Snack food consumption among Bangladeshi children, supplementary data from a large RCT

Designing Front-of-Package Labels to Inform Consumers and Encourage Healthier Food Choices in Bangladesh: A Qualitative Study

Background/Objectives: Front-of-package labeling (FOPL) policies are a useful strategy to inform consumers about foods high in nutrients of concern, but little is known about what type of label works best in Bangladesh, a country with increasing levels of unhealthy food intake and diet-related diseases. Methods: We conducted 10 focus groups with men and women in rural and urban Bangladesh (n = 76). Using a semi-structured discussion guide, we asked consumers for their perceptions of the healthfulness of nutrients and foods, two common FOPLs (a color-coded guideline daily allowance [GDA] label and a warning label), and different visual elements of the warning label (e.g., shape, icon, text). Results: Participants understood the health harms of sugar and salt consumption but were less clear on saturated fat. Both FOPLs were perceived as helpful for identifying unhealthy foods, but the warning labels were perceived as easier to understand and more likely to influence behaviors than the GDA. Regarding the design of warning labels, participants perceived warning devices, holding straps, and octagonal shapes as effective but had mixed reactions to which icons or textual statements were most effective. Conclusions: FOPLs are likely to facilitate Bangladeshi consumers' ability to identify unhealthy products. Further research is needed to understand the impact on food choices as well as the most effective design in this population.

Commonly consumed processed packaged foods in Bangladesh are unhealthy and their nutrient contents are not in conformity with the label declaration

The present study was undertaken to identify the major nutrient content in processed foods commonly consumed in Bangladesh, their label conformity healthiness, and percent daily nutrient contribution. Twenty-four nationally representative composite samples were analyzed using AOAC and other standard methods. Results were compared with label information using a restrictive approach and EU tolerance guidelines. The healthiness of the products was evaluated in terms of the Health Star Rating (HSR) scheme and the UK traffic light labeling system. Among the analyzed samples, fried pulse, chanachur, lozenge, and fried peas had the highest amount of protein, fat, carbohydrates, and dietary fiber, respectively. Biscuits and milk chocolate had high levels of trans fatty acids (TFA) and saturated fatty acids (SFA). It was observed that around half of the products lacked information about saturated fatty acid (46%), followed by total dietary fiber and trans-fat (38% each). Other information was missing in one-fifth of the products, namely protein (17%), total fat (17%), available carbohydrate (17%), energy (17%), sugar (21%), and salt (21%). Label compliance analysis according to the restrictive approach revealed that none of the products accurately reported the salt, sugar, saturated fat, and trans fat content on the label. According to the EU tolerance guideline, approximately half of the products had protein (58%), fat (54%), and carbohydrate (42%) levels that fell within the EU tolerance limit. However, only around one-third of the samples had sugar (21%), salt (38%), and saturated fat (33%) levels that met the EU tolerance limit. In terms of healthiness analysis, according to the HSR, the range of stars was between 0.5 and 2.5 of the foods where fried peas got the highest rating (2.5 stars), while in terms of the UK traffic light system, none of the samples got all green signals. The lozenge got green lights for fat, SFA, and salt contents. It was also found that consumption of 100 g of fried peas or pulse would exceed the acceptable daily limit of salt, sugar, and SFA compared to the daily maximum allowable intake for the 2000 kcal diet recommended by the WHO. However, according to the serving size, biscuits were major contributors of TFA, sugar, and SFA, whereas fried pulse was a key contributor of sodium/salt. Proper regulatory actions should be introduced to promote healthy processed foods with user-friendly front-of-the-pack labeling and monitor their quality to prevent non-communicable diseases (NCDs).

Unhealthy Foods and Sugar-Sweetened Beverages Consumption Among Bangladeshi Adolescents and Their Sociodemographic Determinants: Findings From a Nationally Representative Cross-Sectional Study

BACKGROUND

Consumption of savory crispy or fried snacks (SCFS), sugary snacks (SS), and sugar-sweetened beverages (SSB) is associated with an increased prevalence of obesity and noncommunicable diseases. We aimed to estimate the consumption of SCFS, SS, and SSB among adolescent males and females in Bangladesh and to report the factors associated with their consumption using data from a nationwide cross-sectional survey.

METHODS

We interviewed 4,907 adolescent males and 4,865 females for the seven-day recall on intake of SCFS, SS, and SSB from 82 randomly selected clusters from rural, non-slum urban, and slum areas. Sociodemographic and anthropometry data were also collected.

RESULTS

Consumption of SCFS, SS, and SSB for ≥7 times per week was reported by 11.6%, 28.9%, and 25.6% of the males and 4.9%, 24.8%, and 20.7% of the females, respectively. The weekly mean frequency of SCFS, SS, and SSB intake increased after adjustment for potential confounders among females with higher maternal education and for SCFS and SSB among males with the highest level of father's education. Increased intake of SS and SSB for both males and females was associated with dwelling in a female-headed household. SCFS intake was higher among both males and females from the richest households. Nutritional status, both overweight and obesity, and underweight, was not associated with a more frequent intake of SCFS and SS among males and females; however, a lower frequency of intake of SSB was observed among overweight and obese males. Screen time (television viewing: none, up to 1 hour, and more than 1 hour) was not associated with consumption of SCFS and SSB among both males and females.

CONCLUSION

Consumption of unhealthy snacks and drinks is high among adolescents in Bangladesh and needs to be addressed through policy and program measures to abate the epidemic of obesity and associated NCD.

