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Parajára MDC, Fogal Vegi AS, Machado ÍE, de Menezes MC, Verly-Jr E, Meireles AL. Disability and costs of IHD attributable to the consumption of trans-fatty acids in Brazil. Public Health Nutr 2024; 27:e132. [PMID: 38726481 PMCID: PMC11112431 DOI: 10.1017/s1368980024001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/25/2024] [Accepted: 05/01/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To estimate the disability and costs of the Brazilian Unified Health System for IHD attributable to trans-fatty acid (TFA) consumption in 2019. DESIGN This ecological study used secondary data from the Global Burden of Disease (GBD) Study 2019 to estimate the years lived with disability from IHD attributable to TFA in Brazil in 2019. Data on direct costs (purchasing power parity: 1 Int$ = R$ 2·280) were obtained from the Hospital and Ambulatory Information Systems of the Brazilian Unified Health System. Moreover, the total costs in each state were divided by the resident population in 2019 and multiplied by 10 000 inhabitants. The relationship between the socio-demographic index, disease and economic burden was investigated. SETTING Brazil and its twenty-seven states. PARTICIPANTS Adults aged ≥ 25 years of both sexes. RESULTS IHD attributable to TFA consumption resulted in 11 165 years lived with disability (95 % uncertainty interval 932–18 462) in 2019 in Brazil. A total of Int$ 54 546 227 (95 % uncertainty interval 4 505 792–85 561 810) was spent in the Brazilian Unified Health System in 2019 due to IHD attributable to TFA, with the highest costs of hospitalisations, for males and individuals aged ≥ 50 years or over. The highest costs were observed in Sergipe (Int$ 6508/10 000; 95 % uncertainty interval 576–10 265), followed by the two states from the South. Overall, as the socio-demographic index increases, expenditures increase. CONCLUSIONS TFA consumption results in a high disease and economic IHD burden in Brazil, reinforcing the need for more effective health policies, such as industrial TFA elimination, following the international agenda.
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Affiliation(s)
- Magda do Carmo Parajára
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Aline Siqueira Fogal Vegi
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Ísis Eloah Machado
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Departamento de Medicina de Família, Saúde Mental e Coletiva, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Mariana Carvalho de Menezes
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Departamento de Nutrição Clínica e Social, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Eliseu Verly-Jr
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana Lúcia Meireles
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Departamento de Nutrição Clínica e Social, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
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Nishi SK, Khoury N, Valle Hita C, Zurbau A, Salas-Salvadó J, Babio N. Vegetable and Fruit Intake Variety and Cardiovascular Health and Mortality: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2023; 15:4913. [PMID: 38068771 PMCID: PMC10707746 DOI: 10.3390/nu15234913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION A multitude of evidence supports the consumption of a higher quantity of vegetables and fruits for their cardiovascular benefits. Nonetheless, the extent to which variety is associated with cardiovascular health remains unclear. OBJECTIVE To conduct a systematic review and meta-analysis of observational studies (prospective cohort and cross-sectional studies) assessing the role of a variety of vegetable and fruit consumption in cardiovascular morbidity and mortality in adults. DATA SOURCES MEDLINE-PubMed, Cochrane databases, and reference lists were searched through March 2023. DATA EXTRACTION Two independent reviewers extracted data and assessed the risk of bias (National Heart, Lung, and Blood Institute Tool and Newcastle-Ottawa Scale). DATA ANALYSIS Data were pooled (fixed and random [DerSimonian and Laird] effects for <5 and ≥5 study comparisons, respectively), and heterogeneity was assessed using the Cochran Q statistic and quantified (I2 statistic). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the overall certainty of the evidence. Five cross-sectional (n = 45,761) and seven prospective studies (n = 253,422) met the eligibility criteria. Greater variety of vegetable and fruit consumption was prospectively related to decreased all-cause mortality (risk ratio, 0.89 [95% CI, 0.82-0.97], seven study comparisons, n = 196,925), while no significant associations were observed with assessed cardiovascular-related mortality or morbidity. For all outcomes, the certainty of the evidence was graded as "low" or "very low" owing to inconsistency and/or imprecision. CONCLUSIONS Overall, this study shows that greater variety in vegetable and fruit consumption may reduce all-cause mortality and highlights the need for additional studies with a higher degree of evidence to better understand its role in cardiovascular health.
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Affiliation(s)
- Stephanie K. Nishi
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada;
| | - Nadine Khoury
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
| | - Cristina Valle Hita
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
| | - Andreea Zurbau
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada;
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Nancy Babio
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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Garner JA, Hanson KL, Jilcott Pitts SB, Kolodinsky J, Sitaker MH, Ammerman AS, Kenkel D, Seguin-Fowler RA. Cost analysis and cost effectiveness of a subsidized community supported agriculture intervention for low-income families. Int J Behav Nutr Phys Act 2023; 20:84. [PMID: 37430305 DOI: 10.1186/s12966-023-01481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The food system has a dynamic influence on disparities in food security and diet-related chronic disease. Community supported agriculture (CSA) programs, in which households receive weekly shares of produce from a local farmer during the growing season, have been examined as a possible food systems-based approach for improving diet and health outcomes. The purpose of this study was to estimate the cost of implementing and participating in a multi-component subsidized community supported agriculture intervention and calculate cost-effectiveness based on diet and food security impacts. METHODS Using data from the Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (n = 305; 2016-2018), we estimated programmatic and participant costs and calculated incremental cost-effectiveness ratios (ICERs) for caregivers' daily fruit and vegetable (FV) intake, skin carotenoids, and household food security from program and societal perspectives. RESULTS F3HK cost $2,439 per household annually ($1,884 in implementation-related expenses and $555 in participant-incurred costs). ICERs ranged from $1,507 to $2,439 per cup increase in caregiver's FV intake (depending on perspective, setting, and inclusion of juice); from $502 to $739 per one thousand unit increase in skin carotenoid score; and from $2,271 to $3,137 per household shifted out of food insecurity. CONCLUSIONS Given the known public health, healthcare, and economic consequences of insufficient FV intake and living in a food insecure household, the costs incurred to support these positive shifts in individual- and household-level outcomes via a F3HK-like intervention may be deemed by stakeholders as a reasonable investment. This work helps to advance a critical body of literature on the cost-effectiveness of subsidized CSAs and other economic and food system interventions for the sake of evidence-based allocation of public health resources. TRIAL REGISTRATION ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered. https://www. CLINICALTRIALS gov/ct2/show/NCT02770196 .
