The social distribution of dietary patterns. Traditional, modern and healthy eating among women in a Latin American city

The association between ultra-processed food consumption and health-related quality of life differs across lifestyle and socioeconomic strata

BACKGROUND

In this prospective study, we aimed to examine the association between ultra-processed foods and health-related quality of life (HRQoL) and to evaluate the effect of lifestyle and socioeconomic factors on this association.

METHODS

This study included 1766 adults (aged 18 to 78, 54.3% women), who took part in the Tehran Lipid and Glucose study. The Short-Form 12-Item Health Survey version 2 was used to determine HRQoL, which includes the physical component summary (PCS) and mental component summary (MCS) scores. Ultra-processed food consumption was assessed using a validated semi-quantitative food frequency questionnaire. Lifestyle (physical activity and smoking status) and socioeconomic factors (education level and employment status) were also determined. General linear models (GLM) were applied to estimate the mean (95% confidence interval) for MCS and PCS scores across the ultra-processed foods tertiles. Additionally, the effect of lifestyle and socioeconomic factors on the relationship between ultra-processed foods and HRQoL was examined using GLM.

RESULTS

The median consumption of ultra-processed foods was 11.9% (IQR: 8.2 to 16.8) of total energy intake. There was a significant inverse association between ultra-processed foods consumption and PCS, but not MCS, after adjustment for confounding factors. Significant interactions were observed between ultra-processed food consumption, sex, and occupation on PCS score (all P values < 0.001). The interaction test tended to be significant for smoking status, education levels, and physical activity levels. As ultra-processed food consumption increased, the PCS score significantly decreased in women (P = 0.043), low physical active subjects (P = 0.014), smokers (P = 0.015), and lower-educated individuals (P = 0.022). Non-employed individuals with higher ultra-processed food intake showed a decline in their PCS and MCS scores. While there was no significant difference in MCS score among different strata of lifestyle and socioeconomic status across tertiles of ultra-processed foods.

CONCLUSIONS

Higher intake of ultra-processed foods was associated with poorer physical health, particularly among women, those with unhealthy lifestyles, and low socioeconomic conditions.

The Extent, Range, and Nature of Quantitative Nutrition Research Engaging with Intersectional Inequalities: A Systematic Scoping Review

Addressing malnutrition for all requires understanding inequalities in nutrition outcomes and how they intersect. Intersectionality is increasingly used as a theoretical tool for understanding how social characteristics intersect to shape inequalities in health outcomes. However, little is known about the extent, range, and nature of quantitative nutrition research engaging with intersectional inequalities. This systematic scoping review aimed to address this gap. Between 15 May 2021 and 15 May 2022, we searched 8 databases. Studies eligible for inclusion used any quantitative research methodology and aimed to investigate how social characteristics intersect to influence nutrition outcomes. In total, 55 studies were included, with 85% published since 2015. Studies spanned populations in 14 countries but were concentrated in the United States (n = 35) and India (n = 7), with just 1 in a low-income country (Mozambique). Race or ethnicity and gender were most commonly intersected (n = 20), and body mass index and overweight and/or obesity were the most common outcomes. No studies investigated indicators of infant and young child feeding or micronutrient status. Study designs were mostly cross-sectional (80%); no mixed-method or interventional research was identified. Regression with interaction terms was the most prevalent method (n = 26); 2 of 15 studies using nonlinear models took extra steps to assess interaction on the additive scale, as recommended for understanding intersectionality and assessing public health impacts. Nine studies investigated mechanisms that may explain why intersectional inequalities in nutrition outcomes exist, but intervention-relevant interpretations were mostly limited. We conclude that quantitative nutrition research engaging with intersectionality is gaining traction but is mostly limited to the United States and India. Future research must consider the intersectionality of a wider spectrum of public health nutrition challenges across diverse settings and use more robust and mixed-method research to identify specific interventions for addressing intersectional inequalities in nutrition outcomes. Data systems in nutrition must improve to facilitate this. This review was registered in PROSPERO as CRD42021253339.

