The Healthy Cooking Index: Nutrition Optimizing Home Food Preparation Practices across Multiple Data Collection Methods

Do Crops Grown at Urban Dumpsites Contain Metals at Levels that Pose Unacceptable Health Risks to Consumers?

Excessive dietary metal intake from crops grown on contaminated urban dumpsites poses a global health risk to consumers. We evaluated the health risk to adult and child consumers from dietary exposure to metals and metalloids in crops cultivated at the Mbale (Uganda) dumpsite centre. Thirteen crop types grown on the dumpsite soil were sampled and analyzed for concentrations of 11 metals: Fe, Al, Zn, Mn, Cu, Pb, Cr, Hg, Co, Ni, Cd, and two metalloids: Se and As. Different proportions of the crops were combined into 12 meal classes to simulate the diets of residents and estimate noncancer and cancer risks. The findings indicated that most individual crop types and simulated diets lacked sufficient selenium for bodily functions. Furthermore, their metal accumulations exceeded the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) permissible limits (mg/kg) for Al (20), Fe (100), Ni (10), Cu (20), Mn (10), Pb (0.3), Se (0.05), and Zn (99.4). The four most abundant metals in the various crop types and diets were Al, Fe, Mn, and Zn. A positive correlation between the metals in the crops indicated a common origin, which could possibly be the dumpsite soil. The chronic dietary intake (CDI) of metals was higher in children, and thus children faced higher noncancer and cancer risks compared with adults. The overall CDI values for each metal ranged from 0.000718 to 2.171 in adults, and 0.00125 to 3.781662 in children, which is approximately 1.74 times higher in children than in adult consumers. The noncancer and cancer risks ranged from moderate to high with Co, Cr, Fe, Mn, and Zn being mostly responsible for the high noncancer risks, and Al being the predominant contributor to cancer risks. The total noncancer risk levels equally ranged from moderate (1.4-3.3) for adults, and moderate to high (2.4-5.7) for children; the cancer risks were moderate to high in adults, with Al contributing to between 68% and 92% of the total risks across the 12 meal classes. Overall, CDI values and noncancer and cancer risks were all higher in children than in adults. The vegetables Amaranthus hybridus, Vigna unguiculate, Amaranthus dubius, and Cucurbita maxima significantly contributed to the high noncancer risk to both adults and children, particularly when they constituted 40% or more of the meal. Four additional vegetables (Cocorhrous olitorous, Brassica oleracea, Amaranthus cruentus, and Gynandropsis gynandra) also posed a high risk to children when consumed in large quantities. Our results highlight the urgent need to develop regulatory frameworks and/or rigorously enforce existing land and food governance policies to protect consumers' health from unsafe metal concentrations in crops grown on dumpsites. Environ Toxicol Chem 2024;00:1-17. © 2024 The Author(s). Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Outcomes of Children's Cooking Programs: A Systematic Review of Intervention Studies

OBJECTIVE

To examine the factors that make such programs successful, this systematic review compared the outcomes of children's participation in cooking interventions based on intervention characteristics.

DESIGN

Systematic review of randomized controlled trials of children's participation in cooking interventions published between 1998 and 2022 guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

SETTING

All settings PARTICIPANTS: Children and parents.

MAIN OUTCOME MEASURES

Cooking skills, food acceptance and dietary behavior.

ANALYSIS

Systematic search of 1,104 articles and review of 23 studies (42 articles) meeting inclusion criteria.

RESULTS

Interventions varied in participant age, settings, cooking sessions, and program length. Knowledge of cooking skills, self-efficacy, and child cooking involvement were the most frequent positive outcomes; improvements in dietary intake were rarely achieved. Seven studies had a high rating for research quality.

CONCLUSION AND IMPLICATIONS FOR RESEARCH AND PRACTICE

Lack of standardized assessment, large variability in program characteristics, and insufficient intervention description made it difficult to discern best practices for children's cooking programs. Improvements in intervention development and measurement instruments are needed. Interventions that include hands-on cooking lessons seem promising in improving knowledge and self-efficacy; however, further exploration is required on the factors that make cooking programs successful in the long term.

