Impact of food aid on food variety and dietary diversity of an elderly community in Sharpeville, South Africa

Socio-demographic characteristics associated with the dietary diversity of Thai community-dwelling older people: results from the national health examination survey

Background

Dietary diversity (DD) is an indicator of nutrient intake and is related to health outcomes in older people. Currently, limited research exists regarding factors associated with DD in older people in developing countries, such as Thailand, despite rapid growth in this population. Therefore, this study aims to examine the association between socio-demographic characteristics and DD in Thai older people.

Methods

A cross-sectional study based on the fifth Thai National Health Examination Survey (NHES-V) conducted between 2013 and 2015 was performed. A total of 7,300 nationally representative older participants aged ≥ 60 years were included. The individual-level dietary diversity score (DDS) was assessed as the frequency of consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4 according to the frequency of consumption. The DDS was calculated as the sum of the scores, ranging from 0 to 32. Socio-demographic characteristics, including age, sex, highest education level, wealth index, living conditions, and residential area, were assessed. Data were analyzed using multiple linear regression and adjusted for complex survey design.

Results

The participants had a mean age of 69.7 (SD 7.6) years. The mean DDS of participants was 18.4 (SD 3.9). In the adjusted model, a higher educational level, a higher wealth index, and living in an urban area were positively associated with DDS, with adjusted β (95% CI) values of 1.37 (1.04, 1.70) for secondary education or higher, 0.81 (0.55, 1.06) for the richest group, and 0.24 (0.10, 0.44) for living in an urban area. Nevertheless, living alone had negative associations with DDS, with a β (95% CI) of - 0.27 (- 0.53, - 0.00).

Conclusions

This study showed that a higher educational level, a higher wealth index, and living in an urban area had a positive association, whereas living alone had a negative association with DD among Thai older participants. Interventions aiming to improve dietary diversity among older people might benefit from targeting more vulnerable groups, particularly those with less education and wealth, those living alone, or those in rural areas.

Different Methods to Assess the Nutritional Status of Alzheimer Patients

OBJECTIVE

To assess the body composition and nutritional state of patients with Alzheimer's (Global Deterioration Scale GDS-4) using different methods and to investigate the correlation among methods.

METHODS

A total of 25 Alzheimer GDS-4 patients participated in this transversal descriptive observational study, which used anthropometry, Mini Nutritional Assessment (MNA), the Nutrition Screening Initiative Check List (NSI) and a 24-hour recall questionnaire (R24h).

RESULTS

Anthropometric observations pointed to obesity in patients of both sexes. The MNA showed that 76% of the population was "at risk of malnutrition", and the NSI suggested that 32% had a high nutritional risk, 48% had an "average" nutritional risk, and the remaining 20% a low nutritional risk. The Bland-Alman concordance plot between the NSI and MNA tests pointed to a high degree of agreement, meaning that both tests provided similar results for the group of studied subjects. The nutritional analysis, based on the Kruskal-Wallis test, showed there were significant differences between R24h and MNA in the case of ascorbic acid, iron, zinc and potassium (p < 0.05), and between R24h and NSI in the case of the double unsaturation index and vitamin D3 (p < 0.05). These results suggest that both questionnaires are equally valid for evaluating the nutritional status of Alzheimer patients.

CONCLUSION

Although the NSI and MNA tests provide similar results, we recommend an initial nutritional assessment using the NSI since it is short but provides information on any alteration in food intake as a result of restrictions and/or metabolic alterations.

Educational interventions on nutrition among older adults: A systematic review and meta-analysis of randomized clinical trials

Poor nutrition is a major risk factor for non-communicable diseases and nutritional deficiencies. Dietary interventions have been proposed to improve eating habits. The aim of this systematic review is to evaluate the efficacy of randomized clinical trials of nutritional interventions in food habits among older people. A systematic literature review using the MEDLINE, LILACS, Scopus, Cochrane Library, Web of Science and Google Scholar databases was conducted, according to PRISMA guidelines. The keywords were: food and nutrition education OR educación alimentaria y nutricional OR educação alimentar e nutricional AND clinical trial OR ensayo clínico OR ensaio clínico AND elderly OR aged OR anciano OR idoso AND human OR seres humanos. The pooled standardized mean differences (SMD) and 95 % confidence intervals (CIs) were estimated using a random-effects model. Heterogeneity among studies was assessed using I² tests. After screening based on the title and abstract, and a full-text assessment, 11 studies remained. Results of pooling eleven studies were as follows: SMD = 0.25 (95 % CI = 0.15 - 0.34; I² = 0,0%) for vegetable, SMD = 0.18 (95 % CI = 0.08 - 0.27; I² = 0,0%) for fruit and SMD = 0.27 (95 % CI = 0.18 - 0.36; I² = 58,3%) for fibre intake. Our results suggest that nutritional interventions were effective in increasing vegetable, fruit and fibre intake. However, these results should be analyzed carefully, due to the small number of studies included in the meta-analysis. Further studies should be encouraged due to the aging process.

