Fruit and vegetable consumption in the former Soviet Union: the role of individual- and community-level factors

Street Food and Takeaway Food Purchasing Patterns in Bosnia and Herzegovina

This study aimed to describe street food and takeaway food purchasing patterns in Sarajevo and Banja Luka, throughout the day and by city location. A cross-sectional evaluation of street food and takeaway food customers was conducted in 2017. All eligible vending sites (n = 348) in the vicinity of selected markets and bus stops were included. Data on the food items purchased, and time and geographic location of the purchases were collected. A total of 755 customers purchased 929 food items. Takeaway venues showed higher customer influx (5.0 vs. 2.0 customers observed per 10 min of observation, p < 0.001) and buying rates (6.7 vs. 2.0 items bought per 10 min of observation, p < 0.001; 1.5 vs. 1.0 items bought per customer, p < 0.001) than street food sites. These rates were higher in city peripheries for street food venues, and in city centres for takeaway establishments. The purchase of industrial food products prevailed throughout the day in street food venues, whereas most takeaway purchases comprised homemade foods, with or without industrial beverages. The proportion of customers buying foods and beverages together was higher in takeaway venues (15.3% vs. 6.0%, p < 0.001), especially during lunchtime and in city centres. In street food vending sites, sweet and savoury snacks seemed to be preferred in the afternoon, whereas in takeaway food establishments, savoury pastries and main dishes were mostly purchased at breakfast or lunch, and bread during the morning. Soft drinks and industrial juices were frequently purchased in both types of vending site and at all hours of the day, particularly in the afternoon. Our findings provide an overview of street food and takeaway food buying habits and consumer demands in these cities, reflecting local food culture and dietary behaviours. The identification of the meal contexts and city sub-regions in which specific purchasing practices emerge point to potential priority targets. These insights can be useful when designing interventions adapted to the specificities of these food environments and the food habits of customers.

Patterns of Street Food Purchase in Cities From Central Asia

Street food makes a significant contribution to the diet of many dwellers in low- and middle-income countries and its trade is a well-developed activity in the central Asian region. However, data on its purchase and nutritional value is still scarce. This study aimed to describe street food purchasing patterns in central Asia, according to time and place of purchase. A multicentre cross-sectional study was conducted in 2016/2017 in the main urban areas of four central Asian countries: Dushanbe (Tajikistan), Bishkek (Kyrgyzstan), Ashgabat (Turkmenistan) and Almaty (Kazakhstan). Street food markets (n = 34) and vending sites (n = 390) were selected by random and systematic sampling procedures. Data on the purchased foods and beverages were collected by direct observation. Time and geographic location of the purchases was registered, and their nutritional composition was estimated. A total of 714 customers, who bought 852 foods, were observed. Customers' influx, buying rate and purchase of industrial food were higher in city centers compared to the outskirts (median: 4.0 vs. 2.0 customers/10 min, p < 0.001; 5.0 vs. 2.0 food items/10 min, p < 0.001; 36.2 vs. 28.7%, p = 0.004). Tea, coffee, bread and savory pastries were most frequently purchased in the early morning, bread, main dishes and savory pastries during lunchtime, and industrial products in the mid-morning and mid-afternoon periods. Energy and macronutrient density was highest at 11:00–12:00 and lowest at 09:00–10:00. Purchases were smaller but more energy-dense in city centers, and higher in saturated and trans-fat in the peripheries. This work provides an overview of the street food buying habits in these cities, which in turn reflect local food culture. These findings from the main urban areas of four low- and middle-income countries which are currently under nutrition transition can be useful when designing public health interventions customized to the specificities of these food environments and their customers.