Association between adverse childhood experiences and fruit and vegetable intake among a national sample of U.S. adults

Few studies have examined the role adverse childhood experiences (ACEs) have on specific diet patterns. This study assessed the association between ACEs and daily fruit and vegetable intake (FVI). Data were derived from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) which surveys 50 states and three U.S. territories. Participants who completed the ACEs module were included in the analyses (N = 106,967). Total ACEs included the summed responses from the domains of abuse, household challenges, and neglect. FVI was reported by number of times consumed per day. The two fruit items included fruit (fresh, frozen, and canned) and fruit juice. The four vegetable items included leafy greens, fried potatoes, non-fried potatoes, and other vegetables. All fruit and vegetable items were analyzed separately to see which specific items drove the relationship between total ACEs and total FVI, equaling a total of 8 regression models. Every model controlled for poor mental health days, sex, age, ethnicity, income, body mass index, and physical activity. Total ACEs were positively associated with daily intake of fried potatoes (β = 0.008, p =.025), other potatoes (β = 0.008, p =.049), and other vegetables (β = 0.024, p <.001). Total ACEs were negatively associated with daily intake of fruit (β = -0.016, p <.001). ACEs had non-significant relationships with leafy greens and fruit juice. Findings suggests that those with increased ACEs scores report increased consumption of fried potatoes, non-fried potatoes, and other vegetables, and less of fruit. Findings highlight the need for understanding food context and preparation when analyzing the relationship between ACEs and diet intake.

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.

Nutritional Epidemiology and Dietary Assessment for Patients With Kidney Disease: A Primer

Nutritional epidemiology seeks to understand nutritional determinants of disease in human populations using experimental and observational study designs. Though randomized controlled trials provide the strongest evidence of causality, the expense and difficulty of sustaining adherence to dietary interventions are substantial barriers to investigating dietary determinants of kidney disease. Therefore, nutritional epidemiology commonly employs observational study designs, particularly prospective cohort studies, to investigate long-term associations between dietary exposures and kidney disease. Due to the covarying nature and synergistic effects of dietary components, holistic characterizations of dietary exposures that simultaneously consider patterns of foods and nutrients regularly consumed are generally more relevant to disease etiology than single nutrients or foods. Dietary intakes have traditionally been self-reported and are subject to bias. Statistical methods including energy adjustment and regression calibration can reduce random and systematic measurement errors associated with self-reported diet. Novel approaches that assess diet more objectively are gaining popularity but have not yet fully replaced self-report and require refinement and validation in populations with chronic kidney disease. More accurate and frequent diet assessment in existing and future studies will yield evidence to better personalize dietary recommendations for the prevention and treatment of kidney disease.

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.

Automated wearable cameras for improving recall of diet and time use in Uganda: a cross-sectional feasibility study

BACKGROUND

Traditional recall approaches of data collection for assessing dietary intake and time use are prone to recall bias. Studies in high- and middle-income countries show that automated wearable cameras are a promising method for collecting objective health behavior data and may improve study participants' recall of foods consumed and daily activities performed. This study aimed to evaluate the feasibility of using automated wearable cameras in rural Eastern Ugandan to collect dietary and time use data.

METHODS

Mothers of young children (n = 211) wore an automated wearable camera on 2 non-consecutive days while continuing their usual activities. The day after wearing the camera, participants' dietary diversity and time use was assessed using an image-assisted recall. Their experiences of the method were assessed via a questionnaire.

RESULTS

Most study participants reported their experiences with the automated wearable camera and image-assisted recall to be good (36%) or very good (56%) and would participate in a similar study in the future (97%). None of the eight study withdrawals could be definitively attributed to the camera. Fifteen percent of data was lost due to device malfunction, and twelve percent of the images were "uncodable" due to insufficient lighting. Processing and analyzing the images were labor-intensive, time-consuming, and prone to human error. Half (53%) of participants had difficulty interpreting the images captured by the camera.

CONCLUSIONS

Using an automated wearable camera in rural Eastern Uganda was feasible, although improvements are needed to overcome the challenges common to rural, low-income country contexts and reduce the burdens posed on both participants and researchers. To improve the quality of data obtained, future automated wearable camera-based image assisted recall studies should use a structured data format to reduce image coding time; electronically code the data in the field, as an output of the image review process, to eliminate ex post facto data entry; and, ideally, use computer-assisted personal interviews software to ensure completion and reduce errors. In-depth formative work in partnership with key local stakeholders (e.g., researchers from low-income countries, representatives from government and/or other institutional review boards, and community representatives and local leaders) is also needed to identify practical approaches to ensuring that the ethical rights of automated wearable camera study participants in low-income countries are adequately protected.