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Affiliation(s)
- Jennifer A Garner
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - Karla L Hanson
- Master of Public Health Program, Cornell University, Ithaca, NY, USA
| | - Stephanie B Jilcott Pitts
- Brody School of Medicine, Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Marilyn H Sitaker
- Ecological Agriculture and Food Systems, The Evergreen State College, Olympia, WA, USA
| | - Alice S Ammerman
- Gillings School of Global Public Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald Kenkel
- Cornell Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
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Ajami M, Salehi F, Kalantari N, Asadilari M, Roshanmehr F, Houshiarrad A, Esmaeili M, Abdollahi M. Dietary Patterns in 1125 Iranian Women: Adequacy of Energy and Micronutrient Intakes and Weight Statuses. Int J Prev Med 2023; 14:82. [PMID: 37855009 PMCID: PMC10580216 DOI: 10.4103/ijpvm.ijpvm_133_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/15/2022] [Indexed: 10/20/2023] Open
Abstract
Background Women's nutrition status includes significant effects on their children and household health. The purpose of this study was to assess energy and micronutrient intake adequacy in Iranian women. Methods This study was a part of the Urban HEART Study, which has jointly been developed by the World Health Organization (WHO) Centre for Health Development, Kobe, Japan. In total, anthropometric and dietary intake data were collected from 1125 women in southern Tehran municipality districts. A 24-h recall questionnaire was completed by the expert nutritionists and the participants' anthropometric statuses were assessed. Food intakes were calculated in grams per capita per day. Micronutrients and energy requirements were adapted from WHO/Food and Agriculture Organization (FAO) tables and Iran National Food Consumption Survey, respectively. Results Nearly 71.5% of the women were overweight or obese [body mass index (BMI) ≥25 kg/m2]. Furthermore, 1.2% of the women were underweight (BMI <18.5 kg/m2), while 27.3% had normal weight (BMI = 18.5--24.9 kg/m2). The mean bread/cereal and vegetable intakes were significantly higher in obese group, compared to that in normal/under/overweight group (375.6 g/day ± 151.4, P = 0.05; and 331.4 g/day ± 227.5, P = 0.02), respectively]. Women in the lean group significantly consumed higher quantities of cakes/pastries and had the lowest calcium and iron adequacy ratios, compared to other groups (p = 0.001, P = 0.03, and P = 0.05, respectively). Conclusions These findings suggest that Iranian women, especially those who reside in the southern areas of Tehran, need to change their dietary habits to maintain their health. Moreover, being under/normal weight does not necessarily mean following healthy diets.
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Affiliation(s)
- Marjan Ajami
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Forouzan Salehi
- Department of Community Nutrition, Ministry of Health and Medical Education, Tehran, Iran
| | - Naser Kalantari
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadilari
- Department of Epidemiology and Biostatistics, School of Public Health, and Oncopathology Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Farnaz Roshanmehr
- Department of Advanced Science and Engineering, Waseda University, Tokyo, Japan, Kagawa Nutrition University, Saitama, Japan, Institute of Nutrition Sciences, Saitama, Japan
| | - Anahita Houshiarrad
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Esmaeili
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Abdollahi
- Social Determinants of Health Research Center, and National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tulloch AIT, Oh RRY, Gallegos D. Environmental and public health co-benefits of consumer switches to immunity-supporting food. AMBIO 2022; 51:1658-1672. [PMID: 35076882 PMCID: PMC8787970 DOI: 10.1007/s13280-021-01693-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
During COVID-19, there has been a surge in public interest for information on immunity-boosting foods. There is little scientific support for immunity-supporting properties of specific foods, but strong evidence for food choice impacts on other health outcomes (e.g. risk of non-communicable disease) and environmental sustainability. Here, we relate online recommendations for "immunity-boosting" foods across five continents to their environmental and human health impacts. More frequently recommended food items and groups are plant based and have lower land use and greenhouse gas emission impacts plus more positive health outcomes (reducing relative risks of mortality or chronic diet-related diseases) per serving of food. We identify trade-offs between environmental outcomes of increasing consumption of recommended food items, with aquatic environment impacts increasing with food recommendation frequency. People's reliance on the Internet for health information creates an opportunity to consolidate behaviour change towards consuming foods with multiple co-benefits. Our study identifies win-win options for nudging online information-seeking behaviour towards more sustainable choices for terrestrial biodiversity conservation and human health.
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Affiliation(s)
- Ayesha I. T. Tulloch
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2000 Australia
- School of Biology and Environmental Science, Queensland University of Technology, Brisbane, QLD 4000 Australia
| | - Rachel R. Y. Oh
- School of Biological Sciences, University of Queensland, Brisbane, QLD 4072 Australia
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Leipzig, Germany
- Department of Ecosystem Services, Helmholtz-Centre for Environmental Research – UFZ, Leipzig, Germany
| | - Danielle Gallegos
- Faculty of Health, Woolworths Centre for Childhood Nutrition Research, Queensland University of Technology (QUT), Brisbane, QLD 4101 Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Kelvin Grove, QLD 4059 Australia
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Liu S, Munasinghe LL, Maximova K, Taylor JP, Ohinmaa A, Veugelers PJ. The economic burden of excessive sugar consumption in Canada: should the scope of preventive action be broadened? CANADIAN JOURNAL OF PUBLIC HEALTH 2022; 113:331-340. [PMID: 35292938 PMCID: PMC8923742 DOI: 10.17269/s41997-022-00615-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 01/28/2022] [Indexed: 12/11/2022]
Abstract
Objective Excessive sugar consumption is an established risk factor for various chronic diseases (CDs). No earlier study has quantified its economic burden in terms of health care costs for treatment and management of CDs, and costs associated with lost productivity and premature mortality. This information, however, is essential to public health decision-makers when planning and prioritizing interventions. The present study aimed to estimate the economic burden of excessive free sugar consumption in Canada. Methods Free sugars refer to all monosaccharides and disaccharides added to foods plus sugars naturally present in honey, syrups, and fruit juice. Based on free sugar consumption reported in the 2015 Canadian Community Health Survey–Nutrition and established risk estimates for 16 main CDs, we calculated the avoidable direct health care costs and indirect costs. Results If Canadians were to comply with the free sugar recommendation (consumption below 10% of total energy intake (TEI)), an estimated $2.5 billion (95% CI: 1.5, 3.6) in direct health care and indirect costs could have been avoided in 2019. For the stricter recommendation (consumption below 5% of TEI), this was $5.0 billion (95% CI: 3.1, 6.9). Conclusion Excessive free sugar in our diet has an enormous economic burden that is larger than that of any food group and 3 to 6 times that of sugar-sweetened beverages (SSBs). Public health interventions to reduce sugar consumption should therefore consider going beyond taxation of SSBs to target a broader set of products, in order to more effectively reduce the public health and economic burden of CDs.