Investigating differences in dietary patterns among a small cross-sectional study of young and old Pacific peoples in NZ using exploratory factor analysis: a feasibility study

OBJECTIVES

Obesity among Pasifika people living in New Zealand is a serious health problem with prevalence rates more than twice those of the general population (67% vs 33%, respectively). Due to the high risk of developing obesity for this population, we investigated diet quality of Pacific youth and their parents and grandparents. Therefore, we examined the dietary diversity of 30 youth and their parents and grandparents (n=34) to identify whether there are generational differences in dietary patterns and investigate the relationship between acculturation and dietary patterns.

METHODS

The study design of the overarching study was cross-sectional. Face-to-face interviews were conducted with Pasifika youth, parents and grandparents to investigate dietary diversity, that included both nutritious and discretionary food items and food groups over a 7 day period. Study setting was located in 2 large urban cities, New Zealand. Exploratory factor analyses were used to calculate food scores (means) from individual food items based on proportions consumed over the week, and weights were applied to calculate a standardised food score. The relationship between the level of acculturation and deprivation with dietary patterns was also assessed.

RESULTS

Three distinctive dietary patterns across all participants were identified from our analyses. Healthy diet, processed diet and mixed diet. Mean food scores indicated statistically significant differences between the dietary patterns for older and younger generations. Older generations showed greater diversity in food items consumed, as well as eating primarily a 'healthy diet'. The younger generation was more likely to consume a 'processed diet'. There was significant association between acculturation and deprivation with the distinctive dietary patterns.

CONCLUSION

Our investigation highlighted generational differences in consuming a limited range of food items. Identified dietary components may, in part, be explained by specific acculturation modes (assimilation and marginalised) and high socioeconomic deprivation among this particular study population.

Lifestyles in suburban populations: A systematic review

BACKGROUND

Lifestyle and suburban population are important issues in the field of health. The living conditions of informal settlements can lead to acquisition of an unhealthy lifestyle.

OBJECTIVE

This study has been designed to investigate the articles that have been published regarding lifestyle in suburban populations.

METHODS

The present research was a systematic review of studies in databases including Iranmedex, Magiran, SID, Irandoc, PubMed, Google Scholar, Science Direct and Scopus, in 2017. All Persian and English papers written from 2000 to 2017 were evaluated by two reviewers using an advanced search of the databases with keywords related to lifestyles and suburban population. After completion of the search, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to evaluate the articles.

RESULTS

In total, 19 articles were found to have addressed the lifestyle in suburban populations. The results of these studies showed an unhealthy lifestyle in the most informal settlements. There was no food diversity. Malnutrition was common, especially overweight. The majority of the people did not have enough physical activity, and smoking and alcohol consumption were common, especially in men.

CONCLUSION

Studies showed that suburban populations are among the groups that have unfavorable environmental conditions to acquiring healthy lifestyle and maintaining appropriate health. Therefore, developing infrastructure, improving health services (environment, treatment of diseases, reduction of malnutrition and infant mortality, access to safe drinking water and sanitation, improving waste disposal and recycling it), improving education and smoking prevention programs in improving lifestyle is recommended.

Improving dietary diversity of school adolescents through school based nutrition education and home gardening in Jimma Zone: Quasi-experimental design

PURPOSE

The purpose of this operational study was to assess the effectiveness school-based health and nutrition intervention supported with backyard gardening on the dietary diversity among school adolescents.

METHODS

A total of 1000 school adolescents from 10 to 19years were selected randomly. The intervention involved peer-led behavior change communication and health promotion through school media and health clubs. Data were collected at baseline, midline and end-line using structured questionnaires. Multivariable logistic regression analyses were used to determine the independent effect of interventions.

RESULTS

There was a significant increment of proportion of school children consuming diversified diet among the intervention group from 34.8% at baseline through 65.6% at midline to 74.7% at the end-line (p<0.001). Among control group, there was no change from midline (49.4%) to endline (48.8%), though there was a change from baseline (32.1%) to midline (49.4%). A significant difference of dietary diversity intake was observed between intervention and control groups at midline (F=5.64, p=0.042) and endline (F=5.85, p<0.001) survey. Being in the intervention school (OR=2.55 [1.55, 3.50]), being a boy (OR=1.75 [1.91, 2.56]) and having farmer mothers (OR=2.58 [1.01, 6.87]) were independent positive predictors of a diversified diet intake. However, having a mother who attended secondary schools were inversely associated (OR=0.25 [0.06, 0.97]) with consuming a diversified diet.

CONCLUSION

Findings of this study demonstrated that there was a significant improvement in dietary diversity of adolescents in intervention schools. The results imply that school based nutrition education should be a part of comprehensive school health programs to reach students and potentially their families.

