Neo-Traditional and Industrialized Dietary Patterns Coexist and Are Differentially Associated with Cardiometabolic Health among Adults in Puerto Rico

BACKGROUND

An increasingly industrialized food system has marginalized local, traditional food cultures in Puerto Rico (PR). Recent efforts to decolonize diets have promoted local food intake; however, how resulting dietary patterns may influence cardiometabolic disease remains unknown.

OBJECTIVES

This study aimed to 1) identify dietary patterns in PR and 2) determine their associations with metabolic syndrome (MetS) and its components.

METHODS

Data were obtained from participants (30-75 y) in PROSPECT (PR Observational Study of Psychosocial, Environmental, and Chronic Disease Trends; n = 989). Dietary patterns were derived using partial least squares analysis with food frequency questionnaire data, using nutrients associated with local food purchasing (dietary fiber, magnesium, saturated fat) as response variables. MetS was classified using harmonized criteria from clinical and laboratory measures and medication use. Fully adjusted generalized linear models tested associations between tertiles of dietary patterns and MetS.

RESULTS

Approximately half (52%) of the participants were classified with MetS. Four dietary patterns were revealed: conventional (legumes, coffee, and dairy), industrialized starch and meat-centric (red/processed meats, pasta, and starchy roots), industrialized sugar-centric (rice, sugary beverages, and refined grains), and neo-traditional (local plants and seafood). Individuals in the highest (compared with lowest) tertile of the industrialized starch and meat-centric dietary pattern had higher mean waist circumference (102 compared with 99 cm) (P = 0.01), fasting glucose (106 compared with 98 mg/dL) (P = 0.019), and systolic blood pressure (123 compared with 119 mmHg) (P = 0.022). Individuals in the highest (compared with lowest) tertile of the neo-traditional diet were 0.69 (0.49, 0.97) times less likely to have MetS (P = 0.035) and had 4.1 cm lower mean waist circumference (P = 0.002).

CONCLUSIONS

Promoting a neo-traditional diet and curbing industrialized starch and meat-centric diets may improve cardiometabolic health in PR. Results can guide local food promotion as a healthful, decolonizing approach in island settings.

Mississippi School Food Service Directors' Interest and Experience With Local Food Procurement and Farm to School Activities

BACKGROUND.

The purpose of this study was to collect updated school food service purchasing practices from K-12 public school food service directors (SFSD) in Mississippi and to determine their current abilities, experiences, and desires to engage in Farm to School (F2S) activities.

METHODS.

The online survey was created using questionnaire items from existing F2S surveys. The survey opened in October 2021 and closed in January 2022. Descriptive statistics were used to summarize the data.

RESULTS.

Of the 173 SFSD sent email invitations, 122 (71%) completed the survey. The most common fresh fruit and vegetable purchasing practices included Department of Defense Fresh Program (65%) and produce vendor (64%). Forty-three percent of SFSD purchased at least one locally sourced fruit and 40% purchased at least one locally sourced vegetable, while 46% did not purchase any locally sourced foods. The most common challenges for purchasing from farmers included no relationship with farmers (50%) and food safety regulations (39%). Sixty-four percent of SFSD were interested in at least one F2S activity.

CONCLUSIONS.

Most SFSD do not purchase local foods directly from farmers and almost half do not purchase any local foods regardless of source. Lack of connection with local farmers is a significant challenge to F2S. Recently proposed framework by USDA for shoring up the food supply chain and transforming the food system may help reduce or remove ongoing challenges to F2S participation.

Mississippi Small Farm Product Amounts, Seasonality, and Proximity to K-12 Public Schools

The study's purpose was to determine small farm product amounts and seasonality and examine spatial relationships between small farms and K-12 public schools in Mississippi. Online survey participation invitations were sent via email to farmers and school food service directors from October 2021 to January 2022. Data were summarized using descriptive statistics and proximities between farms (n = 29) and schools (n = 122) determined using spatial analysis. Median yearly amounts for both fresh fruits and vegetables ranged from 1-50 to 201-500 pounds while other product amounts ranged from 1-50 to >1000 pounds. Fresh fruits, fresh vegetables, and other product seasonality ranged from 1 to 6 months, 1 to 12 months, and 3 to 12 months, respectively. In total, 8 out of 12 fresh fruits, 24 out of 25 fresh vegetables, and all other products were harvested during the academic school year. Fifty percent of the schools were within a 20-mile radius of at least one small farm, while 98% were within a 50-mile radius. While many product amounts were small (1-50 pounds), most were harvested during the school year and in close proximity to at least one school. Contracting directly with farmers may be more attractive to school food authorities given current supply chain disruptions and decreasing product availability for school meal programs.

