The barriers and enablers of healthy eating among young adults: a missing piece of the obesity puzzle: A scoping review

Serious Games for Nutritional Education: Online Survey on Preferences, Motives, and Behaviors Among Young Adults at University

Background

Data on nutritional information and digital gameplay are limited among young adults in Germany.

Objective

This survey aimed to gather data on nutritional information sources and digital games for nutritional education (preferences, motives, and behaviors) among young adults at both Munich universities in Germany.

Methods

An online survey was developed by an multidisciplinary research group using EvaSys, an in-house survey software. The questionnaire (47 items) covered questions about baseline characteristics (eg, housing situation and weight), nutrition (eg, nutritional information sources), and digital (nutritional) gameplay (eg, preferences, motives, and behaviors). A feedback field was also provided. This publication is based on a selection of 20 questions (7 baseline characteristics, 2 nutrition, 11 gameplay). Young adults, primarily Munich university students aged from 18 to 24 years, were invited to participate by digital and nondigital communication channels between 2016 and 2017. Statistical analyses were performed using Excel 2013 (Microsoft Corp) and R version 3.1.3 (R Foundation for Statistical Computing).

Results

In total, 468 young adults (342/468, 73.1% women; 379/468, 81.0% university students) participated. Most of the participants (269/468, 57.5%) were aged 18 to 24 years with a BMI in the normal weight range (346/447, 77.4%). Mean body weight was 65.5 [SD 14.0] kg. Most participants reported getting nutritional information from the internet (372/467, 79.7%) and printed media (298/467, 63.8%), less than 1.0% (2/467, 0.4%) named digital games. Apps (100/461, 21.7%) and university/workplace (146/461, 31.7%) were the most desired sources for additional information about nutrition, while 10.0% (46/461, 10.0%) of participants stated wanting digital games. Almost two-thirds (293/468, 62.6%) of participants played digital games, while one-fifth (97/456, 21.3%) played digital games daily using smartphones or tablets. Finally, most respondents (343/468, 73.3%), mainly women, expressed interest in obtaining nutritional information during digital gameplay. However, significant gender differences were shown for nutritional acquisition behaviors and digital gameplay preferences, motives, and behaviors.

Conclusions

Our survey population reported playing digital games (especially men) and wanting nutritional information during digital gameplay (especially women). Furthermore, university or workplace are named as preferred settings for nutritional information. Therefore, a digital game app might have the potential to be a tool for nutritional education among young adults within the university or workplace environment.

Exploring barriers to meeting recommendations for fruit and vegetable intake among adults in regional areas: A mixed-methods analysis of variations across socio-demographics

Fruit and vegetable consumption is low compared to recommendations worldwide. Few studies have investigated intakes of fruit and vegetables and barriers to meeting recommendations in a mixed-method design. Moreover, there is a need to better understand differences in these barriers by population subgroups. This study aimed to examine fruit and vegetable intake and barriers to meeting recommendations and differences by sex, age and socio-economic groups. Data on adults from the cross-sectional Greater Bendigo Active Living Census 2014 were used. Participants self-reported intake of fruit and vegetables and completed an open-ended question on barriers to meeting recommended intakes. Logistic regression analyses were used to examine odds of meeting recommended intakes. Leximancer was used for thematic analyses of barriers. A total of 13,788 individuals (54% female, 52.1 (SD 17.7) years) were included in the quantitative analyses. Qualitative data were available for 5649 of these individuals. Only seven percent of participants met recommended intakes for fruit and vegetables. Barriers were lack of time, that guidelines were perceived as unachievable, the wide variety of other foods available and the high cost and limited availability of fresh fruit and vegetables. The most relevant barriers by subgroups were: taste (12%) and lack of appetite (18%) for males and females, respectively; lack of time (26-28%) and lack of appetite (70%) for young to middle aged adults and older adults, respectively and cost (35%) and availability of fresh fruits and vegetables (22%) for rural and disadvantaged groups. Findings have implications for the design of healthy eating strategies, which may benefit from being tailored to key population groups.

Investigating the Efficacy and Cost-Effectiveness of Technology-Delivered Personalized Feedback on Dietary Patterns in Young Australian Adults in the Advice, Ideas, and Motivation for My Eating (Aim4Me) Study: Protocol for a Randomized Controlled Trial

Background

Web-based health interventions may be easier to access and time efficient relative to face-to-face interventions and therefore may be the most appropriate mode to engage young adults.

Objective

This study aims to investigate the impact of 3 different levels of personalized web-based dietary feedback and support on changes in diet quality.

Methods

The Advice, Ideas, and Motivation for My Eating (Aim4Me) study is a 12-month assessor-blinded, parallel-group randomized controlled trial evaluating the impact of 3 levels of web-based feedback on diet quality, measured using the Australian Recommended Food Score (ARFS). Participants (N=2570) will primarily be recruited via web-based methods and randomized to 1 of 3 groups. Group 1 (control) will receive the Healthy Eating Quiz, a web-based dietary assessment tool that generates a brief feedback report on diet quality. Individuals randomized to this group can use the brief feedback report to make positive dietary changes. Group 2 will receive the Australian Eating Survey, a web-based dietary assessment tool that generates a comprehensive feedback report on diet quality as well as macro- and micronutrient intake. Group 2 will use the comprehensive feedback report to assist in making positive dietary changes. They will also have access to the Aim4Me website with resources on healthy eating and tools to set goals and self-monitor progress. Group 3 will receive the same intervention as Group 2 (ie, the comprehensive feedback report) in addition to a tailored 30-min video consultation with an accredited practicing dietitian who will use the comprehensive feedback report to assist individuals in making positive dietary changes. The self-determination theory was used as the framework for selecting appropriate website features, including goal setting and self-monitoring. The primary outcome measure is change in diet quality. The completion of questionnaires at baseline and 3, 6, and 12 months will be incentivized with a monetary prize draw.

Results

As of December 2019, 1277 participants have been randomized.

Conclusions

The web-based delivery of nutrition interventions has the potential to improve dietary intake of young adults. However, the level of support required to improve intake is unknown.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12618000325202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374420

International Registered Report Identifier (IRRID)

DERR1-10.2196/15999

Influences of club connectedness among young adults in Western Australian community-based sports clubs

BACKGROUND

Along with physical benefits, community-based sport provides opportunities to enhance connectedness, an important protective factor of social and emotional health. However, young Australians participating in sport have been found to drink alcohol at higher levels than their non-sporting peers, and many clubs serve unhealthy food and beverages. This study explored the association between the dependent variable, level of alcohol consumption (AUDIT-C) and connectedness to club and other health behaviours among young people aged 18-30 years who play club sport in Western Australia.

METHODS

An online cross sectional survey measured levels of alcohol consumption (AUDIT-C), alcohol-related harm, connectedness (including volunteering and team cohesion), mental wellbeing, healthy food options and club sponsorship among young adults aged 18-30 years involved in sports clubs in Western Australia (n = 242). Relationships and association between the dependent variable (AUDIT-C) and independent variables were assessed.

RESULTS

Male sportspeople were more likely to drink alcohol at high-risk levels than females (p < .001), and respondents belonging to a club that received alcohol-related sponsorship were more likely to drink at high-risk levels (p = .019). Females were significantly more likely to want healthy food and beverage options provided at their clubs (p = 0.011). When all factors were considered team cohesion (p = 0.02), alcohol expectations (p = < .001), occurrences of experienced alcohol-related harm (p = <.001) and length of club membership (p = 0.18) were significant predictors of high-risk AUDIT-C (R2 = .34, adjusted R2 = .33, F (4, 156) = 20.43, p = <.001). High-risk AUDIT-C and club connectedness predicted strong team cohesion (R2 = .39, adjusted R2 = .39, F (2, 166) = 53.74, p = <.001).

CONCLUSIONS

Findings from this study may inform policy and practice to enhance healthy behaviours among young adults participating in community sports clubs in Australia and other countries.

Sociodemographic factors associated with food insecurity: data from the 2003-2014 New South Wales Population Health Survey

OBJECTIVE

To determine the prevalence and sociodemographic factors associated with food insecurity in the state of New South Wales (NSW), Australia.

