Complexity of nutritional behavior: Capturing and depicting its interrelated factors in a cause-effect model

Contextual factors influence food intake at eating occasions in young adults: A mixed effect analysis

Understanding eating behaviours of young adults is crucial for developing strategies to improve their diet quality. Factors that influence eating behaviours are often multifaceted and highly contextual, with little research focused on young adults. This study examined contextual factors influencing food intake at eating occasions among young adults. Participants (n = 675, 18-30 years) recorded dietary intake and contextual characteristics at eating occasions (n = 27,513) using a smartphone food diary ("FoodNow") over three to four non-consecutive days. Food and beverage intakes were classified into six groups according to the Australian Dietary Guidelines. Eating occasion-level contextual factors, such as consumption location, purchase location, activity, and social context, were recorded via the app, while person-level contextual factors were collected through an online survey. Generalised mixed models with random intercepts were used to investigate effects of contextual factors on food group consumption at meals and snacks. Eating location was associated with vegetable and discretionary food intake; meals that were eaten while in transit were 0.59 serves lower in vegetables (95% CI: -0.93, -0.38; p < 0.001) and 0.31 serves higher in discretionary foods (95% CI: 0.03, 0.54; p = 0.014), compared meals eaten at home. Higher intakes of discretionary foods were observed when friends were present at meals and snacks (0.66 and 0.57 serves, 95% CI: 0.56, 0.88; 0.36, 0.77, p < 0.001). Meals purchased from convenience stores were higher in grain and discretionary foods than meals from other locations (p < 0.001). Majority of person-level factors showed minimal effects on food group consumption. Addressing factors such as purchase location and social contexts during meals and snacks may improve food choices, as small changes at eating occasions can significantly impact overall diet quality over time.

Efficacy of the Nutrition Education and Screening Tool as a Foundation for Exploring Perinatal Diet and Determinants in Aboriginal and Torres Strait Islander Women of Far North Queensland

BACKGROUND/OBJECTIVES

Assessing perinatal diet and its determinants in Australia's Aboriginal and Torres Strait Islander women remains challenging, given the paucity of tools that incorporate Aboriginal ways of knowing, being, and remembering within a quantitative framework. This study aimed to explore the determinants of perinatal nutrition in this population and to evaluate the efficacy of the Nutrition Education and Screening Tool (NEST) in collecting diet-related data in this population.

METHODS

This study employed a Participatory Action Research approach using the NEST as a foundation for structured research inquiry. Self-reported diet and determinants were collected from a cross-sectional cohort of Aboriginal and Torres Strait Islander women from Far North Queensland.

RESULTS

Participants (n = 30) declared excess consumption of meat and alternatives, fruit, vegetables and legumes, and dairy and alternatives. Grain and cereal consumption aligned with recommendations; wild-harvested foods comprised a mean 19.75% of their protein intake. Food frequency data were supported by participants' descriptions of how they eat, combine, rotate, and cook these foods.

CONCLUSIONS

Standard food frequency questionnaires are challenging for Aboriginal and Torres Strait Islanders as their concepts of time and ways of remembering are different from Western understanding. Use of the NEST allowed food frequency items to be explored, clarified, and cross-referenced; yarning provided a degree of support for quantitative data. The results of this study translate to future public health research, practice, and policy. Alternative quantitative measures to determine food frequency should be considered in future studies. These may include the cyclical approach to time that is well understood and integrated by Indigenous cultures.

Effectiveness of nutrition interventions targeting university-level student populations across the League of Arab States: a systematic scoping review

The university setting is an ideal setting to implement nutrition education interventions. Because the transition to college life often overlaps with young adults' increase in independence in food choice and nutrition related behavior, this is an optimal time to target this population and several models exist to best utilize the college setting to support nutrition education interventions. This review aimed to examine the effectiveness of nutrition interventions in university student populations across the League of Arab States. A scoping review following the PRISMA-ScR guidelines was conducted across 14 databases for relevant publications published through May 2023 to find studies conducted across Arab countries. Quality assessment was conducted using the Effective Public Health Practice Project tool. Seven primary studies were included in this review. Although the interventions and outcome measures were disparate, there were positive impacts of the interventions, including improved nutrition knowledge and nutrition habits, knowledge of nutrient sources, and knowledge about the relationship between diet and disease. Recommendations to maximize the efficacy of nutrition interventions conducted across the League of Arab States include purposeful design of the intervention based on a theoretical framework, the use of a control group in the research design, and follow-up measures to examine post-intervention effects. Consideration should also be given to intervention duration and availability in college-students' schedules. Adaptation of intervention materials, measures and delivery methodologies should emphasize local foods, food culture and dietary practices.

