii) policy-mapping of policy actions targeting added sugar consumption globally from the NOURISHING database; and (iii) Spearman's correlations to assess the association between national policy actions across regions and changes in added sugar/NNS sales. SETTING Worldwide. PARTICIPANTS Not applicable. RESULTS Per capita volumes of NNS from beverage sales increased globally (36 %). Added sugars from beverage sales decreased in high-income countries (22 %) but increased in upper-middle-income countries (UMIC) and lower-middle-income countries (LMIC) (13-40 %). Added sugars from packaged food sales increased globally (9 %). Regions with more policy actions had a significant increase in NNS quantities from beverage sales (r = 0·68, P = 0·04). The sweetness of the packaged food supply (the sweetness of each NNS and added sugar, relative to sucrose, multiplied by sales volume) increased over time. CONCLUSIONS The increasing use of NNS to sweeten beverages globally, and in packaged food in UMIC and LMIC, may have health and dietary implications in the future. Their use as a substitute for added sugar should be considered in public health nutrition policymaking.
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Affiliation(s)
- Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Australia
| | - Phillip Baker
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Carley Grimes
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Rebecca Lindberg
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Mark A Lawrence
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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12
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Huse O, Reeve E, Zambrano P, Bell C, Peeters A, Sacks G, Baker P, Backholer K. Understanding the corporate political activity of the ultra - processed food industry in East Asia: a Philippines case study. Global Health 2023; 19:16. [PMID: 36879312 PMCID: PMC9986662 DOI: 10.1186/s12992-023-00916-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Evidence is mounting that the ultra - processed food industry seeks to influence food and nutrition policies in ways that support market growth and protect against regulatory threats, often at the expense of public health. However, few studies have explored how this occurs in lower - middle income countries. We aimed to explore if and how the ultra - processed food industry seeks to influence food- and nutrition - related policy processes in the Philippines, a lower - middle income country in East Asia. METHODS Semi - structured key informant interviews were conducted with ten representatives from the Philippines government and non - government organisations closely involved with nutrition policy making in the Philippines. Interview schedules and data analysis were guided by the policy dystopia model, which we used to identify the instrumental and discursive strategies used by corporate actors to influence policy outcomes. RESULTS Informants were of the view that ultra - processed food companies in the Philippines sought to delay, prevent, water - down and circumvent implementation of globally recommended food and nutrition policies by engaging in a range of strategies. Discursive strategies included various tactics in which globally recommended policies were framed as being ineffective or highlighting potential unintended negative impacts. Instrumental strategies included: directly engaging with policymakers; promoting policies, such as industry - led codes and practices, as substitutes for mandatory regulations; presenting evidence and data that industry has generated themselves; and offering gifts and financial incentives to government individuals and agencies. CONCLUSIONS In the Philippines, the ultra - processed food industry engaged in overt activities designed to influence food and nutrition policy processes in their favour. A range of measures to minimise industry influence on policy processes should be introduced, to ensure that implemented food and nutrition policies align with best practice recommendations.
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Affiliation(s)
- Oliver Huse
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Erica Reeve
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Paul Zambrano
- Alive & Thrive Southeast Asia, FHI 360, Manila, Philippines
| | - Colin Bell
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phillip Baker
- Faculty of Health, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Centre for Preventative Health and Nutrition, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, Australia
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13
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Papier K, Kakkoura MG, Guo Y, Knuppel A, Pei P, Tong TYN, Yu C, Perez-Cornago A, Chang WC, Chen J, Lv J, Li L, Chen Z, Du H, Key TJ. Intakes of major food groups in China and UK: results from 100,000 adults in the China Kadoorie biobank and UK biobank. Eur J Nutr 2023; 62:819-832. [PMID: 36271961 PMCID: PMC9941233 DOI: 10.1007/s00394-022-03031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/05/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Different populations may exhibit differences in dietary intakes, which may result in heterogeneities in diet-disease associations. We compared intakes of major food groups overall, by sex, and by socio-economic status (SES) (defined as both education and income), between participants in the China Kadoorie Biobank (CKB) and the UK Biobank (UKB). METHODS Data were from ~ 25,000 CKB participants who completed a validated interviewer-administered computer-based questionnaire (2013-2014) and ~ 74,000 UKB participants who completed ≥ 3 web-based 24-h dietary assessments (2009-2012). Intakes of 12 major food groups and five beverages were harmonized and compared between the cohorts overall, by sex and by SES. Multivariable-adjusted linear regression examined the associations between dietary intakes and body mass index (BMI) in each cohort. RESULTS CKB participants reported consuming more rice, eggs, vegetables, soya products, and less wheat, other staple foods (other than rice and wheat), fish, poultry, all dairy products, fruit, and beverages compared to UKB participants. Red meat intake was similar in both cohorts. Having a higher SES was generally associated with a higher consumption of foods and beverages in CKB, whereas in UKB dietary intakes differed more by education and income, with a positive association observed for meat and income in both UKB and CKB but an inverse association observed for education in UKB. Associations of dietary intakes with BMI varied between the two cohorts. CONCLUSION The large differences in dietary intakes and their associations with SES and BMI could provide insight into the interpretation of potentially different diet-disease associations between CKB and UKB.
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Affiliation(s)
- Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria G Kakkoura
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Anika Knuppel
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, UK
| | - Pei Pei
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, 100191, China
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Wing Ching Chang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, 100191, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, 100191, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Mae Armitage R, Iatridi V, Thanh Vi C, Richard Yeomans M. Phenotypic differences in taste hedonics: the effects of sweet liking. Food Qual Prefer 2023. [DOI: 10.1016/j.foodqual.2023.104845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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15
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Anyanwu OA, Naumova EN, Chomitz VR, Zhang FF, Chui K, Kartasurya MI, Folta SC. The Socio-Ecological Context of the Nutrition Transition in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Stakeholders. Nutrients 2022; 15:nu15010025. [PMID: 36615684 PMCID: PMC9823366 DOI: 10.3390/nu15010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Indonesia is undergoing a rapid nutrition transition—a shift in food consumption related to globalization, modernization, urbanization, and economic development—with potentially adverse impacts on diets, health, and the environment. This study sought to understand the perspectives of a multi-disciplinary group of experts on the effects of the nutrition transition on dietary behaviors, cardiovascular disease (CVD) risk factors, and the food environment in Indonesia. Methods: In-depth interviews were conducted online with 27 Indonesian experts, who are either healthcare providers, nutrition researchers, or environmental researchers. Interview question guides were developed based on a socio-ecological framework. We analyzed the data using deductive and inductive approaches. Results: Experts described a disconnect between awareness about and adherence to healthy diets among Indonesians. They highlighted a marked generational divide in food preferences between the younger population (<40y) and older population (40y+), due to the nutrition transition. Experts perceived that the nutrition transition has also resulted in more eating out, which promotes obesity, through the unhealthy menu offerings from restaurants. Experts also implied that traditional diets are no better than modern diets, due to unhealthy cooking practices, especially frying; suggesting that the combination of higher consumption of fast foods and unhealthy cooking practices may have worsened CVD risk factors in the population. Conclusion: Multi-disciplinary experts indicated that the nutrition transition has negatively impacted diets, health, and food environment in Indonesia. Our findings offer potential hypotheses that can be tested using quantitative approaches, to inform policy and the design of programs to reduce the adverse impacts of the nutrition transition in Indonesia.
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Affiliation(s)
- Oyedolapo A. Anyanwu
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
- Correspondence:
| | - Elena N. Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Virginia R. Chomitz
- Public Health & Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA 02111, USA
| | - Fang-Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Kenneth Chui
- Public Health & Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA 02111, USA
| | - Martha I. Kartasurya
- Department of Public Health Nutrition, Universitas Diponegoro, Semarang 50275, Jawa Tengah, Indonesia
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
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Huse O, Reeve E, Bell C, Sacks G, Baker P, Wood B, Backholer K. Strategies used by the soft drink industry to grow and sustain sales: a case-study of The Coca-Cola Company in East Asia. BMJ Glob Health 2022; 7:bmjgh-2022-010386. [PMID: 36593644 PMCID: PMC9730366 DOI: 10.1136/bmjgh-2022-010386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The market and non-market activities of the food and beverage industry contribute to unhealthy and unsustainable dietary patterns, increasingly in low-income and middle-income countries (LMICs). We aimed to describe how The Coca-Cola Company (TCCC), as the world market leader in the sugar-sweetened beverage sector, operationalises their activities in LMICs in East Asia, among the world's most highly populated yet under-researched countries, to illustrate the ways in which these activities may negatively influence health outcomes. METHODS We adopted a theoretically-guided qualitative research design and documentary analysis method. Data sources included: industry documents and web pages, marketing case studies obtained from the World Advertising Research Centre, media reports, global trade summaries and websites of industry associations. To guide data analysis, we synthesised a conceptual framework from existing commercial determinants of health literature, to describe ways in which the market and non-market activities of TCCC influence health. RESULTS TCCC leverages subsidiary companies and investments in international networks to expand its supply chains. The company engages in frequent political activities to minimise the implementation of nutrition policies that may impact profits. The company markets products, particularly on digital and mobile devices, often targeting children, adolescents and mothers, and undertakes public relations activities related to human rights, environmental sustainability and community and economic supports, and these public relations activities are often integrated into marketing campaigns. The identified activities of TCCC are frequently in direct contrast to efforts to improve the healthfulness of population diets in East Asia LMICs. CONCLUSIONS A public health analysis of the market and non-market activities of corporations active in unhealthy commodity industries needs to be broad in scope to cover the diverse set of strategies used to increase their market power and influence. Governments should consider a suite of policy options to attenuate these commercial determinants of unhealthy diets.