DESIGN

Cross-sectional analysis of food insecurity data collected by the NSW Population Health Survey between 2003 and 2014. Multiple logistic regression was used to examine associations with key sociodemographic variables.

SETTING

NSW, Australia.

PARTICIPANTS

212 608 survey participants responded to the food insecurity survey question between 2003 and 2014. 150 767 of them were aged ≥16 years. The survey sample was randomly selected and weighted to be representative of the NSW population.

RESULTS

On average 6 % of adults aged ≥16 years experienced food insecurity in NSW. The odds of food insecurity appeared to increase from one survey year to the next by a factor of 1·05. Food insecurity was found to be independently associated with age, sex, marital status, household size, education, employment status, household income, smoking status, alcohol intake and self-rated health. The association with income, smoking status and self-rated health appeared to be the strongest among all covariates and showed a gradient effect. Food insecurity appeared to increase significantly between the age of 16 and 19 years.

CONCLUSIONS

The prevalence of food insecurity appears to be rising over time. Given the negative health consequences of food insecurity, more rigorous measurement and monitoring of food insecurity in NSW and nationally is strongly recommended. The findings provide support for interventions targeting low-income and younger population groups.

Usability of Food Size Aids in Mobile Dietary Reporting Apps for Young Adults: Randomized Controlled Trial

Background

Young adults are more likely to use self-managed dietary reporting apps. However, there is scant research examining the user experience of different measurement approaches for mobile dietary reporting apps when dealing with a wide variety of food shapes and container sizes.

Objective

Field user experience testing was conducted under actual meal conditions to assess the accuracy, efficiency, and subjective reaction of three food portion measurement methods embedded in a developed mobile app. Key-in–based aid (KBA), commonly used in many current apps, relies on the user’s ability to key in volumes or weights. Photo-based aid (PBA) extends traditional assessment methods, allowing users to scroll, observe, and select a reduced-size image from a set of options. Gesture-based aid (GBA) is a new experimental approach in which the user makes finger movements on the screen to roughly describe food portion boundaries accompanied by a background reference.

Methods

A group of 124 young adults aged 19 to 26 years was recruited for a head-to-head randomized comparison and divided into 3 groups: a KBA (n=42) control group and PBA (n=41) and GBA (n=41) experimental groups. In total, 3 meals (ie, breakfast, lunch, and dinner) were served in a university cafeteria. Participants were provided with 25 dishes and beverages for selection, with a variety of food shapes and containers that reflect everyday life conditions. The accuracy of and time spent on realistic interaction during food portion estimation and the subjective reaction of each aid were recorded and analyzed.

Results

Participants in the KBA group provided the highest accuracy in terms of hash brown weight (P=.004) and outperformed PBA or GBA for many soft drinks in cups. PBA had the best results for a cylindrical hot dog (P<.001), irregularly shaped pork chop (P<.001), and green tea beverage (660 mL; P<.001). GBA outperformed PBA for most drinks, and GBA outperformed KBA for some vegetables. The GBA group spent significantly more time assessing food items than the KBA and PBA groups. For each aid, the overall subjective reaction based on the score of the System Usability Scale was not significantly different.

Conclusions

Experimental results show that each aid had some distinguishing advantages. In terms of user acceptance, participants considered all 3 aids to be usable. Furthermore, users’ subjective opinions regarding measurement accuracy contradicted the empirical findings. Future work will consider the use of each aid based on food or container shape and integrate the various advantages of the 3 different aids for better results. Our findings on the use of portion size aids are based on realistic and diverse food items, providing a useful reference for future app improvement of an effective, evidence-based, and acceptable feature.

Trial Registration

International Standard Randomized Controlled Trial Registry ISRCTN36710750; http://www.controlled-trials.com/ISRCTN36710750.

A social marketing perspective of young adults' concepts of eating for health: is it a question of morality?

BACKGROUND

Poor dietary choices are a risk factor for non-communicable diseases. Young adults have low levels of engagement towards their health and may not see the importance in the adoption of healthy eating behaviours at this stage in their lives. Here we utilise social marketing principles, digital ethnography and online conversations to gain insights into young adults' attitudes and sentiments towards healthy eating.

METHODS

Young Australian adults who use social media at least twice a day were recruited by a commercial field house. Using a mixture of methods, combining online polls, forums and conversations, participants (n = 195, 18-24 years old) engaged in facilitated discussions over an extended 4 week period about health and eating-related topics. Data were analysed using thematic analysis constant comparison approach. A post-hoc conceptual framework related to religion was theorised and used as a metaphor to describe the results.

RESULTS

Findings demonstrate that different segments of young adults with varying attitudes and interest towards healthy eating exist. We developed a conceptual framework based on consumer segmentation which adopted religious metaphors as a typology of 'consumers'. Some young adults practice and believe in the message of healthy eating (saints), whilst some oppose these messages and are not motivated to make any change (sinners), another segment are both aware of and interested in the issues but do not put healthy eating behaviours as a current priority (person in the pew).

CONCLUSIONS

Consumer segmentation and social marketing techniques assist health professionals to understand their target audience and tailor specific messages to different segments. Segmentation provides insights on which groups may be most easily influenced to adopt the desired behaviours. The typology presented may be a useful tool for health professionals and social marketers to design strategies to engage young adults in healthy eating, particularly those in the pew who are contemplating a change but lacking the motivation. The utilisation of marketing segmentation in health promotion has the potential to enhance health messaging by tailoring messages to specific segments based on their needs, beliefs and intentions and therefore drive the efficient use of resources towards those most likely to change.

Language of Health of Young Australian Adults: A Qualitative Exploration of Perceptions of Health, Wellbeing and Health Promotion via Online Conversations

Young adults (YA) are in a critical stage of life for the encouragement of healthy behaviours such as healthy eating and exercising. This research explored Australian YA values and perceptions related to health, healthy behaviours and health promotion efforts. This qualitative analysis involved n = 166, Australian 18–24 year-olds recruited through a market research field house. Participants (63% currently studying at tertiary level) engaged in a facilitated in-depth online conversation around health and healthy eating over four weeks. Leximancer^TM and manual inductive thematic coding were utilised for analysis via the lens of emerging adulthood and health communication theories. Health was seen as multi-faceted, with particular importance placed on mental health and exercise. Some participants focussed on physical appearance, often fuelled by comparison to others. Many believed that at their age and health status, adopting health-enhancing behaviours without short-term tangible benefits was not a priority. Participants did not prioritise health-enhancing behaviours due to barriers such as a perceived lack of money, knowledge and time often due to studying or working and perceived effort. Strategies they proposed to encourage healthy eating included: incentivising healthy food; quick and affordable healthy recipes; and communicating the short-term tangible benefits of healthy behaviours. There is a need for focussed health messaging that address the needs and desires of YA and directly address the barriers they face.

Environmental, Socioeconomic, Maternal, and Breastfeeding Factors Associated with Childhood Overweight and Obesity in Ceará, Brazil: A Population-Based Study

Childhood obesity is now an epidemic in many countries worldwide and is known to be a multifactorial condition. We aimed to examine the relationship of environmental, socioeconomic, and nutritional factors with childhood overweight and obesity. We conducted a population-based cross-sectional study of children from 2 to 6 years of age in Ceará, Brazil. Children’s nutritional status was assessed by body mass index (BMI) Z scores categorized as overweight and obesity. Ordinal logistic regression models were used to assess the relationship between the factors with overweight and obesity. A total of 2059 children participated, of which 50.4% were male. The mean age was 46 ± 17 months, with a prevalence of overweight and obesity of 12.0% (95% CI 10.7–13.6) and 8.0% (6.7–9.5), respectively. In multivariate analysis, the probability of childhood obesity increased as family income increased (adjusted hazard ratio (aHR) 0.6 (95% CI 0.37–0.95), p-value = 0.03). Moreover, families with fewer children had more than 30% fewer overweight children (aHR 0.68; 95% CI 0.48–0.96). Environmental, socioeconomic, and child nutritional factors were associated with overweight and obesity. The results provided could be used to design integrated interventions spanning from conception, or earlier, through the first years of life and may improve child nutritional outcomes.

A free-produce stand on campus: impact on fruit and vegetable intake in Dutch university students

OBJECTIVE

To investigate the effects of providing free fruit and snack vegetables at a university on students' fruit intake, snack vegetable intake and total vegetable intake.