Exploration of the nutrition knowledge among general population: multi-national study in Arab countries

BACKGROUND

Knowing what to eat and realizing the significance of healthful eating habits are among the important steps to promoting eating behavior. The current study aims to assess the nutrition knowledge (NK) among a convenient sample in four different countries, determine the association between different demographic factors and NK, and investigate the need for future interventions on nutrition in the four selected countries.

METHODS

A cross-sectional multi-national survey study among a convenient sample of 8,191 subjects from Egypt, Syria, Saudi Arabia, and Jordan who undertook surveys between January 2019 and January 2020. A pre-tested interview questionnaire was utilized for data collection from study participants. It included three sections: i) Sociodemographic characteristics:. ii). Section two included twenty-one questions related to NK.. iii). Section three included one question about NK sources.

RESULTS

About three-quarters showed inadequate nutrition knowledge (73.1%). Youth (15-24 yrs.) were more dependent on social media, with 87% using it as a primary source of NK, while adults (≥ 25 yrs.) demonstrated that 43% of them used social media. In contrast, TV was more prominent among them, with participants' characteristics such as living with parents, body mass index, and country of residence showing no association with NK. However, female sex, education, and reading nutrition articles are significantly correlated with adequate knowledge (p < 0.001). Significant predictors of satisfactory knowledge were age, sex, education, living with parents, and reading nutrition articles.

CONCLUSION

The study revealed low levels of NK indicating an urgent need to implement educational programs to promote nutrition knowledge. As NK is a modifiable determinant of diet intake and can positively impact the need for developing strategies in counselling and raising awareness among the general population to improve their health status.

Perspectives on Neuronutrition in Prevention and Treatment of Neurological Disorders

The term neuronutrition has been proposed as part of nutritional neuroscience, studying the effects of various dietary components on behavior and cognition. Other researchers underline that neuronutrition includes the use of various nutrients and diets to prevent and treat neurological disorders. The aim of this narrative review was to explore the current understanding of the term neuronutrition as the key concept for brain health, its potential molecular targets, and perspectives of its nutritional approach to the prevention and treatment of Alzheimer's and Parkinson's diseases, multiple sclerosis, anxiety, depressive disorders, migraine, and chronic pain. Neuronutrition can be defined as a part of neuroscience that studies the influence of various aspects of nutrition (nutrients, diet, eating behavior, food environment, etc.) on the development of nervous disorders and includes nutrition, clinical dietetics, and neurology. There is evidence that the neuronutritional approach can influence neuroepigenetic modifications, immunological regulation, metabolic control, and behavioral patterns. The main molecular targets in neuronutrition include neuroinflammation, oxidative/nitrosative stress and mitochondrial dysfunction, gut-brain axis disturbance, and neurotransmitter imbalance. To effectively apply neuronutrition for maintaining brain health, a personalized approach is needed, which includes the adaptation of the scientific findings to the genetic, biochemical, psycho-physiological, and environmental features of each individual.

How public catering accelerates sustainability: a German case study

Public catering has become increasingly important in recent years. With increasing annual customers, the sector's impact on the environment is also growing continuously. At the same time, public catering offers a lever to promote sustainable nutrition that has rarely been used so far. Small changes in kitchen practices and food offers can thus be multiplied into a significant positive impact on environmental challenges, such as climate change or loss of biodiversity due to the large number of servings. In contrast to private households, management decisions in public catering can influence the food-related environmental impact of thousands of customers. This article deals with the nationwide level of greenhouse gas (GHG) emissions and resource use in the German public catering segment "business" and its saving potentials by different scenarios of unsupported and supported recipe revision. In this paper, we define "unsupported" as the intuitive optimization of recipes by employees of public catering businesses. In contrast, "supported" approaches had to meet specific target goals, for example of the Deutsche Gesellschaft für Ernährung; engl. German Nutrition Society or the sustainable level. Specifically, we will test how (A) an unsupported recipe revision, (B) a recipe revision based on dietary recommendations and (C) a recipe revision using scientific guidance affect the environmental impact of a dish. As a methodological framework, an online survey of public catering companies was conducted as well as a scenario analysis at menu level and at nationwide level. The results are based on empirical data on the one hand, and on extrapolations on the other. The results show that the nationwide implementation of recipe revision according to scientific guidance-such as concrete target goals for the GHG emissions per serving-can save up to 44% of resource use in the German business catering sector (which corresponds to 3.4 million tons of resources per year) and as much as 40% of GHG emissions (0.6 million tons GHG emissions per year). Even in the scenario of unsupported recipe revision, GHG and resource savings of up to 20% can be realized. The results show that public catering can reduce its material and carbon footprint by 20% overnight. Moreover, the findings show indications for the sustainable transformation of public catering. Nevertheless, it must be noted that these are some first steps of the transformation, which will require further changes with even greater impacts and political activities.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11625-022-01183-2.

