Inequalities in education and national income are associated with poorer diet: Pooled analysis of individual participant data across 12 European countries

Background

Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases.

Methods

Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored.

Findings

Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14μg, 95% CI 12, 16) in higher educated individuals.

Interpretation

Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.

A multicentre study of street foods purchased in urban areas of Central Asia: the FEEDCities Project

Background

Street food (SF) is a strong tradition in Central Asia, where urbanization and westernization of food habits is occurring. Research on SF consumption is scarce, and crucial to understand its implications for public health. This study aims to describe the SF purchases in urban areas of Tajikistan, Kyrgyzstan, Turkmenistan and Kazakhstan.

Methods

A cross-sectional study was conducted in Dushanbe, Bishkek, Ashgabat and Almaty in 2016/2017. SF markets (n = 34) and vending sites (n = 270) were selected by random and systematic sampling. Data on customers’ characteristics and food items purchased was collected by direct observation. Nutritional composition of the food items (n = 852) was obtained by laboratorial analysis (n = 582) or food composition tables and labels (n = 270).

Results

A total of 714 customers were identified. The most commonly purchased foods and beverages were savoury pastries/snacks (23.2%), main dishes (19.0%), sweet pastries/confectionery (17.9%), tea/coffee (11.3%) and soft drinks/juices (9.8%). Fruit was the least frequently purchased food (1.1%). Nearly one-third of customers purchased industrial food items; this proportion was significantly higher in Kazakhstan (43.2%) and Turkmenistan (32.3%). The median energy content of a SF purchase ranged between 352kcal (Tajikistan) and 568kcal (Turkmenistan). The median saturated (SFA) and trans fat contents were 4.74g and 0.36g, respectively; the highest values were 9.01g for SFA (Turkmenistan) and 0.60g for trans fat (Kazakhstan), accounting for 40.6% and 27.3% of the maximum daily recommendations, respectively. Sodium-potassium ratio was far above recommended, reaching the highest values of 6.57 and 5.17 in Tajikistan and Kyrgyzstan.

Conclusions

Frequent purchase of industrial food reflects a shift to a westernized dietary pattern. Public health policies in these settings should aim to increase fruit availability and to improve SF nutritional composition, namely its lipid profile and sodium content.

Key messages

A relevant proportion of customers bought industrial foods, while fruit was rarely purchased, reflecting the nutrition transition process that is occurring in developing countries. Street food meals showed concerning levels of saturated fat, trans-fat and sodium, which must be considered when designing strategies targeted to improve the urban food environment in these settings.

An exploration of socio-economic and food characteristics of high trans fatty acid consumers in the Dutch and UK national surveys after voluntary product reformulation

Trans fatty acids (TFA) increase the risk of mortality and chronic diseases. TFA intakes have fallen since reformulation, but may still be high in certain, vulnerable, groups. This paper investigates socio-economic and food consumption characteristics of high TFA consumers after voluntary reformulation in the Netherlands and UK. Post-reformulation data of adults aged 19-64 was analysed in two national surveys: the Dutch National Food Consumption Survey (DNFCS) collected 2007-2010 using 2*24hr recalls (N = 1933) and the UK National Diet and Nutrition Survey (NDNS) years 3&4 collected 2010/11 and 2011/12 using 4-day food diaries (N = 848). The socio-economic and food consumption characteristics of the top 10% and remaining 90% TFA consumers were compared. Means of continuous data were compared using t-tests and categorical data means using chi-squared tests. Multivariate logistic regression models indicated which socio-demographic variables were associated with high TFA consumption. In the Dutch analyses, women and those born outside the Netherlands were more likely to be top 10% TFA consumers than men and Dutch-born. In the UK unadjusted analyses there was no significant trend in socio-economic characteristics between high and lower TFA consumers, but there were regional differences in the multivariate logistic regression analyses. In the Netherlands, high TFA consumers were more likely to be consumers of cakes, buns & pastries; cream; and fried potato than the remaining 90%. Whereas in the UK, high TFA consumers were more likely to be consumers of lamb; cheese; and dairy desserts and lower crisps and savoury snack consumers. Some socio-demographic differences between high and lower TFA consumers were evident post-reformulation. High TFA consumers in the Dutch 2007-10 survey appeared more likely to obtain TFA from artificial sources than those in the UK survey. Further analyses using more up-to-date food composition databases may be needed.

