Preventing Type 2 Diabetes with Home Cooking: Current Evidence and Future Potential

Promoting healthy cooking patterns in China: Analysis of consumer clusters and the evolution of cooking pattern trends

Cooking methods can change the composition of foods and have important effects on human health. The Chinese people have developed many distinct and unique cooking methods. However, the daily cooking patterns of Chinese people and the characteristics and evolution of trends in cooking patterns commonly used by Chinese consumers remain unclear. The objective of this study was to identify the major cooking patterns and discuss their effects on human health, as well as to identify the cooking pattern consumer clusters and the evolution of trends in Chinese consumer cooking patterns. From March to June 2021, this study interviewed 4,710 residents in Eastern China regarding the consumption frequency of each cooking method when food is prepared at home or when eating out. Exploratory factor analysis, K-Means cluster analysis, Chi-square test, pairwise comparisons of multiple sample rates, and multivariate linear regression were used to identify the cooking patterns and cooking pattern consumer clusters, to assess differences in consumption preferences between consumer clusters, and to examine the relationship between demographic characteristic variables and different cooking patterns. Results revealed three major cooking patterns, namely traditional Chinese (cooking methods with native Chinese characteristics), bland, and high-temperature cooking patterns, as well as seven cooking pattern consumer clusters and their demographic characteristics in the Eastern Chinese population. With increases in age, education level, and income, consumers tended to choose the healthy "Bland" cooking pattern. Further, there was a higher proportion of people aged 36-65 years in the C3 cluster, which is characterized by the "Bland" cooking pattern. However, participants who were male and younger made fewer healthy choices in their cooking patterns. Specifically, a higher proportion of participants aged 21-35 years were found in the C5 cluster, which is characterized by the unhealthy "High-temperature" cooking pattern. Therefore, culinary health education should focus on individuals who are male and young. Specifically, the shift in cooking patterns among people aged 21-35 years should receive special attention.

Cooking behaviours after Diabetes Prevention Program (DPP) participation among DPP participants in Baltimore, MD

OBJECTIVE

The Diabetes Prevention Program (DPP) is a widely implemented 12-month behavioural weight loss programme for individuals with prediabetes. The DPP covers nutrition but does not explicitly incorporate cooking skills education. The objective of the current study is to describe food and cooking skills (FACS) and strategies of recent DPP participants.

DESIGN

Photo-elicitation in-depth interviews were conducted from June to August, 2021.

SETTING

Baltimore, MD, USA.

PARTICIPANTS

Thirteen Black women who participated in DPP.

RESULTS

The DPP curriculum influenced participants' healthy cooking practices. Many participants reported shifting from frying foods to air-frying and baking foods to promote healthier cooking and more efficient meal preparation. Participants also reported that their participation in DPP made them more mindful of consuming fruits and vegetables and avoiding foods high in carbohydrates, fats, sugars and Na. With respect to food skills, participants reported that they were more attentive to reading labels and packaging on foods and assessing the quality of ingredients when grocery shopping.

CONCLUSIONS

Overall, participants reported changing their food preferences, shopping practices and cooking strategies to promote healthier eating after completing the DPP. Incorporating hands-on cooking skills and practices into the DPP curriculum may support sustained behaviour change to manage prediabetes and prevent development of type 2 diabetes among participants.

Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring

BACKGROUND

Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools.

OBJECTIVE

The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system.

DESIGN

A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool.

PARTICIPANTS/SETTING

The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population.

MAIN OUTCOME MEASURES

All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green = healthiest intake, red = least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s.

STATISTICAL ANALYSES

Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls.

RESULTS

Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r = 0.75 (95% confidence interval [CI] = 0.65, 0.82).

CONCLUSIONS

The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.

