Health and Nutritional Beliefs and Practices among Rural Elderly Population: An Ethnographic Study in Western Spain

Barriers and Enablers of Healthy Eating Among University Students in Oaxaca de Juarez: A Mixed-Methods Study

Background/Objectives: The transition to university life brings significant social, psychological, and environmental changes, making it a critical period for establishing long-term dietary habits. However, many Mexican university students fail to meet national dietary guidelines, increasing their risk of non-communicable diseases. This study examines the determinants of healthy eating among university students in Oaxaca using a holistic, multi-level approach grounded in the Social Ecological Model (SEM) and Social Cognitive Theory (SCT). Methods: A mixed-methods approach was employed, integrating ethnography with a validated self-report questionnaire completed by 411 students at the Universidad Autónoma Benito Juárez de Oaxaca (UABJO). The ethnographic data included observations, field notes, photographs, informal conversations, and 13 semi-structured interviews. Data triangulation provided a comprehensive understanding of dietary behaviors by capturing both self-reported patterns and real-world eating practices and the food environment, as captured through ethnographic methods. The analysis included descriptive statistics, normality tests, and parametric tests to assess significant differences. Results: The findings revealed a decline in diet quality, characterized by low fruit and vegetable intake, high snack consumption, and irregular meal patterns, particularly among students living independently. Key barriers included academic stress, time constraints, low cooking self-efficacy, limited nutritional knowledge, peer pressure, and negative social norms, which contributed to reliance on convenient, processed foods. The lack of healthy food options on campus and the high perceived cost of nutritious food further led students to prioritize cheap, calorie-dense foods over healthier choices. Conversely, enablers included structured university schedules; peer support; hands-on culinary interventions; and improved access to affordable, healthy food. Conclusions: Addressing these barriers requires multi-level interventions that enhance nutrition literacy, cooking self-efficacy, and peer-led strategies while improving the campus food environment. Future research should explore SCT-based initiatives leveraging social networks and culinary education to foster sustainable dietary behavior change in university settings and assess how these findings can be applied in other socioeconomic and cultural contexts.

Health status, lifestyle and quality of life in older adults of rural and urban areas of Tarragona province (Catalonia, Spain): a cross-sectional descriptive study

BACKGROUND

People over 60 years old represent 26.5% of the world's population, and enhancing health emerges as an opportunity. Thus, this study aims to describe and compare the health status (sarcopenia parameters), lifestyles, quality of life, and malnutrition risk of older adults from rural and urban areas of Tarragona province (Catalonia, Spain).

METHODS

The study was a cross-sectional study comparing rural and urban areas of Tarragona province, including 14 of 61 villages as rural areas (500- ≤ 2,000 inhabitants) and 5 of 8 cities as urban areas (≥ 20,000 inhabitants). The variables assessed were: sarcopenia parameters (muscle mass, muscle strength, and physical performance) and lifestyles (diet, physical activity, sleep quality), quality of life and risk of malnutrition. A total of 291 older adults, n = 189 (rural areas) and n = 102 (urban areas), including 80% women with a mean age of 67.37 (rural areas) and 69.12 (urban areas), were studied.

RESULTS

The mean of muscle mass (kg) is higher in men from rural areas (57.59 ± 7.01 vs. 53.48 ± 6.82; p = 0.047) than in urban areas. Compared with urban areas, more people from rural areas accomplish the recommendations of consumption of fruits and vegetables (13.8% vs. 4.9%; p = 0.019), and dairy products (95.8% vs. 88.2%; p = 0.015) along with their high-intensity physical activity (76.7% vs. 65%; p = 0.046). Additionally, in rural areas, more people presented better sleep and quality of life, including physical and emotional roles dimensions, than the urban areas individuals (p ≤ 0.05). No difference among groups was shown in nutritional status.

CONCLUSION

Sarcopenia parameters of urban and rural older adults are similar, except for the highest muscle mass of older adults from rural areas compared to urban ones. In addition, older adults living in rural areas show healthier lifestyles and better quality of life than urban individuals, reinforcing the importance of adapting actions according to the people's environment.

