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Tapsoba VA, Compaore EWR, Zeba AN, Some JW, Manga JS, Diouf A, Moubarac JC, Vandevijvere S, Dicko MH. Food environment in Burkina Faso: priority actions recommended to the government using Food-EPI tool. Front Nutr 2024; 11:1420323. [PMID: 39091684 PMCID: PMC11293057 DOI: 10.3389/fnut.2024.1420323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction The food environment is an important factor in the efforts of countries worldwide to achieve a transition to sustainable food systems. The objective of this study is to formulate and prioritize actions to be addressed to the government of Burkina Faso for the creation of a healthy food environment, which will contribute to reducing malnutrition in all its forms and non-communicable diseases. Methods National experts were brought together to identify and prioritize actions to fill the gaps identified through a multi-step assessment process following the methodology of the Healthy Food and Environment Policy Index (Food-EPI). Results Up to 20 priority policy actions were recommended to the Burkina Faso government. Actions in the policy component focused mainly on regulation of food promotion and marketing, particularly to children, and others in the infrastructure support component focused largely on political leadership, i.e., strong and visible political support from the government to improve the food environment, population nutrition, diet-related non-communicable diseases and their inequalities. Conclusion The priority actions to be recommended to the government will strengthen advocacy for government decisions to create a healthier food environment in the country.
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Affiliation(s)
- Viviane Aurelie Tapsoba
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | - Ella W. R. Compaore
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | | | | | | | - Adama Diouf
- Laboratory for Research into Human Nutrition and Food (LARNAH), Department of Animal Biology, Faculty of Science and Technology, Cheikh Anta Diop University (UCAD), Dakar, Senegal
| | | | | | - Mamoudou Hama Dicko
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
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Langner J, Langston K, Mrachek A, Faitak B, Martin P, Cueto A, Clampitt JL, Long CR, Bartow A, Bodey S, McElfish PA. Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools. THE JOURNAL OF SCHOOL HEALTH 2024; 94:653-660. [PMID: 38267004 DOI: 10.1111/josh.13437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition. METHODS The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food. CONCLUSIONS Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.
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Affiliation(s)
- Jonathan Langner
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Krista Langston
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Ally Mrachek
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Bonnie Faitak
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Pamela Martin
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Alexa Cueto
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | - Jennifer L Clampitt
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
| | | | | | | | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762
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Iyassu A, Laillou A, Tilahun K, Workneh F, Mogues S, Chitekwe S, Baye K. The influence of adolescents' nutrition knowledge and school food environment on adolescents' dietary behaviors in urban Ethiopia: A qualitative study. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 5:e13527. [PMID: 37150888 PMCID: PMC11258761 DOI: 10.1111/mcn.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/09/2023]
Abstract
Adolescence is a critical period of physical, cognitive, and social development that needs to be supported with healthy diets. Dietary behaviours of adolescents can be shaped by their nutrition-literacy and their interaction with parents and peers as well as their school food environment. Therefore, the present study aimed to assess factors that influence dietary behaviours of adolescents in urban Ethiopia. Sex-disaggregated, focused group discussions (n = 70) were conducted in 36 private and government schools (n = 12/city) among adolescents (n = 432) 15-19 years of age in Addis Ababa, Bahir Dar, and Dire Dawa. Photovoice was applied in a subgroup of participants (n = 216) to gain further insights into adolescents' perception of their school food environment. Key informant interviews were conducted among school principals (n = 36). Adolescents had a relatively good nutrition knowledge and recognised the importance of diverse diets, but misperceptions also existed. They identified fruit and vegetables as healthy foods, but their consumption was deterred by food safety concerns. The adolescents identified foods high in salt, fat, and sugar, including processed/packaged foods as unhealthy, but still consumed them frequently due to their taste, affordability, availability and accessibility in and around schools. Both undernutrition and overweight/obesity were linked to social exclusion and bullying in school. Effective behavioural change communication is required to address common misperceptions. School nutrition programs should integrate water, sanitation and hygiene programs to ensure food safety. Regulations promoting healthy eating while discouraging unhealthy dietary behaviours are vital. Interventions to make nutrient-dense and healthy foods available, accessible, and affordable are urgently needed to improve the nutrition and health outcome of adolescents.
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Affiliation(s)
- Abreham Iyassu
- Research Center for Inclusive Development in Africa (RIDA)Addis AbabaEthiopia
| | | | - Kassahun Tilahun
- Department of Psychology, College of Social ScienceDebre Berhan UniversityDebre BerhanEthiopia
| | | | | | | | - Kaleab Baye
- Research Center for Inclusive Development in Africa (RIDA)Addis AbabaEthiopia
- Center for Food Science and NutritionAddis Ababa UniversityAddis AbabaEthiopia
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Pineda E, Atanasova P, Wellappuli NT, Kusuma D, Herath H, Segal AB, Vandevijvere S, Anjana RM, Shamim AA, Afzal S, Akter F, Aziz F, Gupta A, Hanif AA, Hasan M, Jayatissa R, Jha S, Jha V, Katulanda P, Khawaja KI, Kumarendran B, Loomba M, Mahmood S, Mridha MK, Pradeepa R, Aarthi GR, Tyagi A, Kasturiratne A, Sassi F, Miraldo M. Policy implementation and recommended actions to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): a comparative analysis in South Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 26:100428. [PMID: 39040122 PMCID: PMC11260855 DOI: 10.1016/j.lansea.2024.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/28/2024] [Accepted: 05/10/2024] [Indexed: 07/24/2024]
Abstract
Background The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments. Methods This study reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka from 2020 to 2022 using the Healthy Food Environment Policy Index (Food-EPI) and compared them with global best practices. Seven policy domains and six infrastructure support domains were considered, employing 47 good practice indicators to prevent NCDs. Stakeholders from government and non-governmental sectors in South Asia (n = 148) were invited to assess policy and infrastructure support implementation using the Delphi method. Findings Implementation of food environment policies and infrastructure support in these countries was predominantly weak. Labelling, monitoring, and leadership policies received a moderate rating, with a focus on food safety, hygiene, and quality rather than obesity prevention. Key policy gaps prioritized for attention included front-of-pack labelling, healthy food subsidies, unhealthy food taxation, restrictions on unhealthy food promotion, and improvements in school nutrition standards to combat NCDs. Interpretation Urgent action is required to expand food policies beyond hygiene and food security measures. Comprehensive strategies targeting NCD prevention are crucial to combat the escalating burden of NCDs in the region. Funding This research was funded by the NIHR (16/136/68 and 132960) with aid from the UK Government for global health research. Petya Atanasova also acknowledges funding from the Economic and Social Research Council (ESRC) (ES/P000703/1). The views expressed are those of the authors and not necessarily of the NIHR, the UK government or the ESRC.