DESIGN

Free fruit and raw snack vegetables (e.g. bite-sized tomatoes) were provided in a stand in the form of a miniature wooden house located in the central hall of the university's main building, which students regularly pass through on their way to lectures and the cafeteria. Three interventions tested with a pre-test/post-test design were performed. In these three interventions, small changes to the appearance of the stand were made, such as placing potted plants around it. Demographic characteristics and fruit and vegetable intakes were assessed with questionnaires.

SETTING

A Dutch university of applied science.

PARTICIPANTS

Intervention 1 included 124 students; Intervention 2 included ninety-two students; Intervention 3 included 237 students.

RESULTS

Longitudinal linear regression analyses showed that post-test snack vegetable intake was consistently higher compared with pre-test. In the three interventions, post-test snack vegetable intakes were between 11 and 14 g/d higher than at the pre-test, which is comparable to three bite-sized tomatoes. No differences in fruit intake or total vegetable intake were found. Subgroup analyses showed that, in all three interventions, students with the lowest pre-test fruit intake and total vegetable intake reported the largest increase in fruit intake and snack vegetable intake after the interventions.

CONCLUSIONS

Providing free fruit and vegetables to students at their university might be beneficial for those with low habitual intakes.

Social-ecological influences on unhealthy dietary behaviours among Moroccan adolescents: a mixed-methods study

OBJECTIVE

To identify the prevalence of unhealthy dietary behaviours and their social-ecological influences in adolescents.

DESIGN

The study used a sequential explanatory mixed-methods design, which begins with the collection of quantitative data, followed by the collection of qualitative data to explain and enrich the quantitative findings. Quantitative data were collected via a global school-based student health survey and were analysed using quantitative approaches. Qualitative data were obtained via focus group discussions and were analysed thematically.

SETTING

Middle and high secondary schools in Taza city, Morocco.

PARTICIPANTS

Our quantitative analyses included 764 students (14-19 years). For the qualitative part, seventeen focus group discussions were conducted with 100 participants (fifty-six adolescents, twenty-six parents and eighteen teachers).

RESULTS

Of total student participants, 46·1 % skipped breakfast, 60·6 % had inadequate intake of fruits and vegetables (F&V), 39·4 % consumed soft drinks and 28·0 % consumed fast foods. All of these dietary behaviours could coexist in the same person except for inadequate intake of F&V. Gender, academic performance, age, perceived family income and education level of mother were associated with unhealthy dietary behaviours. Qualitative findings identified seven themes regarding social-ecological influences on adolescents' dietary behaviours: cognitive, affective/biological, lifestyle, outcome expectation, social network, accessibility/availability and macro-level influences.

CONCLUSIONS

The prevalence of unhealthy dietary behaviours in our study group is a concern. Dietary behaviours are the result of inseparable interactions among social-ecological influences. Modifiable factors identified may be useful when designing a future intervention aimed at improving breakfast and F&V consumption and reducing fast/snack-food consumption among adolescents.

Formative work to design a digital learning self-assessment and feedback tool to prevent weight gain among college students

OBJECTIVE

While colleges have implemented brief, tailored interventions for health-risk areas such as alcohol prevention, theoretically-guided digital learning offerings for weight gain prevention have lagged behind in programming and implementation. Thus, the objective was to design and usability test a weight gain prevention digital learning platform for college students with modules targeting key nutrition and physical activity behaviors.

METHODS

Development occurred in iterative phases: formative research, descriptive normative data collection, prototype development, and usability testing. Formative research consisted of background work and survey administration to incoming and current freshmen. Prototype development was guided by theories of behavior change and cognitive processing, and consisted of brief assessment and feedback using written text, graphs, and videos. Iterative usability testing was conducted.

RESULTS

Current freshmen reported eating more quick order meals per week than incoming freshman, but fewer high-fat snacks and fewer sugary beverages. Current freshmen reported more sedentary time than incoming freshmen. Based on iterative testing results, eight behavioral targets were established: breakfast, high-fat snacks, fried foods, sugary beverages, fruit/vegetables, physical activity, pizza intake, and sedentary behavior. Initial usability testers indicated the modules were easy to understand, held their attention, and were somewhat novel. Analysis of qualitative feedback revealed themes related to content, layout, structure and suggested refinements to the modules.

CONCLUSIONS

A gap exists for evidence-based obesity prevention programs targeted to adolescents as they transition into adulthood. Brief, tailored digital learning interventions show promise towards addressing key behavioral nutrition and physical activity targets among students during the transition to college.

Lifestyle and Psychological Factors Associated with Pregnancy Intentions: Findings from a Longitudinal Cohort Study of Australian Women

BACKGROUND

Preconception is a critical time for the establishment of healthy lifestyle behaviours and psychological well-being to reduce adverse maternal and offspring outcomes. This study aimed to explore relationships between preconception lifestyle and psychological factors and prospectively assessed short- (currently trying to conceive) and long-term (future parenthood aspirations) pregnancy intentions.

METHODS

Data from Wave 3 (age 25-30 years; n = 7656) and Wave 5 (age 31-36 years; n = 4735) from the Australian Longitudinal Study of Women's Health were used. Pregnancy intentions and parenthood aspirations were evaluated. Logistic regressions explored cross-sectional associations between demographic, lifestyle and psychological factors and pregnancy intentions/parenthood aspirations.

RESULTS

In multivariable models, parity and marital status were associated consistently with pregnancy intentions and parenthood aspirations. Few lifestyle behaviours and no psychological factors were associated with pregnancy intentions. Alcohol intake was the only behaviour associated with aspirations to have a first child. Aspirations for a second/subsequent child were associated negatively with physical activity, sitting time, diet quality, lower anxiety and higher stress.

CONCLUSIONS

It appears that women are not changing their behaviours when they form a decision to try to conceive. Interventions are needed that address women's preconception needs, to optimise lifestyle and improve health outcomes for women and their families.

Identification of food insecurity factors in French-speaking Belgium: a qualitative study

BACKGROUND

Diet is an essential determinant of health. Among the health determinants, we find access problems that are summarized as food insecurity. While such food insecurity has been studied in other countries and correlated to several health problems, it has been scarcely assessed in Belgium. The purpose of this work was to determine the factors of food insecurity existing within the Belgian population.

METHOD

From November 2016 to February 2017, a qualitative study using semi-structured interviews with 19 adults present attending the waiting rooms of six Public Social Action Centers in French-speaking Belgium, analyzed by grounded theory.

RESULTS

In Belgium, for given food preferences and needs, food insecurity could be summarized as inadequacy between necessary and available resources within two dimensions: at the access level, for financial, temporal, informational, and freedom of action, and at the food use level, for temporal factors, material, knowledge, and skills. In these situations of inadequacy, participants reported finding either strategies to restore balance, or being forced to alter the quality or quantity of their diet.

CONCLUSION

While several factors of food insecurity may exist in Belgium, it appears essential that the first line of care these factors into consideration, since they could interfere with care and health, and because the first line of care is ideally placed to inform and refer the patients in question. Several courses of action are proposed in this work, which must still be confirmed by other studies.

Segmenting Young Adult University Student's Eating Behaviour: A Theory-Informed Approach

The purpose of this paper is to extend behavioural theory and segmentation application. Specifically, this paper draws on three segmentation bases and behavioural theory that extends focus beyond individual psychological predispositions to form segments within the healthy eating context for young adult university students (20–35 years) in Queensland, Australia. Participants were invited to take part in an online survey via email and through face to face intercept to ensure a diverse cross section was obtained. Structural equation modelling revealed that the Motivation, Opportunity, and Ability (MOA) framework can be utilised to explain healthful eating behaviour and two-step cluster analysis uncovered two distinct segments with education, motivation to eat healthily and Turconi’s eating behaviour scores being the most important variables within the wider multivariate segment formation. This paper contributes to literature in the following ways. First, it confirms the importance of behavioural bases in segment formation and supports inclusion of other bases, namely demographics and psychographics. Next, it provides evidence of the value of including behavioural theory, which extends focus beyond what individuals think to understand how the environment may support them. Finally, this paper demonstrates that the MOA framework together with eating behaviour and demographic factors (education) can produce theoretically informed segments.

