Les déterminants de la saine alimentation chez les Canadiens à faible revenu

Supermarket promotions in Western Sweden are incompatible with Nordic dietary recommendations and differ by area-level socioeconomic index

BACKGROUND

Large supermarket chains produce weekly advertisements to promote foods and influence consumer purchases. The broad consumer reach of these ads presents an opportunity to promote foods that align with dietary recommendations. Thus, the aim of this study was to investigate the health quality of supermarkets' weekly food promotions in a large region of Sweden with attention to more and less advantaged socioeconomic index areas.

METHODS

Analysis of weekly advertisements from 122 individual stores, representing seven chains, was carried out in a large region of Sweden from 2-29 March in 2020. Food promotions were divided into categories according to the Nordic Nutrition Recommendations and World Health Organization Regional Office for Europe's nutrient profile model, and defined as 'most healthy', 'healthy', 'unhealthy' and 'most unhealthy'. A mean socioeconomic index was used to classify each store location to determine whether proportions of the 'most unhealthy' foods differed between more advantaged and more disadvantaged socioeconomic index areas.

RESULTS

In total, 29,958 food items were analyzed. Two-thirds of promotions belonged to the food groups considered 'most unhealthy' and 'unhealthy'. In the 'most unhealthy' food group 'sugar-rich beverages and foods' constituted approximately 23.0% of the promotions. Food promotions had 25% increased odds to be from the 'most unhealthy' group (odds ratio 1.25, confidence interval 1.17, 1.33) in more disadvantaged socioeconomic index areas. This association could be explained by the supermarket chain the stores belonged to.

CONCLUSIONS

Our findings indicate that Swedish supermarkets promote a large proportion of unhealthy foods as classified by the Nordic Nutrition Recommendations. We also observe that certain national supermarket chains tend to locate their stores in more disadvantaged areas and promote a greater proportion of unhealthy foods in their weekly advertisements compared to the more advantaged areas. There is an urgent need for supermarkets to shift promotions toward healthier food items.

An Overview of the Sociological and Environmental Factors Influencing Eating Food Behavior in Canada

This review extensively discusses various socio environmental factors affecting eating behavior of the general public within Canada including the development and implementation of national policies. A framework representing the determinants of healthy eating can be grouped into four categories i.e., the individual determinants, the economic environment, the social environment and the physical environment. This framework allowed for addressing food insecurity and social economic ecosystem of Canadians. Lastly, we investigate the role in which biotechnology plays in improving food security and addresses the significant impact biotechnology has contributed toward on agriculture and the food market. Overall, this review using such sources as Web of Science, Pub Med and Scopus provides significant contribution toward understanding the social economic environment and eating behavior of people living in Canada. In conclusion, this has led to identify a research gap as there is a significant need to address the development and implementation of policies in the food and nutrition environment.

Early life exposure to phthalates in the Canadian Healthy Infant Longitudinal Development (CHILD) study: a multi-city birth cohort

BACKGROUND

Few studies have examined phthalate exposure during infancy and early life, critical windows of development. The Canadian Healthy Infant Longitudinal Development (CHILD) study, a population-based birth cohort, ascertained multiple exposures during early life.

OBJECTIVE

To characterize exposure to phthalates during infancy and early childhood.

METHODS

Environmental questionnaires were administered, and urine samples collected at 3, 12, and 36 months. In the first 1578 children, urine was analyzed for eight phthalate metabolites: mono-methyl phthalate (MMP), mono-ethyl phthalate (MEP), mono-butyl phthalate (MBP), mono-benzyl phthalate (MBzP), mono-2-ethylhexyl phthalate (MEHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono-3-carboxypropyl phthalate (MCPP). Geometric mean (GM) concentrations were calculated by age, together with factors that may influence concentrations. Trends with age were examined using mixed models and differences within factors examined using ANOVA.