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Affiliation(s)
- Oliver Huse
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Erica Reeve
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
| | - Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Duong C, Jenkins M, Pyo E, Nguyen PH, Huynh T, Nguyen‐Viet H, Young MF, Ramakrishnan U. Understanding maternal food choice for preschool children across urban-rural settings in Vietnam. MATERNAL & CHILD NUTRITION 2022; 19:e13435. [PMID: 36346156 PMCID: PMC9749606 DOI: 10.1111/mcn.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/27/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022]
Abstract
Improving diet quality of preschool children is challenging in countries undergoing food environment and nutrition transition. However, few studies have sought to understand how mothers in these countries decide what and how to feed their children. This study aims to explore maternal experiences, perspectives and beliefs when making food choice decisions for preschool children in urban, peri-urban and rural areas in northern Vietnam. Two focus group discussions and 24 in-depth interviews were carried out and analysed using thematic analysis. The results showed that mothers across the urban-rural spectrum shared the intention to feed children safe, nutritious food for better health and weight gain while satisfying child food preferences to improve appetite and eating enjoyment. These food choice intentions were embedded within family food traditions, whereby mothers emphasised nutritious food and adopted strict feeding styles during lunch and dinner but were flexible and accommodating of child preferences during breakfast and side meals. These intentions were also embedded within the physical food environment, which provided a mix of healthy and unhealthy food through informal food retailers. Despite these intentions, mothers faced financial constraints and difficulties in managing children's refusal to chew, changes in eating mood and strong eating temperament. These findings support policies to limit the presence of unhealthy food in informal food retail and encourage meal-specific feeding strategies to help children enjoy nutritious food, transition from soft to textured food and become more cooperative during mealtime.
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Affiliation(s)
- Cam Duong
- Nutrition and Health Sciences Program, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Mica Jenkins
- Nutrition and Health Sciences Program, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Euisun Pyo
- Nutrition and Health Sciences Program, Laney Graduate SchoolEmory UniversityAtlantaGeorgiaUSA
| | - Phuong Hong Nguyen
- International Food Policy Research InstituteWashingtonDistrict ColumbiaUSA
| | - Tuyen Huynh
- Alliance Bioversity International and CIATAsia HubHanoiVietnam
| | - Hung Nguyen‐Viet
- Animal and Human Health ProgramInternational Livestock Research InstituteNairobiKenya
| | - Melissa F. Young
- Hubert Department of Global HealthEmory UniversityAtlantaGeorgiaUSA
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Vissers E, Wellens J, Sabino J. Ultra-processed foods as a possible culprit for the rising prevalence of inflammatory bowel diseases. Front Med (Lausanne) 2022; 9:1058373. [PMID: 36419796 PMCID: PMC9676654 DOI: 10.3389/fmed.2022.1058373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Inflammatory bowel diseases (IBD) are chronic inflammatory disorders of the gastrointestinal tract, and the exact pathogenesis is still unclear. It is believed that IBD develops in response to a complex interaction between the microbiota, environmental factors, and the immune system, in genetically predisposed individuals. Identifying these environmental factors will offer more insight in the development of the disease, and reveal new therapeutic targets for IBD patients. One of the environmental factors that has gained more interest over the last years is our diet. The prevalence of IBD has increased significantly and this increase is thought to be associated with a ‘Western diet', characterized by high intake of fats, added sugar, meat, and ultra-processed foods (UPFs). The UPFs now account for almost 50% of the energy intake in Westernized countries and are therefore an important characteristic of this Western diet. UPFs are characterized by higher amounts of salt, fat, sugar and the presence of different food additives. Epidemiological studies have found associations between UPF intake and a range of non-communicable diseases, including inflammatory bowel disease (IBD). Preclinical and clinical evidence suggest that non-nutritive ingredients and additives, present in UPFs, can negatively affect different components of the intestinal barrier, such as the microbiota, the mucus layer, the epithelium, and the immune cells in the lamina propria. Disruption of this barrier can cause the immune system to encounter an increased bacterial exposure, leading to an aberrant immune response. In this article, the available evidence on the possible role of UPFs and their components in the increasing incidence and prevalence of IBD is reviewed. These findings can be translated to the clinic and may be helpful to consider when giving dietary advice to IBD patients. A better understanding of the role of UPFs may lead to less restrictive diets for patients with IBD, hence increasing the dietary compliance and efficacy of exclusion diets.
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Affiliation(s)
- Eva Vissers
- Department of Chronic Diseases, Metabolism and Aging, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Judith Wellens
- Department of Chronic Diseases, Metabolism and Aging, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - João Sabino
- Department of Chronic Diseases, Metabolism and Aging, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- *Correspondence: João Sabino
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Colozza D. A qualitative exploration of ultra-processed foods consumption and eating out behaviours in an Indonesian urban food environment. Nutr Health 2022:2601060221133897. [PMID: 36330688 DOI: 10.1177/02601060221133897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Increased consumption of ultra-processed foods and drinks high in unhealthy fats, salt and sugar is a major driver behind rising non-communicable disease rates in Asia-Pacific. Urban residence is considered a risk factor for increased consumption of these products; yet, evidence on consumption behaviours and drivers from urban populations in the region remains limited. Aim: To understand perceptions and drivers of unhealthy fats, salt and sugar foods and drinks consumption and eating out behaviours in Yogyakarta city, Indonesia. Methods: In-depth qualitative data were collected through open-ended interviews and prolonged interactions in the local food environment, from a purposeful sample (N = 45) equally distributed across three urban communities. Data were analysed according to the principles of content analysis and following an iterative approach. Results: Despite showing high nutritional health awareness, respondents and their household members consumed ultra-processed foods high in unhealthy fats, salt and sugar regularly. Home consumption of these products was based primarily on economic considerations and convenience, but also related to attending requests from other family members, individual preferences and tastes, and social functions. Similarly, despite a reported preference for home-cooked traditional foods, several participants or their family members would frequently eat ready-made meals away from home, due to conflicting school or work commitments. Discussion: Results suggest that public health interventions focused on nutrition education among Indonesian communities should be coupled with measures addressing urban food environment characteristics that promote the consumption of unhealthy diets, be tailored to specific age groups, and leverage traditional food cultures.
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Affiliation(s)
- David Colozza
- Department of Global Health and Social Medicine, 4616King's College London, London, UK
- Department of Geography, 4616King's College London, London, UK
- Department of Geography, 37580National University of Singapore, Singapore
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Drivers and distribution of the household-level double burden of malnutrition in Bangladesh: analysis of mother-child dyads from a national household survey. Public Health Nutr 2022; 25:3158-3171. [PMID: 36111605 PMCID: PMC9991823 DOI: 10.1017/s1368980022002075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The double burden of malnutrition (DBM) has become an emerging public health issue in many low- and middle-income countries. This study aims to provide important evidence for the prevalence of different types of DBM at the national and subnational levels in Bangladesh. DESIGN The study utilised data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-2018. Multivariable logistic regression was performed to identify the sociodemographic factors associated with DBM. SETTING Nationally representative cross-sectional survey. PARTICIPANTS 8697 mothers aged 15 to 49 years with <5 children. RESULTS The overall prevalence of the DBM was approximately 21 %, where the prevalence of overweight mother (OWM) & stunted child/wasted child/underweight child (SC/WC/UWC) and underweight mother (UWM) & overweight child (OWC) was 13·35 % and 7·69 %, respectively, with a higher prevalence among urban households (OWM & SC/WC/UWC = 14·22 %; UWM & OWC = 10·58 %) in Bangladesh. High inequality was observed among UWM & OWC dyads, concentration index (CI) = -0·2998, while low level of inequality of DBM were observed for OWM & SC (CI = 0·0153), OWM & WC (CI = 0·1165) and OWM & UWC (CI = 0·0135) dyads. We observed that the age and educational status of the mother, number of children, fathers' occupation, size and wealth index of the household, and administrative division were significantly associated with all types of DBM. CONCLUSIONS Health policymakers, concerned authorities and various stakeholders should stress the prevalence of DBM issues and take necessary actions aimed at identifying and addressing the DBM in Bangladesh.
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Sinha S, Haque M. Obesity, Diabetes Mellitus, and Vascular Impediment as Consequences of Excess Processed Food Consumption. Cureus 2022; 14:e28762. [PMID: 36105908 PMCID: PMC9441778 DOI: 10.7759/cureus.28762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 12/15/2022] Open
Abstract
Regular intake of ready-to-eat meals is related to obesity and several noninfectious illnesses, such as cardiovascular diseases, hypertension, diabetes mellitus (DM), and tumors. Processed foods contain high calories and are often enhanced with excess refined sugar, saturated and trans fat, Na+ andphosphate-containing taste enhancers, and preservatives. Studies showed that monosodium glutamate (MSG) induces raised echelons of oxidative stress, and excessive hepatic lipogenesis is concomitant to obesity and type 2 diabetes mellitus (T2DM). Likewise, more than standard salt intake adversely affects the cardiovascular system, renal system, and central nervous system (CNS), especially the brain. Globally, excessive utilization of phosphate-containing preservatives and additives contributes unswervingly to excessive phosphate intake through food. In addition, communities and even health experts, including medical doctors, are not well-informed about the adverse effects of phosphate preservatives on human health. Dietary phosphate excess often leads to phosphate toxicity, ultimately potentiating kidney disease development. The mechanisms involved in phosphate-related adverse effects are not explainable. Study reports suggested that high blood level of phosphate causes vascular ossification through the deposition of Ca2+ and substantially alters fibroblast growth factor-23 (FGF23) and calcitriol.
