Cooking at Home: A Strategy to Comply With U.S. Dietary Guidelines at No Extra Cost

[Digital educational materials on culinary skills as a health promotion strategy in Primary Health Care]

This study aims to report on the development and validation of digital educational materials based on the dimensions of home cooking skills (HCS) assessed on a scale destined for PHC professionals, following the recommendations of The Dietary Guidelines for the Brazilian Population and on The Food and Nutrition Education Framework (FNE) for Public Policies. Five videos and graphic materials were developed with proposals for activities to develop HCS and encourage its implementation in actions and guidelines in the community and in professional care. The content of the materials was evaluated by experts using the Two-Round Delphi-based technique and statistical analyses for evidence of consensus. Specialists presented comments to improve the products and their applicability. The materials presented decoded language and playful illustrations with characters representative of the target population. Evidence of satisfactory content validity was presented and can be used in permanent education actions, seeking the qualification of the workforce and in FNE actions within the scope of the law. The graphic materials make it possible to associate the content of the videos with practice in contexts consistent with the reality of the individuals.

A cooking intervention increased food literacy of students who frequently used the campus food pantry: A Pilot Program

OBJECTIVES

Students who obtain food from a campus food pantry may benefit from participating in a nutrition/cooking intervention.

PARTICIPANTS AND METHODS

Twenty-seven students 18-30 years of age attending a university in the southeastern US participated in the IRB approved study. One 2-hour class was offered each week for four weeks in the on-campus cooking laboratory. Subjects indicated how often they cooked a dinner meal at home and completed the Eating and Food Literacy Behaviors Questionnaire (EFLBQ) before and after participating in the program.

RESULTS

The total EFLBQ, Factor 1 (Health and Nutrition) and Factor 3 (Food Preparation) scores, and the frequency of cooking a dinner meal at home were all higher post-program (all p < 0.05).

CONCLUSIONS

This pilot study suggests that an on-campus cooking program can increase the food literacy and frequency of cooking meals by university students who obtained items from the campus food pantry.

Could commercial meal kits be part of the solution to food insecurity during pregnancy? An Australian exploratory study

AIM

To explore the nutritional content of meal kits from two main Australian companies over a 6-week period against healthy eating guidelines for pregnancy.

METHOD

Across the 6-week period, weekly meal kits from both Provider 1 and Provider 2 were purchased, 36 individual meals were assessed. All data were analysed for the development of a macronutrient and micronutrient profile of meals. Extracted data were macronutrient, vitamin, and mineral composition, which were compared against the healthy eating guidelines for pregnant women in Australia and New Zealand.

RESULTS

Meal kits include higher levels of sodium, and lower levels of dietary fibre, calcium, magnesium, zinc, iron, thiamin, riboflavin, grains, and dairy when compared against the guidelines for healthy eating for pregnant women in Australia and New Zealand.

CONCLUSIONS AND IMPLICATIONS

Meal kits may increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation. They have the potential to provide nutritionally adequate meals to pregnant women as a way to mitigate food insecurity or hunger during pregnancy and may provide some nutritional benefits and have the potential to remove some of the challenges with maintaining an adequate diet when pregnant.

Greater Frequency of Cooking Dinner at Home and More Time Spent Cooking Are Inversely Associated With Ultra-Processed Food Consumption Among US Adults

BACKGROUND

Cooking at home has been promoted as a strategy to improve diet quality; however, the association between cooking behavior and ultra-processed food intake is unknown.

OBJECTIVE

The objective of this study was to examine associations between frequency of cooking dinner at home and time spent cooking dinner with ultra-processed food intake.

DESIGN

Cross-sectional, nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey were analyzed.

PARTICIPANTS/SETTING

Participants were 9,491 adults (20 years and older) in the United States.

MAIN OUTCOME MEASURES

The main outcome measure was the proportion of energy intake (averaged from two 24-hour dietary recalls) from the following 4 Nova food-processing groups: (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) ultra-processed foods.

STATISTICAL ANALYSES PERFORMED

Separate linear regression models examined associations between cooking frequency and time spent cooking dinner and proportion of energy intake from the 4 Nova food-processing groups, adjusting for sociodemographic characteristics and total energy intake.

RESULTS

Ultra-processed foods comprised >50% of energy consumed independent of cooking frequency or time spent cooking. Higher household frequency of cooking dinner and greater time spent cooking dinner were both associated with lower intake of ultra-processed foods (P trends < .001) and higher intake of unprocessed or minimally processed foods (P trends < .001) in a dose-response manner. Compared with cooking 0 to 2 times/wk, adults who cooked dinner 7 times/wk consumed a mean of 6.30% (95% CI -7.96% to -4.64%; P < .001) less energy from ultra-processed foods. Adults who spent more than 90 minutes cooking dinner consumed 4.28% less energy from ultra-processed foods (95% CI -6.08% to -2.49%; P < .001) compared with those who spent 0 to 45 minutes cooking dinner.

CONCLUSIONS

Cooking at home is associated with lower consumption of ultra-processed foods and higher consumption of unprocessed or minimally processed foods. However, ultra-processed food intake is high among US adults regardless of cooking frequency.

Post hoc analysis of food costs associated with Dietary Approaches to Stop Hypertension diet, whole food, plant-based diet, and typical baseline diet of individuals with insulin-treated type 2 diabetes mellitus in a nonrandomized crossover trial with meals provided

BACKGROUND

Americans consume diets that fall short of dietary recommendations, and the cost of healthier diets is often cited as a barrier to dietary change. We conducted a nonrandomized crossover trial with meals provided utilizing 2 diets: Dietary Approaches to Stop Hypertension (DASH) and whole food, plant-based (WFPB), and thus had intake data from baseline and both intervention diets.

OBJECTIVES

Using actual diet records, describe food costs of baseline diets of individuals with type 2 diabetes (T2DM) as well as therapeutic DASH and WFPB diets.

METHODS

Three-day food records were collected and analyzed for each 7-d diet phase: baseline, DASH, and WFPB. Nutrient content was analyzed using the Nutrient Data System for Research and cost was determined using Fillet, an application to manage menu pricing. Food costs were calculated for each diet as consumed and adjusted to a standardized 1800 kcal/d. Ingredient-only costs of food away from home (FAFH) were approximated and analyzed. Costs were analyzed using linear mixed-effect models as a function of diet.

RESULTS

Fifteen subjects enrolled; 12 completed all dietary phases. The baseline, DASH, and WFPB diets, as consumed, cost $15.72/d (95% CI; $13.91, $17.53), $12.74/d ($11.23, $14.25), and $9.78/d ($7.97, $11.59), respectively. When adjusted to an 1800 kcal/d intake, the baseline, DASH, and WFPB diets cost $15.69/d ($13.87, $17.52), $14.92/d ($13.59, $16.26), and $11.96/d ($10.14, $13.78), respectively. When approximated ingredient-only costs of FAFH were analyzed, as consumed baseline [$11.01 ($9.53, $12.49)] and DASH diets [$11.81 ($10.44, $13.18)] had similar costs; WFPB diet [$8.83 ($7.35, $10.31)] cost the least.

CONCLUSIONS

In this short-term study with meals provided, the food costs of plant-predominant diets offering substantial metabolic health benefits were less than or similar to baseline food costs of adults with insulin-treated T2DM. Longer-term data without meal provision are needed for more generalizable results. This trial was registered at clinicaltrials.gov as NCT04048642.

Associations between cooking skills, cooking with processed foods, and health: a cross-sectional study

To improve health outcomes, home cooking has been suggested as a solution to reduce intakes of processed foods. However, little is known about how cooking skills or cooking with processed foods influence health. This cross-sectional study examined associations between diet and health outcomes with cooking skills and cooking with processed foods. The dataset included a nationally representative sample of 18 460 adults from Canadian Community Health Survey (CCHS) annual component rapid response modules on food skills. In the CCHS rapid response modules, diet and health outcomes (fruit and vegetable intake, general health, mental health, and obesity) and data related to cooking skills and cooking with processed foods were collected through self-report. Separate logistic regression models were fitted for each outcome, controlling for age, income, and education, and stratified by sex. Adults with poor cooking skills were less likely to have adequate fruit and vegetable intake (≥5 servings per day) (p < 0.001), very good general health (p < 0.001) or mental health (p < 0.001), and obesity (p = 0.02) compared to advanced cooking skills. Adults who cooked with highly processed foods were less likely to have adequate fruit and vegetable intake (p < 0.001), very good general health (p = 0.002) or mental health (p < 0.001), but more likely to have obesity (p = 0.03) compared to cooking with minimally processed foods. Cooking skills alone appear insufficient to protect against obesity. Results suggest that not only are cooking skills important, but the quality of ingredients also matter. Limiting the use of processed foods in addition to improving cooking skills are potential intervention targets to promote better health and diet outcomes.