"Planeterranea": An attempt to broaden the beneficial effects of the Mediterranean diet worldwide

Non-communicable diseases (NCDs) lead to a dramatic burden on morbidity and mortality worldwide. Diet is a modifiable risk factor for NCDs, with Mediterranean Diet (MD) being one of the most effective dietary strategies to reduce diabetes, cardiovascular diseases, and cancer. Nevertheless, MD transferability to non-Mediterranean is challenging and requires a shared path between the scientific community and stakeholders. Therefore, the UNESCO Chair on Health Education and Sustainable Development is fostering a research project-"Planeterranea"-aiming to identify a healthy dietary pattern based on food products available in the different areas of the world with the nutritional properties of MD. This review aimed to collect information about eating habits and native crops in 5 macro-areas (North America, Latin America, Africa, Asia, and Australia). The information was used to develop specific "nutritional pyramids" based on the foods available in the macro-areas presenting the same nutritional properties and health benefits of MD.

Mississippi Farmers' Interest in and Experience with Farm to School

The study’s purpose was to collect demographic and farm characteristics from Mississippi small farmers and to determine their abilities, experiences, and desires to engage in Farm to School (F2S) activities. The online survey was created using items taken from existing F2S surveys. Invitations to participate were sent via email to farmers beginning in October 2021 and ending in January 2022. Descriptive statistics were used to summarize the data. Of the 258 individuals with valid email addresses, 43 (17%) completed the online survey, and 38 fit the definition of small farm (<USD 250,000 in gross cash farm income). Mean farm acreage was 68 (range 1−480 acres). Twenty-six (70%) farms did not have any certifications. Common selling practices included farm stands/stores (n = 18; 49%) and farmers markets (n = 16; 43%). Only 4 farmers (11%) sold to schools with half indicating the experience was difficult. Common challenges included no relationship with school staff (n = 14; 44%) and guarantying quantity/date (n = 11; 34%). Twenty-six (68%) farmers expressed an interest in at least one F2S activity. To facilitate mutually beneficial relationships between small farmers and school food service staff, work is needed to connect the two groups and guide farmers in navigating school procurement rules and regulations.

COVID-19’s Impact on Farmers Market Sales in the Washington, D.C., Area

We use a sales database of farmers market vendors in the Washington, D.C., area to estimate how first half 2020 sales were impacted by the coronavirus (COVID-19) outbreak. We use 2019 data as a counterfactual for sales that would have occurred in 2020 in the absence of COVID-19. For neighborhood weekend markets that were able to remain open during the pandemic, the change in 2020 average sales between the winter and spring is between 75% and 79% lower than in 2019. Other farmers markets, particularly weekday markets in business districts, experienced delayed openings or were closed for the entire year.

Farm to School Activities and Student Outcomes: A Systematic Review

Farm to school programs (F2SPs) operate in 42% of school districts and are supported in part through federal and state policies as well as philanthropic funding. Although research evaluating the effects of farm to school-related activities on student outcomes is growing, a systematic review of the results and thus a synthesis of implications for future programming have not occurred. The primary objective of this systematic literature review is to summarize and evaluate studies on student outcomes associated with farm to school-related activities up to 1 September, 2017. Four databases spanning 4 research disciplines were used to identify full-text, English-language studies. Twenty-one studies were reviewed: 7 explicitly investigated F2SPs, and 14 evaluated the impact of school-based interventions that were relevant to activities reported in the 2013 and/or 2015 Farm to School Census. All of the F2SP studies (n = 7) and 85.7% of farm to school-related activity studies (n = 12) were multicomponent, and there was a wide variety of implemented intervention components across the reviewed studies. Results from F2SP and farm to school-related activity studies consistently show positive impacts on food and nutrition-related knowledge; most studies also suggest a positive relation between farm to school-related activities and healthy food selection during school meals, nutrition self-efficacy, and willingness to try fruits and vegetables. The impact of farm to school activities on fruit and vegetable consumption and preferences is unclear. The most common F2SP study limitations were study designs that preclude causal inference, outcome measurement with no reported or limited psychometric testing, lack of long-term outcome evaluation, and challenges related to quantifying intervention implementation. These findings underscore the need for more conclusive evidence on the relation between farm to school-related activities and changes in fruit and vegetable consumption.

Brazilian Artisanal Cheeses: An Overview of their Characteristics, Main Types and Regulatory Aspects

A large variety of cheeses exist in Brazil, reflecting historical and cultural aspects. Brazilian artisanal cheeses present differences in the processing, ripening time (when applied), type of milk used, texture, size, shape, color, moisture content, flavor, the use or not of starter cultures, among others. This review describes the main artisanal cheeses produced in Brazil, focusing on general and particular characteristics associated with their making process and geographical identity. Overall, the high variability of the physicochemical data and deficiency of information on sensorial properties of Brazilian artisanal cheeses were noticed. On the other hand, culture-dependent methods were mostly used to expand the knowledge into the microbiology of these cheeses, whereas their microbial diversity has been recently discovered through the use of 16S rRNA gene sequencing-based methods. The certification of a geographical indication for Brazilian artisanal cheeses may encompass an essential milestone for adding value to these products. Regardless of their significance in the diet, culture, and economy of producing regions, taken together, the reviewed literature discloses the need of insightful studies to generate scientific data to support the expansion of the market, while ensuring the protection of historic aspects related to the production of Brazilian artisanal cheeses.