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Characterizing Retail Food Environments in Peri-Urban Pakistan during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148614. [PMID: 35886466 PMCID: PMC9324779 DOI: 10.3390/ijerph19148614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: To date, there are limited data in low- and middle-income countries (LMICs) that collect, monitor, and evaluate food environments in standardized ways. The development of a pilot survey tool, tailored to LMICs and focused on retail food environments, is necessary for improving public health nutrition. (2) Methods: A novel survey tool was developed and piloted in a sample of village retail food environments (n = 224) in Matiari, Pakistan between October 2020 to April 2021. Villages were randomly selected, and food outlets were surveyed within a 500-m radius from each village center. Descriptive statistics (counts and percentages) were used to describe the characteristics of food outlets and the availability of food. To test whether there was a difference in characteristics or in the mean of number of healthy, unhealthy, and total food items available by village size, a χ2 test or one-way ANOVA was conducted, respectively. (3) Results: In total, 1484 food outlets were surveyed for food accessibility, availability, and promotion across small (n = 54), medium (n = 112), and large villages (n = 58). In small and medium-sized villages, mobile food vendors were the predominant food outlet type (47.8% and 45.1%, respectively), whereas in large villages, corner stores (36%) were more prominent. The mean number of total food items (p < 0.006) and unhealthy food items (p < 0.001) available in food outlets differed by village size. The proportion of food outlets with available fruits, meat and poultry, water, and sugar-sweetened beverages also differed by village size (p < 0.001). (4) Conclusions: This study informs the global evidence gap in the current understanding of food environments in various ethnically diverse and dynamic LMICs, and the developed methodology will be useful to other LMICs for measuring and monitoring the food environment, especially among vulnerable population groups. This work complements current national and provincial survey efforts in Pakistan.
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The global food environment transition based on the socio-demographic index. GLOBAL FOOD SECURITY 2022. [DOI: 10.1016/j.gfs.2022.100632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Lo CH, Khandpur N, Rossato SL, Lochhead P, Lopes EW, Burke KE, Richter JM, Song M, Korat AVA, Sun Q, Fung TT, Khalili H, Chan AT, Ananthakrishnan AN. Ultra-processed Foods and Risk of Crohn's Disease and Ulcerative Colitis: A Prospective Cohort Study. Clin Gastroenterol Hepatol 2022; 20:e1323-e1337. [PMID: 34461300 PMCID: PMC8882700 DOI: 10.1016/j.cgh.2021.08.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The rising incidence of inflammatory bowel disease in regions undergoing Westernization has coincided with the increase in ultra-processed food (UPF) consumption over the past few decades. We aimed to examine the association between consumption of UPFs and the risk of Crohn's disease (CD) and ulcerative colitis (UC). METHODS We performed a prospective cohort study of 3 nationwide cohorts of health professionals in the United States-the Nurses' Health Study (1986-2014), the Nurses' Health Study II (1991-2017), and the Health Professionals Follow-up Study (1986-2012). We employed Cox proportional hazards models with adjustment for confounders to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for CD and UC according to self-reported consumption of UPFs. RESULTS The study included 245,112 participants. Over 5,468,444 person-years of follow-up, we documented 369 incident cases of CD and 488 incident cases of UC. The median age at diagnosis was 56 years (range, 29-85 years). Compared with participants in the lowest quartile of simple updated UPF consumption, those in the highest quartile had a significantly increased risk of CD (HR, 1.70; 95% CI, 1.23-2.35; Ptrend = .0008). Among different UPF subgroups, ultra-processed breads and breakfast foods; frozen or shelf-stable ready-to-eat/heat meals; and sauces, cheeses, spreads, and gravies showed the strongest positive associations with CD risk (HR per 1 standard deviation increase in intake, 1.18 [95% CI, 1.07-1.29], 1.11 [95% CI, 1.01-1.22], and 1.14 [95% CI, 1.02-1.27], respectively). There was no consistent association between UPF intake and UC risk. CONCLUSIONS Higher UPF intake was associated with an increased risk of incident CD. Further studies are needed to identify specific contributory dietary components.
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Affiliation(s)
- Chun-Han Lo
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Neha Khandpur
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil,Center for Epidemiological Studies in Health and Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Sinara Laurini Rossato
- Graduation course in Public Health, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Paul Lochhead
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Emily W. Lopes
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin E. Burke
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James M. Richter
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andres Victor Ardisson Korat
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Qi Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Teresa T. Fung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Department of Nutrition, Simmons University, Boston, Massachusetts, USA
| | - Hamed Khalili
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ashwin N. Ananthakrishnan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Liwin LK. Shifting educational gradients in body mass index trajectories of Indonesians: an age period cohort analysis. BMC Public Health 2022; 22:1004. [PMID: 35585591 PMCID: PMC9115941 DOI: 10.1186/s12889-022-13379-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Globally, the number of obese adults has increased rapidly in many developing countries. The links between increased educational attainment and lower risks of overweight/obesity have been studied in a number of high-income contexts. However, educational attainment can have a different association with obesity at different levels of economic development and different stages of the nutritional transition, and these associations may vary by period and cohort. This study aims to provide evidence on the shifting of educational gradients in overweight/obesity in Indonesia, a low middle income country. Methods Using five waves of Indonesian Family Life Survey (IFLS), this study examines the Body Mass Index (BMI) trajectories of 14,810 individuals from 1993 to 2014. This study analyses how educational gradients in BMI have shifted over time and across cohorts using a hierarchical age-period-cohort (HAPC) model to account for the effects of age and the changes in historical periods (social and environmental contexts). Results In older generations, higher educational attainment is associated with higher BMI, but the gap between educational groups shrinks in more recently-born cohorts. The BMI of lower educational groups is catching up with that of the tertiary educated, leading to an increased risk of overweight/obesity among low educated individuals. Having tertiary education lowers the risk of weight gain (-0.04 point) among recently-born cohort of women, but it still increases the risk (+ 0.04 point) for men. Conclusion Changes in access to education and the ongoing nutritional transition in Indonesia are leading to a shifting of educational gradients in overweight/obesity over time. The rising trends in BMI among low-educated and younger individuals are of substantial concern for Indonesian public health due to their implications for the risk of communicable and non-communicable diseases in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13379-3.
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Affiliation(s)
- Lilipramawanty Kewok Liwin
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia.
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de Medeiros GCBS, Mesquita GXB, Lima SCVC, Silva DFDO, de Azevedo KPM, Pimenta IDSF, de Oliveira AKDSG, Lyra CDO, Martínez DG, Piuvezam G. Associations of the consumption of unprocessed red meat and processed meat with the incidence of cardiovascular disease and mortality, and the dose-response relationship: A systematic review and meta-analysis of cohort studies. Crit Rev Food Sci Nutr 2022; 63:8443-8456. [PMID: 35491892 DOI: 10.1080/10408398.2022.2058461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study was to examine the associations of unprocessed red meat and processed meat consumption with cardiovascular disease (CVD) incidence and mortality, and the dose-response relationship. METHODS Published literature was retrieved through a structured search of 10 electronic databases: MEDLINE/PubMed, Scopus, SciELO, LILACS, ScienceDirect, Web of Science, Cochrane (CENTRAL), WHOLIS, PAHO and Embase, without language or year of publication restrictions. In addition, we searched the references of published studies. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes: The PRISMA Statement. RESULTS Twenty-one prospective cohort studies were included in the systematic review. The CVDs evaluated in the inserted studies were stroke, heart failure (HF) and coronary heart disease (CHD). Considering the heterogeneity found in the studies, for the meta-analysis, 9 articles were included. The results presented in the meta-analysis of the association of consumption of unprocessed red meat and CVD indicated that there was a significant association with total stroke incidence (RR 1.10; 95%; CI 1.01 to 1.19; p = 0.02). There was no association with Ischemic stroke incidence, nor CHD Mortality with consumption of unprocessed red meat. However, for Hemorrhagic Stroke Mortality the assessment in the consumption of unprocessed red meat showed an association of protection for women (RR 0.64; 95%; CI 0.45 to 0.91; p = 0.01). As for the results of the meta-analysis of the association between consumption of processed meat and CVD, they indicated that there was a significant association with total stroke incidence (RR 1.17; 95%; CI 1.08 to 1.26; p < 0.0001). There was no association with Ischemic stroke, nor with CHD Mortality with consumption of processed meat. Some studies that showed no association of risk, presented a significant linear trend dose response for the association of the consumption of unprocessed red meat (Bernstein et al. 2010; Nagao et al. 2012) or processed meat (Bernstein et al. 2012) and CVD. CONCLUSION According to the results found in the meta-analysis, the consumption of unprocessed red meat and processed meat are associated with the incidence of stroke, however, no positive association was observed in relation to mortality from CVD. This systematic review and meta-analysis protocol was registered on the PROSPERO (number: CRD42019100914).