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Affiliation(s)
- Elisa Pineda
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- The George Institute for Global Health UK, School of Public Health, Imperial College London, London, United Kingdom
| | - Petya Atanasova
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Dian Kusuma
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London, United Kingdom
| | - Himali Herath
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Ministry of Health, Colombo, Sri Lanka
| | - Alexa Blair Segal
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
| | | | | | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Saira Afzal
- King Edward Medical University, Lahore, Pakistan
| | - Fahmida Akter
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Faiza Aziz
- King Edward Medical University, Lahore, Pakistan
| | - Ananya Gupta
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
- Institute of Endocrinology, Diabetes & Metabolism, Max Super Speciality Hospital, New Delhi, India
| | - Abu Abdullah Hanif
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Renuka Jayatissa
- Nutrition Department, Medical Research Institute, Ministry of Health, Colombo, Sri Lanka
| | - Sujeet Jha
- Institute of Diabetes, Endocrinology & Metabolism, Max Super Speciality Hospital (A Unit of Devki Devi Foundation), New Delhi, India
| | - Vinitaa Jha
- Research & Academics, Clinical Directorate, Max Healthcare, New Delhi, India
| | | | - Khadija Irfan Khawaja
- Institute of Endocrinology & Metabolism, Services Institute of Medical Sciences (SIMS), Lahore, Pakistan
| | | | - Menka Loomba
- Office of Research, Max Super Speciality Hospital (A Unit of Devki Devi Foundation), New Delhi, India
| | - Sara Mahmood
- Institute of Endocrinology & Metabolism, Services Institute of Medical Sciences (SIMS), Lahore, Pakistan
| | - Malay Kanthi Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | - Akansha Tyagi
- Office of Research, Max Super Speciality Hospital (A Unit of Devki Devi Foundation), New Delhi, India
| | | | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
| | - Marisa Miraldo
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
- Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
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Perry M, Mardin K, Chamberlin G, Busey EA, Taillie LS, Dillman Carpentier FR, Popkin BM. National Policies to Limit Food Marketing and Competitive Food Sales in Schools: A Global Scoping Review. Adv Nutr 2024; 15:100254. [PMID: 38876396 PMCID: PMC11295572 DOI: 10.1016/j.advnut.2024.100254] [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: 04/04/2024] [Revised: 05/20/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024] Open
Abstract
School food environments contribute to children's nutritional intake and overall health. As such, the World Health Organization and other public health organizations encourage policies that restrict children's access and exposure to foods and beverages that do not build health in and around schools. This global scoping review explores the presence and characteristics of policies that restrict competitive food sales and marketing for unhealthy foods across 193 countries using evidence from policy databases, gray literature, peer-reviewed literature, and primary policy documents. Policies were included if they were nationally mandated and regulated marketing and/or competitive foods in the school environments. Worldwide, only 28% of countries were found to have any national-level policy restricting food marketing or competitive food sales in schools: 16% of countries restrict marketing, 25% restrict competitive foods, and 12% restrict both. Over half of policies were found in high-income countries. No low-income countries had either policy type. Eight marketing policies (27%) and 14 competitive foods policies (29%) lacked explicit guidelines for either policy monitoring or enforcement. Future research is needed to assess the prevalence of policies aimed at improving other key aspects of the school food environment, such as dietary quality of school meals or food procurement, as well as assess the implementation and efficacy of existing policies.
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Affiliation(s)
- Michelle Perry
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kayla Mardin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Grace Chamberlin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Health Policy, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily A Busey
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lindsey Smith Taillie
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Francesca R Dillman Carpentier
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Barry M Popkin
- Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A Narrative Review of Public Health Interventions for Childhood Obesity. Curr Obes Rep 2024; 13:87-97. [PMID: 38172483 DOI: 10.1007/s13679-023-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). RECENT FINDINGS Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Erica Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, The Greater Boston Food Bank, Boston, USA
| | - Ellen McMahon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Lauren Kruse
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, USA
| | - Emma K Edmondson
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
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Randby JS, Ogden T, Lien N. Implementation and effectiveness of a school-based intervention to increase adherence to national school meal guidelines: a non-randomised controlled trial. Public Health Nutr 2024; 27:e25. [PMID: 38164650 PMCID: PMC10830359 DOI: 10.1017/s1368980023002938] [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: 06/19/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Implementation of school meal guidelines is often inadequate, and evidence for effective implementation strategies for school-based nutrition interventions is limited. The aim of the present study was to examine the implementation and effectiveness of a multi-strategy implementation intervention to increase adherence to the Norwegian national school meal guideline. DESIGN The study was a school-based hybrid implementation effectiveness trial with a pre-post non-equivalent control group design, testing three implementation strategies: internal facilitation, training and an educational meeting. SETTING Primary schools and after-school services in two counties in south-east Norway. PARTICIPANTS School principals, after-school leaders and class teachers from thirty-three schools in the intervention county and principals and after-school leaders from thirty-four schools in a comparison county. RESULTS There was a significant difference of 4 percentage points in change scores between the intervention and the comparison groups at follow-up, after adjusting for baseline adherence (B = 0·04, seB = 0·01, t = 3·10, P = 0·003). The intervention effect was not associated with the school's socio-economic profile. School-level fidelity was the implementation dimension that was most strongly correlated (r s = 0·48) with the change scores in the intervention group, indicating that principals' support is important for gaining the largest intervention effects. CONCLUSIONS A school-based intervention with low intensity, based on trained teachers as internal facilitators, can increase adherence to the national school meal guideline among Norwegian primary schools, irrespective of local socio-economic conditions. Implementation fidelity, at an organisational level, may be a useful predictor for intervention outcomes in schools.