Dietary counseling based on artificial intelligence for patients with nonalcoholic fatty liver disease

BACKGROUND

About 25% of the general population in Japan are reported to have nonalcoholic fatty liver disease (NAFLD). NAFLD and nonalcoholic steatohepatitis carry a risk of progressing further to hepatocellular carcinoma. The primary treatment for NAFLD is dietary therapy. Dietary counseling plays an essential role in dietary therapy. Although artificial intelligence (AI)-based nutrition management software applications have been developed and put into practical use in recent years, the majority focus on weight loss or muscle strengthening, and no software has been developed for patient use in clinical practice.

AIM

To examine whether effective dietary counseling is possible using AI-based nutrition management software.

METHODS

NAFLD patients who had been assessed using an AI-based nutrition management software application (Calomeal) that automatically analyzed images of meals photographed by patients and agreed to receive dietary counseling were given dietary counseling. Blood biochemistry tests were performed before (baseline) and 6 mo after (6M follow-up) dietary counseling. After the dietary counseling, the patients were asked to complete a questionnaire survey.

RESULTS

A total of 29 patients diagnosed with NAFLD between August 2020 and March 2022 were included. There were significant decreases in liver enzyme and triglyceride levels at the 6M follow-up compared to baseline. The food analysis capability of the AI used by Calomeal in this study was 75.1%. Patient satisfaction with the AI-based dietary counselling was high.

CONCLUSION

AI-based nutrition management appeared to raise awareness of dietary habits among NAFLD patients. However, it did not directly alleviate the burden of registered dietitians, and improvements are much anticipated.

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.

Cooking After Cancer: the Structure and Implementation of a Community-Based Cooking Program for Cancer Survivors

Cancer survivors are a growing population that may particularly benefit from nutrition and lifestyle interventions. Community-based programs teaching healthy cooking skills are increasingly popular and offer an opportunity to support survivors within communities. The objective of this study is to describe the curriculum and implementation of a cooking class program designed for cancer survivors, housed within an established community-based organization. First, we evaluated the class curriculum for specific constructs. An evidence-based measure of healthy cooking constructs, the Healthy Cooking Index (HCI), was used to analyze included recipes and revealed both summative cooking quality scores and individual constructs underlying the overall curriculum. Second, a self-report questionnaire based on the HCI was conducted during the first and last class of the 6-week series. This allowed for a comparison between baseline cooking practices of participants and class curricula, as well as changes in reported practices after class participation. Using the HCI items and coding system, we found the curriculum focused on seven recurring constructs (measuring fat and oil, using citrus, herbs and spices, low-fat cooking methods, olive oil, and adding fruit and vegetables). Baseline reports demonstrated that many participants already practiced the main constructs driving the curriculum. As a potential result of this overlap, no changes in practices were found between the first and last session among class participants. Cooking classes for cancer survivors should be structured to not only reinforce positive existing behaviors but also to promote other healthy cooking practices and reduce less healthy behaviors such as using red meat and animal fats. The HCI can be used to understand the underlying constructs of existing cooking class curricula and current practices of survivor populations, allowing for a more tailored approach to practical nutrition education in this high-risk group.

Home Cooking Quality Assessment Tool Validation Using Community Science and Crowdsourcing Approaches

OBJECTIVE

To refine a measure of home cooking quality (defined as the usage level of practices with the potential to influence the nutrient content of prepared foods) and conduct a construct validation of the revised tool, the Healthy Cooking Questionnaire 2 (HCQ2).

DESIGN

Two validation approaches are described: (1) a community science approach used to refine and validate Healthy Cooking Questionnaire (HCQ) constructs, and (2) responses to the revised HCQ (HCQ2) in a sample of Amazon Mechanical Turk (MTurk) workers to determine questionnaire comprehension.

SETTING

The Community Scientist Program at the University of Texas MD Anderson Cancer Center facilitated discussion groups to refine the HCQ questions and validate constructs. MTurk workers were subsequently recruited to complete the refined survey so that comprehension and associations with demographic variables could be explored.