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Affiliation(s)
- Gidyenne Christine Bandeira Silva de Medeiros
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Collective Health Postgraduate Program (PPGSCoL), Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Systematic Review and Meta-Analysis Laboratory (Lab-SYS), National Council for Scientific and Technological Development (CNPq), Federal University of Rio Grande do Norte, Natal, RN, Brasil
| | | | - Severina Carla Vieira Cunha Lima
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Graduate Program in Nutrition, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brasil
| | - David Franciole de Oliveira Silva
- Collective Health Postgraduate Program (PPGSCoL), Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Graduate Program in Nutrition, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brasil
| | - Kesley Pablo Morais de Azevedo
- Collective Health Postgraduate Program (PPGSCoL), Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Systematic Review and Meta-Analysis Laboratory (Lab-SYS), National Council for Scientific and Technological Development (CNPq), Federal University of Rio Grande do Norte, Natal, RN, Brasil
| | - Isac Davidson Santiago Fernandes Pimenta
- Collective Health Postgraduate Program (PPGSCoL), Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Systematic Review and Meta-Analysis Laboratory (Lab-SYS), National Council for Scientific and Technological Development (CNPq), Federal University of Rio Grande do Norte, Natal, RN, Brasil
| | - Ana Katherine da Silveira Gonçalves de Oliveira
- Graduate Program in Health Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Systematic Review and Meta-Analysis Laboratory (Lab-SYS), National Council for Scientific and Technological Development (CNPq), Federal University of Rio Grande do Norte, Natal, RN, Brasil
| | - Clélia de Oliveira Lyra
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Collective Health Postgraduate Program (PPGSCoL), Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Graduate Program in Nutrition, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brasil
| | - Daniel Guillén Martínez
- Department of Nursing, San Antonio de Murcia Catholic University, Spain
- Systematic Review and Meta-Analysis Laboratory (Lab-SYS), National Council for Scientific and Technological Development (CNPq), Federal University of Rio Grande do Norte, Natal, RN, Brasil
| | - Grasiela Piuvezam
- Collective Health Postgraduate Program (PPGSCoL), Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN , Brasil
- Department of Public Health, Federal University of Rio Grande do Norte, Natal, RN, Brasil
- Systematic Review and Meta-Analysis Laboratory (Lab-SYS), National Council for Scientific and Technological Development (CNPq), Federal University of Rio Grande do Norte, Natal, RN, Brasil
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Huse O, Reeve E, Baker P, Hunt D, Bell C, Peeters A, Backholer K. The nutrition transition, food retail transformations, and policy responses to overnutrition in the East Asia region: A descriptive review. Obes Rev 2022; 23:e13412. [PMID: 34981877 DOI: 10.1111/obr.13412] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The East Asia region is facing an increasing burden of overweight, obesity and related noncommunicable diseases, resulting from an ongoing nutrition transition. This study aimed to document the growing burden of overweight and obesity, and the accompanying dietary shifts, in the East Asia region and describe the policy responses to this. METHODS We present noncommunicable disease risk factor collaboration data on trends in the burden of malnutrition, and Euromonitor International data on trends in dietary purchases, in the East Asia region. We searched the NOURISHING and GINA databases to identify food and nutrition policies implemented in these countries. RESULTS There is an ongoing nutrition transition in the East Asia region, notably in upper-middle and lower-middle income countries. The prevalence of overweight, obesity, and accompanying health conditions, purchases of ultra-processed foods and beverages, and purchasing from supermarkets, fast-food and takeaway outlets, and other convenience retailers, are increasing. The policy response to this nutrition transition is limited, with the majority of policies implemented in higher-income countries. CONCLUSIONS East Asian countries are facing a growing burden of malnutrition, due in part to the dietary shifts occurring here. An ecological approach to policy intervention is needed to drive transformative food systems change.
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Affiliation(s)
- Oliver Huse
- Global Obesity Centre, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Australia
| | - Erica Reeve
- Global Obesity Centre, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition. Faculty of Health, Deakin University, Geelong, Australia
| | - Daniel Hunt
- Independent Researcher and Freelance Public Health Consultant, Bath, UK
| | - Colin Bell
- Global Obesity Centre, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation. Faculty of Health, Deakin University, Geelong, Australia
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Khusun H, Februhartanty J, Anggraini R, Mognard E, Alem Y, Noor MI, Karim N, Laporte C, Poulain JP, Monsivais P, Drewnowski A. Animal and Plant Protein Food Sources in Indonesia Differ Across Socio-Demographic Groups: Socio-Cultural Research in Protein Transition in Indonesia and Malaysia. Front Nutr 2022; 9:762459. [PMID: 35242792 PMCID: PMC8886573 DOI: 10.3389/fnut.2022.762459] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Plant-based diets in lower-income countries are often associated with inadequate protein nutrition and adverse health outcomes. Objective To examine the diversity of protein food sources, in both animal and plant, across diverse socio-demographic groups in Indonesia as compared to Malaysia. Design The SCRiPT (Socio Cultural Research in Protein Transition) study was based on population-based samples recruited in Indonesia (N = 1665) and in Malaysia (N = 1604). Data from 24-h in-person dietary recalls in each country were used to construct the frequency counts of protein sources by food group. Protein sources were defined as fish, poultry, red meat (beef, pork, and mutton), eggs, dairy, and plants (cereals, pulses, and tubers). The percent reported frequencies for animal and plant proteins were compared across socio-demographic strata and by country. Analyses were based on one-way Anovas and general linear model regressions adjusting for covariates. Results Animal protein frequency counts were 34% of total in Indonesia, but 50% in Malaysia's. Higher reported consumption frequencies for poultry and red meat in both countries were associated with urban living, greater modernization, and higher socioeconomic status, with stronger social gradients observed in Indonesia. Reported fish consumption was higher in Indonesia than in Malaysia. Fish was more likely to be listed by rural island populations in Indonesia and was associated with lower education and incomes. Consumption frequencies for plant-based proteins were associated with lower socio-economic status in Indonesia and in Malaysia. Conclusions More affluent groups in both countries reported higher frequencies for meat, eggs, and dairy as opposed to fish. Greater economic development in Southeast (SE) Asia is associated with more animal protein, particularly from poultry, which may displace fish, the traditional source of high quality protein for the region.
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Affiliation(s)
- Helda Khusun
- SEAMEO Regional Center for Food and Nutrition (RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Judhiastuty Februhartanty
- SEAMEO Regional Center for Food and Nutrition (RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Roselynne Anggraini
- SEAMEO Regional Center for Food and Nutrition (RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Elise Mognard
- Taylor's Toulouse University Center, Subang Jaya, Malaysia
- Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
| | - Yasmine Alem
- Taylor's Toulouse University Center, Subang Jaya, Malaysia
- Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- CERTOP UMR-CNRS 5044, University of Toulouse Jean Jaurès, Toulouse, France
| | - Mohd Ismail Noor
- Faculty of Health Sciences, Community Health Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norimah Karim
- Faculty of Health Sciences, Community Health Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Cyrille Laporte
- CERTOP UMR-CNRS 5044, University of Toulouse Jean Jaurès, Toulouse, France
| | - Jean-Pierre Poulain
- Taylor's Toulouse University Center, Subang Jaya, Malaysia
- Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- CERTOP UMR-CNRS 5044, University of Toulouse Jean Jaurès, Toulouse, France
| | - Pablo Monsivais
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Adam Drewnowski
- Department of Epidemiology, Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
- *Correspondence: Adam Drewnowski
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Krishan P, Bhopal RS, Vlassopoulos A, Curry G, Kakde S. Could high heat cooking and food processing promoting neo-formed contaminants partially explain the high prevalence of chronic kidney disease in South Asian populations? A hypothesis. Diabetes Metab Syndr 2022; 16:102398. [PMID: 35182827 DOI: 10.1016/j.dsx.2022.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/28/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS The occurrence of chronic heart and kidney diseases among the South Asian populations has been rising exponentially over the years. Research has been carried out in the past to explain the increased susceptibility with no resultant strong evidence. Various possible causes have been suggested with a previous hypothesis suggestive of high heat cooking techniques being responsible for increased production of neo-formed contaminants such as advanced glycation end products (AGEs) and trans-fatty acids (TFAs) leading to increased chronic heart diseases among the South Asian diaspora (India, Pakistan, Bangladesh, Sri Lanka in South Asia and overseas). The aim of this study proposes the high-heating cooking techniques and subsequent NFCs also to be responsible for the development of chronic kidney ailments among the South Asians. METHODS Review of the literature was conducted to ascertain the burden of accumulation and actions of AGEs and TFAs on kidney structure and functions. The varied high-heat cooking techniques including reheating of oils, food processing and kinds of food sources and their association with increased NFCs production and kidney damage were explored. RESULTS Higher NFCs content of AGEs/TFAs in reheated oils at elevated temperatures and TFAs among processed and fast foods of South Asians was associated with elevated diabetic complications and CKDs progression in few animal and human studies but the research on the actual burden of NFCs in the renal tissues of South Asians was lacking. CONCLUSION We hypothesize the high heat cooked foods generating increased levels of NFCs to be responsible for the preponderance of higher risk of CKDs among South Asians. Scientific exploration of the hypothesis to obtain quantifiable evidence of NFCs is suggested.