Changing Food Consumption and Nutrition Intake in Kazakhstan

Food resource is an important bond that connects human beings and nature. In this study, we investigated the changes in food consumption and nutrition intake in Kazakhstan from a spatial and temporal perspective, from 2001 to 2018. The data were obtained from the Bureau of Statistics, international organizations and our social interview work. After the start of the 21st century, it was found that per capita food consumption significantly increased; however, the consumption of crop, vegetables and milk decreased. Per capita meat consumption was similar in both urban and rural areas. However, some food consumption showed differences between urban and rural areas. Changes of food consumption quantity and structure also had some effects on nutrient intake and the proportion of nutrients. Per capita energy intake in the national, urban and rural areas all increased remarkably. The energy intake changes in eastern states increased much more than that in western states. Protein intake in rural and urban areas was similar; however, the gap between carbohydrates and fat intake in urban and rural areas increased. The intake of protein, carbohydrates and fat in different states showed the same trend. Food consumption and nutrition intake are affected by economic, social and ecological factors.

The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review

Introduction

Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions.

Methods

We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of the food environment and a diet, nutrition or health outcome. Study selection was done independently in duplicate. Data extraction and quality appraisal using the National Heart Lung and Blood Institute checklists were completed based on published reports using a prepiloted form on Covidence. Data were synthesised narratively.

Results

74 studies met eligibility criteria. Consistent evidence reported an association between availability characteristics in the neighbourhood food environment and dietary behaviour (14 studies, 10 rated as good quality), while the balance of evidence suggested an association with health or nutrition outcomes (17 of 24 relevant studies). We also found a balance of evidence that accessibility to food in the neighbourhood environment was associated with diet (10 of 11 studies) although evidence of an association with health outcomes was contradictory. Evidence on other neighbourhood food environment characteristics was sparse and mixed. Availability in the school food environment was also found to be associated with relevant outcomes. Studies investigating our other primary outcomes in observational studies of the school food environment were sparse, but most interventional studies were situated in schools. We found very little evidence on how workplace and home food environments are associated with relevant outcomes. This is a substantial evidence gap.

Conclusion

‘Zoning’ or ‘healthy food cart’ interventions to alter food availability may be appropriate in urban LMIC.

PROSPERO registration number

CRD42020207475.

Street food in Eastern Europe: a perspective from an urban environment in Moldova

Street food is popular in Eastern Europe, but its diversity and nutritional value are unknown. This study aimed to characterise the street food environment in Chişinău, Moldova, including the vending sites and vendors, food availability and nutritional composition of foods and beverages. All street food vending sites (single point of sale) located in a 1-km buffer centred on the main public market were systematically selected (n 439; n 328 participants). Data on vending sites' characteristics (mobility, type of physical set-up and access to electricity), operating periods and food availability were collected. Samples of the most commonly available foods of unknown composition were collected (twenty-eight home-made and twenty-four industrial). Macronutrients, Na and K were quantified through chemical analysis. Fruits, beverages and food other than fruits were available in 2·5, 74·3 and 80·8 % of the vending sites, respectively. Among the latter, 66·4 % sold only industrial foods (e.g. pretzels, biscuits, wafers, chocolate and ice cream), 21·5 % only home-made (e.g. savoury and sweet pastries) and 12·1 % both. Home-made foods presented larger serving sizes and energy/serving (median kJ/serving: 1312·5 v. 670·3, P = 0·022); industrial foods were more energy-dense (median kJ/100 g: 1797·0 v. 1269·8, P = 0·002). High SFA, trans-fat and Na contents were found, reaching 10·9 g/serving, 1·4 g/serving and 773·7 mg/serving, respectively. Soft drinks and alcoholic beverages were available in 80·7 and 42·0 % of the vending sites selling beverages, respectively. Concluding, industrial snacks and home-made pastries high in Na and unhealthy fat were frequent in Chişinău. Prevention of diet-related diseases in Moldova may benefit from the improvement of the nutritional profile of street food.

Macronutrient composition of street food in Central Asia: Bishkek, Kyrgyzstan

BACKGROUND

Urban areas in central Asia are currently undergoing nutrition transition. Street food is very popular, but the specific foods available and their nutritional composition are unknown. The aim was to describe the availability and macronutrient composition of street foods in Bishkek, Kyrgyzstan.