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Affiliation(s)
- Jorunn Sofie Randby
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Pb. 1046 Blindern, 0317Oslo, Norway
- Department of Child and Adolescent Health, Norwegian Directorate of Health, Pb. 220 Skøyen, 0213Oslo, Norway
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, P.b. 7053 Majorstuen, 0306Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Pb. 1046 Blindern, 0317Oslo, Norway
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de Frel DL, Wicks H, Bakk Z, van Keulen N, Atsma DE, Janssen VR. Identifying barriers and facilitators to adopting healthier dietary choices in clinical care: a cross-sectional observational study. Front Nutr 2023; 10:1178134. [PMID: 38188877 PMCID: PMC10767758 DOI: 10.3389/fnut.2023.1178134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background and aims Adopting healthier diets can drastically improve societal health. Our environment plays a crucial role in daily dietary choices and hospitals in particular can stimulate patients to adopt healthier eating habits. Unfortunately, no robust clinically applicable cuing tools exist to help guide in-hospital dietary interventions. The purpose of this study was to identify patient-related barriers and facilitators to adopting healthier dietary choices. Methods and results This cross-sectional observational study was conducted on the cardiology ward of a university medical center between June 2020 and January 2021. Of the 594 patients asked and the 312 completed surveys on healthy eating intentions, 285 responses were considered for analysis. Notably, the majority of respondents were male (68.8%), with an average hospital stay of 3.3 days. The results indicate that cardiac patients attribute significantly greater influence on their dietary behavior to doctors compared to other caregivers, including dieticians (X2 = 37.09, df = 9, p < 0.001). Also, younger patients (below 70 years of age) were more inclined to plan changing dietary behavior than older patients. Most mentioned facilitators for adopting a healthier diet were more information/counseling, help in preparing food, support from family and friends, and more emphasis from a doctor. Conclusion The study highlights the importance of involving doctors in formulating dietary policies and patient-directed interventions within hospital settings. It also sheds light on the barriers and facilitators for promoting healthier dietary behaviors among patients during their hospitalization.
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Affiliation(s)
- Daan L. de Frel
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Hope Wicks
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Zsuzsa Bakk
- Section of Methodology and Statistics, Department of Psychology, Leiden University, Leiden, Netherlands
| | - Nicole van Keulen
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Douwe E. Atsma
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Veronica R. Janssen
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
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Rozga M, Handu D. Nutrition Interventions for Pediatric Obesity Prevention: An Umbrella Review of Systematic Reviews. Nutrients 2023; 15:5097. [PMID: 38140356 PMCID: PMC10745722 DOI: 10.3390/nu15245097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Nutrition interventions to prevent pediatric obesity can help to establish healthy habits to improve current and future health. The objective of this umbrella review of systematic reviews (SRs) is to examine the impact of obesity prevention interventions with a nutrition component on body mass index measures, overweight/obesity prevalence, and cost-effectiveness in participants 2-17 years old. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used, and this umbrella review was registered on PROSPERO (CRD42023443033). Included SRs were required to search ≥2 databases and to assess the risk of bias (RoB) of primary studies, and they were published 2017-June 2023. Database searches identified 4776 articles, and 31 SRs were included. In all age groups combined, interventions with both nutrition and physical activity were effective and cost-effective in all settings combined, and in the community setting specifically. In children ≤5 years old, interventions in the home and family, community, and healthcare settings demonstrated some efficacy, whereas in children 6-12 years old, school interventions were most effective. Evidence with individuals 13-17 years was limited. The certainty of evidence was generally low due to RoB in included studies, inconsistency, and imprecision. Pediatric obesity prevention interventions with nutrition should be tailored to the developmental stage to ensure appropriateness and efficacy.
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Affiliation(s)
- Mary Rozga
- Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995, USA;
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Pongutta S, Ferguson E, Davey C, Tangcharoensathien V, Limwattananon S, Borghi J, Wong CKH, Lin L. The impact of a complex school nutrition intervention on double burden of malnutrition among Thai primary school children: a 2-year quasi-experiment. Public Health 2023; 224:51-57. [PMID: 37734276 DOI: 10.1016/j.puhe.2023.08.023] [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: 04/20/2023] [Revised: 07/22/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE This study assessed the impacts of the Dekthai Kamsai programme on overweight/obesity, underweight and stunting among male and female primary school students. STUDY DESIGN A quasi-experiment was conducted in 16 intervention and 19 control schools across Thailand in 2018 and 2019. In total, 896 treated and 1779 control students from grades 1 to 3 were recruited. In intervention schools, a set of multifaceted intervention components were added into school routine practices. Anthropometric outcomes were measured at baseline and at the beginning and end of every school term. METHODS Propensity score matching with linear and Poisson difference-in-difference analyses were used to adjust for the non-randomisation and to analyse the intervention's effects over time. RESULTS Compared with controls, the increases in mean BMI-for-age Z-score (BAZ) and the incidence rate of overweight/obesity were lower in the intervention schools at the 3rd, 4th and 8th measurements and the 3rd measurement, respectively. The decrease in mean height-for-age Z-score (HAZ) was lower at the 4th measurement. The decrease in the incidence rate of wasting was lower at the 5th, 7th and 8th measurements. The favourable impacts on BAZ and HAZ were found in both sexes, while the favourable impact on overweight/obesity and unfavourable impact on wasting were found in girls. CONCLUSIONS This intervention might be effective in reducing BAZ, overweight/obesity, poor height gain, but not wasting. These findings highlight the benefits of a multifaceted school nutrition intervention and a need to incorporate tailor-made interventions for wasting to comprehensively address the double burden of malnutrition.
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Affiliation(s)
- S Pongutta
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand; London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - E Ferguson
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK
| | - C Davey
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - V Tangcharoensathien
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand.
| | - S Limwattananon
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand.
| | - J Borghi
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - C K H Wong
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Science Park, Hong Kong SAR, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Science Park, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China.
| | - L Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Špečkauskienė V, Trišauskė J, Grincaitė M, Kriaučionienė V, Petrauskienė A. Changes of anthropometric indicators of lithuanian first-graders in 2008-2019 according to International Obesity Task Force (IOTF) and World Health Organization (WHO) definitions. BMC Public Health 2023; 23:2097. [PMID: 37880648 PMCID: PMC10601166 DOI: 10.1186/s12889-023-17031-6] [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] [Received: 06/06/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION The monitoring of children's growth plays a crucial role in assessing their growth patterns and indicating their weight status. Overweight and obesity, determined by cut-offs of body mass index (BMI), are most commonly associated with unhealthy nutrition, non-communicable diseases, and other health disorders. The World Health Organization (WHO) initiated the WHO European Childhood Obesity Surveillance Initiative (COSI) to measure routinely trends in children's anthropometric changes, which allow intercountry comparisons within the European Region. Lithuania joined the COSI initiative. Our study aims to evaluate and compare underweight, normal and elevated weight (overweight and obesity) changes of Lithuanian first-graders during eleven years period. METHODS This study was composed according to the COSI study protocol, and it compares the five rounds of anthropometric measurements of Lithuanian first-graders (7-8-year-old) from 2008 to 2019. The main analysed variables were weight and height; calculated BMI, weight-for-age (W/A), height-for-age (H/A) and body mass index-for-age (BMI/A) z-scores. Changes of the indicators were evaluated according to the International Obesity Task Force (IOTF) cut-offs and WHO child growth standards, grouped by 4 estimates: underweight (thinness), normal weight, overweight and obesity. All comparisons were performed between age groups, gender and COSI round year. RESULTS The mean values for weight, height, W/A and H/A Z-scores were significantly higher for both age and gender groups when comparing later COSI round years (2016 or 2019) to earlier years (2008-2013, in some cases 2016 is included in this range). Time trends of the WHO growth standards and IOTF cut-offs indicate significant decrease among 7-year-old overweight group for boys and girls. Also, a significant decrease was indicated among boys aged 8 years in the overweight group according to the WHO definitions. The only significant increase in trend were expressed in girl's group with obesity aged 8 years according to IOTF cut-offs. CONCLUSION The prevalence of overweight and obesity of first-grade children in Lithuania indicates positive changes, that is the proportion of children with elevated body weight decreased, during eleven-year period. However, it is important to continue the monitoring of children's growth tendencies.
