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Kenney E, Rampalli KK, Samin S, Frongillo EA, Reyes LI, Bhandari S, Boncyk M, Nordhagen S, Walls H, Wertheim-Heck S, Ickowitz A, Cunningham SA, Ambikapathi R, Ekesa B, Matita M, Blake CE. How Livelihood Change Affects Food Choice Behaviors in Low- and Middle-Income Countries: A Scoping Review. Adv Nutr 2024; 15:100203. [PMID: 38462217 PMCID: PMC11007434 DOI: 10.1016/j.advnut.2024.100203] [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: 11/01/2023] [Revised: 01/29/2024] [Accepted: 03/05/2024] [Indexed: 03/12/2024] Open
Abstract
Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, including behaviors relating to food production, acquisition, preparation, distribution, and consumption. A literature search was conducted using 4 databases: PubMed, PsycInfo, AGRICOLA, and Embase. The search was further enhanced by expert solicitations. Studies were included if they measured or focused on a livelihood change, described or assessed a change in ≥1 food choice behavior, and focused on LMIC. Studies were excluded if they focused on migration from LMIC to a high-income country. Of the 433 articles that were identified, 53 met the inclusion criteria. Five mechanisms of how livelihood change can affect food choice were identified: occupation, locality, time, income, and social relations. Changes in occupation altered the balance of the availability and affordability of foods in local food environments compared with individual food production. Changes in location, time use, and income influenced where food was purchased, what types of foods were acquired, and how or where foods were prepared. Additionally, changes in social relationships and norms led to expanded food preferences, particularly among urban populations. Time limitations and higher discretionary income were associated with consumption of ultraprocessed foods. Understanding the relationships between the changes in livelihood occuring in LMIC and food choices of households in these countries can inform the development of policies, programs, and other actions to promote sustainable healthy diets and planetary health.
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Affiliation(s)
- Emma Kenney
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
| | - Krystal K Rampalli
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sharraf Samin
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Ligia I Reyes
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Division of Nutritional Science, College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - Shiva Bhandari
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Morgan Boncyk
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Department of Public Health, Purdue University, West Lafayette, IN, United States
| | - Stella Nordhagen
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Helen Walls
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sigrid Wertheim-Heck
- Environmental Policy Group, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Amy Ickowitz
- Center for International Forestry Research-World Agroforestry Center, Beit Zayit, Israel
| | - Solveig A Cunningham
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, United States; Department of Global Development, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, United States
| | - Beatrice Ekesa
- Alliance of Bioversity International and CIAT, Kampala, Uganda
| | - Mirriam Matita
- Extension Department, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Christine E Blake
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Seeking Sweetness: A Systematic Scoping Review of Factors Influencing Sugar-Sweetened Beverage Consumption in Remote Indigenous Communities Worldwide. BEVERAGES 2023. [DOI: 10.3390/beverages9010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It is well-established that remote Indigenous communities have higher rates of sugar-sweetened beverage (SSB) consumption than non-Indigenous counterparts, which results in higher rates of chronic diseases such as type 2 diabetes mellitus (T2DM), obesity, and kidney disease. The aetiology leading to this behaviour remains understudied and overlooked. Therefore, the aim of this literature review is to understand the underpinning factors that contribute to SSB consumption in remote Indigenous communities. Studies were identified through five databases (n = 2529) and grey literature searching (n = 54). Following the PRISMA guidelines, each paper was assessed for eligibility, which left 34 studies for inclusion in the review. Within these papers, 37 different factors were found to influence SSB consumption in remote Indigenous communities. These were organised according to the Determinants of Nutrition and Eating (DONE) framework. SSB consumption was found to influence intake through each main level of the framework; individual (n = 9), interpersonal (n = 18), environmental (n = 9), and policy (n = 3). Preference was identified to be the most common factor to influence intake (n = 19), followed by health literacy (n = 15) and community availability (n = 12). Despite this, interventions to reduce SSB intake have never targeted this factor. This paper highlights the importance of a multi-level whole-of-system approach and suggests that an individual’s taste/preference should shape the direction of future research and intervention in this area.
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Neufeld LM, Andrade EB, Ballonoff Suleiman A, Barker M, Beal T, Blum LS, Demmler KM, Dogra S, Hardy-Johnson P, Lahiri A, Larson N, Roberto CA, Rodríguez-Ramírez S, Sethi V, Shamah-Levy T, Strömmer S, Tumilowicz A, Weller S, Zou Z. Food choice in transition: adolescent autonomy, agency, and the food environment. Lancet 2022; 399:185-197. [PMID: 34856191 DOI: 10.1016/s0140-6736(21)01687-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023]
Abstract
Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. We describe patterns of dietary intake, then draw on existing literature to map how food choice can be influenced by unique features of adolescent development. Pooled qualitative data is then combined with evidence from the literature to explore ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Adolescents must be active partners in shaping local and global actions that support healthy eating patterns. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values beyond nutrition or health.