Cooking behavior among mothers of children aged 2-5 years old in Kendari, Southeast Sulawesi, Indonesia

BACKGROUND

Cooking at home was associated with parental feeding practices. This study aimed to explore the interplay of components in cooking behavior of mothers with young children aged 2-5 years old in Kendari city of Southeast Sulawesi, Indonesia.

METHODS

This qualitative study involved 33 mothers from Kendari city, which was represented by each two sub-districts in coastal and mainland areas that were randomlyselected. Six focus group discussions (FGDs) were carried out using 20-item guide questions. The guide questions were developed following the Model of Goal-Directed Behavior (MGDB) theory approach exploring the components of cooking behavior i.e., skill, intention, desire, confidence, and attitude in cooking. Data analysis was performed in the field to assist decision on data saturation, followed by data analysis at desk through multilevel coding from the verbatim transcripts using NVivo R1 software. The data was analyzed thematically using pre-determined themes according to the MGDB theory. Emerging topics on enabling factors and constraints were captured to enhance our understanding of the complexity of cooking behavior.

RESULTS

The mothers' mean age was about 30 years old with a comparable representation of younger and older mothers. Most mothers were housewives and accomplished secondary school level. The mothers' intention was shown as they frequently cooked at home and allocated time for cooking. The enabling factors included their knowledge about food and nutrition, food source availability, their confidence in cooking meals and following recipes, and their motivation to keep their children healthy representing some intrinsic factors. The main constraint was the lack of skill to make snacks. The other extrinsic barriers were dependence on mobile food sellers and the availability of food kiosks that facilitated children's snack preferences.

CONCLUSION

The study obtained some insights that mothers had favorable cooking intention and desire, were supported with a confidence in some basic cooking skills. However, the existing constraints that encouraged the development of unfavorable children's snacking habit were beyond the mothers' control. A cookbook specifically for snack recipes that utilizes local ingredients may assist mother in preparing more healthier options for the children.

Associations Between Household Frequency of Cooking Dinner and Ultraprocessed Food Consumption and Dietary Quality Among US Children and Adolescents

Introduction: Dietary quality is poor and intake of ultraprocessed foods (UPFs) is high among children and adolescents in the United States. Low dietary quality and high UPF intake are associated with obesity and higher risk of diet-related chronic diseases. It is unknown whether household cooking behavior is related to improved dietary quality and lower consumption of UPFs among US children and adolescents. Methods: Nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey (n = 6032 children and adolescents ≤19 years of age) were used to examine the relationships between household cooking frequency of evening meals and children's dietary quality and UPF intake using multivariate linear regression models adjusted for sociodemographics. Two 24-hour diet recalls were used to assess UPF intake and dietary quality [Healthy Eating Index-2015 (HEI-2015)]. Food items were categorized according to Nova classification to obtain the UPF percent of total energy intake. Results: A higher household frequency of cooking dinner was associated with lower UPF intake and higher overall dietary quality. Compared to children in households cooking dinner 0-2 times per week, children in households cooking dinner 7 times/week had lower intake of UPFs [β = -6.30, 95% confidence interval (CI) -8.81 to -3.78, p < 0.001] and marginally higher HEI-2015 scores (β = 1.92, 95% CI -0.04 to 3.87, p = 0.054). The trends toward lower UPF intake (p-trend <0.001) and higher HEI-2015 scores (p-trend = 0.001) with increasing cooking frequency were significant. Conclusions: In this nationally representative sample of children and adolescents, more frequent cooking at home was associated with lower intake of UPFs and higher HEI-2015 scores.

Associations between cooking self-efficacy, attitude, and behaviors among people living alone: A cross-sectional survey analysis

Cooking-related literacy and attitudes may play important roles in preventing and reducing diet-related chronic diseases and nutrition disparities. People living alone are an under-researched but growing population who face above average food insecurity rates. This study's objectives were to 1) test how cooking self-efficacy and attitude are stratified demographically among a sample of people living alone, focusing on variations across gender, age, and food security, and 2) examine how cooking self-efficacy and attitude are associated with two indicators of cooking behavior - cooking frequency and convenience orientation. We draw from a cross-sectional survey analysis of 493 adults living alone in Illinois, USA with validated measures for cooking self-efficacy, attitude, frequency, convenience orientation, and demographic characteristics. Hierarchical linear regression models were used to examine demographic factors explaining variation in self-efficacy and attitude, with attention to interactions between gender, food insecurity, and age. Poisson and OLS linear regression models were used to examine associations between self-efficacy and attitude and cooking frequency and convenience orientation. We find cooking-related self-efficacy and attitude showed strong but distinct associations with cooking frequency and convenience orientation. Overall, food insecure groups had lower self-efficacy than those who were food secure; however, food insecure women had higher self-efficacy than men in similar positions, apart from older-adult women who held particularly low efficacy. Cooking attitudes varied in small ways, notably with food insecure younger and older women possessing more negative cooking attitudes than middle-aged women. This research highlights the importance of understanding the cooking-related orientations of single-living people, while demonstrating that this group's ability to prevent and manage food insecurity is not uniform. These results can inform targeted interventions around food and nutrition insecurity, cooking attitudes, and self-efficacy among single-living populations.

Designing a Digital Culinary Education Intervention for Parents With Low Income

OBJECTIVE

To examine cooking practices, online information-seeking habits, and intervention preferences among parents with low income to inform the development of a digital cooking intervention on the basis of the Healthy Cooking Index.

METHODS

This formative research study included a brief survey followed by in-depth interviews (from February to April, 2021) with parents of a child aged 6-11 years with low income (n = 20; 100% female, 70% African American or Hispanic White). Interview transcripts were analyzed using a semistructured hybrid coding approach.

RESULTS

Three main themes were identified to inform the development of the intervention: (1) current Healthy Cooking Index behaviors, (2) preferences for digital cooking intervention content, and (3) design and delivery preferences. A 7-step process was used to develop the intervention and integrate qualitative findings.

CONCLUSIONS AND IMPLICATIONS

Online culinary programs targeting parents with low income may consider short, mobile-friendly video formats and focus on easy-to-prepare recipes adaptable to family preferences.

Home-prepared meals among college students at-risk for food insecurity: A mixed-methods study

The ability to prepare meals at home is an important life skill with potential to improve dietary quality and reduce costs and thus may be particularly important for college students with food insecurity. However, heavy time demands, limited financial resources, and therefore other barriers such as lack of motivation to follow a healthy diet may constrain meal preparation skills. To gain greater insight into this issue, we conducted a mixed-methods study. The quantitative component assessed relationships among food security, motivation, and meal preparation skills. The qualitative component used focus groups to more closely consider college students' perceptions, values, and barriers surrounding preparing meals at home, including current practices, desired future practices, and the ways in which the campus could support their efforts. The survey (n = 226) assessed food security, meal preparation skills, and motivation (i.e., perceived ability and willingness) to consume a healthy diet. Ten focus groups (n = 60) discussed food choice, meal preparation practices, and ways in which the campus could help students develop meal preparation skills. Students with food insecurity had lower meal preparation skills and lower perceived ability to consume a healthy diet. However, a) willingness to consume a healthy diet and b) the impact of both willingness and perceived ability did not differ by food security status. Focus group data indicated that in-person and online cooking classes, information cards in the food pantry, and incentives (e.g., kitchen equipment and vouchers from local grocery stores) were popular ideas for improving home-meal preparation. A greater understanding of meal preparation skills and their interconnectedness to food choice and the campus environment may inform effective ways to support the ability and willingness of college students with food insecurity to prepare meals at home.

Real-time predictors of food parenting practices and child eating behaviors in racially/ethnically diverse families

BACKGROUND

Prior research has shown associations between controlling food parenting practices (e.g., pressure-to-eat, restriction) and factors that increase risk for cardiovascular disease in children (e.g., low diet quality, obesity). This study aimed to examine associations between real-time parental stress and depressed mood, food parenting practices, and child eating behaviors in a longitudinal cohort study.

METHODS

Children ages 5-9 years and their families (n = 631) from six racial/ethnic groups (African American, Hispanic, Hmong, Native American, Somali/Ethiopian, White) were recruited for this study through primary care clinics in a large metromolitan area in the US (Minneapolis/St. Paul, MN) in 2016-2019. Ecological momentary assessment was carried out over seven days with parents at two time points, 18 months apart. Adjusted associations between morning stress and depressed mood of parents on food parenting practices and child eating behaviors at the evening meal were examined. Interactions tested whether food security, race/ethnicity and child sex moderated associations.