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Affiliation(s)
- Vita Špečkauskienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania.
- Department of Physics, Mathematics, and Biophysics, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, LT, 50162, Lithuania.
| | - Justina Trišauskė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
| | - Monika Grincaitė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
| | - Vilma Kriaučionienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
| | - Aušra Petrauskienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, LT47181, Lithuania
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Tandoh A, Laar A, Pradeilles R, Le Port A, Osei-Kwasi H, Amevinya GS, Aryeetey RNO, Agyemang C, Holdsworth M. Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal. BMJ Open 2023; 13:e075166. [PMID: 37770260 PMCID: PMC10546112 DOI: 10.1136/bmjopen-2023-075166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4-15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana. DESIGN The community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions. SETTING Greater Accra Region, Ghana. PARTICIPANTS 18 key informants from various school/education/citizen sectors, which together represented the 'school community' of Greater Accra Region. RESULTS The mean readiness scores indicated that the 'school community' was at the 'preplanning' stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for 'leadership' was the highest of all dimensions (5.36±1.60), corresponding to the 'preparation' stage. The lowest scores were found for 'community knowledge of efforts' (3.19±2.45) and 'resources for efforts' (3.64±0.87), both of which were at a 'vague awareness' stage. CONCLUSIONS The 'school community' recognised that the marketing and availability of unhealthy food and beverages was a problem. Additionally, current leadership was actively supportive of continuing/improving efforts that create healthier children's food environments. However, actions that aim to increase the 'school community's' knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness appropriate strategies.
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Affiliation(s)
- Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Rebecca Pradeilles
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Agnes Le Port
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
| | - Hibbah Osei-Kwasi
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Gideon Senyo Amevinya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Richmond Nii Okai Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri-food systems), Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro Montpellier, IRD, Montpellier, France
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Buksh SM, Hay P, de Wit JBF. Perceptions on Healthy Eating Impact the Home Food Environment: A Qualitative Exploration of Perceptions of Indigenous Food Gatekeepers in Urban Fiji. Nutrients 2023; 15:3875. [PMID: 37764659 PMCID: PMC10535398 DOI: 10.3390/nu15183875] [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] [Received: 08/02/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
The home food environment (HFE) can have important direct and indirect impacts on dietary practices. Nutrient transitions in the HFE of Pacific Island countries (PICs) are key contributors of the high rates of adult and childhood overweight and obesity in the region. Pacifica mothers are important sociocultural agents who play critical roles in their HFE through setting eating-appropriateness standards and mitigating the impacts of food availability and accessibility on the HFE. This study used an interpretative phenomenological approach to explore how urban indigenous Fijian mothers perceive healthy eating and how these perceptions impacted the food decisions they made for their families. Mothers in this study held complex, multifaceted perceptions on healthy eating and these perceptions had both positive and negative impacts on the family food choices they made, the strategies they adopted for healthy eating and their perceived motivators for healthy eating. The findings of this study underscore the need for a deeper understanding and analysis of uptake of public health messaging related to healthy and unhealthy eating and the importance of targeted promotion of healthful nutrition in this community. Promoting consumption of traditional and locally grown foods can enhance nutrition and food security and combat nutrition transition in the region.
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Affiliation(s)
- Shazna M. Buksh
- School of Law and Social Sciences, The University of the South Pacific, Suva 1168, Fiji;
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Science, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - John B. F. de Wit
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Science, Utrecht University, 3584 CS Utrecht, The Netherlands
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Nelson TD, Stice E. Contextualizing the Neural Vulnerabilities Model of Obesity. Nutrients 2023; 15:2988. [PMID: 37447312 DOI: 10.3390/nu15132988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
In recent years, investigators have focused on neural vulnerability factors that increase the risk of unhealthy weight gain, which has provided a useful organizing structure for obesity neuroscience research. However, this framework, and much of the research it has informed, has given limited attention to contextual factors that may interact with key vulnerabilities to impact eating behaviors and weight gain. To fill this gap, we propose a Contextualized Neural Vulnerabilities Model of Obesity, extending the existing theory to more intentionally incorporate contextual factors that are hypothesized to interact with neural vulnerabilities in shaping eating behaviors and weight trajectories. We begin by providing an overview of the Neural Vulnerabilities Model of Obesity, and briefly review supporting evidence. Next, we suggest opportunities to add contextual considerations to the model, including incorporating environmental and developmental context, emphasizing how contextual factors may interact with neural vulnerabilities to impact eating and weight. We then synthesize earlier models and new extensions to describe a Contextualized Neural Vulnerabilities Model of Obesity with three interacting components-food reward sensitivity, top-down regulation, and environmental factors-all within a developmental framework that highlights adolescence as a key period. Finally, we propose critical research questions arising from the framework, as well as opportunities to inform novel interventions.