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Affiliation(s)
- Prerna Krishan
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Raj S Bhopal
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Antonis Vlassopoulos
- Department of Food Science & Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855, Athens, Greece
| | - Gwenetta Curry
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Smitha Kakde
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
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Dai J, Zulkefli NF, Moy FM, Humphries DL. The Importance of Sociocultural Context When Choosing to Eat Healthier. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:143-150. [PMID: 34952802 DOI: 10.1016/j.jneb.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore how working women in metropolitan Malaysia make food decisions. DESIGN A grounded theory approach and semistructured interviews. SETTING A large university in metropolitan Malaysia. PARTICIPANTS Twenty-four female employees purposively recruited to vary in ethnicity, body mass index, age, and marital status via convenience sampling. PHENOMENON OF INTEREST Perceptions of sociocultural influences on healthy eating behavior among working women. ANALYSIS Researchers audio-recorded interviews and analyzed verbatim transcripts. RESULTS Working women shared a desire to eat a healthier, more balanced diet by reducing processed food consumption through home-cooked meals. Participants described aspects of their living situations and cultural values about food that made it seem impossible to change their diets. Living with other people limited their ability to cook the food they wanted to eat. In addition, unspoken rules about communal eating in Malaysia, such as not refusing food and not wasting food, prevented working women from practicing healthy eating. CONCLUSIONS AND IMPLICATIONS In this population of working women in metropolitan Malaysia, experiences of time scarcity and limited sociocultural support for behavior change were major barriers to healthy eating. Interventions could prioritize leveraging these realities about food to facilitate environments in which women feel like they have control of their own food intake.
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Affiliation(s)
- Jane Dai
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Nur Fadzlina Zulkefli
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Foong Ming Moy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Debbie L Humphries
- Department of Epidemiology of Chronic Disease, School of Public Health, Yale University, New Haven, CT
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Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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A Proposed Research Agenda for Promoting Healthy Retail Food Environments in the East Asia-Pacific Region. Curr Nutr Rep 2021; 10:267-281. [PMID: 34894342 DOI: 10.1007/s13668-021-00381-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW This paper aimed to summarise existing literature on strategies to improve the healthiness of retail food environments in the East Asia and Pacific (EAP) region, and propose a prioritised research agenda on this topic. RECENT FINDINGS Little research on retail food environments has been conducted in the EAP region. Several approaches for measuring retail food environments were identified, although none have been tailored to the EAP context. A small number of policies and initiatives to promote healthy retail food environments have been implemented in EAP. Lessons learnt from successful implementation of initiatives in other regions could be applied in EAP. Retail food environments have a strong influence on food choices and health outcomes. Research can contribute to efforts to improve the healthiness of retail food environments in EAP by (1) describing the current state of retail food environments to highlight areas of good practice and concern and (2) identifying policies and initiatives that are likely to be effective, and mechanisms for their successful implementation.
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Watanabe M, Sianoya A, Mishima R, Therdtatha P, Rodriguez A, Ramos DC, Lee YK, Dalmacio LM, Nakayama J. Gut microbiome status of urban and rural Filipino adults in relation to diet and metabolic disorders. FEMS Microbiol Lett 2021; 368:6445026. [PMID: 34849762 DOI: 10.1093/femsle/fnab149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022] Open
Abstract
Here, we aim to understand the condition of the gut microbiome of Filipino adults in relation to their diet and metabolic status. Compared to rural Albay (n = 67), the gut microbiome of subjects living in urban Manila (n = 25) was more colonized by the order Clostridiales, which was negatively correlated with host carbohydrate consumption. Principal component analysis using the genus composition of the 92 total subjects indicated four microbiome types: one type driven by Prevotella, which was associated with high rice consumption and mainly consisted of healthy Albay subjects, one Clostridiales-driven group containing a number of type 2 diabetes mellitus (T2D) subjects from both Manila and Albay who showed lower butyrate levels in association with a decrease in Mediterraneibacter faecis, and the other two types showing dysbiosis-like microbiomes with Lactobacillus and Bifidobacterium overgrowth, with a high ratio of T2D and obese subjects. Multivariate logistic regression analysis suggested high dietary energy intake, and two Veillonellaeae genera, Dialister and Megasphaera, as T2D risk factors, while Prevotella and M. faecis as anti-T2D factors. In conclusion, low-carbohydrate diets restructured the Prevotella-driven gut microbiome, which may predispose Filipino people with high energy diet to T2D.
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Affiliation(s)
- Mai Watanabe
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan
| | - Abraham Sianoya
- Department of Biochemistry and Molecular Biology (DBMB), College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila 1000 Philippines
| | - Riko Mishima
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan
| | - Phatthanaphong Therdtatha
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan
| | - Abigail Rodriguez
- Department of Biochemistry and Molecular Biology (DBMB), College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila 1000 Philippines
| | - Donna Christene Ramos
- Department of Biochemistry and Molecular Biology (DBMB), College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila 1000 Philippines
| | - Yuan Kun Lee
- Department of Microbiology and Immunology, National University of Singapore, 5 Science Drive 2, Singapore 117545, Singapore
| | - Leslie Michelle Dalmacio
- Department of Biochemistry and Molecular Biology (DBMB), College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila 1000 Philippines
| | - Jiro Nakayama
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan
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Khan JR, Gulshan J. Assessing the double burden of malnutrition among Bangladeshi reproductive-aged women: A comparison between unconditional and conditional quantile regression. Health Sci Rep 2021; 4:e391. [PMID: 34622024 PMCID: PMC8485620 DOI: 10.1002/hsr2.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/16/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND AIMS The coexistence of undernutrition and overnutrition creates a double burden of malnutrition (DBM) among women in Bangladesh. This study aimed to assess heterogeneous effects of sociodemographic factors on women's nutritional status using quantile regression (QR) models and to investigate the differences between the results of unconditional QR (UQR) and conditional QR (CQR) models. METHODS A sample of 17 285 nonpregnant women aged 15 to 49 years was extracted from the latest Bangladesh Demographic and Health Survey, 2017-2018. Women's nutritional status was determined using body mass index (BMI). The UQR and CQR were used to estimate the heterogeneous effects of sociodemographic factors on women's BMI. RESULTS Results show that the estimated effects of sociodemographic factors varied across the BMI distribution. For the same quantile, the effects differed between UQR and CQR. For instance, education was significantly positively associated with BMI. In UQR, secondary educated women achieved an increase of 0.996 and 1.720 in BMI at 10th and 90th quantiles, respectively, compared to noneducated women, whereas conditional effects were 1.336 and 1.492 at 10th and 90th quantiles, respectively, in CQR. These results also indicate secondary education appeared to have a lesser (or higher) impact in the lower (or upper) tail of BMI distribution, and unconditional and conditional effects for the same quantile varied notably. Other factors such as women's age, occupation, household wealth, number of children ever born and household size, religion, and place of residence were significantly associated with BMI and showed heterogeneous effects. CONCLUSION Overall, there is a need to focus on heterogeneous effects of factors on women's nutritional status. Patterns of unconditional heterogeneous effects would be more informative than conditional heterogeneous effects while studying factors' effects. These findings may aid in developing strategies targeting high-risk groups to combat the double burden of malnutrition.
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Affiliation(s)
- Jahidur Rahman Khan
- Health Research Institute, Faculty of Health University of Canberra Canberra Australian Capital Territory Australia
- Biomedical Research Foundation Dhaka Bangladesh
| | - Jahida Gulshan
- Institute of Statistical Research and Training (ISRT), University of Dhaka Dhaka Bangladesh
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Sousa S, Gelormini M, Damasceno A, Lopes SA, Maló S, Chongole C, Muholove P, Moreira P, Lunet N, Padrão P. Street Food in Maputo, Mozambique: The Coexistence of Minimally Processed and Ultra-Processed Foods in a Country under Nutrition Transition. Foods 2021; 10:2561. [PMID: 34828841 PMCID: PMC8622954 DOI: 10.3390/foods10112561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 01/31/2023] Open
Abstract
The aim was to characterise the extent of processing and nutritional composition of the street foods offered in Maputo, Mozambique. A cross-sectional study was conducted in October-November 2014 in the urban district of KaMpfumu. Twenty public transport stops were randomly selected, around which 500 meters buffers were drawn. All streets within these buffers were canvassed to identify all street food vending sites. Street food offer was assessed through interviews. Nutritional composition was estimated using standardised recipes (for homemade foods), food labels (for industrial products) and food composition tables (for in natura foods). The processing extent was classified using the "NOVA" food classification. A total of 810 vending sites were assessed. Unprocessed/minimally processed foods were available at 70.5% of vending sites (mainly fruit, water, and tea) and ultra-processed foods at 59.0% (mostly cakes, cookies, confectionery, and soft drinks). Energy content per 100 g of unprocessed or minimally processed foods was significantly lower than in all other food groups. In all food groups, contribution to total energy value was highest for carbohydrates (range: 33.1-51.2%), followed by fats (range: 29.3-36.0%) and protein (range: 6.8-18.6%). Public health policies targeting the improvement of this urban food environment should consider not only the nutritional composition but also the processing extent of the foods and beverages available.