Using principal component analysis to explore consumers' perception toward quinoa health and nutritional claims in Gweru, Zimbabwe

Quinoa is one of the ancestral grains now considered as the "superfoods of the future" due to their characteristics as functional foods with great environmental adaptability. The Zimbabwe Resilience Building Fund has introduced quinoa in Zimbabwe to increase resilience of farming systems in light of environmental shocks. In order to improve adoption of the crop, it is important to understand the combined effects of socio-demographic variables on consumer perceptions of the crop. However, there is limited literature on the combined effects of socio-demographic variables on quinoa health and nutritional benefits in Zimbabwe. In this study, we used principle component analysis to identify consumers' perception about health and nutritional benefits of quinoa in Gweru Urban District, Gweru, Zimbabwe. A questionnaire was designed and applied to 200 participants. However, only 167 forms were valid for analysis. Age, education, and income level are main factors that determine consumer perceptions on health and nutritional claims. The results indicate that quinoa need to be promoted a as a crop that goes beyond food and income security by placing additional emphasis on health and nutritional aspects. This is very insightful in light of the need to improve the uptake of the crop by smallholder farmers in Zimbabwe. However, the use of self-reporting survey method has received criticism for failing to get detailed information on perceptions of individuals. These findings could be handy to promote quinoa as a climate smart crop with additional health and nutritional benefits. This is one of the novel research studies exploring the motives of Zimbabwean consumers towards quinoa as a functional food crop. The work also contributes to knowledge on consumer food preferences.

Sociodemographic determinants of food consumption pattern: Pró-Saúde Study

AIMS

To identify dietary patterns (DP) and to investigate their association with sociodemographic aspects.

METHODOLOGY

A cross-sectional data analysis of a sub-sample from Phase 4 of the Pró-Saúde Longitudinal Study (2012-2013), constituting a total of 520 participants. DP were obtained by principal component analysis from a food frequency questionnaire. Association between DP and sociodemographic aspects was analyzed by adjusted logistic regression.

RESULTS

Four DP were identified: processed and ultraprocessed products; fresh food; meats and alcoholic beverages; and traditional Brazilian foods. There was a greater adherence chance to "processed and ultraprocessed products" pattern among adults ≥ 55 years and lower chance among men. The probability of adherence to "fresh food" pattern was directly associated to men, subjects with a high educational level and inversely associated to adults aged ≥ 60 years. There was a lower chance of "meats and alcoholic beverages" pattern among men and increased chance of adherence to "traditional Brazilian foods" pattern among whites, subjects with ≥ 60 years and low schooling.

CONCLUSION

Sociodemographic factors were important determinants of DP, especially gender, schooling and age. Presence of a DP composed of processed and ultraprocessed products indicates the need for awareness strategies and supply limitation in this population, since it affects their health.

Cross-sectional association between diet quality and cardiometabolic risk by education level in Mexican adults

OBJECTIVE

Understanding the association between diet quality and cardiometabolic risk by education level is important for preventing increased cardiometabolic risk in the Mexican population, especially considering pre-existing disparities in diet quality. The present study examined the cross-sectional association of overall diet quality with cardiometabolic risk, overall and by education level, among Mexican men and women.

DESIGN

Cardiometabolic risk was defined by using biomarkers and diet quality by the Mexican Diet Quality Index. We computed sex-specific multivariable logistic regression models.

SETTING

Mexico.

PARTICIPANTS

Mexican men (n 634) and women (n 875) participating in the Mexican National Health and Nutrition Survey 2012.

RESULTS

We did not find associations of diet quality with cardiometabolic risk factors in the total sample or in men by education level. However, we observed that for each 10-unit increase in the dietary quality score, the odds of diabetes risk in women with no reading/writing skills was 0·47 (95 % CI 0·26, 0·85) relative to the odds in women with ≥10 years of school (referent). Similarly, for each 10-unit increase of the dietary quality score, the odds of having three v. no lipid biomarker level beyond the risk threshold in lower-educated women was 0·27 (95 % CI 0·12, 0·63) relative to the odds in higher-educated women.