PARTICIPANTS

Ten community scientists participated in the refinement of the HCQ. The revised tool (HCQ2) was completed by 267 adult US-based MTurk workers.

VARIABLES MEASURED

Demographics, HCQ concepts, HCQ2, Self-Reported Questionnaire Comprehension.

ANALYSIS

Comprehension items were examined using descriptive statistics. Exploratory analysis the relationships between cooking quality and demographic characteristics, meal type, cooking frequency, as well as patterns of food preparation behavior was conducted on the MTurk sample RESULTS: The HCQ was refined through activities and consensus-building. MTurk responses to the HCQ2 indicated high comprehension and significant differences in cooking quality scores by demographic factors.

CONCLUSIONS AND IMPLICATIONS

This study refined and validated a self-report measure of cooking quality. Cooking quality measures offer critical evaluation methods for culinary programs.

Validation of an Automated Wearable Camera-Based Image-Assisted Recall Method and the 24-h Recall Method for Assessing Women's Time Allocation in a Nutritionally Vulnerable Population: The Case of Rural Uganda

Accurate data are essential for investigating relationships between maternal time-use patterns and nutritional outcomes. The 24 h recall (24HR) has traditionally been used to collect time-use data, however, automated wearable cameras (AWCs) with an image-assisted recall (IAR) may reduce recall bias. This study aimed to evaluate their concurrent criterion validity for assessing women’s time use in rural Eastern Ugandan. Women’s (n = 211) time allocations estimated via the AWC-IAR and 24HR methods were compared with direct observation (criterion method) using the Bland–Altman limits of agreement (LOA) method of analysis and Cronbach’s coefficient alpha (time allocation) or Cohen’s κ (concurrent activities). Systematic bias varied from 1 min (domestic chores) to 226 min (caregiving) for 24HR and 1 min (own production) to 109 min (socializing) for AWC-IAR. The LOAs were within 2 h for employment, own production, and self-care for 24HR and AWC-IAR but exceeded 11 h (24HR) and 9 h (AWC-IAR) for caregiving and socializing. The LOAs were within four concurrent activities for 24HR (−1.1 to 3.7) and AWC-IAR (−3.2 to 3.2). Cronbach’s alpha for time allocation ranged from 0.1728 (socializing) to 0.8056 (own production) for 24HR and 0.2270 (socializing) to 0.7938 (own production) for AWC-IAR. For assessing women’s time allocations at the population level, the 24HR and AWC-IAR methods are accurate and reliable for employment, own production, and domestic chores but poor for caregiving and socializing. The results of this study suggest the need to revisit previously published research investigating the associations between women’s time allocations and nutrition outcomes.

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.

Covid-19 and the Subsequent Lockdown Modified Dietary Habits of Almost Half the Population in an Italian Sample

The Covid-19 pandemic led to lockdowns in several parts of the world and, hence, changed some daily habits, including social interactions, the ability to perform sports, and-possibly-diet. The Italian government established and promulgated lockdown policies on 9 March 2020. We aim at assessing the effects of Covid-19-induced confinement policies on self-reported food consumption of self-selected Italians by means of a questionnaire that was created and diffused by the Internet. Nearly half, i.e., 49.6% of responders did not substantially modify their diet during the lockdown; however, 46.1% of them reported that they were eating more during confinement, and 19.5% gained weight. In particular, we report an increase in "comfort food" consumption, notably chocolate, ice-cream, and desserts (42.5%) and salty snacks (23.5%). In addition, 42.7% percent of this cohort attributed this increase to higher anxiety levels. Related to this, 36.8% of responders reported a decrease in alcohol consumption, even though 10.1% of them reported an increase. Interestingly, 21.2% of responders increased their consumption of fresh fruit and vegetables. Only 33.5% of those who declared decreased consumption attributed this change of diet to lower availability and ease of purchasing such items. Equally interesting, over half of responders, i.e., 56.2%, admitted that fruit and vegetables did not appeal to them while in lockdown. Purchases of ready-made meals were reduced by nearly 50%. Future large-scale similar studies should be undertaken worldwide and will help public health authorities shape their reactions to future, unavoidable pandemics.