Associations of Leisure-Time Physical Activity Trajectories with Fruit and Vegetable Consumption from Childhood to Adulthood: The Cardiovascular Risk in Young Finns Study

A physically active lifestyle and a diet rich in vegetables and fruits have a central role in promoting health. This study examined the associations between leisure-time physical activity (LTPA) trajectories and fruit and vegetable consumption (FVC) from childhood to middle age. The data were drawn from the Cardiovascular Risk in Young Finns Study with six age cohorts. Participants were 9 to 18 years (n = 3536; 51% females) at baseline in 1980 and 33 to 48 years at the last follow-up in 2011. LTPA and FVC were self-reported. LTPA trajectories were identified using latent profile analyses, after which the mean differences in FVC across the trajectories were studied. Active, low-active, decreasingly and increasingly active trajectories were identified for both genders. An additional trajectory describing inactivity was identified for females. Those who were persistently active or increased their LTPA had higher FVC at many ages when compared to their inactive or low-active counterparts (p < 0.05). In females prior to age 42 and in males prior to age 24, FVC was higher at many ages in those with decreasing activity than in their inactive or low-active counterparts (p < 0.05). The development of LTPA and FVC from childhood to middle age seem to occur in tandem.

Determinants of eating behaviours in Australian university students: A cross-sectional analysis

AIM

This study aimed to explore clustering among individual eating behaviours in a sample of Australian university students, and explore associations between clustered eating behaviours and demographic characteristics.

METHODS

A cross-sectional analysis of data from the University of Newcastle (UON) Student Healthy Lifestyle Survey 2017 was conducted. Measures included eating behaviours (eg, vegetables, energy-dense nutrient poor [EDNP] food intakes) assessed using short diet questions, and demographic characteristics (eg, age, undergraduate/postgraduate student). Factor analysis was used to explore clustering of individual eating behaviours (ie, identify factors). Linear regression models were used to explore associations between eating behaviour factors identified and demographic characteristics.

RESULTS

A total of 3062 students (70% female; 56% aged 17-24 years) were included in the analysis. The six eating behaviour factors identified (characterised by higher consumption of the named foods/drinks) were; EDNP snack foods, meat and takeaway foods, fruit and vegetables, sugary drinks, breakfast, and breads and cereals. A higher fruit and vegetable factor score was associated with being female (P < .001), and a higher meat and takeaway foods factor score was associated with being male (P < .001) and of younger age (P < .001).

CONCLUSIONS

Nutrient-rich foods clustered together and EDNP foods clustered together, that is, the identified factors represent either nutrient-rich or EDNP foods. Interventions in the university setting should target students with the poorest eating behaviours, including males and younger students.

Meat, Masculinity, and Health for the "Typical Aussie Bloke": A Social Constructivist Analysis of Class, Gender, and Consumption

Food choice is complex and influenced by a range of social, environmental, structural, and individual factors. Poor diet is one of the major contributors to the burden of disease, in particular for men who habitually have lower intakes of fruits and vegetables and higher intakes of meat. Food choice has been linked to the expression of masculine identities. This research used a Bourdieusian framework to explore the influential drivers of young Australian men's eating habits based on occupational groupings. Twenty men aged 19-30 years participated in in-depth semistructured interviews. Analysis used a grounded theory, social constructivist approach and identified five themes: performative masculinities and meat; meat cuts across social class; the influence of masculine autonomy on dietary choice; women protecting Australian men's health; and the role of environmental and structural barriers. These results indicated that habitus remains a useful conceptual framework to explain the results, and cultural capital is reinforced as a phenomenon. Occupation and gender appear to no longer be primary drivers of food choice in this group of men. Rather there is a shift toward an understanding of multiple masculinities and the development of microcultures with interactions between structure and agency. Meat still features in the food world of Australian men, but there are shifts to deprioritize its importance. There needs to be a more nuanced understanding of the importance of autonomy and control as well as the role of women in relation to men's dietary intakes and how this can be harnessed for positive dietary change.

Are Psychological Distress and Resilience Associated with Dietary Intake Among Australian University Students?

University students report unhealthy diets and experience poorer mental health than the general population. This study explores the association between psychological distress and resilience with dietary intake in a sample of Australian university students. Cross-sectional data from the University of Newcastle Student Healthy Lifestyle Survey 2017 were analysed. Psychological distress (Kessler Scale), resilience (Brief Resilience Scale) and fruit, vegetable, soft drink, takeaway food and breakfast intakes (short diet questions) were assessed. Socio-demographic (e.g., gender), student (e.g., undergraduate/postgraduate) and health characteristics (e.g., physical activity) were captured. Multivariate linear regression models explored associations between psychological distress and resilience with dietary intake, with adjustment for potential confounders. Analysis included 2710 students (mean age 26.9 ± 9.5 years, 30.4% male). In adjusted models, lower psychological distress was associated with higher fruit (β = -0.37, p = 0.001) and vegetable (β = -0.37, p < 0.001) serves/day, more frequent breakfast consumption (p < 0.001) and less frequent soft drink and takeaway food consumption (p < 0.001). Higher resilience was associated with higher fruit (β = 0.03, p = 0.022) and vegetable (β = 0.06, p < 0.001) serves/day, more frequent breakfast consumption (p = 0.005), and less frequent soft drink (p < 0.001) and takeaway food consumption (p = 0.001). These results highlight a potential link between psychological distress and resilience with diet, and that further research in this area is warranted.

Levels of Physical Activity, Obesity and Related Factors in Young Adults Aged 18-30 during 2009-2017

The objective of this study was to analyze the temporal trend of physical activity and body mass index in young adults aged 18–30 in Spain and to ascertain their relationship with sociodemographic and psychosocial variables in the period of 2009–2017. Methods: A descriptive study with a sample of 10,061 young adults aged 18–30 years was performed. The data were obtained from the European Health Survey in Spain in 2009 and 2014 and the National Health Survey in 2011/2012 and 2017. The chi-square test was used for qualitative variables, and multiple linear regression analysis was performed for physical activity. Results: Sedentary levels had decreased in 2017 as compared to 2011/2012 (p < 0.001); smokers were more sedentary than non-smokers (p < 0.001); men were more active than women (p < 0.001); and the year with the highest physical activity was 2014. Body mass index in the total sample increased from 2009 to 2017 (p < 0.01), showing a significant increase in obesity in women (p < 0.05) and no difference in men (p ≥ 0.05). Conclusions: In the period 2011/2012–2017, the sedentary lifestyle of young adults was reduced and physical activity was increased, with men being more active than women.

'Oh God, I Have to Eat Something, But Where Can I Get Something Quickly?'-A Qualitative Interview Study on Barriers to Healthy Eating among University Students in Germany

Healthy eating can prevent individuals across all age groups from developing overweight/obesity and non-communicable diseases such as type 2 diabetes and cardiovascular disease. However, unhealthy eating habits (e.g., a high level of fast food consumption) have been found to be widespread among university students. Thus, it seems necessary to develop prevention strategies to improve students' eating habits. However, to ensure that such strategies are successful, it is important that they fit the needs of the target population. By conducting qualitative interviews with students (n = 20), we aimed to get a deeper understanding of barriers to healthy eating. Students were asked about barriers to healthy eating and to suggest possible ideas that could improve their eating behavior in the future. Our findings revealed that students are especially affected by time-related barriers (e.g., a lack of time due to university commitment) and environmental barriers (e.g., a lack of cheap, tasty, and healthy meal options at the university canteen). Time-related barriers were also related to motivational barriers (e.g., being too lazy to cook after a busy day at university). In addition, knowledge/information-related barriers, social-support-related barriers, and transition-related barriers emerged from our interviews. The variety of barriers addressed and the different views on some of these, indicate that various strategies seem to be needed to improve the eating behavior among university students and to prevent them from gaining weight and developing non-communicable diseases in the future.