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Affiliation(s)
- Timothy D Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Eric Stice
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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15
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Sabău MM, Mititean P, Pocol CB, Dabija DC. Factors Generating the Willingness of Romanian Consumers to Buy Raw Milk from Vending Machines. Foods 2023; 12:2193. [PMID: 37297438 PMCID: PMC10252582 DOI: 10.3390/foods12112193] [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: 04/19/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
The use of automatic raw milk dispensers for products obtained from Romanian farms can represent an effective method of encouraging the development of short supply chains and promoting sustainable production and consumption systems. There are very few studies in the literature, especially in emerging economies, that analyze consumer perception regarding the use of raw milk dispensers; most of the research is focused on technical aspects regarding how such machines function and food safety, and less on consumers' perceptions towards them or consumer satisfaction, loyalty, or intention to use them. Therefore, the objective of this research was to investigate the willingness of Romanian consumers to buy raw milk from vending machines. In this regard, the authors drew a conceptual model to assess the factors that trigger willingness to buy raw milk from vending machines and then implemented a quantitative-based survey among Romanian consumers who buy raw milk from vending machines. The data were analyzed by modeling structural equations with SmartPLS. The results reveal that the generation of consumer willingness to buy raw milk from vending machines depends on how consumers perceive raw milk but also on the product safety, reusability of the milk bottle, and the provenance of the raw milk, as well as the nutritional qualities of the unprocessed raw milk. The paper extends previous studies based on the stimulus-organism-response (SOR) and deepens the understanding of consumers' perception towards raw milk dispensers. Furthermore, the results also highlight possible managerial strategies that aim to improve the understanding of consumers.
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Affiliation(s)
- Marius Mircea Sabău
- Department of Economic Sciences, University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, 400372 Cluj-Napoca, Romania;
| | - Pompei Mititean
- Department of Accounting and Audit, Faculty of Accounting and Management Information Systems, Bucharest University of Economic Studies, 010374 Bucharest, Romania;
| | - Cristina Bianca Pocol
- Department of Animal Production and Food Safety, University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, 400372 Cluj-Napoca, Romania
| | - Dan-Cristian Dabija
- Department of Marketing, Faculty of Economics and Business Administration, Babeș-Bolyai University, 400591 Cluj-Napoca, Romania
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16
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Osei AN, Djekic-Ivankovic M, Larson CP, Agbemafle I, Agbozo F. Effect of school-based nutrition interventions among primary school children in sub-Saharan Africa: a systematic review protocol. BMJ Open 2023; 13:e068901. [PMID: 37072365 PMCID: PMC10124275 DOI: 10.1136/bmjopen-2022-068901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Preadolescents are passing through an intensive growth and development period that will benefit from healthy eating practices. For those attending school, school environments offer several potential benefits and have been demonstrated to influence the quality of dietary intakes and consequentially, nutritional status of school-aged children (SAC). Considering the amount of time children spend in school and the enormous potential of evidence-based interventions, the purpose of this review is to critically appraise peer-reviewed literature addressing the impact of school-based interventions on the nutritional status of SAC aged 6-12 years in sub-Saharan Africa. METHODS AND ANALYSIS A systematic search will be conducted in the following databases and online search records: Medline, CINAHL, Web of Science, Embase, Global health, Global Index Medicus, Cochrane library, Hinari and Google Scholar using search terms and keywords codeveloped with two librarians. An additional search will also be conducted from the reference list of identified literature. Search results of titles and abstracts will be initially screened for eligibility criteria by two independent reviewers and where there is disagreement, a third reviewer will be consulted. Articles meeting these criteria will then undergo a full-text review for the eligibility and exclusion criteria. The Joanna Briggs Institute critical appraisal tool will be used to assess the risk of bias. Data from articles meeting all study criteria will be extracted, analysed and synthesised. A meta-analysis will also be conducted if sufficient data are available. ETHICS AND DISSEMINATION This systematic review is limited to publicly accessible data bases not requiring prior ethical approval to access. The results of the systematic review will be disseminated through publications in peer-reviewed journals as well as conference and stakeholder presentations. PROSPERO REGISTRATION NUMBER CRD42022334829.
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Affiliation(s)
- Angela Nyamekye Osei
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | | | - Charles P Larson
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Isaac Agbemafle
- Fred N Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Faith Agbozo
- Fred N Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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Woodside JV, Nugent AP, Moore RE, McKinley MC. Fruit and vegetable consumption as a preventative strategy for non-communicable diseases. Proc Nutr Soc 2023:1-14. [PMID: 36785878 DOI: 10.1017/s0029665123002161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
A high intake of fruit and vegetables (FV) has consistently been associated with a reduced risk of a number of non-communicable diseases. This evidence base is largely from prospective cohort studies, with meta-analyses demonstrating an association between increased FV intake and reduced risk of both CHD and stroke, although the evidence is less certain for cancer and diabetes. Controlled intervention trials examining either clinical or intermediate risk factor endpoints are more scarce. Therefore, evidence that FV consumption reduces the risk of disease is so far largely confined to observational epidemiology, which is hampered by some methodological uncertainties. Although increased FV intake is promoted across all dietary guidelines, national surveys confirm that dietary intakes are suboptimal and are not increasing over time. A range of barriers to increasing FV intake exist, including economic, physical and behavioural barriers that must be considered when exploring potential opportunities to change this, considering the feasibility of different approaches to encourage increased FV consumption. Such interventions must include consideration of context, for example, challenges and uncertainties which exist with the whole food system.
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Affiliation(s)
- J V Woodside
- Centre for Public Health, Institute for Clinical Science A, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - A P Nugent
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - R E Moore
- Centre for Public Health, Institute for Clinical Science A, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - M C McKinley
- Centre for Public Health, Institute for Clinical Science A, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
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18
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Vega-Salas MJ, Murray C, Nunes R, Hidalgo-Arestegui A, Curi-Quinto K, Penny ME, Cueto S, Lovegrove JA, Sánchez A, Vimaleswaran KS. School environments and obesity: a systematic review of interventions and policies among school-age students in Latin America and the Caribbean. Int J Obes (Lond) 2023; 47:5-16. [PMID: 36216909 PMCID: PMC9549440 DOI: 10.1038/s41366-022-01226-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The rapid rise in obesity rates among school children in Latin America and the Caribbean (LAC) could have a direct impact on the region's physical and mental health, disability, and mortality. This review presents the available interventions likely to reduce, mitigate and/or prevent obesity among school children in LAC by modifying the food and built environments within and around schools. METHODS Two independent reviewers searched five databases: MEDLINE, Web of Science, Cochrane Library, Scopus and Latin American and Caribbean Health Sciences Literature for peer-reviewed literature published from 1 January 2000 to September 2021; searching and screening prospective studies published in English, Spanish and Portuguese. This was followed by data extraction and quality assessment using the Cochrane risk-of-bias tool (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), adopting also the PRISMA 2020 guidelines. Due to the heterogeneity of the intervention's characteristics and obesity-related measurements across studies, a narrative synthesis was conducted. RESULTS A total of 1342 research papers were screened, and 9 studies were included; 4 in Mexico, and 1 each in Argentina, Brazil, Chile, Colombia, and Ecuador. Four studies reported strategies for modifying food provision; four other targeted the built environment, (modifying school premises and providing materials for physical activity); a final study included both food and built environment intervention components. Overall, two studies reported that the intervention was significantly associated with a lower increase over time in BMI/obesity in the intervention against the control group. The remaining studies were non-significant. CONCLUSIONS Data suggest that school environmental interventions, complementing nutritional and physical education can contribute to reduce incremental childhood obesity trends. However, evidence of the extent to which food and built environment components factor into obesogenic environments, within and around school grounds is inconclusive. Insufficient data hindered any urban/rural comparisons. Further school environmental intervention studies to inform policies for preventing/reducing childhood obesity in LAC are needed.