On the Future(s) of Energy Communities in the German Energy Transition: A Derivation of Transformation Pathways

Active participation of citizens in the sustainable energy transition—particularly in energy communities—is explicitly desired by the European Union and considered vital for a successful transformation of Europe’s energy system. Currently, energy communities, i.e., citizen-led groups generating energy from renewable sources can be found across Europe, though current numbers are small. However, it is expected that the majority of EU households will be active in some form in the generation of energy by 2050. In order to understand how such a development could come about, and if desired, how it could be ensured, we developed and applied a quasi-dynamic model using the Cross-Impact Balance (CIB) approach and with it analyzed and assessed such a transition in detail. Data for the CIB model was derived from case studies, interviews, three surveys including two discrete choice experiments, expert workshops, and complementary secondary data. A central consideration of the model is a differentiated representation of the heterogeneity of actors in society and their interactions. Main results obtained from the application of the model are possible transformation pathways of citizen participation in the energy transition of Germany. A key finding was that if current trends continue, a citizen-driven energy transition based on energy communities will unlikely be successful. We conclude that several framework conditions must change simultaneously from the status quo so that different social groups in society can be active in the generation of energy. These include changes such as the abolition of hindering regulations and the expansion of financial support schemes with a focus on lower socioeconomic groups. Furthermore, only in a combination of conducive social factors such as neighborhood cohesion and conducive social influence, as well as favorable economic conditions, can energy communities become an important player in Germany’s future energy system.

Polish Adaptation of the Dutch Eating Behaviour Questionnaire (DEBQ): The Role of Eating Style in Explaining Food Intake-A Cross-Sectional Study

Knowledge of associations between emotional, external, and restrained eating with food choices is still limited due to the inconsistent results of the previous research. The aim of the study was to adopt the Dutch Eating Behavior Questionnaire (DEBQ) and then to examine the relationship between emotional, external, and restrained eating styles and dietary patterns distinguished on the basis of intake of fruit and vegetables (fresh and processed separately), fruit and/or vegetable unsweetened juices, sweets and salty snacks, and the adequacy of fruit and vegetable intake. The cross-sectional study was conducted in 2020, in a sample of 1000 Polish adults. The questionnaire consisted of the Dutch Eating Behavior Questionnaire, questions on selected food groups intake, and metrics. DEBQ structure was tested using both exploratory and confirmatory factor analysis (EFA, CFA) and structural equation modelling (SEM), while multi-group analysis was used to test measurement invariance. Logistic regression was applied to investigate the association between eating styles and dietary patterns, identified with the use of K-means cluster analysis. EFA, CFA and SEM revealed a three-factor, 29-item tool with satisfactory psychometric parameters. Restrained eating (ResEat) and external eating (ExtEat) were found to decrease chances of low intake of both favorable (fruit, vegetables, and unsweetened juices) and unfavorable (sweets and salty snacks) foods and increased the chances of their moderate intake. ResEat increased the probability of the high intake of favorable and moderate or high intake of unfavorable foods. ResEat and ExtEat were predisposed to adequate intake of fruit and vegetables while emotional eating had the opposite effect. Gender, education, and BMI were also found to determine food intake. Our results provide evidence that both eating styles and sociodemographic characteristics should be taken into account while explaining food intake as they may favor healthy and unhealthy eating in different ways.

Studying dietary intake in daily life through multilevel two-part modelling: a novel analytical approach and its practical application

BACKGROUND

Understanding which factors influence dietary intake, particularly in daily life, is crucial given the impact diet has on physical as well as mental health. However, a factor might influence whether but not how much an individual eats and vice versa or a factor's importance may differ across these two facets. Distinguishing between these two facets, hence, studying dietary intake as a dual process is conceptually promising and not only allows further insights, but also solves a statistical issue. When assessing the association between a predictor (e.g. momentary affect) and subsequent dietary intake in daily life through ecological momentary assessment (EMA), the outcome variable (e.g. energy intake within a predefined time-interval) is semicontinuous. That is, one part is equal to zero (i.e. no dietary intake occurred) and the other contains right-skewed positive values (i.e. dietary intake occurred, but often only small amounts are consumed). However, linear multilevel modelling which is commonly used for EMA data to account for repeated measures within individuals cannot be applied to semicontinuous outcomes. A highly informative statistical approach for semicontinuous outcomes is multilevel two-part modelling which treats the outcome as generated by a dual process, combining a multilevel logistic/probit regression for zeros and a multilevel (generalized) linear regression for nonzero values.