An Umbrella Review of Systematic Reviews on Food Choice and Nutrition Published between 2017 and-2019

The objective of this umbrella review was to provide an update on the latest knowledge in the field of food choice and nutrition. Databases Scopus and ISI-Web of Science were searched for "food choice" AND nutrition. Papers were included if they were systematic reviews published between January 2017 and August 2019 on any subpopulation group. In total, 26 systematic reviews were kept. Data were extracted with a predetermined grid including first author, publication year, country, population group, explanatory constructs (intervention focus) and reported outcomes. Common indicators for outcome measures on food choice and nutrition studies are nutrition knowledge, healthy food choices, food purchases and food and nutrient intake. The most common strategy implemented to alter food choice with a nutritional aim is nutrition education, followed by provision of information through labels. Among children, parent modelling is key to achieving healthy food choices. In general, combining strategies seems to be the most effective way to achieve healthier food consumption and to maintain good nutrition in all age groups.

Socio-Ecological Influences on Adolescent (Aged 10-17) Alcohol Use and Unhealthy Eating Behaviours: A Systematic Review and Synthesis of Qualitative Studies

Excess body weight and risky alcohol consumption are two of the greatest contributors to global disease. Alcohol use contributes directly and indirectly to weight gain. Health behaviours cluster in adolescence and track to adulthood. This review identified and synthesised qualitative research to provide insight into common underlying factors influencing alcohol use and unhealthy eating behaviours amongst young people aged 10–17. Sixty two studies met inclusion criteria. Twenty eight studies focused on alcohol; 34 focused on eating behaviours. Informed by principles of thematic analysis and meta-ethnography, analysis yielded five themes: (1) use of alcohol and unhealthy food to overcome personal problems; (2) unhealthy eating and alcohol use as fun experiences; (3) food, but not alcohol, choices are based on taste; (4) control and restraint; and (5) demonstrating identity through alcohol and food choices. Young people faced pressure, reinforced by industry, to eat and drink in very specific ways, with clear social consequences if their attitudes or behaviour were deemed unacceptable. No qualitative studies were identified with an explicit and concurrent focus on adolescent eating behaviours and alcohol consumption. Further exploratory work is needed to examine the links between food and alcohol in young people’s emotional, social and cultural lives.

"That is an Awful Lot of Fruit and Veg to Be Eating". Focus Group Study on Motivations for the Consumption of 5 a Day in British Young Men

Young men do not consume enough fruit and vegetables, increasing their risk for future ill health. To understand what motivates their food choice, a novel conceptual framework that included key concepts from the theory of planned behavior and risk theory was developed. Thirty-four British men (18-24 years) took part in focus groups, where innovative visual qualitative methods provided insight into participants' motivations for fruit and vegetable consumption. Based on information from food diaries, participants were described as high (4+ portions) or low (up to 3 portions) consumers. Interviews were coded thematically into concepts and characteristics of the conceptual framework. Young men were generally unaware of the UK government's recommendation to consume 5 portions of fruit and vegetable a day and chronic health risks associated with low consumption. High consumers were motivated by perceived risk, perceived behavioral control, and health-conscious self-identity. They held internalized, holistic beliefs about diet and health, whereas low consumers' beliefs were externalized, based on physical appearances. Low consumers were driven by social influences to consume cheap, easily available convenience foods. The conceptual framework differentiated levels of fruit and vegetable consumption between the two groups and provided new information about young men's motivations for fruit and vegetable consumption.

Assessment of an e-training tool for college students to improve accuracy and reduce effort associated with reading nutrition labels

Objective: Nutrition labels are often underutilized due to the time and effort required to read them. We investigated the impact of label-reading training on effort, as well as accuracy and motivation. Participants: Eighty college students (21 men and 59 women). Methods: The training consisted of a background tutorial on nutrition followed by three blocks of practice reading labels to decide which of two foods was the relatively better choice. Label-reading effort was assessed using an eye tracker and motivation was assessed using a 6-item scale of healthy food-choice empowerment. Results: Students showed increases in label-reading accuracy, decreases in label-reading effort, and increases in empowerment. Conclusions: The nutrition label e-training tool presented here, whether used alone or as part of other wellness and health programs, may be an effective way to boost students' label-reading skills and healthy food choices, before they settle into grocery shopping habits.

Monetary Cost of the MyPlate Diet in Young Adults: Higher Expenses Associated with Increased Fruit and Vegetable Consumption

Background

Cost is a commonly reported barrier to healthy eating. This is a secondary research analysis designed to examine the food expenditures of young adults on a university campus following the United States Department of Agriculture (USDA) MyPlate guidelines for fruits and vegetables.

Methods

Meal receipts and dietary intake were recorded weekly. Anthropometrics and clinical assessments were recorded before intervention. Researchers rated compliance based on the participant's dietary food log, receipt matching, food pictures, and reports during weekly 1-hour consultations.

Results

Fifty-three young adults (18–30 years old) at-risk of, or diagnosed with, metabolic syndrome (MetS) were enrolled in the study, with 10 excluded (n = 43) from analyses due to enrollment in a fixed cost university campus dining meal plan. A two sample t-test assessed differences in food costs and regression analysis determined associations between food cost and diet compliance while controlling for confounding factors of age, sex, and body mass index (BMI). Diet compliant subjects (n = 38) had higher weekly food cost at $95.73 compared to noncompliant subjects (n = 5) who spent $66.24 (p=0.01). A regression analysis controlling for age, sex, BMI, and geographical region also indicated cost differences based on diet compliance (p < 0.0001).

Conclusion

Results indicate an ∼$29.00 per week increase in food cost when eating the recommended amount of fruit and vegetables. These findings can contribute to research incentive design, program planning cost, and determining effective interventions to improve diet in this population.

Non-Hispanic Black Adolescents' Self-Reported Health Behaviors Associated With Childhood Obesity in an Urban Clinic

Background: The prevalence of children with overweight or obese weight status in the United States is ~30%. Limited data exist on urban adolescents’ self-reported health behaviors and their perceptions to healthy living. Objectives: To examine adolescents’ self-reported health behaviors and perceived barriers and their associations with weight status. Methods: In 2014, patients (ages 9+ years) were enrolled and completed health behavior surveys. Measurements were categorized into body mass index (BMI)-for-age percentiles. Adolescents without obesity (including underweight, healthy weight, and overweight) were compared against adolescents with obesity. Results: A total of 132 adolescents were enrolled. The only factor that was statistically significant between the 2 weight groups was frequent exercise, which decreased odds of obesity by 0.34 (95% CI 0.13-0.93). Surprisingly, the odds of being obese increased significantly by 11.1 (95% CI 4.2-33.3) in those reporting trying to lose weight. Conclusions: To combat obesity, we reiterate the need for frequent exercise. Health care professionals should consider highlighting increased frequency of exercise and explore why adolescents with obesity were more inclined to report weight loss methods.

Feasibility and Preliminary Efficacy of the Eating Advice to Students (EATS) Brief Web-Based Nutrition Intervention for Young Adult University Students: A Pilot Randomized Controlled Trial

Young adult university students are a priority population for nutrition intervention. This study assessed the feasibility and preliminary efficacy of the EATS (Eating Advice to Students) brief (i.e., single use) web-based nutrition intervention for young adult university students. A 3-month pilot randomized controlled trial (RCT) was conducted with 124 students aged 17–35 from the University of Newcastle, Australia. Participants were randomized to EATS (n = 62) or attention control (n = 62). EATS aimed to improve four target eating behaviors (vegetables, fruit, discretionary foods, breakfast). Primary outcomes were feasibility (recruitment, retention, usage, program acceptability). Recruitment and retention numbers were recorded, the program acceptability was assessed by a process evaluation survey and the website usage was objectively tracked. Preliminary efficacy was assessed via changes in diet quality (primary), fruit, vegetables, discretionary foods and breakfast intake, measured using Food Frequency Questionnaire. Recruitment was completed in five weeks. Retention was 73% (90/124) at 3-months. Intervention participants used EATS 1.5 ± 1.0 times. Satisfaction with EATS was rated at 4.04 ± 0.74 (maximum five). Intervention participants significantly decreased the percentage energy/day from discretionary foods compared with control (−4.8%, 95%CI −8.6, −1.1, p = 0.012, d = −0.34). No significant between-group differences were observed for diet quality, fruit, vegetable or breakfast intakes. EATS demonstrated high feasibility, particularly for reach and acceptability. The university setting and a brief web-based intervention show promise in engaging young adults to improve their eating behaviors.