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Affiliation(s)
- Siyuan Liu
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Lalani L Munasinghe
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Katerina Maximova
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer P Taylor
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Arto Ohinmaa
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paul J Veugelers
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
- School of Public Health, University of Alberta, 3-50 University Terrace, Edmonton, AB, T6G 2T4, Canada.
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Segmentation of Consumer Preferences for Vegetables Produced in Areas Depressed by Drought. SUSTAINABILITY 2022. [DOI: 10.3390/su14106190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The megadrought in Chile’s north and central zones has impacted the horticultural production of family farming. One way to mitigate these effects is by adding value to vegetables. However, no studies show the main attributes consumers value of vegetables produced in the megadrought zone. The study’s objective was to evaluate consumer preferences and identify segments based on the extrinsic attributes of vegetables grown in areas depressed by drought. We surveyed 946 vegetable buyers from the Antofagasta, Valparaiso, and Maule regions. Through the conjoint analysis technique, we identified that the main attributes preferred by consumers were presentation (45.3%) and type of vegetables (21.8%), followed by labeling (15.9%), producers (10.3%), and origin (6.7%). The cluster analysis revealed the existence of three segments. The largest segment is motivated by the way vegetables are presented (49.7%), followed by a second segment that values multi-attributes (31.9%) and a smaller segment that is interested in labeling (18.4%). These findings can help position these products in the market and raise awareness of family farming and the economic and production problems that they currently face.
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Prowse R, Doan N, Philipneri A, Thielman J, Hack S, Harrington DW, Jessri M. Creating "Plates" to Evaluate Canadians' Dietary Intake in Relation to the 2019 Canada's Food Guide. CAN J DIET PRACT RES 2022; 83:152-159. [PMID: 35503904 DOI: 10.3148/cjdpr-2022-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: Explore Canadians' dietary intake in relation to the 2019 Canada's Food Guide (CFG) Plate using novel volume-based food analyses, by age and meal occasion.Methods: Foods reported in 24-hour recalls by 20,456 Canadians in the 2015 Canadian Community Health Survey - Nutrition were classified as: Vegetables and Fruits, Whole Grain Foods, Protein Foods, Non-Whole Grain Foods or Other Foods (high in fat, sugar, sodium). Food volumes were used to calculate percent contributions of each grouping to total intake, stratified by age (1-6; 7-12; 13-17; 18-64; 65+years) and meal (breakfast, lunch, supper, snack), applying sample survey weights and bootstrapping.Results: By volume, the Canadian population diet included: 29% Vegetables and Fruits, 22% Protein Foods, 7% Whole Grains, 24% Non-Whole Grain Foods, and 18% Other Foods. Intakes of Protein Foods (1-6 years) and Other Foods (7-12; 13-17 years) were higher in children than adults by volume, relative to total intake. Whole Grains intake was highest at breakfast. Other Foods intake was highest at snack.Conclusions: The volume-based population diet of Canadians reported on a single day includes a substantial proportion of non-recommended foods. There are opportunities to design interventions that target specific foods, ages, and meals to align intake with recommendations.
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Affiliation(s)
- Rachel Prowse
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL
| | - Natalie Doan
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Anne Philipneri
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Justin Thielman
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Salma Hack
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Dan W Harrington
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON
| | - Mahsa Jessri
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC
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Khatti-Dizabadi F, Yazdani-Charati J, Amani R, Mostafavi F. Investigating the predictive power of constructs of extended Pender's health promotion model and some background factors in fruit and vegetable consumption behavior among government employees. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:91. [PMID: 35573630 PMCID: PMC9093655 DOI: 10.4103/jehp.jehp_214_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/07/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Daily consumption of fruit and vegetable (F and V) can effectively reduce the risk factors of cardiovascular diseases; therefore it is necessary to identify the factors affecting this behavior. This study aimed to determine the Predictive Power of Pender's Health promotion model (HPM) constructs in F and V consumption behavior and the effects of some background variables on this behavior. MATERIALS AND METHODS A descriptive-correlation study was conducted on 418 employees working in different offices of Qaemshahr, Mazandaran Province from April 8, 2019, to July 23, 2019. The participants filled out a questionnaire about perceived F and V Consumption behavior based on Pender's HPM Constructs. The data were statistically analyzed by descriptive statistics and parametric tests, including the Pearson correlation, Independent- Sample t-test, One-Way analysis of variance test, and multiple linear regression, in SPSS-22. RESULTS The mean age of participants was 40.25 ± 7.56 years. The results showed that F and V consumption behavior was positively correlated with some constructs of Pender's HPM including, behavioral outcome (r = 0.51, P < 0.001), previous related behavior (r = 0.48, P < 0.001), commitment to action (r = 0.47, P < 0.001), perceived self-efficacy and behavior-related emotions (r = 0.39, P < 0.001). Behavioral outcome alone explained 26% of the dependent variable changes (F and V consumption behavior). The results also indicated that there was a significant relationship between gender and F and V consumption behavior (P = 0.01). CONCLUSION The study findings demonstrated that some of Pender's HPM Constructs could predict F and V consumption behavior. Behavioral outcome alone was a strong predictor of this behavior. Therefore, in addition to background variables, these constructs should be taken into account in the development of training interventions and courses.