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Affiliation(s)
- María Jesús Vega-Salas
- Carrera de Nutrición y Dietética, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, 7820436, Chile.
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6DZ, UK.
| | - Claudia Murray
- Department of Real Estate and Planning, Henley Business School, University of Reading, Reading, RG6 6UD, UK.
| | - Richard Nunes
- Department of Real Estate and Planning, Henley Business School, University of Reading, Reading, RG6 6UD, UK
| | - Alessandra Hidalgo-Arestegui
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6DZ, UK
| | | | - Mary E Penny
- Instituto de Investigación Nutricional (IIN), Lima, 15024, Peru
| | - Santiago Cueto
- Grupo de Análisis para el Desarrollo (GRADE), Lima, 15063, Peru
- Departamento de Psicología, Pontificia Universidad Católica del Peru, Lima, 15088, Peru
| | - Julie Anne Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6DZ, UK
- Institute for Food, Nutrition and Health (IFNH), University of Reading, Reading, RG6 6AH, UK
| | - Alan Sánchez
- Grupo de Análisis para el Desarrollo (GRADE), Lima, 15063, Peru
| | - Karani Santhanakrishnan Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6DZ, UK
- Institute for Food, Nutrition and Health (IFNH), University of Reading, Reading, RG6 6AH, UK
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PULAT DEMİR H, KARŞIDAĞ K. İlköğretim Çağındaki Çocuklarda Obezite Üzerinde Etkili Olan Bazı Faktörlerin İncelenmesi: İstanbul Örneği. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1199259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Amaç: Çocukluk çağında obezite tüm dünyada artmaktadır. Bu çalışma ilköğretim çağındaki çocuklarda obezite üzerinde etkili olan bazı faktörlerin araştırılması amacıyla yapılmıştır.Yöntem: Çalışma İstanbul'da iki farklı okulda 621 ilköğretim öğrencisi üzerinde gerçekleştirilmiştir. Çocuklar 7-15 yaş grubunda olup rastgele örneklem yöntemi ile seçilmiştir. Çocuklara demografik özellikler, beslenme ve fiziksel aktivite ile ilgili sorulardan oluşan bir anket uygulanmış olup, bazı antropometrik ölçümleri alınmıştır. Çocukların Beden Kütle Indeksi (BKİ) değerleri Türk çocuklarının persentillerine göre sınıflandırılmıştır. Veriler SPSS 13.0 programı ile değerlendirilmiştir.Bulgular: Öğrencilerin %47,5’i kız, %52,5’i erkektir. BKİ sınıflandırmasında öğrencilerin %11,8'i obez bulunmuştur. Özel okuldaki öğrencilerde obezite prevalansı %17,3 devlet okulundaki öğrencilerde %6,6’dır (p<0,05). Üniversite mezunu anne ve babaların çocuklarında, aile birey sayısı üç kişi olanlarda obezite oranı daha fazladır (p<0,05). Beslenme alışkanlıklarına göre düzenli akşam yemeği tüketmeyenlerde ve sevinçli/mutlu olduğunda iştah değişimi olmayanlarda daha fazla obezite oranı görülmüştür (p<0,05). Ayrıca, okula özel araba ile giden öğrencilerin obezite oranı en fazladır (%18,2; p< 0,05).Sonuç: Çalışma sonucunda çocuklarda obezite oranı yüksek eğitim düzeyine sahip anne ve babaların çocuklarında, özel okula giden çocuklarda ve üç kişilik ailelerde yaşayanlarda daha yüksek bulunmuştur. Çocuklarda obezite gelişimini önlemek için okullarda düzenli olarak antropometrik ölçümlerin alınması, öğrencilere ve ebeveynlere sağlıklı beslenmeye yönelik eğitimlerin verilmesi faydalı olabilir.
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Londoño-Cañola C, Serral G, Díez J, Martínez-García A, Franco M, Artazcoz L, Ariza C. Retail Food Environment around Schools in Barcelona by Neighborhood Socioeconomic Status: Implications for Local Food Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010649. [PMID: 36612971 PMCID: PMC9819657 DOI: 10.3390/ijerph20010649] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 05/14/2023]
Abstract
Childhood obesity is a relevant public health problem. The school food environment has been identified as an important factor for promoting healthy eating behaviors. This study assessed the availability of and proximity to unhealthy food stores around schools (n = 22) in the city of Barcelona and its association with neighborhood socioeconomic status (NSES). We conducted this cross-sectional study between 2019 and 2020. First, we identified all food retailers (n = 153) within a 400-m buffer around each school and identified those selling unhealthy food products. Then, we used Poison regression models to measure the association between NSES and the healthy food availability index (HFAI), adjusting for population density and distance. A total of 95% of the food establishments studied were classified as unhealthy (n = 146). In all, 90% of schools that had, at least, two unhealthy retailers in their proximity. There were significant differences in the mean distance to unhealthy establishments according to neighborhood SES and population density (p < 0.05). We found a positive association between schools located in higher SES neighborhoods and a higher availability and affordability of healthy food products (IIR = 1.67, 95% CI = 1.45−1.91 p = 0.000). We found strong social inequalities in the supply of healthy foods in Barcelona. Local food policy interventions addressing retail food environment around schools should consider socioeconomic inequalities.