RESULTS

High levels of parental stress and depressed mood experienced earlier in the day were associated with controlling food parenting practices and child food fussiness at dinner the same night. Results were dependent on food security status, race/ethnicity, and child sex.

CONCLUSIONS

Health care professionals may want to consider, or continue, screening parents for stress, depression, and food insecurity during well-child visits and discuss the influence these factors may have on food parenting practices and child eating behaviors. Future research should use real-time interventions such as ecological momentary intervention to reduce parental stress and depressed mood to promote healthy food parenting practices and child eating behaviors.

Diet Quality and Its Association with Lifestyle and Dietary Behaviors among Croatian Students during Two COVID-19 Lockdowns

The present study aims to assess the diet quality, the relationship between diet quality and lifestyle, and the association of diet quality with body mass index and students' field of study during COVID-19 lockdown periods (spring and winter) in 2020. Datasets were collected via an anonymous online self-reported questionnaire distributed during two time periods using social media. A total of 1939 Croatian students (82.4% women and 17.6% men) completed the questionnaire. Diet quality was assessed using the pro-healthy diet index (pHDI) and non-healthy diet index (nHDI). An increase in diet quality was noted during both lockdown periods but was lower during the winter lockdown. Cooking for oneself was associated with a high level of pHDI, while ordering or buying ready-to-eat food was linked to a low level of pHDI. Additionally, a decrease in screen time and increased physical activity was associated with high pHDI values. Furthermore, during both lockdown periods, students with a BMI above 30 kg/m² had the highest nHDI values compared to other students. Although positive changes were found during both lockdown periods, they were less pronounced throughout the winter lockdown. Further studies are needed to elucidate the real impact of these changes in the post-COVID period.

What's in a commercial meal kit? Structured review of Australian meal kits

OBJECTIVE

The aim of this project is to review the products and recipes contained within popular subscription meal kits to determine if they are suitable for wider use among people who are food insecure.

DESIGN

Across the 6-week period, weekly meal kits from both HelloFresh and Markey Spoon were purchased, resulting in thirty-six individual meals that were prepared and assessed. Meals were assessed based on the content included in the meal kit compared with the recipe card and the nutrition panel, the costs of the individual foods if purchased at one of two major supermarkets and the ease of preparation.

SETTING

Australia.

PARTICIPANTS

Households were comprised of two, 2-person households who were provided with 2 meals each week, and two, single-person households who were provided with one meal each week.

RESULTS

The findings of this research suggest that while the meal kits are convenient and, in general, the recipes are easy to follow, and the meals would be made again, the high levels of salt and fat may preclude these kits from regular inclusion in a healthy diet. The meal kits were also found to be more costly than the same ingredients if purchased from a major supermarket. However, the convenience of having most of the foods needed to prepare a full meal with little to no wastage may counterbalance this cost.

CONCLUSIONS

Meal kits may be a useful component of a healthy diet, that can increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation.

Sociodemographic Variation in Children's Health Behaviors During the COVID-19 Pandemic

Background: Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, how they vary by sociodemographic characteristics, and the extent to which parent coping strategies mitigate the impact of pandemic-related financial strain on these behaviors. Methods: This study used pooled data from 50 cohorts in the Environmental influences on Child Health Outcomes Program. Children or parent proxies reported sociodemographic characteristics, health behaviors, and parent coping strategies. Results: Of 3315 children aged 3-17 years, 49% were female and 57% were non-Hispanic white. Children of parents who reported food access as a source of stress were 35% less likely to engage in a higher level of physical activity. Children of parents who changed their work schedule to care for their children had 82 fewer min/day of screen time and 13 more min/day of sleep compared with children of parents who maintained their schedule. Parents changing their work schedule were also associated with a 31% lower odds of the child consuming sugar-sweetened beverages. Conclusions: Parents experiencing pandemic-related financial strain may need additional support to promote healthy behaviors. Understanding how changes in parent work schedules support shorter screen time and longer sleep duration can inform future interventions.

Complex, Varied and Evolving Manifestations of Food Agency in Daily Life Among Diabetes Prevention Program Participants in Baltimore, Maryland

OBJECTIVE

To characterize food agency (one's capacity to procure and prepare food in particular contexts) among Diabetes Prevention Program (DPP) participants and gather perspectives about experiences with DPP.

DESIGN

Photograph-elicitation in-depth interviews and survey measures.

SETTING

Baltimore, Maryland (June-August 2021).

PARTICIPANTS

Black women (n = 13) who participated in DPP.

PHENOMENON OF INTEREST

Food agency and strategies used to procure and prepare food and the influence of DPP on daily food behaviors. Surveys measured food agency using the Cooking and Food Provisioning Action Scale and cooking behaviors.

ANALYSIS

Thematic analysis of qualitative in-depth interviews and descriptive statistics for quantitative measures.

RESULTS

As quantitative and qualitative data revealed, participants were frequent and confident cooks with high food agency. Participants viewed cooking as a key strategy for healthy eating and desired more hands-on cooking instruction within DPP to develop new healthy cooking skills. The primary barriers identified were related to lack of time or energy. Food procurement and preparation practices shifted over time, and DPP was a key influence on current behaviors.

CONCLUSIONS AND IMPLICATIONS

Food agency is complex and manifests heterogeneously in daily life. A life course, contextual, and food agency-based approach could be considered for future diabetes prevention interventions.

Patterns of home cooking practices among participants in a behavioral weight loss program: A latent class analysis

Cooking education is a popular approach to health promotion; however, the relationship between specific cooking practices, diet and weight loss is not well understood. The goal of this study was to 1) evaluate the relationship between cooking practices, dietary behaviors, and weight loss after a weight loss intervention and 2) identify patterns of cooking practices and their implications on weight loss. Using a quasi-experimental, single-arm cohort study design, we analyzed data from 249 adults with overweight/obesity who were participating in a weight loss program. Participants self-reported demographics, height and weight, and diet and physical activity behaviors. The Health Cooking Questionnaire 2 (HCQ2) was used to collect information on cooking practices post intervention. The HCQ2 responses were used to generate Healthy Cooking Index (HCI) scores, a summative measure of cooking practices with the potential to influence health. Latent Class Analysis (LCA) was utilized to define distinct patterns of cooking behaviors. Cooking patterns and HCI scores were examined relative to participant demographics, dietary behaviors, and weight loss. HCI scores post-intervention were positively associated with age, weight loss, and favorable dietary behaviors in this study. The LCA revealed three distinct patterns of cooking behavior (Red Meat Simple, Vegetarian Simple, Health & Taste Enhancing). The Red Meat Simple cooking pattern was associated with less weight loss compared to other patterns. The findings of this study set the foundation for more research on cooking education as a method for improving weight loss outcomes in the context of behavioral interventions.

Results from the Strong Families Start at Home/Familias Fuertes Comienzan en Casa: feasibility randomised control trial to improve the diet quality of low-income, predominantly Hispanic/Latinx children

OBJECTIVE

To describe the feasibility, acceptability and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention.

DESIGN

Pilot randomised controlled trial.

SETTING

Participants received six visits with a community health worker trained in motivational interviewing (three home visits, three phone calls); an in-home cooking or reading activity; personalised feedback on a recorded family meal or reading activity; text messages and tailored printed materials.

PARTICIPANTS

Parents and their 2-5-year-old child were randomised into intervention (responsive food parenting practices/nutrition) or control (reading readiness) groups.

RESULTS

Parents (n 63) were mostly mothers (90 %), Hispanic/Latinx (87 %), born outside the USA (62 %), with household incomes <$25 k (54 %). Despite delivery during COVID-19, 63 % of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group (n 24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component Healthy Eating Index-2015 scores (point estimate (PE) = 2·14, 95 % CI (0·17, 1·48); PE = 1·71, 95 % CI (0·16, 1·47), respectively) and negative treatment effects for sodium (PE = -2·09, 95 % CI (-1·35, -0·04)). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE = 1·08, 95 % CI (0·61, 2·00)), reducing distractions during mealtimes (PE = -0·79, 95 % CI (-1·52, -0·19)), using food as a reward (PE = -0·54, 95 % CI (-1·35, -0·04)) and providing a supportive meal environment (PE = 0·73, 95 % CI (0·18, 1·51)).

CONCLUSION

Given the continued disparities in diet quality among low-income and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.