Joint analysis of BICEP2/keck array and Planck Data

We report the results of a joint analysis of data from BICEP2/Keck Array and Planck. BICEP2 and Keck Array have observed the same approximately 400  deg^{2} patch of sky centered on RA 0 h, Dec. -57.5°. The combined maps reach a depth of 57 nK deg in Stokes Q and U in a band centered at 150 GHz. Planck has observed the full sky in polarization at seven frequencies from 30 to 353 GHz, but much less deeply in any given region (1.2  μK deg in Q and U at 143 GHz). We detect 150×353 cross-correlation in B modes at high significance. We fit the single- and cross-frequency power spectra at frequencies ≥150  GHz to a lensed-ΛCDM model that includes dust and a possible contribution from inflationary gravitational waves (as parametrized by the tensor-to-scalar ratio r), using a prior on the frequency spectral behavior of polarized dust emission from previous Planck analysis of other regions of the sky. We find strong evidence for dust and no statistically significant evidence for tensor modes. We probe various model variations and extensions, including adding a synchrotron component in combination with lower frequency data, and find that these make little difference to the r constraint. Finally, we present an alternative analysis which is similar to a map-based cleaning of the dust contribution, and show that this gives similar constraints. The final result is expressed as a likelihood curve for r, and yields an upper limit r_{0.05}<0.12 at 95% confidence. Marginalizing over dust and r, lensing B modes are detected at 7.0σ significance.

A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework

This paper presents the NOURISHING framework of food policies to promote healthy diets, and uses the framework to summarize the policy actions taken by the Bellagio meeting countries. NOURISHING was developed by WCRF International to formalize a comprehensive policy package that brings together the key domains of action and policy areas. It aims to provide global level recommendations for a comprehensive response, within which policymakers have the flexibility to select specific policy options suitable for their national/local contexts and target populations. It also aims to provide a framework for reporting, categorizing and monitoring policy actions taken around the world, and for systematically categorizing, updating, interpreting and communicating the evidence for policy to policymakers. In this paper we explain the structure for NOURISHING and the rationale behind it. We also use the framework to report on and categorize the policy actions implemented in the Bellagio countries.

Role changes experienced by clinical staff in relation to clients' recovery from psychosis

This study investigates the subjective experiences of staff from many interdisciplinary teams working with clients in the recovery process from psychosis. The clinical staff interviewed in this study included: staff nurses, clinical nurse specialists, occupational therapists, psychologists, social workers, rehabilitation workers, recreation therapists, music therapists, psychiatrists, and lodging home operators. The purpose of this study was to examine the clinical staff's changing roles and relationships with clients recovering from psychosis. The investigation used a naturalistic qualitative design with an ethnographic method of data analysis. The participants were clinical staff working with clients about to commence treatment with clozapine or risperidone. The settings used were a tertiary-care psychiatric hospital and a general hospital. The clinical staff members who participated in the study were interviewed every 3 months. In the initial interview, members of the clinical staff were asked about their knowledge regarding the new medication and their role in the decision to try the new medication. In all the interviews, clinical staff members were asked about how the recovery process was progressing with the client. Data regarding clinical staff fears related to the client's situation, changes in their relationships with the client and the client's family, and what they perceived to be current rehabilitation implications, were collected. Some of the clinical staff roles that evolved during the recovery process were: health teacher; advocate; counsellor; and support person.