Lifestyle Habits and Nutritional Profile of the Spanish Population: A Comparison Between the Period During and After the COVID-19 Pandemic

The aim of this study was to investigate the changes in habits regarding the health and lifestyle of the Spanish population during and after the COVID-19 pandemic. A cross-sectional design was used. Data were collected during the pandemic from 22,181 participants and after the pandemic from 3907 participants using the NutSo-HH Scale, assessing demographic, nutritional, and lifestyle variables. Key findings reveal a slight increase in exercise duration (+6.61%) post-pandemic, along with reductions in fried food (-3.57%), juice (-6.45%), and alcohol consumption (-9.66%). Conversely, there were notable increases in the consumption of ultra-processed foods (+2.16%), soft drinks (+6.47%), and coffee/energy drinks (+38.95%). Sleep quality, body image, and self-perceived health showed minor declines. These findings indicate that despite some positive behavioral changes, there is still a significant dependence on unhealthy dietary choices, negatively impacting both mental and physical health. The results highlight the need for public health strategies which encourage healthier eating, increased physical activity, and better sleep quality to reduce the long-term effects of lifestyle changes brought on by the pandemic. Focused interventions are necessary to curb the rising consumption of ultra-processed foods and sugary beverages while fostering overall well-being. This study underscores the vital role of ongoing surveillance and customized public health initiatives to enhance general health in the post-pandemic era.

Beliefs, Evaluations, and use of commercial infant Food: A survey among German parents

Complementary feeding is a critical milestone for parents, who must decide the extent to which they feed their infants with homemade foods (HMFs) or commercial infant foods (CIFs). The current study focused on how parents perceive and evaluate CIFs and what drives them to use these products. Understanding the wide variety of factors that influence parents' decisions to use CIFs as a food source is crucial to helping them make more balanced food choices for their infants. Data from an online survey with 858 German parents revealed their negative perceptions of CIFs, particularly in terms of nutritional quality and texture, and concerns that CIFs contain higher levels of pesticides and heavy metals compared to HMFs, despite acknowledging the expertise of the infant nutrition industry. These perceptions were likely to be driven by the 'natural-is-better' belief and parents' desire for control over the ingredients in their infants' meals, contributing to their skepticism towards CIFs. Additionally, our study found that while many parents know traditional nutrition guidelines, they are less familiar with recent updates. Parents' benefit beliefs about CIFs and parents' trust in the food industry strongly influenced the use of CIFs, while infant age and parent gender had a less strong, yet significant influence on CIFs consumption. Overall, the present study offers new quantitative insights into the factors that motivate parents to use CIFs. Furthermore, it underscores the need for health authorities to improve their communication strategies towards parents concerning new dietary guidelines.

Intermittent Fasting: Socio-Economic Profile of Spanish Citizens Who Practice It and the Influence of This Dietary Pattern on the Health and Lifestyle Habits of the Population

Intermittent fasting (IF) is a dietary approach that has gained popularity in recent years. More and more Spanish people are following this eating pattern, which consists of alternating periods of fasting with periods of food intake. Its benefits include improved metabolic and vascular health and weight loss.

OBJECTIVES

1. To study the prevalence of IF among the Spanish population. 2. To explore how demographic factors influence the choice to adopt this dietary approach.

METHODS

A descriptive cross-sectional study was conducted on the Spanish population using the NutSo-HH questionnaire, which was constructed, validated, and disseminated by the research team through a non-probabilistic snowball sampling approach, collecting socio-demographic data and nutritional, social and lifestyle habits of the population.

RESULTS AND CONCLUSIONS

A valid sample of 22,181 people participated, of whom 4.59% (n = 1018) said they practiced IF. The data show that more middle-aged men than women practice IF. In addition, individuals who follow IF methods are less likely to have no control over their food intake, are less scared to gain weight and have a higher body image, but no differences were found related to unhealthy food and nights out. There were also no significant differences in terms of the level of education, income, size of municipality, or region of residence. In conclusion, a person who practices IF seems to have adopted a healthier lifestyle and social habits.

The shift from old age to very old age: an analysis of the perception of aging among older people

Background

The oldest-old (individuals over 90 years) are a fast-growing population. Understanding the perceptions of older people about very old age is the first step towards developing optimal geriatric care for an aging population. This study aimed to explore the potential shift from old age to very old age through the exploration of older people’s perception of aging.

Methods

Qualitative study conducted through individual interviews in the homes of older people. We voluntarily chose to include persons a decade under and above 90 years old to explore other factors than age that could participate in the shift from old age to very old age. The sampling was theoretical. We carried out the analyses using an inductive approach based on the phases of grounded theory. The researchers used triangulation. Collection was concluded when theoretical saturation was reached.

Results

Fourteen participants were interviewed. The shift from old age to very old age was not based on age but occurred when participants became conscious of the irreversibility of aging and its effects, and when they started living day-by-day, renouncing to any plan in a near future. The transition to very old age seemed to be preceded by a progressive disengagement from non-essentials activities. Participants reported a sensation of progressive social exclusion due to the loss of contemporaries or spouse, the difficulty to connect with younger generations or the absence of relationships in their neighborhood. The last step of life was feared, not because of the idea of death itself but because of the associated suffering and loss of autonomy.