Building Flavor and Confidence in the Kitchen: A Pilot Virtual Cooking Class on Healthy Snacking

Cooking meals at home is associated with more healthful eating and even other healthy behaviors, such as increased physical activity, but for many there are numerous barriers to making this a reality. Healthy teaching kitchen interventions aim to help patients overcome these barriers. Our pilot program worked to address this issue by demonstrating the feasibility and acceptability of a virtual culinary medicine session designed for outpatient clinic patients. Participants were recruited from a single community primary care clinic for a virtual culinary medicine session. Of the 29 subjects who attended the class, 13 (45%) filled out the pre-course survey, and 8 (26%) filled out the post-course survey. Average participant confidence in preparing snacks at home from fresh ingredients increased from 3.62 to 4.38 out of 5 after attending this session, though the results were not statistically (OR .47; P = .172; 95% CI .16 to 1.3). Post-participation comments were overwhelmingly positive. This study showed that a virtual cooking class is feasible in a community clinic setting and is positively received. In addition, a culinary class teaching healthy cooking techniques paired with nutrition training may improve patient's confidence in the kitchen.

Cooking at home to retain nutritional quality and minimise nutrient losses: A focus on vegetables, potatoes and pulses

Cooking at home has experienced a decline in many countries since the mid-20th century. As rates of obesity have increased, there has been an emphasis on more frequent home cooking, including its incorporation into several food-based dietary guidelines around the world as a strategy to improve dietary quality. With the recent trend towards the adoption of diets richer in plant-based foods, many consumers cooking at home may now be cooking plant foods such as vegetables, potatoes and pulses more often. It is, therefore, timely to explore the impact that different home cooking methods have on the range of nutrients (e.g. vitamin C and folate) and bioactive phytochemicals (e.g. carotenoids and polyphenols) that such plant foods provide, and this paper will explore this and whether advice can be tailored to minimise such losses. The impact of cooking on nutritional quality can be both desirable and/or undesirable and can vary according to the cooking method and the nutrient or phytochemical of interest. Cooking methods that expose plant foods to high temperatures and/or water for long periods of time (e.g. boiling) may be the most detrimental to nutrient content, whereas other cooking methods such as steaming or microwaving may help to retain nutrients, particularly those that are water-soluble. Dishes that use cooking liquids may retain nutrients that would have been lost through leaching. It may be helpful to provide the public with more information about better methods to prepare and cook plant foods to minimise any nutrient losses. However, for some nutrients/phytochemicals the insufficient and inconsistent research findings make clear messages around the optimal cooking method difficult, and factors such as bioaccessibility rather than just quantity may also be important to consider.

Food Insecurity and Less Frequent Cooking Dinner at Home Are Associated with Lower Diet Quality in a National Sample of Low-Income Adults in the United States during the Initial Months of the Coronavirus Disease 2019 Pandemic

BACKGROUND

Food insecurity is a critical public health problem in the United States that has been associated with poor diet quality. Cooking dinner more frequently is associated with better diet quality.

OBJECTIVE

This study aimed to examine how food insecurity and dinner cooking frequency are associated with diet quality during the initial months of the coronavirus disease 2019 pandemic.

DESIGN

This cross-sectional study analyzed data from a national web-based survey (June 23 to July 1, 2020).

PARTICIPANTS/SETTING

Participants were 1,739 low-income (<250% of the federal poverty level) adults in the United States.

MAIN OUTCOME MEASURES

The outcome was diet quality, measured by the Prime Diet Quality Score (PDQS-30D). The PDQS-30D is a food frequency questionnaire-based, 22-component diet quality index.

STATISTICAL ANALYSES PERFORMED

Food security status (high, marginal, low, or very low) and frequency of cooking dinner (7, 5 to 6, 3 to 4, or 0 to 2 times/week) were evaluated in relation to PDQS-30D scores (possible range = zero to 126) in age- and sex and gender-, and fully adjusted linear regression models. Postestimation margins were used to predict mean PDQS-30D score by food security status and dinner cooking frequency. The interaction between food security status and frequency of cooking dinner was also tested.

RESULTS

Overall, the mean PDQS-30D score was 51.9 ± 11 points (possible range = zero to 126). The prevalence of food insecurity (low/very low) was 43%, 37% of the sample cooked 7 times/week and 15% cooked 0 to 2 times/week. Lower food security and less frequent cooking dinner were both associated with lower diet quality. Very low food security was associated with a 3.2-point lower PDQS-30D score (95% CI -4.6 to -1.8) compared with those with high food security. Cooking dinner 0 to 2 times/week was associated with a 4.4-point lower PDQS-30D score (95% CI -6.0 to -2.8) compared with cooking 7 times/week. The relationship between food insecurity and diet quality did not differ based on cooking dinner frequency.

CONCLUSIONS

During the initial months of the coronavirus disease 2019 pandemic food insecurity and less frequently cooking dinner at home were both associated with lower diet quality among low-income Americans. More research is needed to identify and address barriers to low-income households' ability to access, afford and prepare enough nutritious food for a healthy diet.

Definitions and Assessment Methods of ‘Home Cooking’ in Studies with Dietary Variables: A Scoping Review

Home cooking is a complex idea that involves multiple skills and behaviors and can be interpreted differently. Using six databases (two of which were Japanese), this scoping review examined the definitions and methods used in studies investigating the relationship between home cooking and dietary variables. Of the 40 studies (2 in Japanese) included in this review, 8 provided definitions but did not specify the extent or level that convenience foods can be allowed in food preparation. The methods were classified into two categories, namely, perception-dependent (n = 29) if using a self-reported instrument, or perception-independent (n = 11) if based on investigators’ classification. Subsequently, indicators of home cooking were classified based on survey attributes (e.g., frequency, location). All but five studies used single indicators, primarily the preparation frequency (n = 18). Quality of analysis was also evaluated. Studies that used multiple indicators or perception-independent methods showed high or moderate overall quality. In contrast, studies that used single indicators based on perception-dependent methods tended to have a low overall quality. The consistency of the relationship between home cooking and dietary variables depended on study quality. In conclusion, the definitions of home cooking were inconsistent across studies, and lacked consensus for examining the association between dietary outcomes.

The Effect of the COVID-19 Pandemic on Saudi Adults' Behavior Regarding Food Literacy and Food Consumption

Background

The coronavirus pandemic has forced worldwide closures, especially of restaurants closed, which partly contributed to people all over the world changing the way they choose and prepare foods.

Objective

The objective of this study was to compare changes in behavioral food literacy (planning, selecting, and preparing food) and food consumption before and during the COVID-19 crisis in the Kingdom of Saudi Arabia (KSA).

Design

This was a cross-sectional study, with data from an online survey made in UAntwerpen Qualtrics Accounts and collected from April-June 2020. The study was part of the International Corona Cooking Survey.

Results

There were 2788 respondents (83%, n = 2323 females) who reported that the COVID-19 home lockdown had positively affected all their behavioral food literacy components (all p<0.05) except feeling confident about cooking a variety of healthy meals in which the difference was not significant (p>0.05); however, its impact on their food consumption was varied. There was a noticeable positive increase in fruit intake (Z= -3.330, p=0.001) and a noticeable positive decrease in processed meat (Z= -11.375, p<0.001) and sweetened drinks consumption (Z= -2.403, p<0.05). There were simultaneously noticeable adverse effects represented in the reduction in the consumption of the vegetable group (Z= -3.447, p=0.001) and an increase in sweets consumption (Z= -2.268, p<0.05). However, the overall impacts of these changes as measured by the Hedges’ g measure indicated a small effect (Hedges’ g = 0.04, 95% CI (-0.07, -0.16)).

Discussion and conclusions

Even though the pandemic may have created a sense of responsibility for one's health and increased people's nutritional awareness, the Saudi population may be still a long way from having healthy eating habits. Public health campaigns need to increase the population's level of nutritional awareness, educate them about the meaning of healthy eating, and how they can achieve that by advocating the national dietary guidelines and providing reliable and accurate information by authorized official bodies.

Consumer behavior during the COVID-19 pandemic: An analysis of food purchasing and management behaviors in U.S. households through the lens of food system resilience

The COVID-19 pandemic has stimulated considerable interest in the resilience of the U.S. food system. Less attention has been paid to the resiliency characteristics of the final link in the food system - individual households. We use national survey data from July 2020 to understand the food acquisition, preparation, and management strategies that households implemented in response to the pandemic. We find a substantial increase in the amount of food prepared and consumed at home which scales with respondents' time availability, perceived risks of dining out, and pandemic-induced income disruption. We then identify several household responses to support this increase in home food consumption that are in line with practices suggested to enhance resiliency at other links in the food supply chain, including increased cold storage capacity and enhanced in-house capability via improved cooking and food management skills. We discuss how responses such as improved food skills can reduce the propagation of shocks through the supply chain by allowing greater flexibility and less waste, while actions such as increased home cold storage capacity could undermine system resilience by exacerbating bullwhip effects, i.e., amplifying consumer demand shocks that are propagated to upstream food supply chain actors.

Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation

Guidelines recommend primary care providers refer children with obesity to behavioral interventions, but given limited program availability, access, and parental engagement, referrals remain rare. We developed telehealth coaching interventions for families whose children received care at a health system in Pennsylvania, United States in 2019-2020. Intervention referrals were facilitated by the pediatrician and/or project team for 6–12-year-old children with obesity following well-child visits. Participants chose one of three 26-week interventions focused on healthy eating, physical activity, or a hybrid clinical/nutrition intervention. Interventions engaged parents as change agents, enhancing self-efficacy to model and reinforce behavior and providing resources to help create a healthy home environment. We enrolled 77 of 183 eligible parent/child dyads. We used mixed methods to evaluate the interventions. Repeated measures models among participants showed significant reductions in obesogenic nutrition behaviors post-intervention and at 1-year follow-up, including a reduction in sugar-sweetened beverage intake of 2.14 servings/week (95% confidence interval: −3.45, −0.82). There were also improvements in obesoprotective nutrition behaviors (e.g., frequency of family meals, parental self-efficacy related to meal management). One year post-baseline, we observed no significant differences in changes in body mass index (BMI) z-scores comparing child participants with matched controls. Given potential impacts of COVID-19 community restrictions on study outcomes, we conducted qualitative interviews with 13 participants during restrictions, which exemplified how disrupted routines constrained children’s healthy behaviors but that intervention participation prepared parents by providing cooking and physical activities at home. Findings support the potential of a telehealth-delivered nutrition intervention to support adoption of healthy weight behaviors.

Multisite Medical Student-Led Community Culinary Medicine Classes Improve Patients' Diets: Machine Learning-Augmented Propensity Score-Adjusted Fixed Effects Cohort Analysis of 1381 Subjects

Background. Healthy diet represents one of the largest single modifiable risk factors proven to decrease rates of obesity and associated chronic disease, but practical approaches to improving dietary habits through nutritional intervention are limited. Objective. To evaluate the effectiveness of a medical student-led, 6-week culinary course on participants' dietary knowledge and behaviors, particularly focusing on the tenets of the Mediterranean diet (MedDiet). Design. This study is a prospective multisite cohort study evaluating the effects of a 6-week, hands-on community culinary education course offered at 3 sites. Participants' knowledge of cooking skills, eating habits, and adherence to the MedDiet were evaluated using a survey prior to beginning and 6 weeks after the completion of the course. Analysis was conducted using multivariable regression to assess subjects' diets, associated behaviors, and nutrition beliefs according to the number of classes to which they were exposed (0 to >6). Statistical results were then compared with the machine learning results to check statistical validity after selection of the top-performing algorithm from 43 supervised algorithms using 10-fold cross-validation with performance assessed according to accuracy, root relative square error, and root mean square error. Results. Among the 1381 participants, cooking classes significantly improved patients' overall 9-point MedDiet adherence (β = 0.62, 95% CI 0.23-1.00, P = .002). Participants were more likely to meet MedDiet point requirements for fruit intake (odds ratio [OR] 2.77, 95% CI 1.46-5.23, P = .002), vegetable intake (OR 4.61, 95% CI 1.85-11.53, P = .001), legume intake (OR 2.48, 95% CI 1.45-4.26, P = .001), and olive oil use (OR 2.87, 95% CI 1.44-5.74, P = .003), and were less likely to believe that cooking takes excessive time (OR 0.31, 95% CI 0.16-0.59, P < .001). Conclusion. Hands-on culinary education courses were associated with increased MedDiet adherence and improved knowledge of healthful eating. Such interventions thus represent a cost-effective option for addressing rates of obesity and obesity-related chronic illness.

Analysis of the Correlation between Meal Frequency and Obesity among Chinese Adults Aged 18-59 Years in 2015

This study aimed to investigate the relationship between meal frequency and obesity in Chinese adults aged 18 to 59 years. The data came from the 2015 Chinese Adult Chronic Disease and Nutrition Surveillance (CACDNS 2015) and provincial dietary environment data from the 2015 National Statistical Yearbook. A total of 34,206 adults aged 18 to 59 who took part in the diet survey were selected as the study participants. A two-level multivariate logistic regression model was used to adjust for the socioeconomic and nutritional status of individuals. For parameter estimation, a numerical integral approach was used to analyze the relationship between meal frequency (including meals at home, the workplace or school dining halls, and eating away from home) and obesity. A two-level “provincial−individual” logistic multivariate regression analysis was performed with obesity as the dependent variable. The two-level multivariate analysis of variance model fitting results showed that after adjusting for the effects of gender, age, occupation, education, marital status, family per capita annual income, provincial gross domestic product (GDP), restaurant industry turnover, consumer price index of EAFH food, and energy intake, the frequency of eating at home was not associated with obesity (all p > 0.05); the frequency of eating at dining halls ≥1 to <2 times per day (OR = 0.784, p = 0.0122) showed a negative association with obesity; the frequency of eating away from home < 1 times per day and ≥1 to <2 times per day were positively correlated with obesity (<1 time per day: OR = 1.123, p = 0.0419; ≥1 to <2 times per day: OR = 1.249, p = 0.0022). The results of the two-level random-intercept logistic multivariate mixed-effects prediction model for obesity in adults aged 18 to 59 years showed that no statistical association was noticed between the frequency of eating at home and obesity in adults aged 18 to 59 years. However, adults who ate out < 1 time and ≥1 to <2 times a day showed higher risks of obesity than those who did not eat out, with OR = 1.131 (95% CI 1.012−1.264) and OR = 1.258 (95% CI 1.099−1.440), while adults who ate at school and workplace dining halls ≥1 to <2 times a day may have a reduced risk of obesity, with OR = 0.790 (95% CI 0.656−0.951). This result could not be found based on the definition of eating out in previous studies. Therefore, it is recommended to exclude nonprofit collective canteens such as school and workplace dining halls from the definition of eating away from home, and to redefine eating out in terms of health effects. At the same time, it is also recommended to strengthen collective nutritional interventions around canteens, improve the nutritious meal system in school and workplace canteens, and create healthy canteens.

Life before and after COVID-19: The 'New Normal' Benefits the Regularity of Daily Sleep and Eating Routines among College Students

After the COVID-19 lockdown, a 'new normal' was established, involving a hybrid lifestyle that combined face-to-face with virtual activity. We investigated, in a case-control study, the impact of the 'new normal' on daily sleep and eating routines, compared with pre-pandemic conditions. To do this, we propose using social and eating jet lag as markers of the regularity in daily routines. Additionally, we studied whether the 'new normal' had an impact on the body mass index (BMI), diet quality, and other health-related variables. This study included 71 subjects in the pre-pandemic group, and 68 in the 'new normal' group (20-30 years). For all participants, we evaluated social and eating jet lag, BMI, diet and sleep quality, eating behaviors, physical activity, and well-being. General linear models were used to compare outcome variables between pre-pandemic and 'new normal' groups. The results revealed that the 'new normal' was associated with greater regularity in daily sleep and eating routines (-0.7 h of social jet lag (95% CI: -1.0, -0.4), and -0.3 h of eating jet lag (95% CI: -0.5, -0.1)), longer sleep duration on weekdays (1.8 h (95% CI: 1.5, 2.2)), and lower sleep debt (-1.3 h (95% CI: -1.7, -0.9)). Regarding BMI and other health-related variables, we observed that these variables were similar between 'new normal' and pre-pandemic groups. These findings indicate that the 'new normal' had a positive impact on daily sleep and eating routines. Additionally, our results indicated that the 'new normal' offered college students a more sustainable lifestyle, which was associated with more hours of sleep during the week and lower sleep debt. This, in the long run, could have a positive impact on BMI and overall health.