METHODS

A multilevel two-part model combining a multilevel logistic regression to predict whether an individual eats and a multilevel gamma regression to predict how much is eaten, if an individual eats, is proposed. Its general implementation in R, a widely used and freely available statistical software, using the R-package brms is described. To illustrate its practical application, the analytical approach is applied exemplary to data from the Eat2beNICE-APPetite-study.

RESULTS

Results highlight that the proposed multilevel two-part model reveals process-specific associations which cannot be detected through traditional multilevel modelling.

CONCLUSIONS

This paper is the first to introduce multilevel two-part modelling as a novel analytical approach to study dietary intake in daily life. Studying dietary intake through multilevel two-part modelling is conceptually as well as methodologically promising. Findings can be translated to tailored nutritional interventions targeting either the occurrence or the amount of dietary intake.

From causal loop diagrams to future scenarios: Using the cross-impact balance method to augment understanding of urban health in Latin America

Urban health is shaped by a system of factors spanning multiple levels and scales, and through a complex set of interactions. Building on causal loop diagrams developed via several group model building workshops, we apply the cross-impact balance (CIB) method to understand the strength and nature of the relationships between factors in the food and transportation system, and to identify possible future urban health scenarios (i.e., permutations of factor states that impact health in cities). We recruited 16 food and transportation system experts spanning private, academic, non-government, and policy sectors from six Latin American countries to complete an interviewer-assisted questionnaire. The questionnaire, which was pilot tested on six researchers, used a combination of questions and visual prompts to elicit participants' perceptions about the bivariate relationships between 11 factors in the food and transportation system. Each participant answered questions related to a unique set of relationships within their domain of expertise. Using CIB analysis, we identified 21 plausible future scenarios for the system. In the baseline model, 'healthy' scenarios (with low chronic disease, high physical activity, and low consumption of highly processed foods) were characterized by high public transportation subsidies, low car use, high street safety, and high free time, illustrating the links between transportation, free time and dietary behaviors. In analyses of interventions, low car use, high public transport subsidies and high free time were associated with the highest proportion of factors in a healthful state and with high proportions of 'healthy' scenarios. High political will for social change also emerged as critically important in promoting healthy systems and urban health outcomes. The CIB method can play a novel role in augmenting understandings of complex urban systems by enabling insights into future scenarios that can be used alongside other approaches to guide urban health policy planning and action.

Developing our understanding of nutrition in depression

Research to date has convincingly demonstrated that nutrition impacts depression. Population-based studies have shown that diet, food types, dietary supplements, gut bacteria, endocrine systems and obesity all play a role in depression. While nutrition could provide an important therapeutic opportunity in depression, clinical trials have not shown clinically meaningful results, and it appears unlikely that nutrition is a central determinant of depression. Conversely, however, prior research is inconclusive to inferring that nutrition does not have a clinically significant effect. This would require elucidating precisely when nutrition affects depression which necessitates an alternative, more granular, model for the nutrition–depression interaction. The network theory of mental disorders, which studies how mental disorders arise from a causally related network of symptoms and external factors, is proposed as an alternative model for understanding the complexity of the nutrition–depression link. This approach would uncover which relationships, between aspects of nutrition and depression symptoms, warrant further study at a population and laboratory level. Furthermore, from within nutrition science, is a movement dubbed ‘New Nutrition Science’ (NNS) that aims to integrate biological, social and environmental determinants of nutrition. NNS is important to nutrition–depression research which has yet to reveal how social factors impact the nutrition–depression interaction. Network theory methodology is fully compatible with the network modelling already used in NNS. Embracing both network theory and NNS in future research will develop a full and complex understanding of nutrition in depression.