CONCLUSIONS

Diet quality has a stronger protective association with some cardiometabolic disease risk factors for lower- than higher-educated Mexican women, but no association with cardiometabolic disease risk factors among men. Future research will be needed to understand what diet factors could be influencing the cardiometabolic disease risk disparities in this population.

Variation in dietary intake and body fatness by socioeconomic status among women in the context of Costa Rican nutrition transitions

The Nutrition Transition model posits that vegetable oils, animal source foods (ASFs) and caloric sweeteners contribute to increases in adiposity and hence body mass index. Body mass index (BMI) is increasing more rapidly among Latin American populations of low versus high socioeconomic status (SES). The objectives of this study among Costa Rican women were to: (1) compare indicators of adiposity and dietary intake by SES and (2) evaluate the relationship between intake of foods high in vegetable oils, ASFs or caloric sweeteners and body fatness. This cross-sectional study, conducted in 2014-2015, included 128 low-, middle- and high-SES non-pregnant, non-lactating women aged between 25 and 45 years with 1-4 live births. Anthropometry was used to assess BMI, body composition and body fat distribution. Dietary recalls (n = 379) were used to assess dietary intake. Percentage body fat was greater in low- versus high-SES women (31.5 ± 3.9 vs 28.2 ± 4.7%). Skinfold measurements at four sites on the upper and lower body were greater in low- versus high-SES women. Body mass index did not vary in low- versus high-SES women. Intake frequency of foods high in vegetable oils was greater in low- and middle- (1.8 and 1.8 times/day, respectively) versus high- (1.1 times/day) SES women. For individual foods, intake frequency varied significantly by SES for high-fat condiments, fried vegetables, dairy, sweetened coffee/tea and pastries and desserts. Intake frequency of Nutrition Transition food categories was not associated with percentage body fat after adjustment for energy intake. Indicators of body composition provide additional information beyond BMI that are useful in understanding SES-adiposity associations in Latin America. Approaches to understanding diet and adiposity in Latin America that focus on vegetable oils, ASFs and caloric sweeteners should consider within-country variation in the pace of the Nutrition Transition, especially when explaining variation in adiposity by SES.

Dietary patterns and their association with sociodemographic and behavioral factors: 2015 Women's Health Research, São Leopoldo (RS)

INTRODUCTION

Dietary patterns may be more predictive of disease risk than individual nutrients or foods.

OBJECTIVE

To identify dietary patterns and associated factors among adult women.

METHOD

Population-based cross-sectional study with 1,128 women, aged 20 to 69 years, living in São Leopoldo, Rio Grande do Sul. Food intake was assessed with a frequency questionnaire. The principal component analysis identified dietary patterns. We estimated crude and adjusted prevalence ratios using Poisson regression with robust variance.

RESULTS

Threedietary patterns - responsible for 25.8% of the total variance - were identified: healthy (fruits, vegetables, and whole foods); risk (ultra-processed foods); and Brazilian (rice and beans). The healthy pattern showed the largest percentage of explained variation (11.62%). The probability of adherence to the healthy pattern increased linearly with age and schooling and was higher among ex-smokers [prevalence ratio (PR)=1.22; confidence interval of 95% (95%CI) 1.04 - 1.42]. Younger women and those with better schooling had more chances of adhering to the risk pattern. The probability of adherence to the Brazilian pattern increased as schooling decreased and was higher among non-white women (PR = 1.29; 95%CI 1.04- 1.59).

CONCLUSIONS

While adherence to healthy and risk patterns behaved differently according to women's age, it was similar regarding schooling. Socioeconomic conditions defined adherence to the Brazilian pattern.

Nutrition transition profiles and obesity burden in Argentina

Objective

The present study aimed to identify nutrition transition (NT) profiles in Argentina (2005–2013) and assess their association with obesity in the adult population.