Cooking at Home, Fast Food, Meat Consumption, and Dietary Carbon Footprint among US Adults

Shifting consumer behavior towards more sustainable diets can benefit environmental sustainability and human health. Although more frequent home cooking is associated with a better diet quality and fast-food consumption with worse diet quality, the environmental impact of diets based on frequency of cooking or eating fast food is not well understood. The objective of this study was to investigate whether the frequency of cooking dinner at home or eating fast food is associated with dietary greenhouse gas emissions (GHGE). We linked 24-h dietary recall data from adult respondents in the 2007-2010 National Health and Nutrition Examination Survey (NHANES) (N = 11,469) to a database of GHGE factors to obtain a measure of dietary GHGE (kgCO2-eq/2000 kcal) (the sum of emissions released in the production of food for an individual's diet), adjusted by energy intake (kgCO2-eq/2000 kcal). We examined associations between frequency of cooking dinner (the only meal for which cooking frequency was measured), frequency of eating fast food, and dietary GHGE and protein sources (beef, pork, poultry, other meat, and fish and seafood (g/2000 kcal)) using generalized linearized regression models that controlled for age, sex, and other socio-economic characteristics. Greater cooking frequency was associated with higher dietary GHGE. In fully adjusted models, cooking 5-6 times/week was associated with an additional 0.058 kgCO2-eq/2000 kcal (SE 0.033) and cooking 7 times/week was associated with an additional 0.057 kgCO2-eq/2000 kcal (SE 0.027) when compared to cooking 0-2 times/week. Individuals in households who cooked dinner more frequently consumed significantly more meat, poultry, and fish (cooking 7 times/week: 148.7 g/2000 kcal vs. cooking 0-2 times/week: 135.4 g/2000 kcal, p-trend = 0.005), which could explain the association with a higher carbon footprint diet. There were few associations of note between fast-food frequency and GHGE. Policies and interventions that reduce consumption of meat and increase consumption of plants when both cooking meals at home and eating meals out are needed to shift toward diets that will be beneficial for both human health and the health of the planet.

Losses, Gains, and Changes to the Food Environment in a Rural Kentucky County during the COVID-19 Pandemic

The COVID-19 pandemic has caused alterations to be made in the way many people access, prepare, and consume food. Rural communities are particularly impacted due to pre-existing structural vulnerabilities, i.e., poverty, lack of infrastructure, and limited fresh food options. This study aimed to characterize experiences of one rural Appalachian community's changes to the food environment during the pandemic. In April 2021, six focus groups were conducted with residents of Laurel County, Kentucky. Using grounded theory, we identified losses, gains, and overall changes to the community food environment since the onset of COVID-19. Seventeen Laurel Countians (17 female; ages 30-74) participated in the six focus groups. Three main themes emerged regarding food environment changes-(1) modifications of community food and nutrition resources, (2) expansion and utilization of online food ordering, and (3) implications of the home food environment. Rural communities faced considerable challenges during the COVID-19 pandemic, in part, due to gaps in existing infrastructure and loss of pre-existing resources. This study illustrates the complexity of changes occurring during COVID-19. Using the preliminary data obtained, we can better understand pre-existing issues in Laurel County and suggestions for future programming to address the inequitable access and response during public health emergencies and beyond.

Exploring the Ingredient Choices and Maximum Budget for Fresh Food Boxes in Taiwan

Fresh food boxes have been popular in many countries for providing convenience and supporting local production, while the convenient access of various market channels in Taiwan makes it difficult to develop. The COVID-19 events shed light on the opportunity to promote fresh food boxes. Due to the complexity of consumer preferences, it is important to investigate the market opportunity of fresh food boxes. A total of 748 valid survey data were collected throughout Taiwan from July to September in 2019. The analysis of variance and interval regression model with random utility theory was adopted to explore food product preferences and to elicit the maximum budget for the fresh food box. Results show that marrow vegetables, fruits, and meats are the major categories that must be included in the list of the fresh food box. The average maximum budget for a fresh food box is about NTD 702 (about USD 25), while the highest maximum budget can reach up to NTD 1202 (about USD 43) for some potential consumers. Although fresh food boxes have a market opportunity in Taiwan, the market potential may be more focused on those who have online market shopping experiences. Marketers would need more marketing strategies to enhance more potential shoppers to adopt the online purchase for fresh food boxes.

Influence of the COVID-19 Lockdown on the Physical and Psychosocial Well-being and Work Productivity of Remote Workers: Cross-sectional Correlational Study

BACKGROUND

Lockdowns imposed during the COVID-19 pandemic have impacted the living and working habits of millions of people, with potentially important implications for their physical, mental, and social well-being.

OBJECTIVE

The primary objective of this study was to investigate the impact of the COVID-19 pandemic on remote workers who were not directly affected by COVID-19.

METHODS

This was a correlational cross-sectional study (with an additional qualitative component) of 184 remote workers surveyed during the first COVID-19 lockdown in the United Kingdom. Standard measures of mental health (Kessler-6 Distress Scale), productivity (Brief Instrument to Assess Workers' Productivity During a Working Day), and physical activity (International Physical Activity Questionnaire) were used, and respondents were further surveyed on changes to their dietary, exercise, smoking, drinking, and socialization habits to produce a well-being change index.

RESULTS

The results revealed associations between sedentary behavior and poorer mental health (τ b=0.14) and between poorer mental health and low work productivity (τ b=-0.39). However, both positive and negative lifestyle changes were reported; a self-reported increase in well-being (with respect to diet, exercise, smoking, alcohol consumption, and socialization) since the start of the pandemic was associated with both better mental health (τ b=-0.14) and better work productivity (τ b=0.14). Of note, among respondents without a mental health diagnosis (137/184, 74.4%), we observed rates of moderate (76/137, 55.5%) and severe (17/137, 12.4%) psychological distress, which were markedly higher than those reported in large prepandemic studies; moreover, 70.1% (129/184) of our respondents reported more sedentary behavior, 41% (69/168) increased their alcohol consumption, and 38.6% (71/184) increased their overall food intake. However, 46% (75/163), 44.8% (39/87) and 51.8% (57/110) of respondents reported spending more time walking and engaging in more moderate and vigorous exercise, respectively. Qualitative analysis revealed many positive adaptations to lockdowns (eg, decreased commuting expenses, flexibility) but also a number of structural obstacles to remote working (eg, lack of support and high expectations from employers, childcare duties).

CONCLUSIONS

These findings may be of practical importance for policy makers and employers in a world in which work involves long-term remote or hybrid employment arrangements; strategies to promote more sustainable remote working are discussed.

Dishing up Science: Integrated Content Links History, Microbiology, and Nutrition

Although public health recommendations encourage educators to include nutrition into the school day to prevent obesity, teachers cite lack of time as a common barrier. Thus, they are often told to integrate nutrition across the curriculum. The purpose of this project was to create an educational program integrating easy-to-demonstrate experiments with lessons illustrating key concepts in microbiology, nutrition, and food history for elementary school groups visiting a museum. Programs were created by researching and developing short lessons with visual aids, hands-on science experiments, handouts, and teacher's guides that could be used by museum staff. These lessons were aligned with New Jersey elementary school curricula and learning standards. This project illustrated a creative approach to integrating microbiology, nutrition, and history content into the curriculum so that teachers could more easily fit nutrition into the school day.

Are meal kits health promoting? Nutritional analysis of meals from an Australian meal kit service

SUMMARY

Meal kits are popular for consumers seeking greater convenience in preparing meals at home. The market share for meal kit subscription services (MKSSs) is growing in developed nations including Australia, however, literature about their health promoting qualities, e.g. nutritional composition, is scarce. This study aimed to assess the characteristics and nutritional composition of meals offered from an MKSS over 12 months. Nutritional data were extracted from recipes available to order from HelloFresh in Australia from 1 July 2017 to 30 June 2018. In total, 346 (251 unique) recipes were retrieved. Per serve (median size 580 g), meals contained a median of 2840 kJ (678 kcal) of energy, 58 g carbohydrate (14 g sugar), 44 g protein, 28 g total fat (8 g saturated fat) and 839 mg sodium. Median energy from macronutrients was total fat (38%), carbohydrates (34%), protein (25%) and saturated fat (11%). This paper is the first to describe characteristics of recipes available from an MKSS over a 12-month period of time. With their growing popularity, meal kit delivery services have the capacity to influence consumer food behaviours, diets and subsequently population health. MKSSs may function to promote health though education, training, and enabling home cooking behaviours, and may be a powerful commitment device for home cooking behaviour change. However, it is important for health professionals, including dietitians and nutritionists, to understand the nutritional risks, benefits and suitability of this contemporary mealtime option before recommending them to clients and members of the public as part of health promotion.

LAY SUMMARY

Meal kit delivery services are growing in popularity in developed countries, complementing busy lifestyles with pre-measured ingredients and recipe instructions delivered to the home. These meal kits have the ability to influence consumer diets and population health, and may support health promoting diet behaviours, e.g. eating vegetables, and enable home cooking. In this study, we reviewed a years' worth of recipes from a popular meal kit service. We report that a typical recipe contained approximately nine different ingredients, comprising three vegetables and required three ingredients from the home pantry. Meals took ∼35 min to prepare and were found to be relatively high in energy from fat and protein, and relatively low in energy from carbohydrates. The level of sodium varied widely and some meals exceeded the Australian Suggested Dietary Target for sodium (<2000 mg). Meal kit recipes were found to have health promoting qualities, frequently including vegetable ingredients, however, improvements to recipes would make these meal kits more health promoting. Current diet intakes and the nutritional composition of meal kits recipes should be reviewed before being recommended by health professionals.