Types of Nutrition Knowledge, Their Socio-Demographic Determinants and Their Association With Food Consumption: Results of the NEMONIT Study

Objectives: To investigate nutrition knowledge in the German population, its determinants and its association with food consumption. Methods: Data were obtained from the NEMONIT study (2014/15, n = 1,505, participants' age: 22-80 years). Nutrition knowledge was measured using the consumer nutrition knowledge scale (CoNKS) in a computer-assisted telephone interview. Two 24-h recalls were conducted to assess food consumption, which was evaluated using the Healthy Eating Index-NVS II. Results: Areas for knowledge enhancement were the understanding of health benefits of fruit and vegetable consumption, the concept of a balanced diet and saturated fatty acids. Nutrition knowledge was higher among females, younger and high socio-economic status participants. Correlations between nutrition knowledge and a favorable diet were significant but low. Analyses of types of nutrition knowledge yielded similar results for procedural knowledge and knowledge on nutrients but not for knowledge on calories. Conclusions: Areas for knowledge enhancement were identified, but an increase in nutrition knowledge alone seems unlikely to result in large improvements of dietary behavior.

Food habits in overweight and obese adolescent girls with Polycystic ovary syndrome (PCOS): a qualitative study in Iran

Background

Polycystic ovary syndrome (PCOS) is a hormonal disorder in women of reproductive age. It seems that over the recent years, PCOS has augmented in adolescent girls due to unhealthy food habits and obesity. So, the present study was conducted to explore the food habits in overweight and obese adolescent girls with PCOS.

Methods

In the present qualitative study, 33 participants were selected using a purposive sampling method. Data were collected through individual in-depth interviews, focus group discussions (FGDs), and field notes. These data were analyzed through the use of conventional qualitative content analysis.

Results

Three main categories were extracted: First, the high consumption of unhealthy food had three sub-categories: “high consumption of fatty and salty foods”, “high consumption of unhealthy snacks”, and “high consumption of sugar-rich foods”. Second, low consumption of healthy food had three sub-categories: “low consumption of dairy products”, “low consumption of fiber-rich foods”, and “low consumption of meat, beans, fish and seafood” Third, inappropriate behavioral habits had three sub-categories: “lack of concentration and consumption of large meals”, “inappropriate dietary and physical activity patterns”, and “skipping the meals and going on arbitrary diets”.

Conclusion

This research through presenting an image of food habits in overweight and obese adolescent girls with PCOS is able to help for designing the necessary interventions to change the food habits, control the symptoms and complications of PCOS, and finally, improve the reproductive health of these girls.

A prototype-targeting intervention for the promotion of healthy eating in adolescents

Purpose

Unhealthy eating among adolescents from families with lower social status is a major concern. The purpose of this paper is to describe the development and evaluation of a prototype-targeting intervention for the promotion of healthy eating in this target group.

Design/methodology/approach

The planning model intervention mapping (IM) was chosen to proceed systematically, to use theory and evidence herein and to make decisions transparent. A controlled study with three times of data assessment was conducted to evaluate process characteristics and effects (N=108).

Findings

“Provide opportunities for social comparison” (behavioural change technique 6.2) was chosen as change method and “perceived similarity” was identified as the condition for its effectiveness. An intervention unit was designed for application. The evaluation results show the feasibility of the unit; materials and activities successfully applied the change method and its condition for effectiveness; and intervention objectives were generally achieved.

Practical implications

A prototype-targeting intervention is provided that is based on theory and evidence, and is suitable for implementation. More generally, the paper can serve as a blueprint for the systematic planning of theory- and evidence-based interventions targeting specific personal determinants for behaviour change.

Originality/value

The paper makes an important contribution to the application of the prototype-related theory and a useful addition of IM to the growing field of intervention development and design.

The DONE framework: Creation, evaluation, and updating of an interdisciplinary, dynamic framework 2.0 of determinants of nutrition and eating

The question of which factors drive human eating and nutrition is a key issue in many branches of science. We describe the creation, evaluation, and updating of an interdisciplinary, interactive, and evolving “framework 2.0” of Determinants Of Nutrition and Eating (DONE). The DONE framework was created by an interdisciplinary workgroup in a multiphase, multimethod process. Modifiability, relationship strength, and population-level effect of the determinants were rated to identify areas of priority for research and interventions. External experts positively evaluated the usefulness, comprehensiveness, and quality of the DONE framework. An approach to continue updating the framework with the help of experts was piloted. The DONE framework can be freely accessed (http://uni-konstanz.de/DONE) and used in a highly flexible manner: determinants can be sorted, filtered and visualized for both very specific research questions as well as more general queries. The dynamic nature of the framework allows it to evolve as experts can continually add new determinants and ratings. We anticipate this framework will be useful for research prioritization and intervention development.