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Affiliation(s)
- Freshteh Khatti-Dizabadi
- Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Yazdani-Charati
- Department of Biostatistics, Center Addiction Research Institutes, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Amani
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Ma Y, McRae C, Wu YH, Dubé L. Exploring Pathways of Socioeconomic Inequity in Vegetable Expenditure Among Consumers Participating in a Grocery Loyalty Program in Quebec, Canada, 2015-2017. Front Public Health 2021; 9:634372. [PMID: 34409001 PMCID: PMC8365471 DOI: 10.3389/fpubh.2021.634372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/08/2021] [Indexed: 01/04/2023] Open
Abstract
Vegetable consumption remains consistently low despite supportive policy and investments across the world. Vegetables are available in great variety, ranging in their processing level, availability, cost, and arguably, nutritional value. A retrospective longitudinal study was conducted in Quebec, Canada to explore pathways of socioeconomic inequity in vegetable expenditure. Data was obtained for consumers who participated in a grocery loyalty program from 2015 to 2017 and linked to the 2016 Canadian census. Vegetable expenditure share (%) was examined as a fraction of the overall food basket and segmented by processing level. Panel random effects and tobit models were used overall and to estimate the stratified analysis by median income split. Consumers allocated 8.35% of their total food expenditure to vegetables, which was mostly allocated to non-processed fresh (6.88%). Vegetable expenditure share was the highest in early winter and lowest in late summer. In the stratified analysis, the low-income group exhibited less seasonal variation, allocated less to fresh vegetables, and spent more on canned and frozen compared to the high-income group. Measures of socioeconomic status were all significant drivers of overall vegetable consumption. Consumers with high post-secondary education in the low-income group spent 2% more on vegetables than those with low education. The complexity of observed expenditure patterns points to a need for more specific vegetable consumption guidelines that include provisions by processing level. Implications for education, marketing, intersectional policies, and the role of government are discussed. Governments can scale present efforts and catalyze health-promoting investments across local, state, national, and global food systems.
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Affiliation(s)
- Yu Ma
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada.,McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Cameron McRae
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada.,McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Yun-Hsuan Wu
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada.,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Laurette Dubé
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada.,McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
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11
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Baldwin JN, Ashton LM, Forder PM, Haslam RL, Hure AJ, Loxton DJ, Patterson AJ, Collins CE. Increasing Fruit and Vegetable Variety over Time Is Associated with Lower 15-Year Healthcare Costs: Results from the Australian Longitudinal Study on Women's Health. Nutrients 2021; 13:2829. [PMID: 34444989 PMCID: PMC8398554 DOI: 10.3390/nu13082829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 01/04/2023] Open
Abstract
Healthcare costs are lower for adults who consume more vegetables; however, the association between healthcare costs and fruit and vegetable varieties is unclear. Our aim was to investigate the association between (i) baseline fruit and vegetable (F&V) varieties, and (ii) changes in F&V varieties over time with 15-year healthcare costs in an Australian Longitudinal Study on Women's Health. The data for Survey 3 (n = 8833 women, aged 50-55 years) and Survey 7 (n = 6955, aged 62-67 years) of the 1946-1951 cohort were used. The F&V variety was assessed using the Fruit and Vegetable Variety (FAVVA) index calculated from the Cancer Council of Victoria's Dietary Questionnaire for Epidemiological Studies food frequency questionnaire. The baseline FAVVA and change in FAVVA were analysed as continuous predictors of Medicare claims/costs by using multiple regression analyses. Healthy weight women made, on average, 4.3 (95% confidence interval (CI) 1.7-6.8) fewer claims for every 10-point-higher FAVVA. Healthy weight women with higher fruit varieties incurred fewer charges; however, this was reversed for women overweight/obese. Across the sample, for every 10-point increase in FAVVA over time, women made 4.3 (95% CI 1.9-6.8) fewer claims and incurred $309.1 (95% CI $129.3-488.8) less in charges over 15 years. A higher F&V variety is associated with a small reduction in healthcare claims for healthy weight women only. An increasing F&V variety over time is associated with lower healthcare costs.
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Affiliation(s)
- Jennifer N. Baldwin
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Lee M. Ashton
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Peta M. Forder
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW 2308, Australia; (P.M.F.); (A.J.H.); (D.J.L.)
| | - Rebecca L. Haslam
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alexis J. Hure
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW 2308, Australia; (P.M.F.); (A.J.H.); (D.J.L.)
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Deborah J. Loxton
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW 2308, Australia; (P.M.F.); (A.J.H.); (D.J.L.)
| | - Amanda J. Patterson
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare E. Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.N.B.); (L.M.A.); (R.L.H.); (A.J.P.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
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12
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Olm M, Stark RG, Beck N, Röger C, Leidl R. Impact of interventions to reduce overnutrition on healthcare costs related to obesity and type 2 diabetes: a systematic review. Nutr Rev 2020; 78:412-435. [PMID: 31769843 DOI: 10.1093/nutrit/nuz070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
CONTEXT In recent decades, obesity and type 2 diabetes mellitus (T2DM) have both become global epidemics associated with substantial healthcare needs and costs. OBJECTIVE The aim of this review was to critically assess nutritional interventions for their impact on healthcare costs to community-dwelling individuals regarding T2DM or obesity or both, specifically using CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria to assess the economic components of the evidence. DATA SOURCES Searches were executed in Embase, EconLit, AgEcon, PubMed, and Web of Science databases. STUDY SELECTION Studies were included if they had a nutritional perspective, reported an economic evaluation that included healthcare costs, and focused on obesity or T2DM or both. Studies were excluded if they examined clinical nutritional preparations, dietary supplements, industrially modified dietary components, micronutrient deficiencies, or undernutrition; if they did not report the isolated impact of nutrition in complex or lifestyle interventions; or if they were conducted in animals or attempted to transfer findings from animals to humans. DATA EXTRACTION A systematic review was performed according to PRISMA guidelines. Using predefined search terms, 21 studies evaluating food habit interventions or taxation of unhealthy foods and beverages were extracted and evaluated using CHEERS criteria. RESULTS Overall, these studies showed that nutrition interventions and taxation approaches could lead to cost savings and improved health outcomes when compared with current practice. All of the included studies used external sources and economic modeling or risk estimations with population-attributable risks to calculate economic outcomes. CONCLUSIONS Most evidence supported taxation approaches. The effect of nutritional interventions has not been adequately assessed. Controlled studies to directly measure economic impacts are warranted.