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Affiliation(s)
| | - Eduardo B Andrade
- Brazilian School of Public and Business Administration (EBAPE), Getulio Vargas Foundation (FGV), Rio de Janeiro, Brazil
| | | | - Mary Barker
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK; MRC Lifecourse Epidemiology Centre, Southampton General Hospital, Southampton, UK; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Lauren S Blum
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | | | - Surabhi Dogra
- Lancet Standing Commission on Adolescent Health and Wellbeing, Noida, India
| | - Polly Hardy-Johnson
- MRC Lifecourse Epidemiology Centre, Southampton General Hospital, Southampton, UK
| | | | - Nicole Larson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Sofia Strömmer
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK; MRC Lifecourse Epidemiology Centre, Southampton General Hospital, Southampton, UK
| | | | - Susie Weller
- Clinical Ethics and Law at Southampton (CELS), Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing, China; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
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Parra KL, Alaofe HS, Ehiri JE, Nuño VL, Mazariegos M, Garcia B, Martinez E, Junkins A, Jolly P. Prevalence and Determinants of Underweight, Overweight, and Obesity: A Cross-Sectional Study of Sociodemographic, Dietary, and Lifestyle Factors Among Adolescent Girls in Jutiapa, Guatemala. Food Nutr Bull 2021; 42:502-519. [PMID: 34809474 PMCID: PMC8622352 DOI: 10.1177/03795721211019638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the incidence of overweight continues to increase among children and adolescents in Guatemala, underweight remains a prominent health problem. However, the prevalence of overweight or underweight and associated risk factors has not been investigated among adolescent girls. OBJECTIVE To determine the prevalence of underweight and overweight/obesity and associated sociodemographic, dietary, and lifestyle factors among adolescent girls in Jutiapa, Guatemala. METHODS A cross-sectional study of a subsample of 392 girls aged 12 to 17 years from an agriculture-nutrition trial was conducted. Anthropometric data were obtained using standard methods. Sociodemographic, dietary, and lifestyle data were collected using a structured questionnaire. Multivariable logistic regression was conducted using underweight (body mass index [BMI] for age < 5th percentile) and overweight/obesity (BMI for age ≥ 85th percentile) as outcome variables. RESULTS The prevalence of underweight and overweight/obesity was 9.9% and 15.6%, respectively. Age (15-17 years), high waist circumference, high blood pressure, father being a farmer, large family (> 5 persons), hours spent watching TV, and high red meat consumption were significantly associated with underweight. Whereas being in school, high waist circumference, high blood pressure, overweight/obese mother, unemployed father, watching TV for more than 2 hours, having soft drinks at home, and meeting fruit recommendations were significantly associated with overweight/obesity. CONCLUSIONS Our findings highlight the importance of concurrently addressing underweight and overweight/obesity among adolescent girls in rural Guatemala. Studies in various parts of the country are needed to confirm the results of the present study and for appropriate strategies to be implemented to reduce both underweight and overweight.
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Affiliation(s)
- Kimberly L. Parra
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Halimatou S. Alaofe
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - John E. Ehiri
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Velia Leybas Nuño
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | | | - Brenda Garcia
- Institute of Nutrition of Central America and Panama, Guatemala
| | - Estefania Martinez
- University of Alabama at Birmingham, School of Public Health Birmingham, AL, USA
| | - Anna Junkins
- University of Alabama at Birmingham, School of Public Health Birmingham, AL, USA
| | - Pauline Jolly
- University of Alabama at Birmingham, School of Public Health Birmingham, AL, USA
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5
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Trübswasser U, Verstraeten R, Salm L, Holdsworth M, Baye K, Booth A, Feskens EJM, Gillespie S, Talsma EF. Factors influencing obesogenic behaviours of adolescent girls and women in low- and middle-income countries: A qualitative evidence synthesis. Obes Rev 2021; 22:e13163. [PMID: 33283419 PMCID: PMC7988604 DOI: 10.1111/obr.13163] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/20/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low- and middle-income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conducted in the Web of Science, SCOPUS, CABI Abstracts, MEDLINE, PsycINFO and Google Scholar. Studies were eligible if they were conducted in LMICs, of qualitative nature, and reported obesogenic behaviours of female adolescents (10-19 years of age) or women of reproductive age (15-49 years of age). The review resulted in 71 included studies from 27 different countries. Thirty-two studies focused on dietary behaviours, 17 on physical activity and 22 on both behaviours. Gender norms and failures to recognize the importance of healthy behaviours across the life cycle were important factors. The abundance and promotion of affordable but unhealthy food, food safety concerns, taste preferences and social desirability of foods drive consumption of unhealthy foods. Busy lives and limited exercise spaces keep girls and women from being physically active. Obesogenic behaviours of adolescent girls and women of reproductive age are influenced by factors at individual, social, physical and environmental levels and require diverse solutions to address these factors in LMICs.