The Singaporean foodscape - Convenience, choice, entertainment, and sociality for young workers

Singapore is famous for its diverse, affordable, and exciting foodscape. This paper focuses on understanding the multifaceted role that the Singaporean food environment plays in working young adults' lives, and how young adults interact with this environment to make food choices. Using a focused ethnographic approach, including 33 semi-structured interviews and participant-observation, we explore the ways in which busy working young adults interact with the foodscape. The food environment provides young adults, who eat out frequently, with highly accessible food options that cater to their budgets and palates. They often dine at hawker centres and similar food establishments with colleagues, friends and family. These establishments offer accessible, affordable, and appealing food. Overall, the foodscape provides a source of popular entertainment through the exploration of diverse cuisines and novel shared social experiences. Young adults are heavy users of social media to maintain social networks and to explore the food environment. Capitalizing on this, food marketing on social media targets this group with the promotion of food-related experiences. While it may not always promote healthy eating, the Singaporean foodscape offers convenience, choice, entertainment, and sociality. In the process, it facilitates the formation of cultural and national identity and the protection of mental well-being through the maintenance and development of relationships, and a sense of belonging.

Hard work, long hours, and Singaporean young adults' health-A qualitative study

Background

As young adults in their 20s to 30s transitioning toward new careers and independence, their dietary and physical activity practices often change, increasing their risk of weight gain. This study explored the ways that Singaporean young adults perceived and experienced the interaction between their working hours, work, and health practices.

Methods

This research used semi-structured interviews to explore the perspectives and experiences of participants. Purposive and snowball sampling was used to recruit 15 men and 18 women, aged 23 to 36, who had worked full-time at their respective jobs in Singapore for at least 1 year. An inductive and deductive thematic analysis approach was employed.

Results

Young working adults' commitment to work was driven by a hard-working culture, a desire to attain better jobs and remuneration, and to fulfill cultural expectations to support their multi-generation families. Their non-work time was largely spent recuperating from work by socializing over food and in sedentary activities.

Conclusion

For young working adults, long work hours are normalized, even though they are a barrier to healthy diets and physical activity. Existing social and institutional norms support a culture that values commitment to work and encourages young adults to devote long hours to building a sound financial future and achieving personal and cultural aspirations. These findings have implications for long-term population health and should be considered in health promotion activities targeting young adults and barriers.

Expectations from a Home Cooking Program: Qualitative Analyses of Perceptions from Participants in "Action" and "Contemplation" Stages of Change, before Entering a Bi-Center Randomized Controlled Trial

Home cooking is an emerging strategy to improve nutrition; however, the literature lacks reports about patient expectations from culinary interventions. Personalized medicine utilizes knowledge about a person's genes; yet, behavioral factors, such as participant "readiness" to make a change, may also impact treatment preferences and outcomes. The purpose is to explore the expectations of participants in different stages of change from a home cooking intervention. Participants were recruited to a randomized controlled trial evaluating the impact of a home cooking intervention on weight. Stage of change assessed by a validated University of Rhode Island Change Assessment scale and expectations through an open-ended questionnaire. Sixteen (21%) participants were in the action stage of change, and 59 (79%) were in the contemplation stage. Participants from both groups shared similar expectations to achieve healthy eating and lifestyle goals and to adopt sustainable change. However, action group expectations also included expanding existing culinary knowledge and change of habits; the contemplation group expectations also included acquiring culinary knowledge, improving self-regulatory skills, and obtaining guidance and support. While action group participants were looking to expand existing knowledge and techniques, contemplation group participants were focusing on acquiring culinary knowledge and skills. This can potentially contribute to developing effective, personalized nutrition interventions.