Advance Quantity Meal Preparation Pilot Program Improves Home-Cooked Meal Consumption, Cooking Attitudes, and Self-Efficacy

OBJECTIVE

To evaluate the effects of a group-based Advance Quantity Meal Preparation (AQMP) program on the consumption of home-cooked meals, cooking attitudes, and self-efficacy in healthy adults.

METHODS

Participants (n = 10) in a group setting prepared healthy meals weekly consisting of 10 entrees and 5 snacks for 6 weeks. A survey assessing cooking attitudes, cooking self-efficacy, and cooking behavior and consumption at 3 time points: preprogram, postprogram (T2), and 3 months postprogram (T3).

RESULTS

The AQMP program increased the proportion of overall home-cooked meal consumption (T2, P = 0.03), home-cooked dinner consumption (T2, P = 0.04), cooking attitudes (T3, P = 0.01), and cooking self-efficacy (T2, P = 0.002).

CONCLUSIONS AND IMPLICATIONS

This pilot study indicates that AQMP may increase home-cooked meal consumption, cooking attitudes, and cooking self-efficacy.

Nutrition in Physical Therapist Practice: Setting the Stage for Taking Action

Diet and nutrition are critical components of health, recovery from disease and illness, performance, and normal growth across the lifespan. Thus, it is important for physical therapists to be knowledgeable about nutrition and to have competency in providing information and guidance to patients/clients. Yet, there is an overwhelming amount of diet and nutrition information available from numerous sources, which makes it difficult to reach conclusions and determine the importance and relevance to patient care. The purpose of this perspective paper is to increase the knowledge and skills of physical therapists by providing guidelines for healthy eating and outlining diet and nutrition information most relevant for physical therapist practice and to clarify professional scope of practice related to diet and nutrition, including boundaries created by law, and the connection between healthy eating and health outcomes, muscle strength, bone health, and wound healing.

Examining Nutrition and Food Waste Trade-offs Using an Obesity Prevention Context

Obesity and food waste are related issues, both exacerbated by an overabundance of food. Efforts to reduce food waste can have varying unintended, obesity-related consequences, which further underscores the need for a systems approach to food waste reduction. Yet, these 2 issues are rarely examined together. It is the authors' point of view that for nutrition educators and other public health practitioners to develop interventions that simultaneously address food waste and obesity, they need to understand how actions at the consumer-level may impact waste and its related food system consequences earlier in the supply chain.

Factors associated with diet changes during the COVID-19 pandemic period in Brazilian adults: Time, skills, habits, feelings and beliefs

This study aimed to identify individual, household and sociodemographic factors associated with changes in food consumption that lead to changes in the diet quality, in the context of the COVID-19 pandemic concerning Brazilian adults. Improvements or worsening in diet quality (IDQ or WDQ) were verified using an exploratory online survey which investigated whether participants (n = 4780) increased or decreased their consumption of food subgroups that mark positive or negative food patterns. Respondents also agreed or disagreed with their beliefs about food safety, cooking skills, family support, home characterization, feelings and behaviors. All factors of influence on the IDQ or WDQ groups were always compared against the general participants (who did not change their diet sufficiently to be classified into these groups). Individuals from the IDQ group spent more time on food (81.4% versus 62.0%), started to cook more often (91.4%), were more confident with their cooking skills (p < 0.01) and positive feelings were at least 2.5 times more prevalent. Adjusted analysis showed the chance to improve diet was 1.39 higher among those who did not feel overworked and increased 1.07 in each additional cooking chore shared between household members. For each additional positive feeling, the odds were 1.41 to IDQ and 0.67 to WDQ. Moreover, for each additional negative feeling the chances for WDQ were 1.21 and 0.90 for IDQ. Those in the WDQ group were more unaware of issues related to contagion during meals, they were not afraid of eating food prepared outside their home and agreed that industrialized food is safer (OR = 1.85). These results highlight the associated factors in improving or worsening diet patterns as a consequence of the COVID-19 pandemic, supporting messages presented in Dietary Guidelines.

Factors associated with ordering food via online meal ordering services

OBJECTIVE

Online meal ordering services are increasing in popularity in Australia and globally. Meals ordered online for home delivery are typically less healthy than home-made meals, potentially contributing to weight gain. The aim of the present study was to identify the types of consumers who are most likely to engage in online meal ordering.

DESIGN

A cross-sectional survey including items relating to demographic and lifestyle factors was disseminated via a web panel provider.

SETTING

Australia.

PARTICIPANTS

A total of 2010 Australian adults aged 18+ years.

RESULTS

More than a quarter of respondents (28 %) engaged in online meal ordering at least once in the previous month. Younger respondents, those with a higher BMI, and those with higher education and income levels were more likely to have done so. Consuming higher levels of sugary drinks and fast-food restaurant patronage were significantly associated with ordering meals online for home delivery.

CONCLUSIONS

The outcomes of this study suggest that the use of online meal ordering services is becoming a common practice in Australia, and it is therefore important to implement evidence-based strategies and policies to encourage individuals to make healthy food choices when using these services.

The Challenging Task of Measuring Home Cooking Behavior

The link between home cooking and health is being actively explored in both observational and experimental studies. However, research on this topic is limited by the lack of cooking behavior metrics. Most existing assessment tools focus only on cooking frequency or one's ability to complete specific a priori food preparations. Cooking is a complex and multifaceted behavior that is influenced by culture, environment, and social norms. More flexible and adaptable measurement approaches are needed to elucidate the spectrum of cooking ability in the population and, in turn, develop meaningful recommendations and interventions.

A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart

Background

Cooking interventions have increased in popularity in recent years. Evaluation by meta-analyses and systematic reviews show consistent changes in dietary quality reports and cooking confidence, but not of cardiovascular (CVD) biomarkers. Interventions evaluating or reporting behavioral mechanisms as an explanatory factor for these outcomes has been sparse. Moreover, evaluations of cooking interventions among communities with health disparities or food access limitations have received little attention in the literature.

Methods

This study will occur over two phases. Phase 1 will assess acceptability among the target population of African-American adults living within an urban food desert. Phase 2 will consist of a 6-week cooking intervention delivered at a community kitchen setting. Pre and post intervention visits for clinical examinations and biomarker collection will be conducted, as well as dietary and cooking skill assessments. Primary outcomes include cooking behavior and feasibility measures. Secondary outcomes are related to dietary quality, psychosocial factors, CVD biomarkers, and food environment measures.

Discussion

This study seeks to demonstrate feasibility of a community-based cooking intervention and to provide necessary information to plan future interventions that identify cooking behavior as an outcome of participation in cooking interventions among African-American adults, especially in relation to dietary and biomarker outcomes.

Trial registration

This study was registered at ClinicalTrials.gov (NCT04305431) on March 12, 2020.

Development and implementation of a community health centre-based cooking skills intervention in Detroit, MI

OBJECTIVE

To develop and implement a community-tailored, food agency-based cooking programme at a community health centre (CHC) and evaluate the effect of the intervention on cooking confidence and food waste.

DESIGN

This study used an exploratory, sequential mixed methods design. Focus groups (n 38) were conducted to inform the development of a cooking intervention, then six cooking classes (n 45) were planned and piloted in the health centre's teaching kitchen. Changes in cooking confidence and related outcomes were assessed using pre- and post-class surveys. Follow-up interviews (n 12) were conducted 2-4 months post-intervention to assess satisfaction and short-term outcomes.

SETTING

A CHC in Detroit, MI.

PARTICIPANTS

Spanish- and English-speaking adults aged ≥18 years recruited at the CHC.

RESULTS

In the formative focus groups, patients identified multiple barriers to cooking healthy meals, including trade-offs between quality, cost and convenience of food, chronic disease management and lack of time and interest. Each cooking class introduced a variety of cooking techniques and food preservation strategies. Participants demonstrated increased confidence in cooking (P 0·004), experimenting with new ingredients (P 0·006) and knowing how to make use of food before it goes bad (P 0·017). In post-class interviews, participants reported that they valued the social interaction and participatory format and that they had used the recipes and cooking techniques at home.

CONCLUSIONS

A community-tailored, hands-on cooking class was an effective way to engage patients at a CHC and resulted in increased cooking confidence.