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Affiliation(s)
- Sofia Sousa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (S.S.); (A.D.); (P.M.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Rua do Campo Alegre 823, 4150-180 Porto, Portugal
| | - Marcello Gelormini
- Agência Italiana para a Cooperação e Desenvolvimento, Rua Damião de Góis 381, 1100 Maputo, Mozambique;
| | - Albertino Damasceno
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (S.S.); (A.D.); (P.M.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Faculdade de Medicina, Universidade Eduardo Mondlane, Avenida Salvador Allende 702, 1100 Maputo, Mozambique
- Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Simão A. Lopes
- Departamento de Matemática e Informática, Universidade Eduardo Mondlane, Av. Julius Nyerere 3453, 1100 Maputo, Mozambique;
| | - Sérgio Maló
- Departamento de Geografia, Universidade Eduardo Mondlane, Av. Julius Nyerere 3453, 1100 Maputo, Mozambique; (S.M.); (C.C.); (P.M.)
| | - Célia Chongole
- Departamento de Geografia, Universidade Eduardo Mondlane, Av. Julius Nyerere 3453, 1100 Maputo, Mozambique; (S.M.); (C.C.); (P.M.)
| | - Paulino Muholove
- Departamento de Geografia, Universidade Eduardo Mondlane, Av. Julius Nyerere 3453, 1100 Maputo, Mozambique; (S.M.); (C.C.); (P.M.)
| | - Pedro Moreira
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (S.S.); (A.D.); (P.M.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Rua do Campo Alegre 823, 4150-180 Porto, Portugal
- Centro de Investigação em Atividade Física, Saúde e Lazer, Faculdade de Desporto, Universidade do Porto, Rua Dr. Plácido Costa 91, 4200-450 Porto, Portugal
| | - Nuno Lunet
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (S.S.); (A.D.); (P.M.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Patrícia Padrão
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; (S.S.); (A.D.); (P.M.); (N.L.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Rua do Campo Alegre 823, 4150-180 Porto, Portugal
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Ho YCL, Lee VSY, Ho MHR, Lin GJ, Thumboo J. Towards a Parsimonious Pathway Model of Modifiable and Mediating Risk Factors Leading to Diabetes Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010907. [PMID: 34682644 PMCID: PMC8536137 DOI: 10.3390/ijerph182010907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022]
Abstract
Modifiable risk factors are of interest for chronic disease prevention. Few studies have assessed the system of modifiable and mediating pathways leading to diabetes mellitus. We aimed to develop a pathway model for Diabetes Risk with modifiable Lifestyle Risk factors as the start point and Physiological Load as the mediator. As there are no standardised risk thresholds for lifestyle behaviour, we derived a weighted composite for Lifestyle Risk. Physiological Load was based on an index using clinical thresholds. Sociodemographics are non-modifiable risk factors and were specified as covariates. We used structural equation modeling to test the model, first using 2014/2015 data from the Indonesian Family Life Survey. Next, we fitted a smaller model with longitudinal data (2007/2008 to 2014/2015), given limited earlier data. Both models showed the indirect effects of Lifestyle Risk on Diabetes Risk via the mediator of Physiological Load, whereas the direct effect was only supported in the cross-sectional analysis. Specifying Lifestyle Risk as an observable, composite variable incorporates the cumulative effect of risk behaviour and differentiates this study from previous studies assessing it as a latent construct. The parsimonious model groups the multifarious risk factors and illustrates modifiable pathways that could be applied in chronic disease prevention efforts.
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Affiliation(s)
- Yi-Ching Lynn Ho
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
- Correspondence:
| | - Vivian Shu Yi Lee
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
| | - Moon-Ho Ringo Ho
- School of Social Sciences, Nanyang Technological University, 48 Nanyang Ave., Singapore 639818, Singapore;
| | - Gladis Jing Lin
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
| | - Julian Thumboo
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Rd., Singapore 169608, Singapore
- Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
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Abstract
AbstractFood systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.
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Wells JCK, Marphatia AA, Amable G, Siervo M, Friis H, Miranda JJ, Haisma HH, Raubenheimer D. The future of human malnutrition: rebalancing agency for better nutritional health. Global Health 2021; 17:119. [PMID: 34627303 PMCID: PMC8500827 DOI: 10.1186/s12992-021-00767-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 09/15/2021] [Indexed: 01/11/2023] Open
Abstract
The major threat to human societies posed by undernutrition has been recognised for millennia. Despite substantial economic development and scientific innovation, however, progress in addressing this global challenge has been inadequate. Paradoxically, the last half-century also saw the rapid emergence of obesity, first in high-income countries but now also in low- and middle-income countries. Traditionally, these problems were approached separately, but there is increasing recognition that they have common drivers and need integrated responses. The new nutrition reality comprises a global ‘double burden’ of malnutrition, where the challenges of food insecurity, nutritional deficiencies and undernutrition coexist and interact with obesity, sedentary behaviour, unhealthy diets and environments that foster unhealthy behaviour. Beyond immediate efforts to prevent and treat malnutrition, what must change in order to reduce the future burden? Here, we present a conceptual framework that focuses on the deeper structural drivers of malnutrition embedded in society, and their interaction with biological mechanisms of appetite regulation and physiological homeostasis. Building on a review of malnutrition in past societies, our framework brings to the fore the power dynamics that characterise contemporary human food systems at many levels. We focus on the concept of agency, the ability of individuals or organisations to pursue their goals. In globalized food systems, the agency of individuals is directly confronted by the agency of several other types of actor, including corporations, governments and supranational institutions. The intakes of energy and nutrients by individuals are powerfully shaped by this ‘competition of agency’, and we therefore argue that the greatest opportunities to reduce malnutrition lie in rebalancing agency across the competing actors. The effect of the COVID-19 pandemic on food systems and individuals illustrates our conceptual framework. Efforts to improve agency must both drive and respond to complementary efforts to promote and maintain equitable societies and planetary health.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population Policy and Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | - Gabriel Amable
- Department of Geography, University of Cambridge, Cambridge, UK
| | - Mario Siervo
- School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hinke H Haisma
- Population Research Centre, Department of Demography, University of Groningen, Groningen, the Netherlands
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Tan T, Leung CW. Associations between perceived stress and BMI and waist circumference in Chinese adults: data from the 2015 China Health and Nutrition Survey. Public Health Nutr 2021; 24:4965-4974. [PMID: 33308370 PMCID: PMC11082812 DOI: 10.1017/s1368980020005054] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the association between perceived stress and adiposity among Chinese adults. DESIGN Cross-sectional study. Perceived stress was assessed using the 14-item perceived stress scale. Associations between quintiles of perceived stress and BMI and waist circumference were assessed using linear regression models and multinomial regression models. Estimates were adjusted for sociodemographic characteristics. SETTING 2015 China Health and Nutrition Survey: 12 provinces covering a variety of geographic, economic development and health indicator situations. PARTICIPANTS A total of 8385 adults of both sexes, aged 18-99 years, were included. RESULTS Overall, the mean perceived stress score was 22·7 (6·2), mean BMI was 24·3 (3·6) kg/m2 and prevalence of obesity (BMI ≥ 30 kg/m2) was 6·0 %. There were inverse associations between perceived stress quintiles with continuous BMI (P < 0·001), BMI categories (P = 0·015) and waist circumference (P = 0·047). Compared to adults in the lowest quintile of perceived stress, adults in the highest quintile of perceived stress had 0·44 kg/m2 lower mean BMI (95 % CI: -0·67, -0·21), 0·72 times the prevalence of obesity (95 % CI: 0·55, 0·94) and 0·73 times the prevalence of abdominal obesity (95 % CI: 0·61, 0·88). Results were similar when using Chinese-specific cut-points. CONCLUSION Our results showed inverse associations between perceived stress quintiles and adiposity among Chinese adults. Future studies should aim to better understand the directionality of the observed associations and the potential biological and behavioural mechanisms underlying these associations in the Chinese population.
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Affiliation(s)
- Tian Tan
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Cindy W Leung
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, SPH I, Ann Arbor, MI48104, USA
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Evelyn H, Aziz AF, Sariman S. Associations of Knowledge, Attitude and Practices of Food Label on Cardiovascular Diseases (CVD) Risk amongst University Students in Selangor, Malaysia. J Nutr Sci Vitaminol (Tokyo) 2021; 66:S275-S282. [PMID: 33612610 DOI: 10.3177/jnsv.66.s275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiovascular diseases (CVD) deaths were on the rise in developing countries. In Malaysia, the accelerating economic transition has been accompanied by high prevalence of CVD risk factors which accounts for 35% of total deaths in 2016. This increasing trend involving not only the elderly but also the young adults. Food label reading is reported to be the key to help individual adopt healthy food choice and dietary habits. Hence, the aim of this study is to determine the associations of knowledge, attitude and practices (KAP) of food label on CVD risk amongst university students. A cross sectional study was conducted on 389 university students aged 19 to 35 y old in Selangor. Information on socio-demographic profile, nutrition knowledge, attitude, and practice of food label were collected using self-administrated questionnaires. Anthropometric data of participants were measured using standardize methodology and blood pressure was measured using Omron blood pressure monitor. The data were tested using Chi-Square test. Average age of the respondents were 23 y. Majority of the respondents had no CVD risk (41%) while (59%) had increased CVD risks. There was a significant association between CVD risk factors (BMI, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP) with knowledge and attitude of using food label (p<0.05). The practice of food label usage showed no significant association (p>0.05) with all CVD risk factors. Considering the importance of understanding and usage of food label in the management of chronic diseases, these findings provide useful information to incorporate nutrition education on food labelling in preventing CVD risks.