RESULTS

The highest urinary concentration was for the metabolite MBP at all ages (GM: 15-32 ng/mL). Concentrations of all phthalate metabolites significantly increased with age ranging from GM: 0.5-15.1 ng/mL at 3 months and 1.9-32.1 ng/mL at 36 months. Concentrations of all metabolites were higher in the lowest income categories except for MEHP at 3 months, among children with any breastfeeding at 12 months, and in urine collected on dates with warmer outdoor temperatures (>17 °C), except for MBzP at 3 months and MEHP at 3 and 12 months. No consistent differences were found by gender, study site, or maternal age.

CONCLUSIONS

Higher phthalate metabolite concentrations were observed among children in lower income families. Examination of factors associated with income could inform interventions aimed to reduce infant phthalate exposure.

Prevalence of Dietary Behavior and Determinants of Quality of Diet among Beneficiaries of Government Welfare Assistance in Poland

Diet, as a modifiable factor for good health maintenance, reduces the risk of numerous non-communicable chronic diseases and prevents premature death. The aim of the study was to examine the prevalence of a dietary behavior and to find out what the determinants of diet quality among the low socio-economic status population are. The studied sample consisted of 1710 respondents. Only 3% of the beneficiaries had healthy dietary habits. Unhealthy dietary habits dominated in all the study group regardless of the subjects' level of education (p < 0.001). Higher odds of unhealthy dietary habits were reported among the respondents with primary, vocational, and secondary education than among the respondents with high education (for the primary education OR = 11.10; 95% CI: 5.86⁻21.01; p ≤ 0.001; for vocational education OR = 10.54; 95% CI: 5.79⁻19.18; p ≤ 0.001 and for secondary education OR = 5.83; 95% CI: 3.48⁻9.79; p ≤ 0.001). The unhealthy dietary behavior prevalence among beneficiaries of government welfare assistance in Poland is much higher than in the general population. Since only educational level is a determinant which is significantly correlated with the unhealthy dietary behavior, promotion of a healthy diet among disadvantaged individuals should be focused on this factor.

Determinants of inequalities in the quality of Brazilian diet: trends in 12-year population-based study (2003-2015)

Background

Recent studies have explored the influence of socioeconomic inequalities on the diet quality. However, there is lack of evidence regarding the level of inequalities in dietary quality and its main contributing factors from population-based follow-up studies. The primary objective of this study was to investigate the level and the determinants of inequalities in diet quality in a representative sample of adolescents, adults and older adults resident in São Paulo, Brazil.

Methods

Data from the Health Survey of São Paulo (ISA-Capital) were analyzed for 2003 (n = 2398), 2008 (n = 1662) and 2015 (n = 1742) surveys. Information on food consumption was obtained through 24-h dietary recall, and diet quality was assessed based on the Revised Brazilian Healthy Eating Index (BHEI-R). The descriptive variables were compared using 95% confidence interval. The scores of BHEI-R and its components were compared across age groups and year. The association between socioeconomic inequalities and diet quality was based on the estimation of concentration index.

Results

We observed that the BHEI-R scores gradually improved over 12-years, with older adults showing the greatest improvement. The increase in overall population score was observed for total fruits, whole fruits, whole grains, oils and sodium. The main contributor to socioeconomic inequality in diet quality in 2003 was ethnic group, and in 2008 and 2015, it was per capita household income; age was a persistent factor of inequality in the population over the years. Concentration indices indicated that lower income individuals had higher BHEI-R scores in 2003; however, there was a shift in favor of higher income individuals in 2008 and 2015.

Conclusions

Changes in the patterns of determination of inequalities according to age, ethnic group or income during the period analyzed show the existence of ongoing process of contribution of demographic and socioeconomic factors in the diet quality of individuals in a large urban center.

Urban-rural disparity of overweight/obesity distribution and its potential trend with breast cancer among Chinese women

Objective

To evaluate the urban-rural disparity of overweight/obesity and explore its potential trend with breast cancer among Chinese women.