Design

A large cross-sectional study was performed considering data sets of nationally representative surveys. A multiple correspondence analysis coupled with hierarchical clustering was conducted to detect geographical clusters of association among sociodemographic and NT indicators. Multilevel logistic regression models were used to assess the effect of NT profile (proxy variable of contextual order) on obesity occurrence.

Setting

First, we used geographically aggregated data about the adult and child populations in Argentina. Second, we defined the population of adults who participated in the National Survey of Chronic Disease Risk Factors (2013) as the study population.

Participants

Twenty-four geographical units that make up the territory of Argentina and 32 365 individuals over 18 years old living in towns of at least 5000 people.

Results

Three NT profiles were identified: ‘Socionutritional lag’ (characterized by undernutrition and socio-economically disadvantaged conditions; profile 1); ‘Double burden of malnutrition’ (undernutrition and overweight in highly urbanized scenarios; profile 2); and ‘Incipient socionutritional improvement’ (low prevalence of malnutrition and more favourable poverty indicator values; profile 3). Profiles 1 and 2 were significantly associated (OR; 95 % CI) with a higher risk of obesity occurrence in adults (1·17; 1·02, 1·32 and 1·44; 1·26, 1·64, respectively) compared with profile 3.

Conclusions

Argentina is facing different NT processes, where sociodemographic factors play a major role in shaping diverse NT profiles. Most of the identified profiles were linked to obesity burden in adults.

Obesogenic Environment Case Study from a Food and Nutrition Security Perspective: Hermosillo City

Obesity and certain nutritional deficiencies are global health problems that emerge in systems of interdependent individual biological and historical factors and social environmental determinants of health. Nutrition security is a framework that assumes stable access to sufficient innocuous and nutritious food (i.e., food security), health care, and sanitation, and information that in conjunction allows self-care-oriented behavior for health protection. To understand the social environment of nutrition insecurity, the object of study was the food distribution and consumption system of a marginalized community in Hermosillo, Mexico. We assessed the distribution of food establishments by social marginalization level in basic geo-statistical areas and the nutrition security status of women in underserved neighborhoods. We found that in Hermosillo >90% of food establishments included for analysis (grocery stores, supermarkets, convenience stores, and beer deposits) were distributed outside of areas with high levels of social marginalization. The nutrition security assessment suggests that low intakes of fruit and vegetables and high intakes of fat and sugar may be associated with food accessibility and acceptability factors in individual decision-making processes. Future research should take into account the variability of food system environments and address the particular needs of communities in terms of food and nutrition security.

Desigualdades sociais no perfil de consumo de alimentos da população brasileira: Pesquisa Nacional de Saúde, 2013

RESUMO: Introdução: É amplamente reconhecido que elevada concentração de renda prevalece no Brasil e que a posição socioeconômica dos segmentos sociais exerce influência nas condições de vida e saúde, incluindo a qualidade da alimentação. Objetivo: Medir a magnitude das desigualdades sociais no perfil da qualidade alimentar da população brasileira. Método: Analisaram-se dados da amostra de 60.202 adultos da Pesquisa Nacional de Saúde de 2013. Foram estimadas as prevalências de indicadores de qualidade alimentar segundo sexo, raça/cor, renda, escolaridade e posse de plano de saúde. Razões de prevalência foram estimadas por meio de regressão múltipla de Poisson. Resultados: Maior prevalência de consumo de alimentos saudáveis foi verificada no sexo feminino, entre os brancos e no grupo de melhor nível socioeconômico. Entretanto,para alguns alimentos considerados não saudáveis, como doces, sanduíches, salgados e pizzas, também foi observada maior prevalência nos segmentos sociais mais favorecidos, nas mulheres e nos brancos, expressando a concomitância de escolhas alimentares saudáveis e não saudáveis. Desigualdade de maior magnitude foi observada quanto à comparação do consumo de leite desnatado e semidesnatado segundo renda (razão de prevalência - RP=4,48). Conclusão: Além de expressiva desigualdade social no perfil alimentar dos brasileiros, foram detectados perfis mistos, incluindo alimentos saudáveis e não saudáveis, sinalizando a necessidade de monitoramento e de intervenções de promoção de alimentação saudável que levem em conta as desigualdades sociais e as contradições no consumo alimentar.