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Affiliation(s)
- Michaela Olm
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of General Practice and Health Services Research, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Renée G Stark
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nathanael Beck
- Munich Center of Health Sciences, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany
| | - Christina Röger
- Competence Center for Nutrition and the Institute of the Bavarian State Ministry of Food, Agriculture and Forestry, Freising, Bavaria, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany
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13
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Dabravolskaj J, Montemurro G, Ekwaru JP, Wu XY, Storey K, Campbell S, Veugelers PJ, Ohinmaa A. Effectiveness of school-based health promotion interventions prioritized by stakeholders from health and education sectors: A systematic review and meta-analysis. Prev Med Rep 2020; 19:101138. [PMID: 32612906 PMCID: PMC7322344 DOI: 10.1016/j.pmedr.2020.101138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 01/28/2023] Open
Abstract
Childhood obesity and associated modifiable risk factors exert significant burden on the health care system. The goal of this systematic review and meta-analysis was to examine the effectiveness of school-based intervention types perceived by Canadian stakeholders in health and education as feasible, acceptable and sustainable in terms of improving physical activity (PA), fruit and vegetable intake, and body weight. We searched multiple databases for studies that evaluated school-based interventions to prevent obesity and associated risk factors (i.e., unhealthy diet, physical inactivity, sedentary behaviour) in children aged 4–18 years from January 1, 2012 to January 28, 2020. From 10,871 identified records, we included 83 and 80 studies in our systematic review and meta-analysis, respectively. Comprehensive School Health (CSH) and interventions which focused on modifications to school nutrition policies showed statistically significant positive effects on fruit intake of 0.13 (95% CI: 0.04, 0.23) and 0.30 (95% CI: 0.1, 0.51) servings per day, respectively. No intervention types showed statistically significant effect on vegetable intake. CSH, modifications to physical education (PE) curriculum, and multicomponent interventions showed statistically significant difference in BMI of −0.26 (95% CI: −0.40, −0.12), −0.16 (95% CI: −0.3, −0.02), and −0.18 (95% CI: −0.29, −0.07), respectively. CSH interventions showed positive effect on step-count per day, but no other types of interventions showed significant effect on any of PA outcome measures. Thus, the results of this systematic review and meta-analysis suggest that decision-makers should carefully consider CSH, multicomponent interventions, modifications to PE curricula and school nutrition policies to prevent childhood obesity.
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Key Words
- BMI, body mass index
- CI, confidence interval
- CSH, Comprehensive School Health
- Childhood obesity prevention
- FV, fruit and vegetable
- HSAT, Healthy School Action Tools
- Health promotion
- MVPA, moderate to vigorous physical activity
- Meta-analysis
- PA, physical activity
- PE, physical education
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RCT, randomized controlled trial
- SES, socioeconomic status
- School-based interventions
- Systematic review
- UK, United Kingdom
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Affiliation(s)
| | | | - John Paul Ekwaru
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Xiu Yun Wu
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
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14
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Dumas AA, Lemieux S, Lapointe A, Provencher V, Robitaille J, Desroches S. Long-term effects of a healthy eating blog in mothers and children. MATERNAL AND CHILD NUTRITION 2020; 16:e12981. [PMID: 32141188 PMCID: PMC7296799 DOI: 10.1111/mcn.12981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 11/26/2022]
Abstract
In the context of low consumption of vegetables and fruits and milk and alternatives among Canadian mothers and children, novel strategies are needed to improve maternal and child nutrition. This study evaluated the long‐term effects of an evidence‐informed healthy eating blog on dietary intakes and food‐related behaviours of mothers and their child. The study presents a secondary outcome analysis of a randomised controlled trial in which 84 mothers (mean age of 37.6 ± 6.7 years) of 2‐ to 12‐year‐old children living in Quebec City, Canada, were randomly assigned to a dietary intervention delivered through a healthy eating blog written by a registered dietitian (RD; n = 42) or a control group (n = 42) during a period of 6 months. Dietary intakes, maternal eating behaviours, food parenting practices, and body weight were measured at baseline, 3 months, at the end of the intervention (6 months), and 6‐month post‐intervention (12 months). Differences between groups were assessed with mixed linear models. Globally, this study found no evidence of long‐term differences in mean dietary intakes in mothers exposed to the blog and their children as well as other food‐related outcomes and body weight compared with the control condition. Potential predictors of adherence to dietary recommendations in mothers and children (e.g., involvement of children in household food activities) were identified. In conclusion, a healthy eating blog written by an RD did not result in evidence of any long‐term differences in dietary intakes and food‐related behaviours in mothers and their children compared with the control condition.
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Affiliation(s)
- Audrée-Anne Dumas
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Simone Lemieux
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Annie Lapointe
- Institute of Nutrition and Functional Foods, Centre de recherche Nutrition, Santé et Société (NUTRISS), Université Laval, Quebec City, Quebec, Canada
| | - Véronique Provencher
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Julie Robitaille
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Sophie Desroches
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
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15
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Hoy MK, Sebastian RS, Goldman JD, Wilkinson Enns C, Moshfegh AJ. Consuming Vegetable-Based Salad Is Associated with Higher Nutrient Intakes and Diet Quality among US Adults, What We Eat in America, National Health and Nutrition Examination Survey 2011-2014. J Acad Nutr Diet 2019; 119:2085-2092. [DOI: 10.1016/j.jand.2019.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022]
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16
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Loewen OK, Ekwaru JP, Ohinmmaa A, Veugelers PJ. Economic Burden of Not Complying with Canadian Food Recommendations in 2018. Nutrients 2019; 11:E2529. [PMID: 31635176 PMCID: PMC6835951 DOI: 10.3390/nu11102529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 11/25/2022] Open
Abstract
Poor diet has been identified as a major cause of chronic disease. In this study we estimated the 2018 economic burden of chronic disease attributable to not complying with Canadian food recommendations. We retrieved the chronic disease risk estimates for intakes of both protective (fruit, vegetables, milk, whole grains, nuts and seeds) and harmful foods (sugar-sweetened beverages, processed meat, red meat) from the Global Burden of Disease Study, and food intakes from the 2015 Canadian Community Health Survey 24-hour dietary recalls (n = 19,797). Population attributable fractions (PAFs) were calculated for all food-chronic disease combinations, and mathematically adjusted to estimate the 2018 annual direct (hospital, physician, drug) and indirect (human capital approach) economic burden for each disease. Not meeting the eight food recommendations was estimated to be responsible for CAD$15.8 billion/year in direct (CAD$5.9 billion) and indirect (CAD$9.9 billion) costs. The economic burden of Canadians under-consuming healthful foods exceeded the burden of overconsumption of harmful foods (CAD$12.5 billion vs. CAD$3.3 billion). Our findings suggest poor diet represents a substantial economic burden in Canada. Interventions may be more effective if they are wide in focus and promote decreased consumption of harmful foods alongside increased consumption of healthful foods, with emphasis on whole grains and nuts and seeds.