Challenges following a personalised diet adhering to dietary guidelines in a sample of Australian university students

BACKGROUND

Food-based dietary guidelines are designed to support populations to adopt a healthy diet. University students studying nutrition related courses are typically en-route to professional roles that involve advocating a healthy diet.

AIM

The present study compared the dietary intake of university students enrolled in a foundation nutrition course against the Australian Dietary Guidelines (ADGs) and Nutrient Reference Values (NRVs), and explored students' experiences of following a 3-day self-determined diet plan adhering to the ADGs/NRVs.

METHODS

Students (n = 115) initially collected, and subsequently analysed a 3-day prospective diet record to determine food group/nutrient intake. Individuals then modified their diet to comply with recommendations (ADGs/NRVs) and attempted to implement the diet plan. Challenges associated with meeting the ADGs/NRVs were described in an online survey form.

RESULTS

Baseline food group and nutrient intakes deviated from the guidelines, with 'lean meats & alternatives' the only group consumed in recommended quantities. Students demonstrated the capacity to plan a modified personal diet adhering to the ADGs food group recommendations. However, when following this, several key challenges to dietary adherence were identified. Challenges were categorised as personal/behavioural factors (e.g. the quantity/type of food) and societal factors (e.g. time, cost, social factors).

CONCLUSION

Overall, this study highlights challenges influencing adherence to dietary guidelines in a sample of undergraduate university students. Understanding these factors may help tailor advice to facilitate improved dietary patterns in this population group.

A Brief Web-Based Nutrition Intervention for Young Adult University Students: Development and Evaluation Protocol Using the PRECEDE-PROCEED Model

Background

Young adults are a priority population for nutrition interventions because of the high prevalence of unhealthy eating behaviors, high risk of weight gain, and the importance of this life stage for developing lifelong eating behaviors. Innovative intervention strategies are needed to reach and engage young adults, whereas more detailed reporting of intervention development and testing would facilitate progress in this challenging research area.

Objective

This paper describes the development of the EATS (Eating Advice To Students) intervention, a targeted, brief Web-based nutrition intervention for young adult (17 to 35 years) university students, and describes the pilot randomized controlled trial (RCT) to assess intervention feasibility.

Methods

EATS was developed using the PRECEDE-PROCEED model. The development involved a cross-sectional survey of university students’ eating behaviors and determinants, a systematic review of brief nutrition interventions, and consultation with a project steering committee. EATS was developed as a website with 4 components: (1) brief screening quiz with personalized feedback, (2) provision of information, tips, and strategies for each target eating behavior (consumption of vegetables, fruit, discretionary foods, and breakfast) and 2 guided exercises to facilitate behavior change, (3) goal setting, and (4) creating strategies. A pilot RCT with students from the University of Newcastle, Australia, was conducted from February to July 2018. The students were randomized to EATS or a brief Web-based alcohol intervention (attention control). The process evaluation included intervention acceptability (Web-based survey postintervention completion) and objective usage data (collected in real time). Efficacy data (Web-based survey at baseline and 3 months) included diet quality, consumption of target food groups (eg, fruits and vegetables), alcohol intake, self-efficacy to perform target eating behaviors, and well-being.

Results

Collection of the 3-month follow-up data was completed in July 2018.

Conclusions

EATS presents an innovative solution to many of the difficulties faced in targeting young adults to improve their eating behaviors. Given the strong methodological approach undertaken, this study provides a significant contribution to advance this research area.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12618000118202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374365&isReview=true (Archived by WebCite at http://www.webcitation.org/765o5fVwa)

International Registered Report Identifier (IRRID)

DERR1-10.2196/11992

Smoking and Physical Activity Trajectories from Childhood to Midlife

Introduction: Despite substantial interest in the development of health behaviors, there is limited research that has examined the longitudinal relationship between physical activity (PA) and smoking trajectories from youth to adulthood in a Finnish population. This study aimed to identify trajectories of smoking and PA for males and females, and study the relationship between these trajectories from youth to adulthood. Methods: Latent profile analysis (LPA) was used to identify trajectories of smoking and PA separately for males and females among 3355 Finnish adults (52.1% females). Participants' smoking and PA were assessed five to eight times over a 31-year period (3⁻18 years old at the baseline, 34⁻49 years at last follow-up). Multinomial logistic regression analysis was used to study the relationship between the trajectories of smoking and PA. Results: Five smoking trajectories and four to five PA trajectories were identified for males and females. Of the PA trajectory groups, the persistently active group were least likely to follow the trajectories of regular smoking and the inactive and low active groups were least likely to follow non-smoking trajectory group. Likewise, inactive (women only) and low active groups were less likely to belong to the non-smokers group. Conclusions: The study suggests that those who are persistently active or increasingly active have substantially reduced probabilities of being in the highest-risk smoking categories.

Image-Based Dietary Assessment and Tailored Feedback Using Mobile Technology: Mediating Behavior Change in Young Adults

Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults' experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food recordTM application (mFRTM) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFRTM and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed [odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39]. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.

Eating Behaviours and Food Cravings; Influence of Age, Sex, BMI and FTO Genotype

Previous studies indicate that eating behaviours and food cravings are associated with increased BMI and obesity. However, the interaction between these behaviours and other variables such as age, sex, BMI and genetics is complex. This study aimed to investigate the relationships between eating behaviours and food cravings, and to examine the influence of age, sex, body mass index (BMI) and fat mass and obesity-associated (FTO) genotype on these relationships. A total of 475 participants (252 female, 223 male, BMI: 25.82 ± 6.14 kg/m², age: 30.65 ± 14.20 years) completed the revised 18-question version of the Three Factor Eating Questionnaire (TFEQ-R18) to assess cognitive restraint, uncontrolled eating and emotional eating, and the Food Cravings Inventory (FCI) to assess cravings for fatty food, sweet food, carbohydrates and fast food. DNA samples were genotyped for the rs9939609 polymorphism in the obesity-linked gene FTO. Questionnaire data was analysed for associations between the TFEQ-R18 and FCI subscales for the whole study group, and the group divided by sex, genotype and age (≤25 years versus >25 years). Finally, mediation analysis was used to explore the relationships between BMI, cognitive restraint and food cravings. FTO AA + AT genotype was associated with increased BMI, but not with differences in eating behavior scores or food craving scores; age was associated with increased BMI and decreases in food craving scores in which this effect was stronger in women compared to men. Increased cognitive restraint was associated with decreased food craving scores in the ≤25 years group. Mediation analysis demonstrated that in this group the association between BMI and reduced food cravings was mediated by cognitive restraint indicating that in this age group individuals use cognitive restraint to control their food cravings. The positive correlation between age and BMI confirms previous results but the findings of this study show that age, sex, FTO genotype and BMI have an influence on the relationships between eating behaviours and food cravings and that these variables interact.

Grocery Shopping, Dinner Preparation, and Dietary Habits among Adolescents and Young Adults in Canada

Purpose: The current study aimed to characterize grocery shopping and dinner preparation behaviours among young people in Canada and to examine associations with eating habits.

Methods: A cross-sectional online survey was conducted with 2008 participants aged 16–24 from across Canada. The survey measured self-reported grocery shopping and dinner preparation behaviours, frequency of eating breakfast and eating meals prepared away from home, frequency of vegetable and fruit intake, and socio-demographic characteristics. Chi-square tests examined differences in proportions; logistic and linear regressions examined dietary habits, including covariates for grocery shopping and dinner preparation and socio-demographics.

Results: Overall, 37.3% had helped with grocery shopping in the past week, and 84.3% had participated in dinner preparation at least 1 day in the past week. Engaging in shopping at least once weekly was associated with increased vegetable and fruit consumption only, whereas more frequent engagement in dinner preparation was associated with increased vegetable and fruit consumption, more frequent breakfast consumption, and fewer meals consumed that were prepared away from home (P < 0.001 for all).

Conclusions: Increased participation in grocery shopping and dinner preparation were associated with healthier dietary habits. Interventions that increase these behaviours may contribute to improving dietary behaviours among adolescents and young adults.

Time trends in adherence to UK dietary recommendations and associated sociodemographic inequalities, 1986-2012: a repeated cross-sectional analysis

Background/objectives

Little is known about time trends in diet quality and associated inequalities in the UK. This study aimed to examine trends in adherence to four UK dietary recommendations, overall and among sociodemographic subgroups, from 1986 to 2012.

