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Sikorski C, Yang S, Stennett R, Miller V, Teo K, Anand SS, Paré G, Yusuf S, Dehghan M, Mente A. Changes in energy, macronutrient, and food consumption in 47 countries over the last 70 years (1950-2019): a systematic review and meta-analysis. Nutrition 2023; 108:111941. [PMID: 36702047 DOI: 10.1016/j.nut.2022.111941] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We aimed to systematically examine trends in dietary energy, macronutrient, and food consumption in different geographic regions. METHODS We searched Medline, Embase, CINAHL, and organizations for studies and reports using individual-level dietary assessments from 1950 to 2019 (PROSPERO CRD42022302843) and quantified changes using multivariable linear mixed-effects models. RESULTS We identified 109 articles and reports from 47 countries, including Europe and Australasia (47% of studies), Asia (30%), Latin America (13%), the Middle East (6%), and North America (4%). In Southeast and East Asia, carbohydrate intake decreased, whereas fat consumption increased; the opposite pattern occurred in North America; and fat decreased while carbohydrate intake remained stable in Europe and Australasia. Consumption of carbohydrate and fat were stable in South Asia, Latin America, and the Middle East, but data were limited in these regions. A greater increase in national gross domestic product over time was associated with decreased carbohydrate and increased fat and protein intake. Dietary saturated fatty acid intake decreased in Northern and Eastern Europe and was stable in other regions. Changes in food varied by region; East and Southeast Asia increased meat, fish, dairy, egg, fruit, and vegetable consumption and decreased intake of grains, roots and tubers, legumes, whereas North America decreased dairy and red meat but increased eggs, nuts, poultry, and vegetable oil intake. Intakes of fruits, nuts, legumes, and roots and tubers were below recommendations in most regions. CONCLUSIONS Our findings indicate regional variations in dietary trends and identify countries that would benefit from nutritional policies aimed at decreasing lower-quality carbohydrate foods and increasing consumption of fruits, vegetables, nuts, legumes, and dairy.
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Affiliation(s)
- Claudia Sikorski
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Shuling Yang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rosain Stennett
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Victoria Miller
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Paré
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Department of Medicine, David Braley Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Andrew Mente
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Kuo CT, Chen DR, Chan CC, Yeh YP, Chen HH. Sex differences in the association between sugar-sweetened beverages consumption and metabolic risks among the working-age population in Taiwan. Public Health Nutr 2023; 26:653-660. [PMID: 35851091 PMCID: PMC9989700 DOI: 10.1017/s1368980022001549] [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: 12/13/2021] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sugar-sweetened beverages (SSB) are linked to increased metabolic risk. However, the sex differences in the relationship between SSB intake and adverse health effects remain unclear. Therefore, the present study examined the association between SSB consumption and metabolic risks among working-age males and females from Taiwanese communities. DESIGN A community-based study utilised data from a comprehensive health screening project conducted by the Public Health Bureau in Changhua County, Taiwan. Metabolic risks included waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, TAG, LDL cholesterol and fasting glucose level using serum tests. SETTING Participants were recruited in Changhua County, Taiwan. PARTICIPANTS Between 2005 and 2014, 92 724 citizens participated in the health screening; our data analysis included 75 278 respondents between 30 and 64. RESULTS The results showed that the frequency of SSB consumption was associated with abnormal waist circumference and elevated total cholesterol, TAG, LDL and glucose in both men and women. Increased SSB consumption frequency was associated with elevated glucose and hypertension in women. Even a slight increase in SSB intake frequency was related to raising the metabolic risks. Similar patterns were evident when models included BMI; however, the associations were attenuated. In the BMI-stratified subgroup analysis, the relationship between SSB consumption and metabolic risks was more pronounced in participants without obesity. CONCLUSION The present study suggests that SSB consumption carries metabolic risk among working-age Taiwanese, particularly women and those without obesity. Health promotion programmes should raise awareness of the health hazards associated with SSB.
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Affiliation(s)
- Chun-Tung Kuo
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, 17 Xuzhou Road, Room 636, Zhongzheng District, Taipei, Taiwan
| | - Duan-Rung Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, 17 Xuzhou Road, Room 636, Zhongzheng District, Taipei, Taiwan
| | - Chang-Chuan Chan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Environmental and Occupational Health Science, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Po Yeh
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Changhua County Public Health Bureau, Changhua County, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Smith KG, Scheelbeek P, Balmford A, Alexander P, Garnett EE. Discrepancies between two long-term dietary datasets in the United Kingdom (UK). Wellcome Open Res 2023; 6:350. [PMID: 36176332 PMCID: PMC9494176 DOI: 10.12688/wellcomeopenres.17245.3] [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] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+23.4% and +1.4%, respectively) and a decrease in fish (-7.1% and -3.2%, respectively). Temporal trends did not agree between the two datasets for dairy, calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.