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Affiliation(s)
- Ho Evelyn
- Faculty of Health and Life Sciences, Management and Science University
| | - Ainor Farahin Aziz
- Faculty of Health and Life Sciences, Management and Science University.,State Health Department Federal Territory of Labuan
| | - Sarina Sariman
- Faculty of Health and Life Sciences, Management and Science University
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Nutrition transition and chronic diseases in China (1990-2019): industrially processed and animal calories rather than nutrients and total calories as potential determinants of the health impact. Public Health Nutr 2021; 24:5561-5575. [PMID: 34376266 DOI: 10.1017/s1368980021003311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To extend analyses of nutrition transition in developed countries to China within the framework of the 3Vs rule considering degree of processing starting with plant/animal calorie ratio (Rule 1), industrially processed foods (IPFs, Rule 2), and food diversity through nutrient intakes (Rule 3). DESIGN Total and main food group (n 13) calorie intakes, percentages of animal and IPF calories, adequacy of the Dietary Reference Intake (DRI) and prevalence of chronic diseases were retrieved from scientific literature and international databases. SETTING China, 1990–2019. PARTICIPANTS Overall population. RESULTS The total calorie intake decreased by 9 % over 30 years while the prevalence of chronic diseases substantially increased. Percentages of IPFs (Rule 1) and animal (Rule 2) calorie intake shifted from 9 to 30 % and 2 to 30 %, respectively. Meanwhile, the overall DRI adequacy (Rule 3) did not improve, with calcium and retinol deficiencies in 2019, and, although remaining above DRI, iron, copper, magnesium, and vitamins E, C and B1–B9 intakes regularly decreased. Notably, the prevalence of obesity increased five-fold, paralleling the exponential increase in IPF calorie intake. Both sources of calories were highly correlated with prevalence of main chronic diseases. CONCLUSIONS Despite a slight decreased of total calorie consumption and small variations of adequacy with DRI, the farther the Chinese population moved away from the 3Vs rule during the 1990–2019 period, the more the prevalence of chronic diseases increased. Further analyses on foods’ transitions will be better assessed when advocating sources/quality of calories (Rules 1/2), rather than only nutrient composition (Rule 3).
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Chavez‐Ugalde Y, Jago R, Toumpakari Z, Egan M, Cummins S, White M, Hulls P, De Vocht F. Conceptualizing the commercial determinants of dietary behaviors associated with obesity: A systematic review using principles from critical interpretative synthesis. Obes Sci Pract 2021; 7:473-486. [PMID: 34401205 PMCID: PMC8346378 DOI: 10.1002/osp4.507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Unhealthy diet is an important preventable risk factor for overweight and obesity. Identifying the key drivers of an unhealthy diet is an important public health aim. "Big Food" has been identified as an influential factor shaping dietary behavior and obesity, and their practices have broadly been labeled as the "commercial determinants of obesity," but there is a lack of definitions and conceptualizations for these terms. This review aimed to synthesize literature on the commercial determinants of dietary behavior associated with obesity. It presents the development of an integrative definition and a conceptual framework involving potential influences on dietary behavior, and it examines the prevalence of certain narratives within papers that focus on children and adolescents. METHODS Four electronic databases (Ovid MEDLINE, PubMed, Web of Science, and Scopus) were searched up to December 2020. Eighty-one articles met the inclusion criteria: they were published in a peer-reviewed academic journal, described a practice from the food/beverage industry in relation to dietary behavior or obesity. Data were integrated using critical interpretative synthesis. RESULTS The commercial determinants of dietary behavior are conceptualized in terms of three corporate spheres of action-political and legal; production, processing and design; and marketing and preference shaping-which enable powerful food industry to successfully pursue their business, market, and political objectives. The most frequently reported sphere of action targeting children and adolescents was marketing and preference shaping. CONCLUSIONS In the included literature, the commercial determinants of dietary behavior associated with obesity have been conceptualized as being part of a complex system where corporate practices are enabled by power structures. The proposed framework can facilitate a structured identification and systematic study of the impact of specific aspects of food industry's strategies and increase opportunities for primary prevention by anticipating industry responses and by discouraging corporate practices that harm health.
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Affiliation(s)
- Yanaina Chavez‐Ugalde
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Russell Jago
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Centre for Exercise, Nutrition & Health Sciences, School for Policy StudiesUniversity of BristolBristolUK
- National Institute for Health Research Collaboration for Leadership, Applied Health Research and Care West (NIHR CLAHRC West)BristolUK
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition & Health Sciences, School for Policy StudiesUniversity of BristolBristolUK
| | - Matt Egan
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Steven Cummins
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Martin White
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Centre for Diet and Activity Research (CEDAR) MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Paige Hulls
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Frank De Vocht
- National Institute for Health ResearchSchool for Public Health ResearchNewcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- National Institute for Health Research Collaboration for Leadership, Applied Health Research and Care West (NIHR CLAHRC West)BristolUK
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Karki S, Alaraudanjoki V, Päkkilä J, Laitala ML, Anttonen V. Different Risk Factors for Erosive Tooth Wear in Rural and Urban Nepal: A National Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157766. [PMID: 34360059 PMCID: PMC8345451 DOI: 10.3390/ijerph18157766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Erosive tooth wear (ETW) is of growing concern, but data on ETW among Nepalese children are scarce. The main aim of the study was to investigate the prevalence and severity of ETW among Nepalese schoolchildren. We also aimed to analyse the risk indicators for ETW according to location (rural/urban) and the role of obesity in the risk for ETW. METHODS This national study was conducted among 5-15-year-old Nepalese schoolchildren from different regions. Altogether, 1137 out of 1151 schoolchildren participated in both a clinical examination and a survey. ETW was recorded using the Basic Erosive Wear Examination. RESULTS The prevalence of ETW was 65%. One-fifth of the examined subjects were in need of preventive or restorative treatment. Living in an urban area and studying in a private school were protective factors for ETW, whereas consuming fruits frequently and using charcoal for tooth cleaning increased the odds for ETW. Central obesity was the strongest risk indicator for ETW among urban residents. CONCLUSIONS ETW of low severity is common among Nepalese children and adolescents. Socio-demographic factors influence the prevalence of ETW in Nepal and there seems to be different factors that play a role in the ETW process according to location of residence.
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Affiliation(s)
- Saujanya Karki
- Research Unit of Oral Health Sciences, University of Oulu, 90014 Oulu, Finland; (S.K.); (M.-L.L.); (V.A.)
| | - Viivi Alaraudanjoki
- Research Unit of Oral Health Sciences, University of Oulu, 90014 Oulu, Finland; (S.K.); (M.-L.L.); (V.A.)
- Finnish Student Health Services Oulu, 90570 Oulu, Finland
- Correspondence:
| | - Jari Päkkilä
- Department of Mathematical Sciences, University of Oulu, 90014 Oulu, Finland;
| | - Marja-Liisa Laitala
- Research Unit of Oral Health Sciences, University of Oulu, 90014 Oulu, Finland; (S.K.); (M.-L.L.); (V.A.)
- Medical Research Centre, Oulu University Hospital and University of Oulu, POB 5281, 90014 Oulu, Finland
| | - Vuokko Anttonen
- Research Unit of Oral Health Sciences, University of Oulu, 90014 Oulu, Finland; (S.K.); (M.-L.L.); (V.A.)
- Medical Research Centre, Oulu University Hospital and University of Oulu, POB 5281, 90014 Oulu, Finland
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A Sustainable and Global Health Perspective of the Dietary Pattern of French Population during the 1998–2015 Period from INCA Surveys. SUSTAINABILITY 2021. [DOI: 10.3390/su13137433] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In France, the evolution of dietary pattern relative to sustainability and global health remains insufficiently studied. The objective of this study was to assess dietary changes during 1998–2015 through three generic metrics potentially related to sustainability. Food consumption data were collected from three French National Individual Study of Food Consumption surveys (INCA) for children (0–17 years) and adults (18–79 years) representative of the French population. The consumed foods were converted into plant (metric 1) and non-ultra-processed (UPF, metric 2) calories, and analyzed in meeting dietary recommended intakes (metric 3). French children and adults consumed high levels of animal and UPF calories, and nutrient deficiencies were observed in adults from the 2015 survey, e.g., fiber, EPA, DHA, magnesium, retinol, and vitamin C. In children, UPF daily calories increased from 42.8 to 45.5% and decreased in adults from 39.2 to 35.0%. In children and adults, diet revegetation was observed. While the level of physical activity decreased, overweight, obesity and type 2 diabetes prevalence increased in French adults. The French dietary pattern is not sustainable for global health unless public health policy is reinforced, with at least a twofold decrease in animal and UPF calories and improved food diversity.
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Dietary health perceptions and sources of nutritional knowledge in an urban food environment: a qualitative study from Indonesia. Public Health Nutr 2021; 24:2848-2858. [PMID: 33023710 PMCID: PMC9884757 DOI: 10.1017/s1368980020003900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate dietary health understandings, healthy foods access perceptions and the main sources of nutritional knowledge of residents in three urban communities of varying socio-economic make-up. DESIGN An ethnographic approach to primary qualitative data collection, involving frequent visits to study areas over 4 months and in-depth interviews. Interviews were recorded, transcribed verbatim and analysed through an iterative approach. SETTING Yogyakarta, Indonesia. PARTICIPANTS A purposive sample of 45 participants divided equally among the 3 communities. Participants were mostly female (93 %), aged between 27 and 75 years (mean 47·7) and largely identified as the person responsible for household food-related decisions (93 %). RESULTS Three overarching themes emerged: (i) dietary health understandings; (ii) healthy foods access perceptions and (iii) sources of nutritional knowledge. Participants employed multifaceted conceptualisation of dietary health. Most identified healthy foods with traditional plant-based foods, inexpensive and locally available from multiple sources. Thus, all participants perceived healthy foods as highly available in the local environment and most (80 %) as affordable. Reported affordability issues referred to specific foods (particularly animal source products) and were independent of income levels. Participants acquired nutritional knowledge from multiple sources, including many community-based initiatives. These were overall perceived as useful, but also as presenting some limitations. CONCLUSIONS The variety in dietary health understandings reported by study participants, and their high perceptions of healthy foods availability in the local environment reinforce the idea that individual- and food environment-level determinants of nutritional behaviours are highly contextual.