Subjects/methods

We conducted a repeated cross-sectional analysis using data from three UK diet surveys: Dietary and Nutritional Survey of British Adults 1986–87 (n = 2018), National Diet and Nutrition Survey (NDNS) 2000–01 (n = 1683) and NDNS Rolling Programme 2008–12 (n = 1632). We measured adherence to dietary recommendations for fruit and vegetables, salt, oily fish, and red and processed meat, estimated using food diary record data. We compared adherence across surveys and by four sociodemographic characteristics: sex, age, socioeconomic position and ethnicity.

Results

Overall, population adherence to dietary recommendations was low to moderate, but improved over time. There were inequalities in adherence to all recommendations at all timepoints according to one or more sociodemographic characteristic. When inequalities were present, women, older adults, those with non-manual occupations and non-Whites were more likely to adhere to dietary recommendations. Although some dietary inequalities declined, most persisted across the three surveys.

Conclusions

The persistence of most inequalities highlights the need for further interventions to reduce dietary inequalities as well as improve overall population diet. The greatest simultaneous improvement in population adherence and reduction of inequalities was observed for salt, which may reflect the success of the UK Salt Reduction Programme. Similarly comprehensive programmes should be encouraged for other dietary components.

Unhealthy dietary patterns among healthcare professionals and students in Mexico

Background

While dietary patterns (DPs) enable the combination of foods that make up a person’s habitual diet to be known, little is known about the DPs of health sector professionals. The objective of this study was to describe the DPs of healthcare students and professionals and assess their association with sociodemographic, lifestyle, anthropometric and biochemical characteristics.

Methods

Cross-sectional design. A sample (n = 319) of healthcare students and professionals in apparent good health who studied or worked at the University of Guadalajara (Mexico) was selected. A semiquantitative food intake frequency questionnaire validated on a Mexican population was administered. Questions covering sociodemographic factors, smoking habits and physical activity were asked. Weight, height, waist circumference, blood pressure, triglycerides, glucose, HDL-cholesterol, LDL-cholesterol and total cholesterol were also measured. DPs were generated from a principal components analysis of 25 food groups, and associations were analyzed using logistic regression adjusted for age and sex.

Results

The majority of participants were younger than 29 years (84%), women (71.2%) and students (59.6%). Three DPs were identified: “Traditional Westernized”, “Healthy” and “Animal protein and alcoholic beverages”. After adjustment, the “Traditional Westernized” DP was positively associated with being younger than 22 years (OR: 2.15; 95%CI: 1.1–4.1); the “Healthy” DP was positively associated with having a daily energy expenditure from physical activity greater than 605 kcal (OR: 4.19; 95%CI: 2.3–7.5), and it was negatively associated with being younger than 22 years (OR: 0.48; 95%CI: 0.2–0.9); and the “Animal protein and alcoholic beverages” DP was positively associated with being male (OR: 3.07; 95%CI: 1.8–5.1) and a smoker (OR: 2.77; 95%CI: 1.2–6.3). No association was found between DPs and anthropometric and biochemical characteristics.

Conclusions

Among the participants evaluated, healthy DP was associated with being physically active while unhealthy DPs were associated with being younger than 22 years, male and a smoker. These data suggest that being knowledgeable about health does not ensure that individuals will engage in healthy behaviors. As is the case among the general population, training and individual efforts aimed at achieving healthy behaviors must be reinforced by initiatives undertaken by social groups, social institutions, the community at large as well as political and business leaders.

Exploring the Perceived Barriers to Following a Mediterranean Style Diet in Childbearing Age: A Qualitative Study

A considerable amount of research has focused on interventions in pregnancy to promote health in current and future generations. This has yielded inconsistent results and focus has turned towards improving health in the preconception period. Promotion of healthy dietary patterns similar to a Mediterranean diet in the preconception years has been suggested as a dietary strategy to prevent maternal obesity and optimize offspring health. However, it is uncertain whether adoption is acceptable in women of childbearing age. This qualitative study aims to investigate the perceived barriers to following a Mediterranean diet in women of childbearing age. Semi-structured focus groups were used to generate deep insights to be used to guide the development of a future intervention. Nulliparous women aged between 20 and 47 years were recruited (n = 20). Six focus groups were digitally audio recorded and transcribed verbatim by the researcher. Thematic analysis was used to analyze data, which occurred in parallel with data collection to ascertain when data saturation was reached. Five core themes were identified: Mediterranean diet features, perceived benefits, existing dietary behavior and knowledge, practical factors, and information source. The present study highlights that a Mediterranean diet is acceptable to childbearing-aged women, and the insights generated will be helpful in developing an intervention to promote Mediterranean diet adoption.

Obesity in Type 1 Diabetes: Pathophysiology, Clinical Impact, and Mechanisms

There has been an alarming increase in the prevalence of obesity in people with type 1 diabetes in recent years. Although obesity has long been recognized as a major risk factor for the development of type 2 diabetes and a catalyst for complications, much less is known about the role of obesity in the initiation and pathogenesis of type 1 diabetes. Emerging evidence suggests that obesity contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in type 1 diabetes. Unique therapeutic strategies may be required to address these comorbidities within the context of intensive insulin therapy, which promotes weight gain. There is an urgent need for clinical guidelines for the prevention and management of obesity in type 1 diabetes. The development of these recommendations will require a transdisciplinary research strategy addressing metabolism, molecular mechanisms, lifestyle, neuropsychology, and novel therapeutics. In this review, the prevalence, clinical impact, energy balance physiology, and potential mechanisms of obesity in type 1 diabetes are described, with a special focus on the substantial gaps in knowledge in this field. Our goal is to provide a framework for the evidence base needed to develop type 1 diabetes-specific weight management recommendations that account for the competing outcomes of glycemic control and weight management.

Participant and interventionist perceptions of challenges during behavioral weight loss treatment

No prior studies have examined how interventionists' perceptions of participants' weight control challenges or the agreement between participants and interventionists on these perceptions relate to outcomes during group-based behavioral weight loss treatment. This study characterized participants' and interventionists' perceptions of, and agreement about, weight control challenges and assessed how these factors relate to weight loss. Three months into treatment, participants and interventionists independently selected three weight control challenges believed to be most relevant for each participant. Weight was measured at baseline, 3 months, and 12 months. Interventionists and participants had "no" (κ < 0) or "slight" (0 < κ< .20) agreement on most challenges. Although endorsement of certain challenges by participants and/or interventionists was related to 3- and 12-month weight losses, agreement between participants and interventionists was unrelated to weight loss at either time point. Additional research is needed to better understand the role of perceived challenges and participant/interventionist agreement about challenges on treatment outcomes.

'Buying Salad Is a Lot More Expensive than Going to McDonalds': Young Adults' Views about What Influences Their Food Choices

Young adults (18⁻30 years of age) are an 'at-risk' group for poor dietary behaviours and less healthy food choices. Previous research with young adults has looked at the barriers and enablers driving their food choices, focusing primarily on university and college students. However, there is less research using qualitative methods with young adults as a broader population group. This study aimed to explore the experiences of young adults in two different yet similar settings: Sydney, Australia and Glasgow, Scotland. Eight focus groups of young adult participants, ranging in size from 2⁻6 participants, were held in Sydney, Australia (n = 14) and Glasgow, Scotland (n = 16) to discuss, explore and compare the determinants and influences of their food choices. Focus group transcripts were coded thematically based on a process of narrative analysis. Three major narratives were identified across both locations: value of food; appeal of food; and emotional connections with food. These narratives were underpinned by a broader narrative of 'performing adulthood.' This narrative reflected a belief amongst participants that they should make rational, informed choices about food despite this conflicting with their broader food environment. Future research could examine which environment-level or policy-based interventions are most acceptable to young adults in terms of influencing their food choices and dietary behaviours.

Social media use for nutrition outcomes in young adults: a mixed-methods systematic review

BACKGROUND

Social media has been widely adopted by young adults, consequently health researchers are looking for ways to leverage this engagement with social media for the delivery of interventions and health promotion campaigns. Weight gain and sub-optimal dietary choices are common in young adults, and social media may be a potential tool to facilitate and support healthier choices.