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Affiliation(s)
- Ursula Trübswasser
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Roos Verstraeten
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Leah Salm
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Dakar, Senegal.,Institute for Development Studies (IDS), Brighton, UK
| | - Michelle Holdsworth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Food and Nutrition in the Global South Research Unit (NUTRIPASS), Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Stuart Gillespie
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Brighton, UK
| | - Elise F Talsma
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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6
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Chacón V, Liu Q, Park Y, Rohloff P, Barnoya J. Diet quality, school attendance, and body weight status in adolescent girls in rural Guatemala. Ann N Y Acad Sci 2021; 1494:59-69. [PMID: 33502805 DOI: 10.1111/nyas.14558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/31/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
A cluster of factors affects nutritional status among adolescent girls in low- and middle-income countries (LMICs). We investigated the association between school attendance and diet quality among 498 rural adolescent girls (352 attending and 146 not attending school) in Tecpán, Guatemala. In a cross-sectional study, we collected sociodemographic and anthropometric data and characterized the dietary intake using a Food Frequency Questionnaire. We then calculated diet quality using the Healthy Eating Score (HES). Multiple linear regression models were conducted to evaluate the effects of school attendance on diet quality. We found that the overall diet quality among the study participants was poor, according to the HES. However, those who attended school had significantly higher intakes of vitamin A-rich fruits and vegetables (P = 0.04), other fruits (P = 0.01), and milk and milk products (P = 0.004), but a higher intake of fast foods, chips, and saturated fatty acids (P < 0.001). Furthermore, the effects of school attendance on diet quality were significant after adjusting for sociodemographic and lifestyle factors (β coefficient = -1.70, 95% CI: -3.30 to -0.11) but was attenuated when further adjusted for weight status (β coefficient = -1.58, 95% CI: -3.17 to 0.02). Our findings suggest that diet quality among girls in rural Guatemala is poor, particularly among those who do not attend school. To advance our understanding of adolescent diet in LMICs, future studies should include adolescents who are out of school.
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Affiliation(s)
- Violeta Chacón
- Unidad de Cirugía Cardiovascular de Guatemala and Fundación Aldo Castañeda, Guatemala City, Guatemala.,Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts
| | - Qinran Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Chimaltenango, Guatemala
| | - Joaquin Barnoya
- Unidad de Cirugía Cardiovascular de Guatemala and Fundación Aldo Castañeda, Guatemala City, Guatemala.,Instituto de Investigación y Estudios Superiores en Salud, Universidad Rafael Landivar, Guatemala City, Guatemala
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7
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Conflicts between adolescents and their caregivers living in slums of Mumbai, India in relation to junk food consumption and physical activity. Public Health Nutr 2020; 24:5207-5217. [DOI: 10.1017/s1368980020001640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective:
To explore influences on the diet and physical activity of adolescents living in Mumbai slums, from the perspectives of adolescents and their caregivers.
Design:
Three investigators from Mumbai conducted six focus group discussions.
Setting:
The study was conducted in suburban Mumbai slums.
Participants:
Thirty-six adolescents (aged 10–12 and 15–17 years) and twenty-three caregivers were recruited through convenience sampling.
Results:
The findings highlighted the complex negotiations between adolescent and caregivers surrounding adolescent junk food consumption and physical activity opportunities. Caregivers learned recipes to prepare popular junk foods to encourage adolescents to eat more home-cooked, and less ‘outside’, food, yet adolescents still preferred to eat outside. To adolescents, the social aspect of eating junk food with friends was an important and enjoyable experience. Caregivers felt that they had no control over adolescents’ food choices, whereas adolescents felt their diets were dictated by their parents. Adolescents wanted to be physically active but were encouraged to focus on their academic studies instead. Gender was also a key driver of physical activity, with girls given less priority to use outside spaces due to cultural and religious factors, and parental fears for their safety.
Conclusions:
These findings show that adolescents and caregivers have different agendas regarding adolescent diet. Adolescent girls have less opportunity for healthy exercise, and are more sedentary, than boys. Adolescents and caregivers need to be involved in designing effective interventions such as making space available for girls to be active, and smartphone games to encourage healthy eating or physical activity.
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