Results

The prevalence of overweight/obesity for Chinese rural women (35.2%, 29.2% for overweight and 6.0% for obesity) was significantly higher than that for Chinese urban women (33.4%, 27.7% for overweight and 5.7% for obesity) (P < 0.001). For either rural or urban women, the prevalence of overweight/obesity was highest in north region, followed by east region for rural women and north-east region for urban women. For rural women, higher prevalence of overweight/obesity was significantly positively associated with elder age, Han nationality, low level of education, no occupation, high family income, less number of family residents, insurance, and elder age at marriage. Similar positive associations were also found for urban women, except negative associations for high family income, less number of family residents, and elder age at marriage. A non-significant positive trend between overweight/obesity and breast cancer was found for rural women [odds ratio (OR): 1.06; 95% confidence interval (CI): 0.87–1.29], but a significant positive trend for urban women (OR: 1.55; 95% CI: 1.19–2.02).

Materials and Methods

A total of 1 210 762 participants were recruited from the Chinese National Breast Cancer Screening Program. Overweight and obesity were defined as body mass index (BMI) ranged 24.0–27.9 kg/m² and BMI ≥ 28.0kg/m², respectively.

Conclusions

There was an obvious urban-rural disparity of overweight/obesity distribution among Chinese women, which could also lead to an obvious disparity of breast cancer distribution.

Changes in growth and sleep across school nights, weekends and a winter holiday period in two Australian schools

Studies suggest that there may be an association between sleep and growth; however, the relationship is not well understood. Changes in biology and external factors such as school schedule heavily impact the sleep of adolescents, during a critical phase for growth. This study assessed the changes in sleep across school days, weekends and school holidays, while also measuring height and weight changes, and self-reported alterations in food intake and physical activity. The impact of morningness-eveningness (M-E) on height change and weight gain was also investigated. In a sample of 63 adolescents (mean age = 13.13, SD = 0.33, 31 males) from two independent schools in South Australia, height and weight were measured weekly for 4 weeks prior to the school holidays and 4 weeks after the school holidays. Participants also completed a Morningness/Eveningness Scale and 7-day sleep, diet and physical activity diaries prior to, during and after the school holidays. Participants at one school had earlier wake times during the weekends than participants attending the other school, leading to a significantly shorter sleep duration on weekends for those participants. Regardless of school, sleep was significantly later and longer during the holidays (p < 0.001) and those with a stronger morning preference fell asleep (F_18,36 = 3.4, p = 0.001) and woke (F_18,44 = 2.0, p = 0.027) earlier than evening types. Growth rate was lower during the holiday weeks. For those attending the school with limited sleep in opportunities, growth after the holidays was lower for those with greater evening preference, whereas for those at the other school, growth was greater for those with greater evening preference. The increase in average weight from pre- to post-holidays was greater for those attending the school with limited opportunities to sleep longer. Participants reported greater food intake during the holidays compared to school days and greater physical activity levels on weekends compared to school days, and school days compared to holidays. Results suggest that time of day preference may impact growth, with evening types who cannot sleep in growing at a slower rate than evening types who can or morning types. This may be related to sleep restriction. Despite sleep being both later and longer during the school holidays, participants' growth slowed during the holiday period. It is possible that this may be a reflection of other behavioural changes in the holidays (increased food intake and reduced physical activity), as sleep timing during the school period was related to growth.

Conceptualizing and contextualizing food insecurity among Greenlandic children

Objective

To review the context of food insecurity in Greenlandic children, to review and compare the outcomes related to food insecurity in Greenlandic children, in other Arctic child populations and in other western societies, and to explore the measure used by the Health Behaviour in School-aged Children (HBSC) study.

Design

The study includes literature reviews, focus group interviews with children and analyses of data from the HBSC study. HBSC is an international cross-national school-based survey on child and adolescent health and health behaviour in the age groups 11, 13 and 15 years and performed in more than 40 countries. The item on food insecurity is “Some young people go to school or to bed hungry because there is not enough food in the home. How often does this happen to you?” (with the response options: “Always”, “Often”, “Sometimes”, or “Never”).

Results

The context to food security among Inuit in Arctic regions was found to be very similar and connected to a westernization of the diet and contamination of the traditional diet. The major challenges are contamination, economic access to healthy food and socio-demographic differences in having a healthy diet. The literature on outcomes related to food insecurity in children in Western societies was reviewed and grouped based on 8 domains. Using data from the Greenlandic HBSC data from 2010, the item on food security showed negative associations on central items in all these domains. Focus group interviews with children revealed face and content validity of the HBSC item.