Optimal formulations of local foods to achieve nutritional adequacy for 6-23-month-old rural Tanzanian children

Background: Achieving nutritional goals of infants and young children while maintaining the intake of local and culture-specific foods can be a daunting task. Diet optimisation using linear goal programming (LP) can effectively generate optimal formulations incorporating local and culturally acceptable foods.

Objective: The primary objective of this study was to determine whether a realistic and affordable diet that achieves dietary recommended intakes (DRIs) for 22 selected nutrients can be formulated for rural 6–23-month-old children in Tanzania.

Design: Dietary intakes of 400 children aged 6–23 months were assessed using a weighed dietary record (WDR), 24-hour dietary recalls and a 7-days food record. A market survey was also carried out to estimate the cost per 100 g of edible portion of foods that are commonly consumed in the study area. Dietary and market survey data were then used to define LP model parameters for diet optimisation. All LP analyses were done using linear program solver (LiPS) version 1.9.4 to generate optimal food formulations.

Results: Optimal formulations that achieved DRIs for 20 nutrients for children aged 6–11 months and all selected nutrients for children aged 12–23 months were successfully developed at a twofold cost of the observed food purchase across age groups. Optimal formulations contained a mixture of ingredients such as wholegrain cereals, Irish potatoes, pulses and seeds, fish and poultry meat as well as fruits and vegetables that can be sourced locally.

Conclusions: Our findings revealed that given the available food choices, it is possible to develop optimal formulations that can improve dietary adequacy for rural 6–23-month-old children if food budget for the child’s diets is doubled. These findings suggest the need for setting alternative interventions which can help households increase access to nutrient-dense foods that can fill the identified nutrient gaps.

Adults and Children in Low-Income Households that Participate in Cost-Offset Community Supported Agriculture Have High Fruit and Vegetable Consumption

This paper examines fruit and vegetable intake (FVI) in low-income households that participated in a cost-offset (CO), or 50% subsidized, community-supported agriculture (CSA) program. CSA customers paid farms upfront for a share of the harvest, and received produce weekly throughout the growing season. A cohort of adults and children 2–12 y in a summer CO-CSA were surveyed online twice: August 2015 (n = 41) and February 2016 (n = 23). FVI was measured by the National Cancer Institute’s (NCI) Fruit and Vegetable Screener (FVS) and an inventory of locally grown fruits and vegetables. FVI relative to United States (US) recommendations and averages, and across seasons, were tested with non-parametric tests and paired t-tests (p < 0.05). Both adults and children in the CO-CSA had higher FVI than the US averages, and more often met recommendations for vegetables. Some summer fruits and vegetables were more often eaten when locally in-season. The CO-CSA model warrants further examination as an avenue for improving vegetable consumption among adults and children in low-income households. However, causality between CO-CSA participation and FVI cannot be inferred, as CO-CSA participants may be positive deviants with respect to FVI. A multi-state randomized controlled trial is currently underway to evaluate impacts of CO-CSAs on FVI and related outcomes.

A Community-Based Positive Deviance/Hearth Infant and Young Child Nutrition Intervention in Ecuador Improved Diet and Reduced Underweight

OBJECTIVE

Underweight and stunting are serious problems in Ecuador that require interventions in the first 2 years of life. The researchers assessed the effectiveness of a Positive Deviance (PD)/Hearth community-based intervention using local foods to improve infant and young children's nutrition.

DESIGN

A quasi-experimental nonrandomized study was conducted between March and October, 2009.

SETTING

The intervention and study were implemented in the Ecuadorian highlands provinces of Chimborazo and Tungurahua.

PARTICIPANTS

Eighty mother-child pairs in 6 intervention communities and 184 mother-child pairs in 9 comparison communities.

INTERVENTION

Mothers met in participatory peer-led PD/Hearth cooking and nutrition education sessions for 12 days.

MAIN OUTCOME MEASURES

Dietary intake and nutritional status were collected at baseline and 6-month follow-up.

ANALYSIS

Multiple linear and logistic regression were used for growth outcomes, and ANCOVA for mean dietary intakes.

RESULTS

Mothers in the intervention were 1.3-5.7 times more likely to feed their children the promoted foods (P < .05). Children in the intervention consumed a higher percentage of recommended intakes for iron, zinc, vitamin A, protein, and energy (P < .05) at follow-up and had improvements in weight-for-age z-score (β = .17; 95% confidence interval, 0.01-0.31). Likelihood of underweight was reduced for children in the intervention (odds ratio = 0.36; 95% confidence interval, 0.13-0.96) CONCLUSIONS AND IMPLICATIONS: The PD/Hearth interventions support mothers to improve infant and young children's nutrition practices and reduce underweight.