High consumption of unhealthy commercial foods and beverages tracks across the complementary feeding period in rural/peri-urban Cambodia

Consumption of unhealthy commercial foods and beverages (UCFB) is common among infants and young children living in low- and middle-income countries. Such foods can displace other nutritious foods, however, there is limited evidence on how this consumption tracks across time. This study assessed and tracked UCFB consumption of children living in rural/peri-urban Cambodia during the complementary feeding period, identified UCFB consumption patterns of these children, and explored the association between UCFB consumption and growth. A 6-month longitudinal cohort study was implemented among 567 caregivers of children aged 10-14 months at recruitment. UCFB consumption was estimated each month via a telephone-administered 7-day food frequency questionnaire, and UCFB consumption patterns were identified based on changes in this frequency of consumption over time. The majority of children either maintained (45.7%, n = 246) or developed (43.5%, n = 234) an unhealthy consumption pattern and only 10.8% (n = 58) of children maintained/transitioned into a healthy consumption pattern. High consumers of UCFB at 10-14 months had a 4.7 (CI: 4.7 [3.1-7.2]) times odds of being high consumers of UCFB at 15-19 months (p < 0.001). There was a trend of lower length-for-age z-scores (LAZ) among children maintaining or developing an unhealthy consumption pattern (~-0. SD LAZ) compared to children maintaining/transitioning into a healthy consumption pattern, however, this association was not statistically significant. Findings indicate that high UCFB consumption begins during infancy and tracks into early childhood. National policies and programmes centred on early interventions addressing the use of UCFB for infant and young child feeding are needed.

Prevalence of Sugar-Sweetened Food Consumption in Rural Bangladeshi Children Aged 6-24 Months

BACKGROUND

While the prevalence of undernutrition in children has decreased in many low- and middle-income countries since the 1990s, prevalences of overweight and obesity have increased. Frequent consumption of sugar-sweetened food might have contributed to this change, although very little is known about sugar-sweetened food consumption in early life.

OBJECTIVES

The objective of this study was to explore the associations between individual, household, and maternal factors and the prevalence of sugar-sweetened food consumption in 6- to 24-month-old children in Bangladesh.

METHODS

Multistage sampling was used to select households with children aged 6-24 months in rural Chatmohar, a subdistrict of Bangladesh (n = 1635). Research assistants conducted a 24-hour qualitative dietary recall questionnaire with the enrolled child's primary caregiver to measure maternal and child dietary patterns. We examined factors associated with the prevalence of child sugar-sweetened food consumption with multivariate logistic regression models. We conducted tests of heterogeneity to explore differential associations between the child sugar-sweetened food consumption prevalence and household income by maternal nutrition knowledge and wealth.

RESULTS

Primary caregivers reported that 62% of toddlers had consumed sugar-sweetened food in the past 24 hours. A higher prevalence of child sugar-sweetened food consumption was associated with both a higher dietary diversity score (OR, 1.19; 95% CI, 1.09-1.29) and a higher prevalence of maternal sugar-sweetened food consumption (OR, 2.54; 95% CI, 1.97-3.28). At higher levels of maternal nutrition knowledge and wealth, more household income was associated with a lower prevalence of child sugar-sweetened food consumption.

CONCLUSIONS

Almost two-thirds of 6- to 24-month-old children in rural Chatmohar, Bangladesh, had consumed sugar-sweetened food in the last day. This is a high and concerning prevalence, and the associated factors identified in this study should be investigated further to identify potential areas of intervention to decrease the prevalence of child sugar consumption in Bangladesh.

Integrated Approach in Addressing Undernutrition in Developing Countries: A Scoping Review of Integrated Water Access, Sanitation, and Hygiene (WASH) + Nutrition Interventions

A scoping review of integrated water access, sanitation, and hygiene (WASH) plus nutrition interventions was conducted mainly to describe different components of intervention and examine their effectiveness in improving nutritional outcomes among children. Of the 8 small- to large-scale interventions, 6 were conducted in sub-Saharan Africa and the remaining 2 in South Asia. All the interventions were done in rural settings; the majority involved sanitation and hygiene deliverables along with the nutrition strategies, such as distribution of nutrition supplements. In assessing effectiveness, no significant improvements were seen in growth indicators; reduction in diarrheal rate among children was also not universal across interventions. Further strengthening of WASH, especially an improvement in "W", or water access, is warranted to ensure uptake of sanitation and hygiene behaviors and prevent the fecal-oral route among children. Improved water access will also enhance the effectiveness of nutrition initiatives, such as promoting vegetable gardening and utilization of child nutrient supplements.

Snack food consumption among Bangladeshi children, supplementary data from a large RCT

Childhood obesity has been associated with consumption of energy-dense foods such as caloric beverages and fast foods. Many low- and middle-income countries like Bangladesh are now experiencing a rising problem of noncommunicable diseases along with the long-standing problem of stunting and undernutrition. WASH Benefits Bangladesh was a large community-based cluster randomized controlled trial conducted in rural Bangladesh. Study clusters were randomized into seven arms: single nutrition (N); water (W); sanitation (S); hygiene (H); combined water, sanitation, and hygiene (WSH); WSH and nutrition (N + WSH); and a double sized control (C). Nutrition intervention messages included four promotional components: maternal nutrition, breastfeeding, complementary feeding, and lipid-based nutrient supplements. The World Health Organization infant food frequency questionnaire (24-hr recall and 7-day recall) was administered at Year 1 and Year 2 of intervention. The likelihood of any snack food consumption was significantly lower (odds ratio 0.37: 95% confidence interval [0.28, 0.49]) in the nutrition intervention arms compared to the control arm in Year 2 follow-up. In addition, in the water intervention arm, fewer children (about 50% less) consumed soft drinks, but not the other sugar-sweetened beverages, compared with control in Year 2. There were no other differences between groups. Simple messages about balanced diet and feeding family foods were effective in lowering commercially produced snack food consumption of the young children in low-income rural communities of Bangladesh. Provision of safe water apparently encouraged mothers to reduce offering unhealthy beverages to the young children.