RESULTS

Trained interviewers collected data on street food vending sites' characteristics and food availability (n = 596). Samples of the most commonly available foods and drinks were collected (n = 80 homemade; n = 40 industrial). Macronutrients were quantified through chemical analysis. Fruit, beverages, and food other than fruit were available in 4.0%, 61.7%, and 81.0% of the vending sites, respectively. Among those selling food other than fruit, 56.5% sold only homemade (e.g., bread, main dishes, snacks, pastries, sandwiches, and cakes), 23.3% both homemade and industrial and 20.2% only industrial foods (e.g., bread, snacks, pastries, cakes, and cookies). Homemade foods presented the highest energy/serving (median kcal/serving: 357 versus 145, p < .001). A high content in saturated and trans-fatty acids was observed in some homemade traditional dishes and snacks, reaching, respectively, 30.2 g/serving and 2.9 g/serving (in homemade manty, a traditional dish). Tea and soft drinks were available in over 50% of the vending sites selling beverages.

CONCLUSION

The high availability of street food in Bishkek highlights its importance for this urban population. Traditional snacks, dishes, and beverages coexist with more westernized products. The variability in energy, macronutrients, and lipid profile of homemade and industrial products reflects heterogeneous culinary practices and ingredients. Policies promoting the availability of healthy foods and ingredients should be implemented.

Distribution characteristics of circulating homocysteine and folate and related factors in agriculture, stock-raising and urban populations: a cross-sectional survey

OBJECTIVE

To investigate homocysteine (Hcy) and folate levels, prevalence of hyperhomocysteinaemia (HHcy) and folate deficiency, which are affected by lifestyles in urban, agricultural and stock-raising populations.

DESIGN

This is a cross-sectional study.

SETTING

Urban, agricultural and stock-raising regions in Emin, China.

PARTICIPANTS

Totally 1926 subjects - 885 (45·9 %) from urban, 861 (44·7 %) from agricultural and 180 (9·4 %) from stock-raising regions - were obtained using multistage stratified random sampling. Inclusion criteria encompassed inhabitants aged ≥15 years who resided at the current address for ≥6 months and agreed to participate in the study. Surveys on health behaviour questionnaires and physical examinations were conducted and blood samples collected.

RESULTS

The folate level of subjects from the stock-raising region was the lowest, followed by those from the agricultural region, and the highest in those from the urban region (3·48 v. 6·50 v. 7·12 ng/ml, P < 0·001), whereas mean Hcy showed no significant difference across regions. The OR for HHcy in stock-raising regions was 1·90 (95 % CI 1·11, 3·27) compared with the urban region after adjusting for all possible covariates. The OR for folate deficiency in stock-raising and agriculture regions was 11·51 (95 % CI 7·09, 18·67) and 1·91 (95 % CI 1·30, 2·82), respectively, compared with the urban region after adjusting for all possible covariates.

CONCLUSIONS

HHcy and folate deficiency are highly prevalent in stock-raisers, which is of important reference for HHcy control in Xinjiang, with a possibility of extension to others with approximate lifestyles.

Are French Canadians able to accurately self-rate the quality of their diet? Insights from the PREDISE study

The main objective of this study was to compare self-rated diet quality with a more comprehensive score of diet quality and to assess the ability of self-rated diet quality to predict adherence to healthy eating guidelines. This study also aimed to evaluate the influence of individual characteristics on the association between self-rated diet quality and the overall diet quality score. As part of the PRédicteurs Individuels, Sociaux et Environnementaux (PREDISE) study, 1045 participants (51% women) from the Province of Québec, Canada, self-rated their diet quality (“In general, would you say that your dietary habits are excellent, very good, good, fair, or poor?”). Three Web-based 24-h food recalls were completed, generating data for the calculation of the Canadian Healthy Eating Index (C-HEI) score, an overall diet quality indicator. Participants rated their diet quality as excellent (2.4%), very good (22.7%), good (49.5%), fair (20.3%), or poor (5.1%). C-HEI scores differed significantly between diet ratings, in the expected direction (p < 0.0001). Self-rated diet quality predicted adherence to healthy eating guidelines (i.e., C-HEI > 68) with a sensitivity of 44.5% and a specificity of 81.5% (C-statistic = 0.63). Sex significantly modified the association between self-rated diet quality and C-HEI score (p interaction = 0.0131); women had higher C-HEI scores than did men in the “good” and “fair” ratings. Self-rated diet quality can be useful in obtaining an overview of the diet quality of a population, but the results of this study suggest that such data should be used with caution given their poor ability to predict adherence to healthy eating guidelines. Individual characteristics may influence one’s ability to appropriately self-evaluate diet quality.