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Affiliation(s)
- Olivia K Loewen
- Population Health Research Intervention Unit, School of Public Health, University of Alberta, Edmonton, AL T6G 2T4, Canada.
| | - John P Ekwaru
- Population Health Research Intervention Unit, School of Public Health, University of Alberta, Edmonton, AL T6G 2T4, Canada.
| | - Arto Ohinmmaa
- Population Health Research Intervention Unit, School of Public Health, University of Alberta, Edmonton, AL T6G 2T4, Canada.
| | - Paul J Veugelers
- Population Health Research Intervention Unit, School of Public Health, University of Alberta, Edmonton, AL T6G 2T4, Canada.
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17
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Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work. Nutrients 2019; 11:nu11061382. [PMID: 31248175 PMCID: PMC6627504 DOI: 10.3390/nu11061382] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7–9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.
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18
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MOHAMED WIRDAH, AZLAN ARIF, TALIB RUZITAABD. Benefits of Community Gardening Activity in Obesity Intervention: Findings from F.E.A.T. Programme. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE 2018. [DOI: 10.12944/crnfsj.6.3.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study determines the beneficial effect of community gardening activity in obesity intervention among overweight and obese adults in semi-urban area. The study was one of the activities in Arus Perdana Research Grant for obesity intervention, The Fit, Eat, Active and Training (F.E.A.T) programme. The study employs a pre-post quasi experimental design assigned into intervention (n=31) and control (n=30) group respectively. The intervention group followed a series of activities for 12 weeks of intervention. In one of the activities, subjects received a nutrition counselling session with nutritionist on daily vegetables intake, while agriculture officers demonstrated the procedure of producing fertilizers from household waste and vegetable gardening techniques. The subjects were divided into groups which planted their own vegetables at the space around community hall and in the pot during the intervention period. There was significant difference (p<0.05) for vegetable intake after 12-week intervention, when 1.8 ± 0.7 serving size for the intervention group is compared to 0.7 ± 0.5 serving size for the control group. The results reported noteworthy reductions (p<0.05) in body weight with -3.5% reduction for the intervention group which was involved in gardening as compared to -0.4% reduction for the control group. Moreover, BMI reductions were observed to be -4.1% and -0.9% and waist circumference reductions were -9.9% and -4.0% for intervention group and control group respectively. In conclusion, the community gardening program is fund to be a successful activity in improving daily vegetable intake, as well as reducing the BMI and waist circumference among obese adults in semi-urban community.
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Affiliation(s)
- WIRDAH MOHAMED
- Nutritional Science Programme, Centre for Community Health, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - ARIF AZLAN
- Nutritional Science Programme, Centre for Community Health, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - RUZITA ABD TALIB
- Nutritional Science Programme, Centre for Community Health, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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19
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Nshimyumukiza L, Lieffers JRL, Ekwaru JP, Ohinmaa A, Veugelers PJ. Temporal changes in diet quality and the associated economic burden in Canada. PLoS One 2018; 13:e0206877. [PMID: 30408076 PMCID: PMC6224068 DOI: 10.1371/journal.pone.0206877] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022] Open
Abstract
A high-quality diet is associated with a reduced of risk of chronic disease and all-cause mortality. In this study, we assessed changes in diet quality and the associated economic burden in the Canadian population between 2004 and 2015. We used a prevalence-based cost-of-illness approach. We first calculated the diet quality using the Healthy Eating Index-Canada-2010 (HEI-C-2010) and 24-hour recall data from the Canadian Community Health Surveys (CCHS) on nutrition (CCHS 2004 cycle 2.2 and the CCHS-NU 2015). We then retrieved relative risks of HEI-2010 quintiles for chronic diseases from meta-analyses. Based on the proportions of the population following diets of varying qualities and these relative risks, we computed the population-attributable fractions and attributable costs (direct health care and indirect costs) by survey year (2004 and 2015) as well as by age and sex group. Costs were estimated in 2017 Canadian dollars for comparison purposes. We observed that on average the diet quality of Canadians improved between 2004 and 2015: the proportion of the Canadian population that did not eat a diet of high quality decreased from 83% to 76%. This improvement in diet quality translated in a decrease in economic burden of $133 million, down from $13.21 billion in 2004 to $13.08 billion in 2015. The economic burden decreased by $219 million among males but increased by $86 million among females. It also decreased among people under the age of 65 years ($333 million) but increased among those over 65 years ($ 200 million). Our findings suggest that, despite some temporal improvements, the diet of the majority of Canadians is of poor quality resulting in a high attributable economic burden. Policy and decision makers are encouraged to expand nutrition programs and policies and to specifically target the elderly in order to prevent chronic diseases and reduce health care costs.
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Affiliation(s)
- Léon Nshimyumukiza
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Jessica R. L. Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Paul Ekwaru
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paul J. Veugelers
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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20
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Lieffers JRL, Ekwaru JP, Ohinmaa A, Veugelers PJ. The economic burden of not meeting food recommendations in Canada: The cost of doing nothing. PLoS One 2018; 13:e0196333. [PMID: 29702680 PMCID: PMC5922758 DOI: 10.1371/journal.pone.0196333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/11/2018] [Indexed: 12/31/2022] Open
Abstract
Few studies have estimated the economic burden of chronic diseases (e.g., type 2 diabetes, cardiovascular diseases, cancers) attributable to unhealthy eating. In this study, we estimated the economic burden of chronic disease attributable to not meeting Canadian food recommendations. We first obtained chronic disease risk estimates for intakes of both protective (1. vegetables; 2. fruit; 3. whole grains; 4. milk; 5. nuts and seeds) and harmful (6. processed meat; 7. red meat; 8. sugar-sweetened beverages) foods from the Global Burden of Disease Study, and food intakes from the 2004 Canadian Community Health Survey 24-hour dietary recalls (n = 33,932 respondents). We then calculated population attributable fractions (PAFs) for all relevant food-chronic disease combinations by age and sex groups. These PAFs were then mathematically combined for each disease for each age and sex group. We then estimated attributable costs by multiplying these combined PAFs with estimated 2014 annual direct health care (hospital, drug, physician) and indirect (human capital approach) costs for each disease. We found that not meeting recommendations for the eight foods was responsible for CAD$13.8 billion/year (direct health care: CAD$5.1 billion, indirect: CAD$8.7 billion). Nuts and seeds and whole grains were the top cost contributors rather than vegetables and fruit. Our findings suggest that unhealthy eating constitutes a tremendous economic burden to Canada that is similar in magnitude to the burden of smoking and larger than that of physical inactivity which were estimated using similar approaches. A status quo in promotion of healthy eating will allow this burden to continue. Interventions to reduce the health and economic burden of unhealthy eating in Canada may be more effective if they are broad in focus and include promotion of nuts and seeds and whole grains along with vegetables and fruit rather than have a narrow focus such as primarily on vegetables and fruit.