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Affiliation(s)
- Kerry G. Smith
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK,
| | - Pauline Scheelbeek
- Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Andrew Balmford
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
| | - Peter Alexander
- School of Geosciences, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP, UK,Global Academy of Agriculture and Food Security, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Emma E. Garnett
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK,Cambridge Institute for Sustainability Leadership, University of Cambridge, Cambridge, CB2 1QA, UK
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Smith KG, Scheelbeek P, Balmford A, Alexander P, Garnett EE. Discrepancies between two long-term dietary datasets in the United Kingdom (UK). Wellcome Open Res 2023; 6:350. [PMID: 36176332 PMCID: PMC9494176 DOI: 10.12688/wellcomeopenres.17245.2] [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] [Accepted: 09/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.
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Affiliation(s)
- Kerry G. Smith
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK,
| | - Pauline Scheelbeek
- Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Andrew Balmford
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
| | - Peter Alexander
- School of Geosciences, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP, UK,Global Academy of Agriculture and Food Security, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Emma E. Garnett
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK,Cambridge Institute for Sustainability Leadership, University of Cambridge, Cambridge, CB2 1QA, UK
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Smith KG, Scheelbeek P, Balmford A, Alexander P, Garnett EE. Discrepancies between two long-term dietary datasets in the United Kingdom (UK). Wellcome Open Res 2023; 6:350. [PMID: 36176332 PMCID: PMC9494176 DOI: 10.12688/wellcomeopenres.17245.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by Defra (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: FAO-FBS estimates were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses . Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.
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Affiliation(s)
- Kerry G. Smith
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK,
| | - Pauline Scheelbeek
- Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Andrew Balmford
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK
| | - Peter Alexander
- School of Geosciences, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP, UK,Global Academy of Agriculture and Food Security, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Emma E. Garnett
- Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK,Cambridge Institute for Sustainability Leadership, University of Cambridge, Cambridge, CB2 1QA, UK
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Yuan TH, Eguchi A, Tai CJ, Tsai CH, Chien JW, Chan CC, Mori C. Comparison of the PCB serum levels among mother-child pairs in areas of Eastern Japan and Central Taiwan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 806:150272. [PMID: 34852429 DOI: 10.1016/j.scitotenv.2021.150272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
Polychlorinated biphenyls (PCBs) have been prohibited for two decades in Japan and Taiwan. The aim of this study was to compare the PCB congeners in maternal and cord serum between two countries. Our study subjects were 248 and 100 mother-child pairs in Japan and Taiwan. The measured levels of 23 serum PCB congeners between two countries were analyzed using gas chromatography-electron capture negative ionization quadrupole mass spectrometry (GC-NICI-qMS). The statistical comparisons were conducted by Student's t-test and principal component analysis with further stratification by maternal age and parity. The maternal total PCBs levels in Japan (426 ± 244 pg/g wet wt) were significantly higher than those in Taiwan (254 ± 155 pg/g wet wt), and the similar results were found in cord total PCBs levels (97 ± 76 and 58 ± 87 pg/g wet wt). It showed different distributions of PCB congeners between two countries. Whether in maternal or cord serum, the CB138, CB153 and CB180 were the highest detectable congeners whether in Japan or Taiwan. And, the CB66, CB99, CB206 and CB209 were only detected in maternal serum of Taiwan. The women of advanced maternal age had higher levels of PCB congeners, especially in Taiwan, and the primiparous women had higher levels of PCB congeners in two countries. In summary, the PCB congeners in Japan's mother-child pairs were with higher levels and different distributions when compared to those in Taiwan, and the maternal age and parity were important factors associated with the PCB levels.
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Affiliation(s)
- Tzu-Hsuen Yuan
- Department of Health and Welfare, College of City Management, University of Taipei, Taiwan
| | - Akifumi Eguchi
- Center for Preventive Medical Sciences, Chiba University, Japan
| | - Chun-Ju Tai
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University, Taiwan
| | | | | | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University, Taiwan
| | - Chisato Mori
- Center for Preventive Medical Sciences, Chiba University, Japan.