Effects of Multivitamin, Multimineral and Phytonutrient Supplementation on Nutrient Status and Biomarkers of Heart Health Risk in a Russian Population: A Randomized, Double Blind, Placebo Controlled Study

The primary objective of this clinical study was to evaluate the effect of a dietary multivitamin, multimineral and phytonutrient (VMP) supplement on blood nutrient status and biomarkers of heart health risk in a Russian population. One hundred twenty healthy adults (40-70 years) were recruited for a 56-day (eight-week) randomized, double blind, placebo controlled study with parallel design. Subjects were divided into two groups and received either a VMP or a placebo (PLA) supplement. Blood nutrient levels of β-carotene, α-tocopherol, vitamin C, B6, B12, red blood cell (RBC) folate, Zinc and Selenium were measured at baseline and on Days 28 and 56, and quercetin was measured at baseline and on Day 56. Blood biomarkers of heart health, i.e. homocysteine (Hcy), high-sensitivity C-reactive protein (hs-CRP), oxidized LDL (ox-LDL), gamma-glutamyl transferase (GGT), uric acid and blood lipid profile, were measured at baseline and Day 56. Dietary VMP supplementation for 56 days significantly increased circulating levels of quercetin, vitamin C, RBC folate and partially prevented the decline in vitamin B6 and B12 status. Both serum Hcy and GGT were significantly reduced (-3.97 ± 10.09 µmol/L; -1.68 ± 14.53 U/L, respectively) after VMP supplementation compared to baseline. Dietary VMP supplementation improved the nutrient status and reduced biomarkers of heart health risk in a Russian population.

The management of acute myocardial infarction in the Russian Federation: protocol for a study of patient pathways

Background: Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics.

Methods: A prospective observational study has recruited a representative sample of AMI patients within 16 hospitals from 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multivariate analyses will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.

The management of acute myocardial infarction in the Russian Federation: protocol for a study of patient pathways

Background: Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics. Methods: A prospective observational study has recruited a representative sample of AMI patients from 16 hospitals in 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multilevel modelling will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.

Prevalence, awareness, treatment and control of dyslipidemia in older persons in urban and rural population in the Astana region, Kazakhstan

BACKGROUND

Despite high cardiovascular mortality in Central Asian republics of the former Soviet Union, there is limited information about major risk factors, including blood lipids. We investigated the prevalence of impaired concentrations of blood lipids, the awareness, treatment and control of hypercholesterolemia, and factors associated with these indicators in urban and rural populations in Kazakhstan.

METHODS

We conducted a cross-sectional study of random urban and rural population samples (the state capital Astana and Akmol village). Men and women aged 50-74 years were examined; a total of 954 adults participated (response rate 59%). Serum concentrations of total, LDL and HDL cholesterol and triglycerides and a range of other cardiovascular risk factors were measured.

RESULTS

The overall prevalence of hypercholesterolemia (total cholesterol ≥6.2 mmol/l) was 37%; among subjects with hypercholesterolemia, 57% were aware of their condition, 41% took medication and 23% had total cholesterol <6.2 mmol/l (4.5% <5 mmol/l). The prevalence, awareness, treatment, and control of hypercholesterolemia were all higher in the urban than the rural area. Similarly, the proportions of subjects with impaired concentrations of specific lipids fractions were also considerably higher in the urban population. Most associations with other covariates were in the expected direction.

CONCLUSIONS

This study found relatively high prevalence of dyslipidemia in the Kazakh population, and the blood lipid profile was less favourable in the urban area. These pronounced urban-rural differences may be related to urbanization, the associated nutrition transition and to access to health care.