Familiarization with White Whole Wheat Improves Acceptability of Whole Grain-Based Baked Products Made with White Whole Wheat Among College Students

Research corroborates that high whole grain intake is associated with lower risk for obesity, type 2 diabetes, cardiovascular diseases, and cancers. Unfamiliarity with, and negative sensory appeal of whole grains limit voluntary food choices to increase their consumption. This study aimed to explore the effectiveness of familiarization with white whole wheat, to improve college students’ acceptability of shortened cakes, muffins, and yeast breads made with white whole wheat flour (WWWF). All-purpose flour (APF) was replaced with WWWF in standardized recipes, and the products scored by 102 college students. Independent t-test was used to analyze if sensory scores for appearance, taste, texture, and overall acceptability between APF and WWWF products were statistically significant. Before familiarization with WWWF, all three APF products scored significantly higher than whole grain counterparts ( P < .05). When participants were familiarized with health benefits and expected sensory profile of whole grain products, sensory scores for appearance, taste, and overall acceptability of WWWF products did not significantly differ from APF counterparts ( P > .05). Familiarization significantly increased overall acceptability scores of WWWF products ( P < .05). Familiarization also increased proportion of students willing to bake with WWWF. Results underscore that familiarization can improve acceptability of WWWF in baked products and students’ willingness to incorporate it in baking, with potential to stimulate dietary modifications.

Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD)

Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.

Development and Validation of a New Home Cooking Frequency Questionnaire: A Pilot Study

Home cooking and the type of cooking techniques can have an effect on our health. However, as far as we know, there is no questionnaire that measures in depth the frequency and type of cooking techniques used at home. Our aim was to design a new Home Cooking Frequency Questionnaire (HCFQ) and to preliminarily assess its psychometric properties. For this purpose we used a five-phase approach, as follows: Phase 1: item generation based on expert opinion, relevant literature and previous surveys; Phase 2: content validity assessed by experts for relevance and clarity (epidemiologists, dietitians, chefs); Phase 3: face validity and inter-item reliability; Phase 4: criterion validity using a 7-day food and culinary record; and Phase 5: test stability and inter-item reliability. The content validity index for scale and item level values provided evidence of the content validity for relevance and clarity. Criterion validity analysis showed intraclass correlation coefficients ranged from 0.31−0.69. Test−retest reliability coefficients ranged from 0.49−0.92, with ƙ values > 0.44. Overall Cronbach’s alpha was 0.90. In conclusion, the HCFQ is a promising tool with sound content and face validity, substantial criterion validity, and adequate reliability. This 174-item HCFQ is the first questionnaire to assess how often people cook and which cooking methods they use at home.

The Impact of a Culinary Coaching Telemedicine Program on Home Cooking and Emotional Well-Being during the COVID-19 Pandemic

The coronavirus pandemic enforced social restrictions with abrupt impacts on mental health and changes to health behaviors. From a randomized clinical trial, we assessed the impact of culinary education on home cooking practices, coping strategies and resiliency during the first wave of the COVID-19 pandemic (March/April 2020). Participants (n = 28) were aged 25–70 years with a BMI of 27.5–35 kg/m². The intervention consisted of 12 weekly 30-min one-on-one telemedicine culinary coaching sessions. Coping strategies were assessed through the Brief Coping with Problems Experienced Inventory, and resiliency using the Brief Resilient Coping Scale. Home cooking practices were assessed through qualitative analysis. The average use of self-care as a coping strategy by the intervention group was 6.14 (1.66), compared to the control with 4.64 (1.69); p = 0.03. While more intervention participants had high (n = 5) and medium (n = 8) resiliency compared to controls (n = 4, n = 6, respectively), this difference was not significant (p = 0.33). Intervention participants reported using home cooking skills such as meal planning and time saving techniques during the pandemic. The key findings were that culinary coaching via telemedicine may be an effective intervention for teaching home cooking skills and promoting the use of self-care as a coping strategy during times of stress, including the COVID-19 pandemic.