Conclusion

Triangulation of the above-mentioned findings indicates that the HBSC measure of food shortage is a reliable indicator of food insecurity in Greenlandic schoolchildren. However, more research is needed, especially on explanatory and mediating factors.

Development of a resource to help consumers select nutrition supplements

PURPOSE

In Canada, many people do not meet all the recommended nutrient intakes with food alone; the use of supplements may be one strategy to compensate for some of these inadequacies. Previous research has revealed several barriers to supplement use, including a lack of knowledge. In this qualitative study, we developed a resource to help inform and educate consumers on the selection of appropriate nutrition supplements.

METHODS

Three focus groups with participants residing in low-income neighbourhoods in Saskatoon, Saskatchewan, and seven key informant interviews were conducted using a semi-structured interview guide and four resource examples. After transcription of the discussion and interviews, thematic analysis was used to identify emergent themes.

RESULTS

Analysis yielded three overarching themes: barriers to use, interdisciplinary issues, and resource expectations. Each overarching theme had several subthemes. Subthemes of the overarching theme of resource expectations were subsequently used to create a new tool to help consumers select an appropriate multivitamin.

CONCLUSIONS

A tool was developed after available resources were explored and stakeholders were interviewed. The new resource was based on community members' and health care professionals' expressed needs, ideas, and beliefs.

Weight status and determinants of health in Manitoba children and youth

PURPOSE

Because of the tremendous increase in overweight and obesity in Canadian children and youth in recent decades, we examined associations among health determinants, healthy living characteristics, and overweight and obesity in Manitoba children and youth.

METHODS

Using descriptive statistics and logistic regression, we identified factors associated with measured overweight and obesity in a sample of 1651 Manitoba children and youth aged two to 17 years from the 2004 Canadian Community Health Survey 2.2-Nutrition.

RESULTS

Thirty-one percent of the children and youth were overweight or obese. Males aged 12 to 17 or from food-insecure homes were more likely to be overweight or obese than were younger males or males from food-secure households. Females from households with higher parental education were less likely to be overweight or obese than were those from households with lower parental education. Female youth who were sedentary for at least three hours daily were more likely to be overweight or obese than were less sedentary female youth. A trend toward significance with overweight or obesity in youth was noted with levels of daily fruit and vegetable consumption and regular physical activity.

CONCLUSIONS

Overweight and obesity in Manitoba children and youth are associated with socio-economic and demographic characteristics, and with food and activity behaviours. These findings can inform health and nutrition policy and practice by indicating health inequities that require particular attention.

Economic access to fruits and vegetables in the greater Quebec City: do disparities exist?

OBJECTIVES

To examine the cost of fruits and vegetables (FV) with respect to different food store types, urbanization level and material deprivation for various urban areas of greater Quebec City.

METHODS

A sample of 85 food stores was selected. They represented five store types (small, conventional, and large grocery stores; greengrocers; convenience stores) in four geographic areas reflecting three different socio-economic levels. We identified three FV baskets (grocery, fresh FV, convenience) by drawing on data on household food spending and consumption, and food supply in the five store types. Four investigators were trained to conduct a survey of prices for the week of September 17-23, 2007. Analysis of variance and t tests were conducted to examine variations in food baskets with regard to the variables defined in this study. A chi-square test was used to measure the frequency distribution of stores throughout the greater Quebec City.

RESULTS

Only food store type had a significant influence on FV cost: cost was much lower in large grocery stores and greengrocers. Convenience stores, where prices are higher, outnumbered all others in deprived urban areas, supporting the contention that there are inequities in economic access.

DISCUSSION

Economic access to FV may differ by area in the greater Quebec City, putting rural inhabitants and less privileged urban dwellers at the greatest disadvantage; this may, in turn, contribute to health disparities. The results point to the need to improve our understanding of the way components of the food environment at the regional level affect social inequality.

Barriers to Healthful Eating and Supplement Use In Lower-income Adults

Purpose: We investigated barriers to healthful eating and vitamin/mineral supplement use among groups at risk for low nutrient intakes, particularly those with low income.