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Increasing Sugar Production in Indonesia Through Land Suitability Analysis and Sugar Mill Restructuring. LAND 2019. [DOI: 10.3390/land8040061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Indonesia is the fourth most populated country in the world with an annual population growth rate of 1.3%. This growth is accompanied by an increase in sugar consumption, which is occurring at an annual rate of 4.3%. The huge demand for sugar has created a large gap between sugar production and demand. Indonesia became the world’s largest sugar importer in 2017–2018. Sugarcane farmers have an important role in sugar production. They are facing problems with declining sugarcane productivity and arable land decreasing. We aimed to understand the sugar production issue in Indonesia and to examine options to increase sugar production. To achieve these aims, a framework consisting of four steps was developed: Analysis of the current situation; problems identification; resolution; and delivering programs; and strategies. The main problems in sugar production in Indonesia were identified, including a stagnation in sugarcane harvest area, low sugarcane productivity, lack of good varieties, and inefficient sugar mills. Based on the identified problems, strategies to increase production were created. Two approaches need to be executed simultaneously: An increase in sugarcane planting area, and an increase in productivity and sugar yield. The first approach in increasing sugar production is the exploration of new sugarcane planting areas outside of Java both on existing agricultural land and in new areas. A land suitability analysis for the whole country was conducted based on a semi-detailed soil map. The main priority for development was the existing agricultural area via an integration system or existing crop exchange. The second approach is restructuring sugar factories through the revitalization of existing sugar mills and investment in the construction of new mills. The challenges that need to be addressed include land availability, provision of high-yielding varieties, and improving the efficiency of sugar mills. General strategies and medium-term programs are presented and discussed. These efforts, if well-executed, will boost Indonesia’s sugar production to meet its domestic demand by 2025, achieving competitiveness in the world market by 2045.
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Muga MA, Owili PO, Hsu CY, Rau HH, Chao JCJ. Dietary patterns, gender, and weight status among middle-aged and older adults in Taiwan: a cross-sectional study. BMC Geriatr 2017; 17:268. [PMID: 29162048 PMCID: PMC5696781 DOI: 10.1186/s12877-017-0664-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/14/2017] [Indexed: 01/03/2023] Open
Abstract
Background Diet has been associated with differences in weight and nutritional status of an individual. The prevalence of overweight and obesity increased among adults in Taiwan. Hence, we examined the relationship between dietary patterns and weight status by gender among middle-aged and older adults in Taiwan. Methods The cross-sectional data of 62,965 participants aged ≥40 years were retrieved from the Mei Jau health screening institutions’ database collected from 2001 and 2010. Diet information was evaluated using a food frequency questionnaire, while the dietary patterns were derived using principal component analysis before summing up and dividing into quintiles of consumption. The association between dietary patterns and weight status among adult men and women was explored using multinomial logistic regression models. Three models were analyzed before stratifying data by gender. Results Two dietary patterns were derived with one reflecting a high consumption of vegetables and fruits (vegetable-fruit dietary pattern) and the other a high consumption of meat and processed foods (meat-processed dietary pattern). After adjustment, highest consumption of vegetables and fruits (Q5) reduced the likelihood of being overweight (OR = 0.91; 95% CI, 0.85–0.97) or obese (OR = 0.85; 95% CI, 0.78–0.92), while highest consumption of meat and processed foods increased the likelihood of being overweight (OR = 1.50; 95% CI, 1.40–1.59) or obese (OR = 1.94; 95% CI, 1.79–2.10). Women were less likely to be overweight or obese with the highest intake of fruits and vegetables (Q5) while both genders were more likely to be overweight or obese with high consumption of meat and processed foods. Conclusions High intake of vegetables and fruits is associated with lower odds of being overweight or obese, especially among women. But, high intake of meat and processed foods is associated with higher odds of overweight and obesity in both genders. Electronic supplementary material The online version of this article (10.1186/s12877-017-0664-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miriam Adoyo Muga
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.,Department of Nutrition and Dietetics, University of Eastern Africa, Baraton, Eldoret, Kenya
| | - Patrick Opiyo Owili
- Department of Public Health, School of Health Sciences, University of Eastern Africa, Baraton, Eldoret, Kenya.,Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Yeh Hsu
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Hsien Rau
- Graduate Institute of Biomedical Informatics, College of Medical Technology, Taipei Medical University, Taipei, Taiwan
| | - Jane C-J Chao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan. .,Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan. .,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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