Contribution of foods prepared away from home to intakes of energy and nutrients of public health concern in adults: a systematic review

A 2011 review associated eating out with increased energy intake. Popular outlets, nutrient composition, and menus may have changed since 2011. This study aimed to investigate relative contributions of foods prepared outside of home to total energy, total and saturated fat, sugars, and sodium intakes. Studies were included if they were observational cohort or cross-sectional, investigated the contributions that foods prepared out of home made to energy, nutrient intakes and/or nutrient densities of adults aged 18-64 years, published between 2009 and 2019. Socio-demographic differences were explored. Data were extracted guided by the STROBE Statement for cohort and cross-sectional studies. A descriptive, qualitative synthesis was conducted. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists for Analytical Cross-sectional and Cohort Studies. Evidence strength was assessed using GRADE. Twenty-six studies were included. Higher consumption of foods purchased outside home increased intakes of energy and nutrients of public health concern, particularly in males and younger adults. Heterogeneity of definitions of foods prepared outside of home made comparison difficult. Studies frequently used self-reported consumption data, prone to misreporting. Foods prepared outside of home are associated with poorer diets. Policy and practice initiatives are required to address this.

Teaching Kitchens in the Learning and Work Environments: The Future Is Now

The learning and working environments of today's hospitals and health systems are designed to predict, diagnose, treat, and manage disease. However, the food environments in these settings are often extraordinarily unappealing, unhealthy, and can adversely impact the well-being of health professionals. What if future health-care sites were designed as showrooms of the most appealing and nutritious foods? What if future cafeterias included ventilated "Teaching Kitchens" as extensions to the everyday "grab and go" check-out lines? What if health-care providers, trainees, staff, and community members had access to foods that were healthy, delicious, affordable, sustainable, and easy to prepare? Most importantly, what if health professionals learned to make these healthy, delicious recipes as part of their required training? "See one, do one, teach one" could become, "See one, taste one, make one, teach one". Teaching Kitchens could serve as both learning laboratories and clinical research centers, whereby teaching kitchen curricula could be tested, through sponsored research, for their impact on behaviors, clinical outcomes, and costs. What if spaces adjacent to Teaching Kitchens were designated "Mindful Eating Spaces," where self-selected patrons could enjoy a "Culinary Feast alongside a Technological Fast" in an effort to carve out a brief oasis of mindful, resilience-building reflection during any given day? This article describes the rationale for and necessary components of such a futurist "Teaching Kitchen" within future working and learning environments. Importantly, if and when Teaching Kitchens are built within health-care settings, they may serve as catalysts of personal and societal health enhancement for all.

Home Meal Preparation: A Powerful Medical Intervention

One of the principles of culinary medicine is to help patients learn how to make nutritious eating simple and easy. In this column, you will learn tools for preparing and storing food; a key component to successful home cooking. While this article is intended to help clinicians learn about food preparation, it is also designed to be used as an educational tool for patients.

Culinary Medicine: Paving the Way to Health Through Our Forks

Recent findings reveal that suboptimal diet is responsible for more deaths than any other risk factor nationally and globally. It is estimated that with improving eating behaviors, 1 in 5 deaths can be prevented, underscoring the urgent need for effective dietary interventions.

Cooking Online With a Chef: Health Professionals' Evaluation of a Live Culinary Coaching Module

Introduction:

Cooking Online With a Chef (COWC) is a live, telemedicine module delivered by a health coach chef to participants who log in from their home kitchen. Our purpose is to identify health professionals’ perceptions on its educational value and to determine feasibility for clinical practice.

Method:

Sixty-four health care professionals participated in a 75-minute COWC module as active participants during a live remote Continuing Medical Education (CME) program that includes five 75-minute telemedicine sessions. Post-program questionnaire elicited feedback on the module educational value and relevance to clinical practice through Likert-type scale and open-ended questions. This report presents descriptive analysis of the Likert-type scale questions and thematic qualitative analysis of the open-ended question.

Results:

Seventy percent of health care professional participants rated the quality of the COWC module as either very good or excellent, and 73% rated its relevance to clinical practice as very good or excellent. Open-ended question feedback showed appreciation of the learning experience with specific suggestions about how to improve participants’ preparation for the module.

Conclusions:

The COWC telemedicine module was well received by self-selected health care professionals. Future studies are being planned to determine the efficacy of the module on patients’ nutrition.