Methods: Twelve focus groups (73 participants) and 11 key informant interviews were conducted in Saskatoon, Saskatchewan. Focus group participants represented a diverse population. Key informants included health professionals and personnel from community-based organizations who worked in a lowincome area. Focus group meetings and key informant interviews were audiotaped and transcribed; thematic coding was used to identify key concepts.

Results: The focus groups and interviews revealed five themes on barriers to healthful eating and to the use of vitamin/mineral supplements: knowledge, income, accessibility, health, and preferences. Key informants were aware of the barriers, and were able to see not only individual and family reasons but also societal influences.

Conclusions: The study results provide valuable information for focusing efforts on reducing barriers to healthful eating and to appropriate vitamin/mineral supplement use.

The context for choice: health implications of targeted food and beverage marketing to African Americans

Targeted marketing of high-calorie foods and beverages to ethnic minority populations, relative to more healthful foods, may contribute to ethnic disparities in obesity and other diet-related chronic conditions. We conducted a systematic review of studies published in June 1992 through 2006 (n = 20) that permitted comparison of food and beverage marketing to African Americans versus Whites and others. Eight studies reported on product promotions, 11 on retail food outlet locations, and 3 on food prices. Although the evidence base has limitations, studies indicated that African Americans are consistently exposed to food promotion and distribution patterns with relatively greater potential adverse health effects than are Whites. The limited evidence on price disparities was inconclusive.

What Do Adults in Prince Edward Island: Know About Nutrition?

Purpose: To assess adults’ knowledge of dietary recommendations, food sources of key nutrients, food choices, and diet-disease relationships.

Methods: A previously validated survey, designed to assess nutrition knowledge, was adapted for use in Prince Edward Island and mailed to a random sample of 3,500 adults (aged 18 to 74). Dillman's Total Design Method was followed and a response rate of 26.4% achieved. Mean scores and 95% confidence intervals (CIs) were calculated for the overall survey and for each section. Demographic variations were assessed by univariate analysis.

Results: Of an overall possible score of 110 points, the mean score with 95% CI was 71.0 (70.1, 71.9). Respondents scored higher on the sections on dietary recommendations, food sources, and food choices than diet-disease relationships. Demographic differences existed in gender, age, education, and income. Findings suggest that adults have good general knowledge of dietary recommendations, but lack knowledge about how to make healthier food choices and the impact of diet on disease risk.

Conclusion: When designing intervention strategies, dietitians should consider targeted messages to provide adults with the information they need to make healthy food choices.

Preschool children's eating behaviours are related to dietary adequacy and body weight

OBJECTIVE

The aim of this paper is to analyse the relationships between eating behaviours (picky eating, irregular eating and overeating), and dietary adequacy in accordance with nutrition recommendations and body weight during the preschool years.

DESIGN AND SETTING

Our analyses were performed using data from the Longitudinal Study of Child Development in Québec (1998-2002), a population-based birth cohort.

SUBJECTS

The study followed a representative sample (n=2103) of children born in 1998 in the Canadian province of Québec.

METHODS

Eating behaviours were derived from self-administered questionnaires when children were 2.5, 3.5 and 4.5 years. Nutrition data were collected from one 24-hour recall interview conducted at home by trained nutritionists at 4.5 years. Children's weight and height were measured at 4.5 years. Statistical analyses were carried out with SAS (version 8.2). Weighted data adjusted for within-variability were used in the analysis, and the significance level was set at 5%.

RESULTS

Picky eaters consume fewer total fats, less energy and less protein than children never reporting picky eating behaviours. Picky eaters were more likely to consume less than dietary recommendations for fruit and vegetables, and meat and alternatives. Overeaters consumed more total energy and more of each macronutrient than children who were never reported as overeaters during the preschool years. These children consumed more servings of grain products and meats and alternatives per day than children not classified as overeaters. Even when the number of servings of grain products consumed was similar for overeaters and children who were never overeaters, overeaters had higher body mass index.

CONCLUSION

Given that children as young as 4.5 years are displaying some form of problematic eating behaviour which is shown to be related to dietary adequacy and body weight, public health professionals should be targeting parents of young children to provide messages about strategies for coping with problematic eating behaviours in early childhood.