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Affiliation(s)
- Catalina Londoño-Cañola
- Agència de Salut Pública de Barcelona, Public Health Agency, 08023 Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut (DCEXS), Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Correspondence:
| | - Gemma Serral
- Agència de Salut Pública de Barcelona, Public Health Agency, 08023 Barcelona, Spain
- Ciber de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Alba Martínez-García
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 Alicante, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28801 Madrid, Spain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Lucía Artazcoz
- Agència de Salut Pública de Barcelona, Public Health Agency, 08023 Barcelona, Spain
- Ciber de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Carlos Ariza
- Agència de Salut Pública de Barcelona, Public Health Agency, 08023 Barcelona, Spain
- Ciber de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
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21
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Pineda E, Poelman MP, Aaspõllu A, Bica M, Bouzas C, Carrano E, De Miguel-Etayo P, Djojosoeparto S, Blenkuš MG, Graca P, Geffert K, Hebestreit A, Helldan A, Henjum S, Huseby CS, Gregório MJ, Kamphuis C, Laatikainen T, Løvhaug AL, Leydon C, Luszczynska A, Mäki P, Martínez JA, Raulio S, Romaniuk P, Roos G, Salvador C, Sassi F, Silano M, Sotlar I, Specchia ML, de Arriaga MT, Terragni L, Torheim LE, Tur JA, von Philipsborn P, Harrington JM, Vandevijvere S. Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries. Lancet Reg Health Eur 2022; 23:100522. [PMID: 36405402 PMCID: PMC9673115 DOI: 10.1016/j.lanepe.2022.100522] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Food environments have been recognised as highly influential on population diets. Government policies have great potential to create healthy food environments to promote healthy diets. This study aimed to evaluate food environment policy implementation in European countries and identify priority actions for governments to create healthy food environments. Methods The Healthy Food Environment Policy Index (Food-EPI) was used to evaluate the level of food environment policy and infrastructure support implementation in Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain in 2019–2021. Evidence of implementation of food environment policies was compiled in each country and validated by government officials. National experts evaluated the implementation of policies and identified priority recommendations. Findings Finland had the highest proportion (32%, n = 7/22) of policies shaping food environments with a “high” level of implementation. Slovenia and Poland had the highest proportion of policies rated at very low implementation (42%, n = 10/24 and 36%, n = 9/25 respectively). Policies regarding food provision, promotion, retail, funding, monitoring, and health in all policies were identified as the most important gaps across the European countries. Experts recommended immediate action on setting standards for nutrients of concern in processed foods, improvement of school food environments, fruit and vegetable subsidies, unhealthy food and beverage taxation, and restrictions on unhealthy food marketing to children. Interpretation Immediate implementation of policies and infrastructure support that prioritize action towards healthy food environments is urgently required to tackle the burden of obesity and diet-related non-communicable diseases in Europe. Funding This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative “A Healthy Diet for a Healthy Life”.
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22
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The Impact of Modifying Food Service Practices in Secondary Schools Providing a Routine Meal Service on Student's Food Behaviours, Health and Dining Experience: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14173640. [PMID: 36079897 PMCID: PMC9460342 DOI: 10.3390/nu14173640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
The education sector is recognised as an ideal platform to promote good nutrition and decision making around food and eating. Examining adolescents in this setting is important because of the unique features of adolescence compared to younger childhood. This systematic review and meta-analysis examine interventions in secondary schools that provide a routine meal service and the impact on adolescents’ food behaviours, health and dining experience in this setting. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Cochrane Handbook recommendations. Studies published in English searched in four databases and a hand search yielded 42 interventions in 35 studies. Risk of bias was assessed independently by two reviewers. Interventions were classified using the NOURISHING framework, and their impact analysed using meta-analysis, vote-counting synthesis or narrative summary. The meta-analysis showed an improvement in students selecting vegetables (odds ratio (OR): 1.39; 1.12 to 1.23; p = 0.002), fruit serves selected (mean difference (MD): 0.09; 0.09 to 0.09; p < 0.001) and consumed (MD: 0.10; 0.04 to 0.15; p < 0.001), and vegetable serves consumed (MD: 0.06; 0.01 to 0.10; p = 0.024). Vote-counting showed a positive impact for most interventions that measured selection (15 of 25; 41% to 77%; p = 0.002) and consumption (14 of 24; 39% to 76%; p = 0.013) of a meal component. Interventions that integrate improving menu quality, assess palatability, accessibility of healthier options, and student engagement can enhance success. These results should be interpreted with caution as most studies were not methodologically strong and at higher risk of bias. There is a need for higher quality pragmatic trials, strategies to build and measure sustained change, and evaluation of end-user attitudes and perceptions towards intervention components and implementation for greater insight into intervention success and future directions (PROSPERO registration: CRD42020167133).
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23
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Smets V, Vandevijvere S. Changes in retail food environments around schools over 12 years and associations with overweight and obesity among children and adolescents in Flanders, Belgium. BMC Public Health 2022; 22:1570. [PMID: 35982440 PMCID: PMC9387020 DOI: 10.1186/s12889-022-13970-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children are susceptible to the food environment. This research assessed changes in retail food environments near schools in Flanders between 2008 and 2020 and associations with children's and adolescents' weight status. METHODS The food environment within a 500 m and 1000 m road network distance to all primary and secondary schools was mapped using spatial indicators. The commercial Locatus database, including addresses of all food retailers in Flanders, was used to calculate the density of different types of food retailers near the school perimeter, the percentage of schools with at least one food retailer of a certain type near the school perimeter and the shortest distance from the school entrance to the nearest food retailer of a certain type. A generalized linear model was used to explore associations between these indicators and the percentage of children and adolescents with overweight at the school level. RESULTS Food environments near schools in Flanders were found to be unhealthy in 2020, with a significant increase in fast food restaurants and convenience stores between 2008 and 2020. The density of fast food restaurants within a 1000 m walking distance from primary and secondary schools increased from 5.3 ±0.3 to 6.3 ±0.4 and from 10.2 ±0.7 to 12.7 ±0.9 respectively between 2008 and 2020, while the density of convenience stores increased from 3.2 ±0.3 to 3.8 ±0.4 and from 6.2 ±0.6 to 7.6 ±0.8 respectively. Food environments near schools with a higher proportion of children from a poor socio-economic background were found unhealthier, regardless of the urbanization level. A significant positive association was found between the density of fast food restaurants as well as the density of convenience stores around primary schools and the percentage of children aged < 6 years and 6-12 years with overweight. A positive, not significant association was found between the density of fast food restaurants as well as the density of convenience stores around secondary schools and the percentage of adolescents, aged 13-14 and 15-18 years with overweight. CONCLUSION Food environments around schools in Flanders became unhealthier over time and were associated with children's weight status.
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Affiliation(s)
- Vincent Smets
- Department of Public Health and Epidemiology, Sciensano (Scientific Institute of Public Health), J.Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Stefanie Vandevijvere
- Department of Public Health and Epidemiology, Sciensano (Scientific Institute of Public Health), J.Wytsmanstraat 14, 1050, Brussels, Belgium.