Small increments in diet cost can improve compliance with the Dietary Guidelines for Americans

Adherence to the Dietary Guidelines for Americans (DGA) may involve higher diet costs. This study assessed the relation between two measures of food spending and diet quality among adult participants (N = 768) in the Seattle Obesity Study (SOS III). All participants completed socio-demographic and food expenditure surveys and the Fred Hutch food frequency questionnaire. Dietary intakes were joined with local supermarket prices to estimate individual-level diet costs. Healthy Eating Index (HEI- 2015) scores measured compliance with DGA. Multiple linear regressions using Generalized Estimating Equations with robust standard errors showed that lower food spending was associated with younger age, Hispanic ethnicity, and lower socioeconomic status. Even though higher HEI-2015 scores were associated with higher diet costs per 2000 kcal, much individual variability was observed. A positive curvilinear relationship was observed in adjusted models. At lower cost diets, a $100/month increase in cost (from $150 to $250) was associated with a 20.6% increase in HEI-2015. For higher levels of diet cost (from $350 to $450) there were diminishing returns (2.8% increase in HEI- 2015). These findings indicate that increases in food spending at the lower end of the range have the most potential to improve diet quality.

A Humanities-Based Explanation for the Effects of Emotional Eating and Perceived Stress on Food Choice Motives during the COVID-19 Pandemic

Perceived stress affects emotional eating and food choices. However, the extent to which stress associates with food choice motives is not completely understood. This study assessed whether emotional eating mediates the associations between perceived stress levels and food choice motives (i.e., health, mood, convenience, natural content, price, sensory appeal, familiarities, weight control, and ethical concerns) during the Coronavirus Disease 2019 pandemic. A total of 800 respondents were surveyed in the United States in June 2020. Their perceived stress, emotional eating, and food choice motives were assessed by the Perceived Stress Scale, Dutch Eating Behavior Questionnaire, and Food Choice Questionnaire, respectively. Moderate to high levels of perceived stress were experienced by the majority (73.6%) of respondents. Perceived stress was significantly correlated with emotional eating (r = 0.26) as well as five out of nine food choice motives: mood (r = 0.32), convenience (r = 0.28), natural content (r = −0.14), price (r = 0.27), and familiarity (r = 0.15). Emotional eating was significantly correlated with four out of nine food choice motives: mood (r = 0.27), convenience (r = 0.23), price (r = 0.16), and familiarity (r = 0.16). The mediation analyses showed that emotional eating mediates the associations between perceived stress and five food choices motives: mood, convenience, sensory appeal, price, and familiarity. Findings were interpreted using theories and concepts from the humanities, specifically, folklore studies, ritual studies, and symbolic anthropology.

How Does Time Use Differ between Individuals Who Do More versus Less Foodwork? A Compositional Data Analysis of Time Use in the United Kingdom Time Use Survey 2014-2015

BACKGROUND

Increased time spent on home food preparation is associated with higher diet quality, but a lack of time is often reported as a barrier to this practice. We compared time use in individuals who do more versus less foodwork (tasks required to feed ourselves and our households, including home food preparation).

METHODS

Cross-sectional analysis of the UK Time Use Survey 2014-15, participants aged 16+ (N = 6143). Time use over 24 h was attributed to seven compositional parts: personal care; sleep; eating; physical activity; leisure screen time; work (paid and unpaid); and socialising and hobbies. Participants were categorised as doing no, 'some' (<70 min), or 'more' foodwork (≥70 min). We used compositional data analysis to test whether time-use composition varied between these participant groups, determine which of the parts varied between groups, and test for differences across population subgroups.

RESULTS

Participants who spent more time on foodwork spent less time on sleep, eating, and personal care and more time on work. Women who did more foodwork spent less time on personal care, socialising, and hobbies, which was not the case for men.

CONCLUSION

Those who seek to encourage home food preparation should be aware of the associations between foodwork and other activities and design their interventions to guard against unintended consequences.

Factors affecting home cooking behavior of women with elementary school children applying the theory of planned behavior

BACKGROUND/OBJECTIVES

The objective of this study was to examine factors affecting cooking behavior at home. We examined components of the theory of planned behavior, perception of cooking skills, and socio-demographic variables affecting cooking behavior at home.

SUBJECTS/METHODS

The study sample included 425 women raising elementary school children living in South Korea. They responded to an online structured questionnaire. The variables affecting cooking behavior at home were assessed using hierarchical regression analysis.

RESULTS

The frequency of cooking behavior at home was 14.1 meals per week. Most respondents showed an intention regarding cooking behavior. The average score for attitude toward cooking behavior at home was 15.1 points (scale of 1 to 25). Attitude and cooking behavior showed a significant positive correlation (P < 0.01, r = 0.22). The subjective norm was 14.6 points (scale of 1 to 25). The subjective norm showed a significant correlation with cooking behavior (P < 0.01, r = 0.18). The control belief was 2.8 points (scale of 1 to 5). The control belief and cooking behavior showed a significant correlation in all questions (P < 0.01, r = 0.25). The subjects were significant confident about their cooking skills, except for Kimchi. Perception of cooking skills showed a significant correlation with all questions concerning cooking behavior (P < 0.01, r = 0.30). Significant variables for predicting intention regarding cooking behavior were perception of cooking skills, employment status, income, and attitude. Significant variables for predicting cooking behavior were employment status, income, control belief, number of children, and behavioral intention.

CONCLUSIONS

In order to provide nutrition education to increase cooking behavior at home, it is necessary to have a positive attitude toward cooking behavior, increase control belief, and improve confidence related to cooking skills. Moreover, differentiated education based on the employment status of women is needed.

The effect of time use and food cost on dietary quality

OBJECTIVE

To develop a questionnaire to measure food nutrition, food expenditures and time spent in food-related activities; and to assess the association between diet quality, time spent in food-related activities and food expenditures using data from a pilot study.

DESIGN

Cross-sectional study. Multiple linear regression models were used to analyse participants' survey response behaviours and the relationship between food nutritional quality and time and money expenditures.

SETTING

Online survey using Qualtrics software in a public university located in West Texas, USA.

PARTICIPANTS

Faculty and staff aged 18 years and older from a public university located in West Texas, USA.

RESULTS

Combining questions from three survey instruments that collect data on food nutrition, food expenditures and time spent in food-related activities resulted in a thirty-page survey instrument. The median completion time of the survey instrument was about 30 min. Preliminary results suggest that time and money expenditures are associated with food quality but that their role is small relative to sociodemographic characteristics such as race and gender.

CONCLUSIONS

Time and money expenditures are associated with food quality but their role is small relative to sociodemographic characteristics such as race and gender.

Cooking skills related to potential benefits for dietary behaviors and weight status among older Japanese men and women: a cross-sectional study from the JAGES

Background

Poor cooking skills have been linked to unhealthy diets. However, limited research has examined associations of cooking skills with older adults’ health outcomes. We examined whether cooking skills were associated with dietary behaviors and body weight among older people in Japan.

Methods

We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study, a self-report, population-based questionnaire study of men (n = 9143) and women (n = 10,595) aged ≥65 years. The cooking skills scale, which comprises seven items with good reliability, was modified for use in Japan. We calculated adjusted relative risk ratios of unhealthy dietary behaviors (low frequency of home cooking, vegetable/fruit intake; high frequency of eating outside the home) using logistic or Poisson regression, and relative risk ratios of obesity and underweight using multinomial logistic regression.

Results

Women had higher levels of cooking skills, compared with men. Women with a moderate to low level of cooking skills were 3.35 (95% confidence interval [CI]: 2.87–3.92) times more likely to have a lower frequency of home cooking and 1.61 (95% CI: 1.36–1.91) times more likely to have a lower frequency of vegetable/fruit intake, compared with women with a high level of cooking skills. Men with a low level of cooking skills were 2.56 (95% CI: 2.36–2.77) times more likely to have a lower frequency of home cooking and 1.43 (95% CI: 1.06–1.92) times more likely to be underweight, compared with men with a high level of cooking skills. Among men in charge of meals, those with a low level of cooking skills were 7.85 (95% CI: 6.04–10.21) times more likely to have a lower frequency of home cooking, 2.28 (95% CI: 1.36–3.82) times more likely to have a higher frequency of eating outside the home, and 2.79 (95% CI: 1.45–5.36) times more likely to be underweight, compared with men with a high level of cooking skills. Cooking skills were unassociated with obesity.

Conclusions

A low level of cooking skills was associated with unhealthy dietary behaviors and underweight, especially among men in charge of meals. Research on improving cooking skills among older adults is needed.