The impact of a conditional cash transfer programme on determinants of child health: evidence from Colombia

OBJECTIVE

Conditional cash transfer (CCT) programmes provide income to low-income families in return for fulfilling specific behavioural conditions. CCT have been shown to improve child health, but there are few systematic studies of their impact on multiple determinants of child health. We examined the impact of a CCT programme in Colombia on: (i) use of preventive health services; (ii) food consumption and dietary diversity; (iii) mother's knowledge, attitudes and practices about caregiving practices; (iv) maternal employment; and (v) women's empowerment.

DESIGN

Secondary analysis of the quasi-experimental evaluation of the Familias en Accion programme. Children and families were assessed in 2002, 2003 and 2005-06. We applied a difference-in-differences approach using logistic or linear regression, separately examining effects for urban and rural areas.

SETTING

Colombia.

SUBJECTS

Children (n 1450) and their families in thirty-one treatment municipalities were compared with children (n 1851) from sixty-five matched control municipalities.

RESULTS

Familias en Accion was associated with a significant increase in the probability of using preventive care services (OR=1·85, 95 % CI 1·03, 3·30) and growth and development check-ups (β=1·36, 95 % CI 0·76, 1·95). It had also a positive impact on dietary diversity and food consumption. No effect was observed on maternal employment, women's empowerment, and knowledge, attitudes and practices about caregiving practices. Overall, Familias en Accion's impact was more marked in rural areas.

CONCLUSION

CCT in Colombia increase contact with preventive care services and improve dietary diversity, but they are less effective in influencing mother's employment decisions, empowerment and knowledge of caregiving practices.

Dietary diversity of formal and informal residents in Johannesburg, South Africa

Background

This paper considers the question of dietary diversity as a proxy for nutrition insecurity in communities living in the inner city and the urban informal periphery in Johannesburg. It argues that the issue of nutrition insecurity demands urgent and immediate attention by policy makers.

Methods

A cross-sectional survey was undertaken for households from urban informal (n = 195) and urban formal (n = 292) areas in Johannesburg, South Africa. Foods consumed by the respondents the previous day were used to calculate a Dietary Diversity Score; a score < 4 was considered low.

Results

Statistical comparisons of means between groups revealed that respondents from informal settlements consumed mostly cereals and meat/poultry/fish, while respondents in formal settlements consumed a more varied diet. Significantly more respondents living in informal settlements consumed a diet of low diversity (68.1%) versus those in formal settlements (15.4%). When grouped in quintiles, two-thirds of respondents from informal settlements fell in the lowest two, versus 15.4% living in formal settlements. Households who experienced periods of food shortages during the previous 12 months had a lower mean DDS than those from food secure households (4.00 ± 1.6 versus 4.36 ± 1.7; p = 0.026).

Conclusions

Respondents in the informal settlements were more nutritionally vulnerable. Achieving nutrition security requires policies, strategies and plans to include specific nutrition considerations.

A simple food quality index predicts mortality in elderly Taiwanese

OBJECTIVES

To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI-R) and the Dietary Diversity Score (DDS) among representative Taiwanese aged 65 and older.

DESIGN

Prospective cohort.

SETTING

The Elderly Nutrition and Health Survey in Taiwan during 1999-2000.

PARTICIPANTS

One thousand seven hundred forty three (860 men and 883 women).

MEASUREMENTS

Dietary quality measures, the ODI-R (0-100) and DDS (0-6) were based on 24-hour dietary recall and a food frequency questionnaire at baseline. Death by National Death Registry up to 2008 was the outcome measure.

RESULTS

During follow-up, 624 subjects died. The survivors had both significantly higher (P <0.001) ODI-R (66.9 vs. 63.6) and DDS (4.69 vs. 4.30) than the deceased. The two indices were correlated (r=0.46). After adjustment for potential covariates, the hazard ratios (HR) (95% CI) were 0.63 (0.42-0.97), 0.71 (0.49-1.04) and 0.53 (0.37-0.76) for those whose ODI-R scores were 60-65, 65-70, >70, respectively, compared to those whose ODI-R scores were > 50 (P for trend <0.001). For DDS, the multi-variable HRs (95% CI) were 0.74 (0.55-1.00), 0.52 (0.38-0.72) and 0.50 (0.31-0.81) for those whose DDS were 4, 5, 6, respectively, compared to those whose DDS were ≤3 (P for trend<0.001). Total cancer, diabetes mortalities and pneumonia were similarly benefited according to trends.

CONCLUSION

ODI-R ≥ 60, and DDS ≥ 4 are predictors of all-cause and cause-specific mortalities. Of the two, DDS is the more predictive. Nutrition policy could be informed and clinical practice enhanced by these population relevant food-health relationships.