Conclusion

Precipitating and slowing factors of the shift to very old age were identified to help general practitioners support older patients throughout their life trajectories.

Predictive Roles of Basal Metabolic Rate and Body Water Distribution in Sarcopenia and Sarcopenic Obesity: The link to Carbohydrates

Sarcopenic obesity is a new category of obesity and is a specific condition of sarcopenia. This study aimed to find the relationship of the basal metabolic rate (BMR) and body water distribution with muscle health and their prospective roles in screening for sarcopenic obesity and sarcopenia. The role of nutrients such as carbohydrates in the relationship was further detected. A total of 402 elderly subjects were recruited. Body composition was estimated by bioelectrical impedance analysis. Sarcopenia was defined by the Asian Working Group for Sarcopenia 2019. The cutoff values were determined by the receiver operating characteristic curve. Mediation analyses were performed using SPSS PROCESS. Higher BMR and BMR/body surface area (BSA) were protective factors against sarcopenic obesity (OR = 0.047, p = 0.004; OR = 0.035, p = 0.002) and sarcopenia (OR = 0.085, p = 0.001; OR = 0.100, p = 0.003) in elderly people. Low extracellular water (ECW)/intracellular water (ICW) and ECW/total body water (TBW) were negatively correlated with the skeletal muscle index (SMI). The intake of dietary carbohydrates in people with sarcopenic obesity was the lowest, but in subjects with obesity, it was the highest (p = 0.023). The results of the moderated mediation model showed that BMR fully mediated the positive relationship between carbohydrates and SMI, which was more obvious in the population with an abnormal body water distribution. BMR or BMR/BSA had the potential role of predicting a higher risk of sarcopenic obesity and sarcopenia. Higher BMR and lower ECW/ICW and ECW/TBW may benefit muscle health. The overconsumption of carbohydrates (especially > AMDR) might be a risk factor for obesity. Moderate dietary carbohydrate intake might promote SMI by regulating BMR and body water distribution in the elderly.

Dietary concepts in the dyad: Results from a qualitative study of middle-aged and older couples

BACKGROUND

The positive effects of a healthy diet on older adults' health status are well established. Yet, inadequate health outcomes prevail. Insufficient healthy dietary styles may be related to the complexity of lay concepts regarding what constitutes a healthy diet. It is hence of importance to disentangle and understand such concepts in depth. The aim of this qualitative study was to explore diet-related intra-couple dynamics and to reconstruct dietary concepts and associated influencing factors among older couples METHODS: The qualitative sample consisted of 15 German couples with at least one partner aged between 50 and 70 years. Study participants were recruited using theoretical sampling. Dyadic guideline-based interviews were conducted from 2016 to 2017. The transcripts were analyzed by means of the Grounded Theory Method RESULTS: Diverse Dyadic dietary concepts emerged from the data material and were shown to be dynamically influenced - among others - within the context of the couple relationship. Three major components showed to be integral to Dyadic dietary concepts: Ideas of healthy diet, Taste and Body images. Moreover, in all of the couples interviewed, one of the partners developed the role of a "Health Expert", who was consensually considered to have more solid health expertise. Different expressions of the HE with corresponding couple dynamics were identified DISCUSSION: This study demonstrates the relevance of diet-related intra-couple dynamics in shaping Dyadic dietary concepts. Particularly, the role of the "Health Expert" within couples showed to decisively influence such concepts. Future research is needed to gain a greater in-depth knowledge on the related influencing factors and couple dynamics. Public health (nutrition) strategies targeting older couples should address such intra-couple dynamics such as the role the partners play for shaping Dyadic dietary concepts.

Rationale and Methods of Evaluation for ACHO, A New Virtual Assistant to Improve Therapeutic Adherence in Rural Elderly Populations: A User-Driven Living Lab

Low therapeutic adherence is a concern for health professionals as it decreases therapeutic efficiency while increasing costs, especially in elderly populations. To increase therapeutic adherence in elderly populations, the technology applied in the medical devices that are used must be adapted to improve usability. This paper outlines the rationale behind, and methods applied to assess the usability of, ACHO (Assistant on Care and Health Offline), a voice assistant that provides elderly patients with reminders of medical appointments to attend and when they need to take their medication. This work is a descriptive, cross-sectional, observational study, and will include a three-phase (analysis, testing and refinement) multidimensional usability analysis of an initial prototype, in the setting of a user-driven Living Lab, which enables the needs and characteristics of the end users to be identified and incorporated into the prototype with each iteration, in which a multidisciplinary team of researchers and users will participate as co-creators. This methodology will allow us to develop a better prototype, increasing usability and, thus, increasing therapeutic adherence.