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Affiliation(s)
- Jessica R. L. Lieffers
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John Paul Ekwaru
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paul J. Veugelers
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Mercier R, Perron J, Weisnagel SJ, Robitaille J. Associations between fruit and vegetables intake and abnormal glucose tolerance among women with prior gestational diabetes mellitus. Eur J Nutr 2018; 58:689-696. [PMID: 29569007 DOI: 10.1007/s00394-018-1669-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Women with prior gestational diabetes mellitus (GDM) are at higher risk of type 2 diabetes (T2D). The aim of this study was to investigate the association between fruit and vegetables (FV) intake and abnormal glucose tolerance (AGT) among women with prior GDM. METHODS A total of 281 women with prior GDM have been recruited a mean of 6 years after their pregnancy in this cohort study. FV intake was obtained with a validated food frequency questionnaire (FFQ). Anthropometric and glycemic components were measured during their clinical visit and women were stratified according to normal glucose tolerance (NGT) or AGT. RESULTS A cross-sectional analysis showed that a total of 155 women had NGT and 126 AGT. Women with AGT had significantly lower FV (6.5 ± 0.2) and vegetables servings (3.9 ± 0.2) and tended to have lower fruit servings (2.6 ± 0.2) than women with NGT (7.4 ± 0.2, 4.5 ± 0.2 and 3.0 ± 0.1, respectively) (p = 0.001, p = 0.04 and p = 0.10, respectively, adjusted for age and BMI). FV intake, per one serving increase, was associated with a reduced likelihood of having AGT [OR = 0.88 (0.81-0.97) after adjustment for age and BMI]. Vegetables or fruit intake tended to be associated with a reduced likelihood of having AGT [OR = 0.88 (0.78-1.00) and OR = 0.88 (0.76-1.02), respectively, after adjustment for age and BMI]. CONCLUSIONS Higher intake of FV may be associated with a lower likelihood of AGT among women with prior GDM. Further studies are needed to confirm these results in this high-risk population.
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Affiliation(s)
- Roxanne Mercier
- School of Nutrition, Laval University, 2425 rue de l'Agriculture, Quebec City, G1V 0A6, Canada.,Institute of Nutrition and Functional Foods (INAF), Laval University, 2440 boulevard Hochelaga, Quebec City, G1V 0A6, Canada
| | - Julie Perron
- Institute of Nutrition and Functional Foods (INAF), Laval University, 2440 boulevard Hochelaga, Quebec City, G1V 0A6, Canada
| | - S John Weisnagel
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, 2705 boulevard Laurier, Quebec City, G1V 4G2, Canada.,Diabetes Research Unit, Laval University Medical Research Center, 2705 boulevard Laurier, Quebec City, G1V 4G2, Canada
| | - Julie Robitaille
- School of Nutrition, Laval University, 2425 rue de l'Agriculture, Quebec City, G1V 0A6, Canada. .,Institute of Nutrition and Functional Foods (INAF), Laval University, 2440 boulevard Hochelaga, Quebec City, G1V 0A6, Canada. .,Endocrinology and Nephrology Axis, CHU de Québec Research Center, 2705 boulevard Laurier, Quebec City, G1V 4G2, Canada.
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22
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Fayet-Moore F, George A, Cassettari T, Yulin L, Tuck K, Pezzullo L. Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis. Nutrients 2018; 10:E34. [PMID: 29301298 PMCID: PMC5793262 DOI: 10.3390/nu10010034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/06/2017] [Accepted: 12/22/2017] [Indexed: 01/16/2023] Open
Abstract
An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million-$1.6 billion for CVD and AUD$18.2 million-$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia.
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Affiliation(s)
- Flavia Fayet-Moore
- Nutrition Research Australia, Level 13 167 Macquarie Street, Sydney, NSW 2000, Australia.
| | - Alice George
- Deloitte Access Economics, 8 Brindabella Circuit, Brindabella Business Park, Canberra Airport, Canberra, ACT 2609, Australia.
| | - Tim Cassettari
- Nutrition Research Australia, Level 13 167 Macquarie Street, Sydney, NSW 2000, Australia.
| | - Lev Yulin
- Deloitte Access Economics, 8 Brindabella Circuit, Brindabella Business Park, Canberra Airport, Canberra, ACT 2609, Australia.
| | - Kate Tuck
- Nutrition Research Australia, Level 13 167 Macquarie Street, Sydney, NSW 2000, Australia.
| | - Lynne Pezzullo
- Deloitte Access Economics, 8 Brindabella Circuit, Brindabella Business Park, Canberra Airport, Canberra, ACT 2609, Australia.