Unhealthy dietary patterns among healthcare professionals and students in Mexico

Background

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

Methods

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

Results

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

Conclusions

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

Healthy eating patterns associated with acculturation, sex and BMI among Mexican Americans

OBJECTIVE

Examine relationships of healthy and unhealthy dietary patterns with BMI, sex, age and acculturation among Mexican Americans.

DESIGN

Cross-sectional. Participants completed culturally tailored Healthy and Unhealthy Eating Indices. Multivariable mixed-effect Poisson regression models compared food pattern index scores and dietary intake of specific foods by BMI, sex, age and acculturation defined by language preference and generational status.

SETTING

Participants recruited from the Cameron County Hispanic Cohort study, Texas-Mexico border region, between 2008 and 2011.

SUBJECTS

Mexican-American males and females aged 18-97 years (n 1250).

RESULTS

Participants were primarily female (55·3 %), overweight or obese (85·7 %), preferred Spanish language (68·0 %) and first-generation status (60·3 %). Among first-generation participants, bilingual participants were less likely to have a healthy eating pattern than preferred Spanish-speaking participants (rate ratio (RR)=0·79, P=0·0218). This association was also found in males (RR=0·81, P=0·0098). Preferred English-speaking females were less likely to consume healthy foods than preferred Spanish-speaking females (RR=0·84, P=0·0293). Among second-generation participants, preferred English-speaking participants were more likely to report a higher unhealthy eating pattern than preferred Spanish-speaking participants (RR=1·23, P=0·0114). Higher unhealthy eating patterns were also found in females who preferred English v. females who preferred Spanish (RR=1·23, P=0·0107) or were bilingual (RR=1·26, P=0·0159). Younger, male participants were more likely to have a higher unhealthy eating pattern. BMI and diabetes status were not significantly associated with healthy or unhealthy eating patterns.

CONCLUSIONS

Acculturation, age, sex and education are associated with healthy and unhealthy dietary patterns. Nutrition interventions for Mexican Americans should tailor approaches by these characteristics.

Socioeconomic Differences in Dietary Patterns in an East African Country: Evidence from the Republic of Seychelles

BACKGROUND

In high income countries, low socioeconomic status (SES) is related to unhealthier dietary patterns, while evidence on the social patterning of diet in low and middle income countries is scarce.

OBJECTIVE

In this study, we assess dietary patterns in the general population of a middle income country in the African region, the Republic of Seychelles, and examine their distribution according to educational level and income.

METHODS

Data was drawn from two independent national surveys conducted in the Seychelles among adults aged 25-64 years in 2004 (n = 1236) and 2013 (n = 1240). Dietary patterns were assessed by principal component analysis (PCA). Educational level and income were used as SES indicators. Data from both surveys were combined as no interaction was found between SES and year.

RESULTS

Three dietary patterns were identified: "snacks and drinks", "fruit and vegetables" and "fish and rice". No significant associations were found between SES and the "snacks and drinks" pattern. Low vs. high SES individuals had lower adherence to the "fruit and vegetables" pattern [prevalence ratio (95% CI) 0.71 (0.60-0.83)] but a higher adherence to the traditional "fish and rice" pattern [1.58 (1.32-1.88)]. Income modified the association between education and the "fish and rice" pattern (p = 0.02), whereby low income individuals had a higher adherence to this pattern in both educational groups.

CONCLUSION

Low SES individuals have a lower consumption of fruit and vegetables, but a higher consumption of traditional foods like fish and rice. The Seychelles may be at a degenerative diseases stage of the nutrition transition.