Memories of hunger, continuities, and food choices: An ethnography of the elderly in extremadura (Spain)

Food choices are a complex subject of study. This study reviews existing literature on the topic, while also offering new perspectives. It introduces empirical materials that suggest the existence of continuities between childhood memories of food insecurity and current nutritional choices and practices among older adults. This is a qualitative study, based on grounded theory, which explores memories of hunger in the aftermath of the Spanish Civil War through ethnographic fieldwork conducted in 12 rural localities in Extremadura (Spain) - analysing current food practices and ideologies among surviving post-war children and tracing continuities between the past and the present. It provides results in the field of food continuities and shows how experiences and memories of hunger have an impact on food choices many decades later Data analysis and interpretation revealed three main categories: food memories of the so-called "years of hunger"; present-day food practices; and continuities between past and present. The inductive-deductive analysis revealed enduring memories that shaped present-day attitudes towards food - i.e. maximisation of ingredients and "zero-waste" practices; conspicuous consumption at particular times of the year; the central role of bread; and even certain food taboos. More than seventy years later, memories of deprivation and hunger are still pervasive and permeate present-day dietary practices and choices.

Important Dependency-Associated Community Resources among Elderly Individuals with a Low Level of Social Support in China

Background: The prevalence of dependency personality disorder is high among elderly individuals with a low level of social support. The objective of this study was to explore the dependency associated with important community resources among elderly individuals with a low level of social support from the perspective of resource demand. Methods: The population-based cross-sectional study was conducted in 22 locations in China. A total of 950 participants aged ≥60 years were selected using a complex multistage sampling design. All the data were collected using questionnaires via face-to-face interviews. The dependency was assessed using the standardized Chinese version of the Minnesota Multiphasic Personality Inventory-II. Community resources were assessed using 43 items. Logistic regression analysis was used to evaluate the association between dependency and important community resources. Results: Bivariate analysis showed that the level of social support was negatively associated with levels of income (p < 0.001) and education (p = 0.008) and was positively associated with social communication and interactions (p < 0.001). The logistic regression analysis showed that the emergency call or survival monitoring system (ECSMS) was the most important community resource that was significantly associated with the levels of dependency; the odds ratio was 2.64 (95% CI, 1.07–3.91; p = 0.031) among elderly individuals with a low level of social support. Conclusions: The levels of dependency were most significantly associated with the ECSMS among elderly individuals with a low level of social support. Our results suggest that improving the ECSMS can be the main problem in the development of community resources.

Treatment Adherence in Chronic Conditions during Ageing: Uses, Functionalities, and Cultural Adaptation of the Assistant on Care and Health Offline (ACHO) in Rural Areas

The increasingly common scenario of an ageing population is related to a rise in the prevalence of problems associated with chronic conditions and comorbidities. Polypharmacy is frequent among this population, and it is a situation that can create medication management and adherence issues. This article introduces the features and functionalities of a voice assistant (Assistant on Health and Care Offline, ACHO) that aims to facilitate treatment adherence among elderly adults. Specifically adapted for its use in rural contexts, it does not require an Internet connection. Its development consisted of two stages: a first stage of problem diagnosis, in which the classic tools of ethnographic fieldwork were used, and a second stage of design implementing methodologies developed by Ambient Assisted Living (AAL) programmes. The main design characteristic of this new digital care system is that it is adapted to the needs of its end-users. It includes features such as voice customisation and the personal identification of medication, it can be connected to other digital devices, and information is introduced and supervised by healthcare professionals. These custom features introduce a safer medication administration procedure, improve supervision strategies, and increase patients' trust in the prescription process.

Family Orchards and Health-Related Quality of Life in the Elderly. A Protocol for a Study in Las Hurdes (Spain) Based on an Ethnographic Approach

Demographic evolution is resulting on an aged population increment in Spain. This growth has been more relevant in rural areas, where the population has traditionally lived under hard socio-economic conditions and leveraging the natural resources such as food from family orchards to survive. Studies that have investigated the possibilities and uses of these traditional family orchards today in relation to health-related quality of life in the elderly are scarce. Based on a previous ethnography, this mixed research aims to describe a protocol that will evaluate the effects of the use of traditional family orchards as a daily resource on fitness and quality of life of the elderly population in Las Hurdes (Spain). Body composition, fitness, mental health, health-related quality of life, and activity-related behaviors of participants will be assessed. The outcomes of this study might enable us to design further tailored physical exercise-based interventions using family orchards as an adequate resource to improve the health-related quality of life and fitness of the elderly in rural areas. In addition, the study detailed here might also be applied to other similar rural areas in Spain and worldwide.