METHODS

We conducted a mixed-methods systematic review of studies examining social media use for nutrition-related outcomes in young adults. Seven databases [EBscohost, ERIC, ProQuest Central, PubMed, Ovid, Scopus, and Emerald] were systematically searched; 1225 abstracts were screened, and 47 full-text articles were assessed for eligibility. Study designs included both quantitative, such as experimental and observational studies, and qualitative, such as focus groups and interviews, approaches. Quality was assessed using the Mixed Methods Appraisal Tool. Quantitative and qualitative results were examined separately, and then synthesized.

RESULTS

Twenty-one studies were included although their use of social media was highly variable. The main purpose of social media was to provide information and social support to participants. In the nine randomized controlled trials, social media was used as one aspect of a multi-faceted intervention. Interventions had a positive statistically significant impact on nutritional outcomes in 1/9 trials. Engagement with the social media component of interventions varied, from 3 to 69%. Young adults appear to be open to receiving healthy eating and recipe tips through social media, however, they are reluctant to share personal weight-related information on their online social networks.

CONCLUSIONS

Information-dissemination is now an acceptable use of social media by young adults. Using social media effectively for social support, either via private groups or public pages, requires careful evaluation as its effectiveness is yet to be demonstrated in experimental designs. Concerns about public social media use may be a contributing factor to poor engagement with social media in research intervention studies aimed at influencing weight. Future research should consider how to best engage with young adults using social media, how to more effectively use social media to support young adults and to facilitate social and peer-to-peer support in making healthier choices.

Communicating health-Optimising young adults' engagement with health messages using social media: Study protocol

BACKGROUND

Obesity is a global health problem. Understanding how to utilise social media (SM) as a platform for intervention and engagement with young adults (YAs) will help the practitioners to harness this media more effectively for obesity prevention.

AIM

Communicating health (CH) aims to understand the use of SM by YAs, including Aboriginal YAs, and in doing so will improve the effectiveness of SM strategies to motivate, engage and retain YAs in interventions to reduce the risk of obesity, and identify and disseminate effective ways for health professionals to deliver obesity prevention interventions via SM.

METHODS

The present study describes the theoretical framework and methodologies for the CH study, which is organised into four interrelated phases, each building on the outcomes of preceding phases. Phase 1 is a mixed methods approach to understand how YAs use SM to navigate their health issues, including healthy eating. Phase 2 utilises co-creation workshops where YAs and public health practitioners collaboratively generate healthy eating messages and communication strategies. Phase 3 evaluates these messages in a real-world setting. Phase 4 is the translation phase where public health practitioners use outcomes from CH to inform future strategies and to develop tools for SM for use by stakeholders and the research community.

DISCUSSION

The outcomes will include a rich understanding of psychosocial drivers and behaviours associated with healthy eating and will provide insight into the use of SM to reach and influence the health and eating behaviours of YAs.

Behavioral Correlates of Empirically-Derived Dietary Patterns among University Students

Given the importance of young adulthood in establishing lifelong dietary habits, it is imperative to better understand potential underlying drivers of dietary behavior in the university-age population. Dietary patterns have been associated with disease risk, but behavioral predictors of dietary pattern adherence are poorly understood, especially among emerging adults. This study aims to evaluate health-related behaviors associated with dietary pattern scores among freshmen participating in the Tufts Longitudinal Health Study (TLHS; n = 630). We previously derived dietary patterns using principal components analysis and orthogonal rotation from dietary intake data. Health-related behavior data were collected via survey. All data were collected during the Spring semesters of 1998⁻2007. Unadjusted linear models were used to determine associations between dietary pattern scores and health-related behaviors. Significant correlates were retained in multivariable regression models, which were adjusted for demographic characteristics. We found that never eating meals away from home was associated with higher adherence to the Prudent and lower adherence to the Western and Alcohol patterns. Intention to lose weight was negatively associated with the Western pattern, while intention to gain weight was positively associated with all dietary patterns. These findings suggest that intervention efforts aimed at improving eating out behaviors and engaging in healthy weight management strategies may promote healthier dietary patterns among university students.

Differences over 12 Years in Food Portion Size and Association with Excess Body Weight in the City of São Paulo, Brazil

Although changes in Brazilian diet have occurred over the last decades, there is no evidence about differences in food portion sizes (FPS) over time. Therefore, we aimed to evaluate the association of FPS with excess body weight (EBW), and to monitor differences in the population from São Paulo, Brazil, from 2003 to 2015. Data came from three cross-sectional population-based studies with 5270 individuals aged ≥12 years in 2003, 2008, and 2015. Dietary data were obtained from 24-h recalls. Logistic regression models were used to evaluate the association between FPS and EBW. Over the years, there was a diverse variation in FPS, with an increase in some groups (white meat, salted snacks, coffee/tea, eggs) and decrease in others (rice, red meat, sweets, pasta, sandwiches, cold cuts). The percentage of people reporting the intake of six food groupings (rice, white meat, sweets, fruits, commercial juices, toasts/biscuits) increased in the period. In this population, EBW was associated with larger FPS of 11 of the 30 food groupings investigated (cold cuts, fried snacks, fruit and commercial juices, pizza, red meat, rice, salted snacks, soft drinks, soups, sugar). These findings could support future interventions and policies for optimal food intake in Brazil.

Effectiveness of lifestyle interventions for preventing harmful weight gain among young adults from lower socioeconomic status and ethnically diverse backgrounds: a systematic review

The incidence of overweight and obesity are increasing with each successive generation of young adults. Associated co-morbidities will emerge at an earlier age unless weight gain is prevented. Evidence has demonstrated young adults (aged 18-35 years) from low socioeconomic and ethnically diverse backgrounds are at greater risk of overweight or obesity, yet it is unclear how to effectively intervene in this population. This systematic review aimed to assess the effectiveness of lifestyle interventions conducted in this population. Thirty studies reporting on lifestyle interventions for prevention of weight gain were identified from eight electronic databases searched. Six interventions included subgroup analyses to determine if ethnicity moderated weight change, and two included subgroup analyses to determine if socioeconomic status had an effect on change in weight. Five of these six studies were effective in preventing weight gain, and subgroup analyses showed no differences in effect by ethnicity. Of these five studies, two included a subgroup analysis that showed socioeconomic status to have no effect on weight outcome. Despite the promising results from these five lifestyle interventions utilizing online and mobile components to effectively reach and prevent weight gain in this priority population, the evidence base of high quality trials is limited.

Dietary patterns and their associations with home food availability among Finnish pre-school children: a cross-sectional study

Objective

To study the associations between home food availability and dietary patterns among pre-school children.

Design

Cross-sectional study in which parents of the participating children filled in an FFQ and reported how often they had certain foods in their homes. We derived dietary pattern scores using principal component analysis, and composite scores describing the availability of fruits and vegetables as well as sugar-enriched foods in the home were created for each participant. We used multilevel models to investigate the associations between availability and dietary pattern scores.

Setting

The DAGIS study, Finland.

Subjects

The participants were 864 Finnish 3–6-year-old children recruited from sixty-six pre-schools. The analyses included 711 children with sufficient data.

Results

We identified three dietary patterns explaining 16·7 % of the variance. The patterns were named ‘sweets-and-treats’ (high loadings of e.g. sweet biscuits, chocolate, ice cream), ‘health-conscious’ (high loadings of e.g. nuts, natural yoghurt, berries) and ‘vegetables-and-processed meats’ (high loadings of e.g. vegetables, cold cuts, fruit). In multivariate models, the availability of fruits and vegetables was inversely associated with the sweets-and-treats pattern (β=−0·05, P<0·01) and positively associated with the health-conscious (β=0·07, P<0·01) and vegetables-and-processed meats patterns (β=0·06, P<0·01). The availability of sugar-enriched foods was positively associated with the sweets-and-treats pattern (β=0·10, P<0·01) and inversely associated with the health-conscious pattern (β=−0·03, P<0·01).

Conclusions

Considering dietary patterns, the availability of sugar-enriched foods in the home seems to have a stronger role than that of fruits and vegetables. Parents should restrict the availability of unhealthy foods in the home.