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Bell W, Coates J, Fanzo J, Wilson NLW, Masters WA. Beyond price and income: Preferences and food values in peri-urban Viet Nam. Appetite 2021; 166:105439. [PMID: 34098002 DOI: 10.1016/j.appet.2021.105439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/16/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
Sub-optimal diets are one of the most important risk factors contributing to the global burden of disease. Developing a better understanding of the drivers of food choice, including the role of individual preferences, is important to address this issue. The objective of this mixed methods research was to identify the relative importance of preferences for different food quality attributes (e.g. nutrition, food safety, price and convenience) that might influence shopping habits and food choice in the context of a rapidly changing peri-urban food environment in Hanoi Province, Viet Nam. A total of 264 women were randomly selected and interviewed using Best-Worst Scaling to elicit preferences among food quality attributes for different food groups (leafy green vegetables, fruits, instant foods, snack foods). A subset of these respondents (n = 40) participated in focus group discussions in order to explore their preferences and food values in more detail. The food quality attributes considered to be most important varied by food group with nutrition and food safety (both immediate and future health) ranking highest for leafy green vegetables and fruits, convenience for instant foods, and taste for snack foods. Price was considered least important across all food groups. Focus group discussions reinforced these results with additional insights particularly regarding trade-offs between nutrition, food safety, convenience, and price. This research demonstrates the feasibility of identifying important drivers of consumption in a South East Asian context using Best-Worst Scaling. These results could help inform the design of behavior change interventions and guide food system policies that seek to shift consumer choices towards healthier diets.
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Affiliation(s)
- Winnie Bell
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02144, United States.
| | - Jennifer Coates
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02144, United States
| | - Jessica Fanzo
- The Berman Institute of Bioethics, Nitze School of Advanced International Studies, Bloomberg School of Public Health, Johns Hopkins University, Washington DC, 20036, United States
| | - Norbert L W Wilson
- Duke Divinity School and Sanford School of Public Policy, Duke University, Durham, NC, 27708, United States
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02144, United States
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Kwok SWH, Pang PCP, Chung MH, Wu CST. Faculty Service-Learning Students as Home-Visitors: Outcomes of a Lifestyle Modification Program for Vulnerable Families With Residents in Rural Indonesian Communities. Front Public Health 2021; 9:597851. [PMID: 34055707 PMCID: PMC8149593 DOI: 10.3389/fpubh.2021.597851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Risks attributed to chronic diseases, cancer, musculoskeletal discomfort, and infectious diseases among Indonesians were found to be associated with lifestyle behaviors, particularly in rural areas. The aim of this study was to examine the outcomes of a home-visiting lifestyle modification program on improving health risk behaviors among Indonesians living in rural areas. Methods: A total of 160 Indonesians living in rural hamlets in the Yogyakarta Region of Indonesia participated in the program in the period of June 21 to July 21, 2019. In the pre-intervention home interview, learning needs of diet, exercise, hand hygiene, and substance use were identified by using structured assessment tools. In the next home visit, the visitors provided health education and facilitated lifestyle planning based on the related affective and cognitive domains of learning. Subsequent follow-up interviews were conducted 3 weeks after intervention. Results: The results showed that the self-reported intake of vegetables, fruits, meat and salt, cooking with less oil, hand hygiene before eating, number of cigarettes smoked, and symptoms of muscle stiffness significantly improved after the intervention. The lifestyle modification program consisted of the affective and cognitive domains of learning, and could lead to the target behavioral changes in self-reported and observable measures over 1 month. Conclusions: The findings contributed to the framework of community-based health education for health risk reduction and behavioral modification in developing rural communities where health care resources were limited. Further studies with control groups and vigorous objective measures were recommended to elucidate its long-term impacts. The factors leading to its sustainability concerning collaborative care partnerships between community residents and faculty resources are worthy of continued exploration.
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Affiliation(s)
| | | | | | - Cynthia Sau Ting Wu
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Dadhich JP, Smith JP, Iellamo A, Suleiman A. Climate Change and Infant Nutrition: Estimates of Greenhouse Gas Emissions From Milk Formula Sold in Selected Asia Pacific Countries. J Hum Lact 2021; 37:314-322. [PMID: 33586512 DOI: 10.1177/0890334421994769] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is growing recognition that current food systems and policies are environmentally unsustainable. There is an identified need to integrate sustainability objectives into national food policy and dietary recommendations. RESEARCH AIMS To (1) describe exploratory estimates of greenhouse gas emission factors for all infant and young child milk formula products and (2) estimate national greenhouse gas emission association with commercial milk formulas sold in selected countries in the Asia Pacific region. METHOD We used a secondary data analysis descriptive design incorporating a Life Cycle Assessment (LCA) concepts and methodology to estimate kg CO2 eq. emissions per kg of milk formula, using greenhouse gas emission factors for milk powder, vegetable oils, and sugars identified from a literature review. Proportions of ingredients were calculated using FAO Codex Alimentarius guidance on milk formula products. Estimates were calculated for production and processing of individual ingredients from cradle to factory gate. Annual retail sales data for 2012-2017 was sourced from Euromonitor International for six purposively selected countries; Australia, South Korea, China, Malaysia, India, Philippines. RESULTS Annual emissions for milk formula products ranged from 3.95-4.04 kg CO2 eq. Milk formula sold in the six countries in 2012 contributed 2,893,030 tons CO2 eq. to global greenhouse gas emissions. Aggregate emissions were highest for products (e.g., toddler formula), which dominated sales growth. Projected 2017 emissions for milk formula retailed in China alone were 4,219,052 tons CO2 eq. CONCLUSIONS Policies, programs and investments to shift infant and young child diets towards less manufactured milk formula and more breastfeeding are "Triple Duty Actions" that help improve dietary quality and population health and improve the sustainability of the global food system.
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Affiliation(s)
- J P Dadhich
- 2219 Breastfeeding Promotion Network of India (BPNI), Pitampura, New Delhi, India
| | - Julie P Smith
- Research School of Population Health, Australian National University, Canberra, Australia
| | | | - Adlina Suleiman
- 248241 Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia/ National Defence University of Malaysia
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Dietary Management of Type 2 Diabetes in the MENA Region: A Review of the Evidence. Nutrients 2021; 13:nu13041060. [PMID: 33805161 PMCID: PMC8064070 DOI: 10.3390/nu13041060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022] Open
Abstract
The alarmingly rising trend of type 2 diabetes constitutes a major global public health challenge particularly in the Middle Eastern and North African (MENA) region where the prevalence is among the highest in the world with a projection to increase by 96% by 2045. The economic boom in the MENA region over the past decades has brought exceptionally rapid shifts in eating habits characterized by divergence from the traditional Mediterranean diet towards a more westernized unhealthy dietary pattern, thought to be leading to the dramatic rises in obesity and non-communicable diseases. Research efforts have brought a greater understanding of the different pathways through which diet and obesity may affect diabetes clinical outcomes, emphasizing the crucial role of dietary interventions and weight loss in the prevention and management of diabetes. The purpose of this review is to explore the mechanistic pathways linking obesity with diabetes and to summarize the most recent evidence on the association of the intake of different macronutrients and food groups with the risk of type 2 diabetes. We also summarize the most recent evidence on the effectiveness of different macronutrient manipulations in the prevention and management of diabetes while highlighting the possible underlying mechanisms of action and latest evidence-based recommendations. We finally discuss the need to adequately integrate dietetic services in diabetes care specific to the MENA region and conclude with recommendations to improve dietetic care for diabetes in the region.
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Armitage RM, Iatridi V, Yeomans MR. Understanding sweet-liking phenotypes and their implications for obesity: Narrative review and future directions. Physiol Behav 2021; 235:113398. [PMID: 33771526 DOI: 10.1016/j.physbeh.2021.113398] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/02/2021] [Accepted: 03/19/2021] [Indexed: 01/21/2023]
Abstract
Building on a series of recent studies that challenge the universality of sweet liking, here we review the evidence for multiple sweet-liking phenotypes which strongly suggest, humans fall into three hedonic response patterns: extreme sweet likers (ESL), where liking increases with sweetness, moderate sweet likers (MSL), who like moderate but not intense sweetness, and sweet dislikers (SD), who show increasing aversion as sweetness increases. This review contrasts how these phenotypes differ in body size and composition, dietary intake and behavioural measures to test the widely held view that sweet liking may be a key driver of obesity. Apart from increased consumption of sugar-sweetened beverages in ESL, we found no clear evidence that sweet liking was associated with obesity and actually found some evidence that SD, rather than ESL, may have slightly higher body fat. We conclude that ESL may have heightened awareness of internal appetite cues that could protect against overconsumption and increased sensitivity to wider reward. We note many gaps in knowledge and the need for future studies to contrast these phenotypes in terms of genetics, neural processing of reward and broader measures of behaviour. There is also the need for more extensive longitudinal studies to determine the extent to which these phenotypes are modified by exposure to sweet stimuli in the context of the obesogenic environment.
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Affiliation(s)
| | - Vasiliki Iatridi
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, UK
| | - Martin R Yeomans
- School of Psychology, University of Sussex, Brighton, BN1 9QH, UK.
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