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Merkiel-Pawłowska S, Chalcarz W. Gender differences and typical nutrition concerns of the diets of preschool children - the results of the first stage of an intervention study. BMC Pediatr 2017; 17:207. [PMID: 29258537 PMCID: PMC5735756 DOI: 10.1186/s12887-017-0962-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/08/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nutrition in children has an important influence on health both in childhood and adulthood. Actions aimed at improving children's nutrition are essential, not only to the children and their families, but also to the whole society. The aim of the study was to present the results of nutrient intake before starting a nutrition and physical activity intervention programme, to investigate gender differences in nutrient intake and to discuss whether the preschoolers' nutrient intake is similar to the intake of their peers from other countries. METHODS Nutrient intake was estimated from seven-day weighed food records kept by parents and preschool staff individually for 122 4-6-year-old children who attended two preschools in Piła, north-western Poland. Nutrient intake was calculated using Dieta 4.0 computer programme including water intake and intake of nutrients from dietary supplements. Statistical analysis was performed using the IBM SPSS Statistics computer programme, version 21.0, according to gender. The study was approved by the Bioethics Committee of the Poznan University of Medical Sciences (reference number 886/08). RESULTS Boys, in comparison to girls, were found to have statistically significantly higher intakes of total protein, total protein per kg of body weight, saturated fatty acids, total carbohydrates, available carbohydrates, lactose, sucrose, total water, vitamin A, beta-carotene, vitamin B2, vitamin B12, vitamin C, calcium, phosphorus, and magnesium. Statistically significantly higher percentage of girls than boys had intakes of vitamin E below AI. CONCLUSIONS Gender was a significant factor of nutrient intake in the studied preschool children. The main nutritional concerns in the studied preschoolers' diets, irrespective of gender, are typical of the diets of preschool children from various parts of Europe and indicate the need to work out common nutritional strategies to improve preschoolers' nutrition across Europe to reduce future burden of diet-related diseases to the European societies.
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Affiliation(s)
- Sylwia Merkiel-Pawłowska
- Food and Nutrition Department of the Eugeniusz Piasecki University School of Physical Education in Poznan, Królowej Jadwigi 27/39 Street, 61-871 Poznan, Poland
| | - Wojciech Chalcarz
- Food and Nutrition Department of the Eugeniusz Piasecki University School of Physical Education in Poznan, Królowej Jadwigi 27/39 Street, 61-871 Poznan, Poland
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Bhaswant M, Brown L, McAinch AJ, Mathai ML. Beetroot and Sodium Nitrate Ameliorate Cardiometabolic Changes in Diet‐Induced Obese Hypertensive Rats. Mol Nutr Food Res 2017; 61. [DOI: 10.1002/mnfr.201700478] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/02/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Maharshi Bhaswant
- Centre for Chronic DiseaseCollege of Health and BiomedicineVictoria University Melbourne 3021 Australia
- Department of BiotechnologyK L University Vaddeswaram Guntur 522502 India
| | - Lindsay Brown
- School of Health and Wellbeing and Institute for Agriculture and the EnvironmentUniversity of Southern Queensland Toowoomba 4350 Australia
| | - Andrew J. McAinch
- Centre for Chronic DiseaseCollege of Health and BiomedicineVictoria University Melbourne 3021 Australia
- Australian Institute for Musculoskeletal ScienceCollege of Health and BiomedicineVictoria University Melbourne 3021 Australia
| | - Michael L. Mathai
- Centre for Chronic DiseaseCollege of Health and BiomedicineVictoria University Melbourne 3021 Australia
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Abstract
AbstractObjectiveAdequate fruit and vegetable intake is important in the prevention of chronic disease. Health literacy is associated with health outcomes but its role in dietary behaviour has received little attention. The present study investigated the association between a multidimensional measure of health literacy, sociodemographic characteristics, and fruit and vegetable intake in rural Australia.DesignA cross-sectional survey on intake of fruits and vegetables (servings/d), demographic characteristics and health literacy profile using a nine-scale Health Literacy Questionnaire (HLQ). Associations between health literacy and fruit and vegetable intake were assessed using logistic regression.SettingA large rural area of Victoria.SubjectsAdults residing in the Grampians region (n1154; 61 % female, mean age 52 (sd17) years).ResultsThe HLQ scale ‘Actively managing my health’ predicted (OR; 95 % CI) fruit (2·31; 1·87, 2·84) and vegetable (1·81; 1·45, 2·26) intake. The scales ‘Appraisal of health information’ (fruits: 1·73; 1·41, 2·13; vegetables: 1·49; 1·20, 1·86), ‘Social support for health’ (fruits: 1·31; 1·06, 1·63; vegetables: 1·40; 1·10, 1·76) and ‘Ability to find good health information’ (fruits: 1·25; 1·05, 1·48; vegetables: 1·36; CI 1·13, 1·63) also predicted fruit and vegetable intake. These associations remained significant after adjusting for age, gender, educational attainment and having private health insurance.ConclusionsHealth literacy, particularly being proactive, appraising information and having social support for health, is associated with greater fruit and vegetable intake. Future interventions should consider the health literacy needs of the community to improve fruit and vegetable intake.
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Identifying Eating Occasion-Based Opportunities to Improve the Overall Diets of Australian Adolescents. Nutrients 2017; 9:nu9060608. [PMID: 28613261 PMCID: PMC5490587 DOI: 10.3390/nu9060608] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/09/2017] [Accepted: 06/09/2017] [Indexed: 11/16/2022] Open
Abstract
Adolescents in Australia have a poor dietary intake, leading to large numbers of them being at risk for inadequate intake of micronutrients, and excessive intake of less healthful dietary components. This study examined dietary intakes at multiple eating occasions to identify opportunities for more targeted recommendations and strategies to improve dietary intakes among adolescents. Data from the first 24-h recall of 14-18 years old in the 2011-2012 National Nutrition and Physical Activity Survey were analysed (n = 772). Participant-defined eating occasions were classified as breakfast, lunch, dinner or other eating occasions combined. The mean percent contribution to the total day intake of top shortfall nutrients (calcium, magnesium, vitamin A, iron), discretionary calories, saturated fat, free sugars and sodium, as well as nutrient density, the foods consumed and the percent of consumers at each eating occasion, were calculated. Breakfast had the lowest prevalence of consumers (81%), contributed the least to total daily energy (14.6%) and almost a quarter of daily calcium and iron. Other eating occasions combined contributed 47.5% of free sugars and were top contributors of daily calcium (34.6%) and magnesium (31.7%). Discretionary foods contributed 32.4% of the energy at lunch, and the sodium content at lunch was 415 mg/1000 kJ. Key opportunities identified for adolescents were to increase breakfast consumption, given the high nutrient densities of breakfasts consumed; improve overall lunch quality, particularly the sodium content; promote the intake of milk, fruit and a variety of vegetables at both lunch and dinner; maintain healthful choices at in-between meal eating occasions while focusing on decreasing the intake of discretionary foods.
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