From hospital to community: bridging therapeutic relationships

The 'Bridge to Discharge' project evolved from a participatory research project. The team included public health nurses, in-patient schizophrenia program nurses and mental health consumers. The project focused on therapeutic relationships and used Peplau's theory of Interpersonal Relations. A broad perspective of therapeutic relationships was used that explicitly included both peer and professional support. The theoretical approach is described and illustrated with a case study.

Bridging the discharge process

Current mental health initiatives are decreasing the number of psychiatric beds and thus increasing the number of clients with serious mental illness who are being served in the community. Such changes have implications for clients' quality of life and health care economics. To implement the changes while addressing the unique needs of psychiatric clients, appropriate models of discharge planning and community integration are critical.

Automated measurement of motor activity in human subjects: effects of repeated testing and d-amphetamine

Repeated exposure to a test setting decreases, and amphetamine increases, motor activity in animals. To evaluate whether these effects also occur in human subjects, we recorded motor activity levels from 12 subjects during a double-blind oral drug discrimination (placebo vs. 75 mg tripelennamine) study. Before each 4-h session, activity monitors were attached to the subject's wrist and ankle. During each session, subjects rated their drug effects hourly (task periods), and could freely choose among leisure activities during intertask intervals (recreational periods). Habituation was evaluated by comparing activity response during initial (training phase) vs. later (discrimination phase) placebo sessions. During later sessions the two training drugs, as well as diazepam (2.5, 5 mg P.O.) and d-amphetamine (5, 10 mg P.O.) were administered. Consistent with animal studies, repeated exposure to the test environment significantly decreased, and d-amphetamine significantly and selectively increased, wrist motor activity. These data indicate that human motor activity is sensitive to environmental factors (task, time), drug class, and d-amphetamine dose. Activity measures may, therefore, be useful in evaluating environment/psychostimulant interactions in humans.

Evaluation of Bridging Institution and Housing-A Joint Consumer-Care Provider Initiative

1. The most common alternative housing choice in the community for individuals with serious mental illness was a boarding home. 2. Community consumers noted that being with other people was the most important benefit of the teaching apartment, followed by eating, learning new skills, and entertainment. 3. Although they reported negative aspects about the homes, most consumers did not want to change anything about their boarding home.

Efficient insertion of odd-numbered transmembrane segments of the tetracycline resistance protein requires even-numbered segments

Functional membrane insertion elements in the pBR322 tetracycline resistance protein were identified by comparing the ability of odd-numbered transmembrane segments and their attached periplasmic loops to insert into the membrane individually or when combined with the next even-numbered segment in the tetracycline resistance protein sequence. The efficiency with which individual odd-numbered segments and periplasmic loops inserted was probed by treating proteins truncated at the distal ends of periplasmic loops P2-P6 with carboxypeptidases and endoproteases in inside-out membrane vesicles. Insertion of odd-numbered segments and attached loops is inefficient when they occupy a C-terminal position in the protein. The C-terminal odd-numbered segment and loop sequences of 34-54% of the molecules of periplasmic loop truncation mutants could be removed by carboxypeptidase Y. In contrast, odd-numbered segments and loops insert efficiently if the next even-numbered segment in the sequence is present. In such cytoplasmic loop truncation mutants, only the cytoplasmic tail sequences of the proteins could be removed by carboxypeptidases. Remarkably, insertion of individual odd-numbered segments and loops is inefficient even though free energies for insertion of these sequences are highly favorable. The results indicate that pairs of adjacent segments, possibly "helical hairpins," are necessary for efficient membrane insertion of the tetracycline resistance protein.

A simple method of securing a dressing on scalp wounds

A method of securing a dressing on scalp wounds, using silastic foam, is described. This method has the advantage of leaving the rest of the scalp uncovered and is particularly effective in the unco-operative patient.

MMPI scales for DSM-III personality disorders: a preliminary validation study

A preliminary investigation of the external validity of MMPI scales designed to measure certain DSM-III Personality disorders (N = 108) is reported. Results indicate that many of these scales are effective for discriminating clinically diagnosed personality disorders from control subjects (N = 640).