The contribution of urbanization to non-communicable diseases: Evidence from 173 countries from 1980 to 2008

It is widely believed that the expanding burden of non-communicable diseases (NCDs) is in no small part the result of major macro-level determinants. We use a large amount of new data, to explore in particular the role played by urbanization - the process of the population shifting from rural to urban areas within countries - in affecting four important drivers of NCDs world-wide: diabetes prevalence, as well as average body mass index (BMI), total cholesterol level and systolic blood pressure. Urbanization is seen by many as a double-edged sword: while its beneficial economic effects are widely acknowledged, it is commonly alleged to produce adverse side effects for NCD-related health outcomes. In this paper we submit this hypothesis to extensive empirical scrutiny, covering a global set of countries from 1980-2008, and applying a range of estimation procedures. Our results indicate that urbanization appears to have contributed to an increase in average BMI and cholesterol levels: the implied difference in average total cholesterol between the most and the least urbanized countries is 0.40mmol/L, while people living in the least urbanized countries are also expected to have an up to 2.3kg/m² lower BMI than in the most urbanized ones. Moreover, the least urbanized countries are expected to have an up to 3.2p.p. lower prevalence of diabetes among women. This association is also much stronger in the low and middle-income countries, and is likely to be mediated by energy intake-related variables, such as calorie and fat supply per capita.

Health-related outcomes of new grocery store interventions: a systematic review

OBJECTIVE

To assess the evidence of the impact of new food store (supermarket/grocery store) interventions on selected health-related outcomes.

DESIGN

A systematic review following the Effective Public Health Practice Project guidelines. All quantitative studies were assessed for their methodological quality. Results were synthesized narratively.

SETTING

Eight electronic databases - MEDLINE, EMBASE, CINAHL, ProQuest Public Health, Web of Science, Scopus, PsycINFO and Cochrane Library - were searched to identify relevant records.

SUBJECTS

Peer-reviewed scholarly journal articles on new grocery store/supermarket interventions with adult study populations, published in the English language after 1995.

RESULTS

Eleven records representing seven new grocery store interventions were identified. Six were assessed having 'weak' methodological quality, one as 'moderate' and two as 'strong'. All studies reported fruit and vegetable consumption but results were not consistent, some studies reporting significantly more and others no increase in consumption. BMI and self-rated health did not show significant improvements. Perceptions of food access, neighbourhood satisfaction and psychological health showed significant improvements.

CONCLUSIONS

Improved food access through establishment of a full-service food retailer, by itself, does not show strong evidence towards enhancing health-related outcomes over short durations. Presently the field is developing and the complex linking pathways/mechanisms are yet to be elucidated. Further evidence, in the form of high-quality research in different communities with longer follow-up periods, is needed to inform policy decisions.

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.

Dysbiotic drift: mental health, environmental grey space, and microbiota

Advances in research concerning the mental health implications of dietary patterns and select nutrients have been remarkable. At the same time, there have been rapid increases in the understanding of the ways in which non-pathogenic microbes can potentially influence many aspects of human health, including those in the mental realm. Discussions of nutrition and microbiota are often overlapping. A separate, yet equally connected, avenue of research is that related to natural (for example, green space) and built environments, and in particular, how they are connected to human cognition and behaviors. It is argued here that in Western industrial nations a ‘disparity of microbiota’ might be expected among the socioeconomically disadvantaged, those whom face more profound environmental forces. Many of the environmental forces pushing against the vulnerable are at the neighborhood level. Matching the developing microbiome research with existing environmental justice research suggests that grey space may promote dysbiosis by default. In addition, the influence of Westernized lifestyle patterns, and the marketing forces that drive unhealthy behaviors in deprived communities, might allow dysbiosis to be the norm rather than the exception in those already at high risk of depression, subthreshold (subsyndromal) conditions, and subpar mental health. If microbiota are indeed at the intersection of nutrition, environmental health, and lifestyle medicine (as these avenues pertain to mental health), then perhaps the rapidly evolving gut-brain-microbiota conversation needs to operate through a wider lens. In contrast to the more narrowly defined psychobiotic, the term eco-psychotropic is introduced.