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24
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Ryan D, Holmes M, Ensaff H. Adolescents' dietary behaviour: The interplay between home and school food environments. Appetite 2022; 175:106056. [PMID: 35447162 DOI: 10.1016/j.appet.2022.106056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 12/29/2022]
Abstract
In the UK, school food standards have looked to improve the nutritional profile of school food provision and the choices made; however, adolescents' choices tend to bias towards micronutrient poor and energy dense options. This study aimed to explore how adolescents make their school food choices, along with how they engage with their environments whilst selecting food. Seven focus group interviews took place with adolescents (n = 28; 13-14 years) in a secondary school in Northern England. Discussions with participants were audio-recorded, transcribed verbatim and then analysed using an inductive thematic approach. Six themes emerged from the data: (1) parents' and adolescents' roles in the home food environment, (2) burgeoning food autonomy, (3) school food choice factors, (4) social aspects of school food, (5) home versus school, (6) food knowledge & beliefs. Adolescents identified two distinct environments during the focus group discussions: the home and school environments. Adolescents juxtaposed the two, in terms of food provision, food choices, rules and customs surrounding food choice. This juxtaposition emerged as an indirect but important influence on adolescents' school food choices. The school and home environments both (in)directly influence adolescents' school food choices, which involve an integration of multiple, often conflicting influences. Adolescents may adopt a number of unhelpful dietary rationalisations as they try to manage and reconcile these influences. Consultation, together with consideration of relevant food choice models, is required to identify opportunities to influence adolescents' food choices at school.
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Affiliation(s)
- D Ryan
- Nutritional Sciences and Epidemiology, School of Food Science & Nutrition, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - M Holmes
- Nutritional Sciences and Epidemiology, School of Food Science & Nutrition, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - H Ensaff
- Nutritional Sciences and Epidemiology, School of Food Science & Nutrition, University of Leeds, Leeds, LS2 9JT, United Kingdom.
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25
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Potential Determinants of Cardio-Metabolic Risk among Aboriginal and Torres Strait Islander Children and Adolescents: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159180. [PMID: 35954531 PMCID: PMC9368168 DOI: 10.3390/ijerph19159180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
Prevention initiatives during childhood and adolescence have great potential to address the health inequities experienced by Aboriginal and Torres Strait Islander (Indigenous) populations in Australia by targeting modifiable risk factors for cardio-metabolic diseases. We aimed to synthesize existing evidence about potential determinants of cardio-metabolic risk markers—obesity, elevated blood pressure, elevated blood glucose, abnormal lipids, or a clustering of these factors known as the metabolic syndrome (MetS)—for Indigenous children and adolescents. We systematically searched six databases for journal articles and three websites for relevant grey literature. Included articles (n = 47) reported associations between exposures (or interventions) and one or more of the risk markers among Indigenous participants aged 0–24 years. Data from 18 distinct studies about 41 exposure–outcome associations were synthesized (by outcome: obesity [n = 18]; blood pressure [n = 9]; glucose, insulin or diabetes [n = 4]; lipids [n = 5]; and MetS [n = 5]). Obesity was associated with each of the other cardio-metabolic risk markers. Larger birth size and higher area-level socioeconomic status were associated with obesity; the latter is opposite to what is observed in the non-Indigenous population. There were major gaps in the evidence for other risk markers, as well as by age group, geography, and exposure type. Screening for risk markers among those with obesity and culturally appropriate obesity prevention initiatives could reduce the burden of cardio-metabolic disease.
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26
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Shoari N, Beevers S, Brauer M, Blangiardo M. Towards healthy school neighbourhoods: A baseline analysis in Greater London. ENVIRONMENT INTERNATIONAL 2022; 165:107286. [PMID: 35660953 DOI: 10.1016/j.envint.2022.107286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Creating healthy environments around schools is important to promote healthy childhood development and is a critical component of public health. In this paper we present a tool to characterize exposure to multiple urban environment features within 400 m (5-10 min walking distance) of schools in Greater London. We modelled joint exposure to air pollution (NO2 and PM2.5), access to public greenspace, food environment, and road safety for 2,929 schools, employing a Bayesian non-parametric approach based on the Dirichlet Process Mixture modelling. We identified 12 latent clusters of schools with similar exposure profiles and observed some spatial clustering patterns. Socioeconomic and ethnicity disparities were manifested with respect to exposure profiles. Specifically, three clusters (containing 645 schools) showed the highest joint exposure to air pollution, poor food environment, and unsafe roads and were characterized with high deprivation. The neighbourhood of the most deprived cluster of schools had a median of 2.5 ha greenspace, 29.0 µg/m3 of NO2, 19.3 µg/m3 of PM2.5, 20 fast food retailers, and five child pedestrian crashes over a three-year period. The neighbourhood of the least deprived cluster of schools had a median of 21.8 ha greenspace, 15.6 µg/m3 of NO2, 15.1 µg/m3 of PM2.5, 2 fast food retailers, and one child pedestrian crash over a three-year period. To have a school-level understanding of exposure levels, we then benchmarked schools based on the probability of exceeding the median exposure to various features of interest. Our study accounts for multiple exposures, enabling us to highlight spatial distribution of exposure profile clusters, and to identify predominant exposure to urban environment features for each cluster of schools. Our findings can help relevant stakeholders, such as schools and public health authorities, to compare schools based on their exposure levels, prioritize interventions, and design local policies that target the schools most in need.
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Affiliation(s)
- Niloofar Shoari
- MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
| | - Sean Beevers
- MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Marta Blangiardo
- MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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27
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Carruba MO, Caretto A, De Lorenzo A, Fatati G, Ghiselli A, Lucchin L, Maffeis C, Malavazos A, Malfi G, Riva E, Ruocco C, Santini F, Silano M, Valerio A, Vania A, Nisoli E. Front-of-pack (FOP) labelling systems to improve the quality of nutrition information to prevent obesity: NutrInform Battery vs Nutri-Score. Eat Weight Disord 2022; 27:1575-1584. [PMID: 34664216 PMCID: PMC9123065 DOI: 10.1007/s40519-021-01316-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 12/31/2022] Open
Abstract
Many systems for classifying food products to adequately predict lower all-cause morbidity and mortality have been proposed as front-of-pack (FOP) nutritional labels. Although the efforts and advances that these systems represent for public health must be appreciated, as scientists involved in nutrition research and belonging to diverse Italian nutrition scientific societies, we would like to draw stakeholders' attention to the fact that some FOP labels risk being not correctly informative to consumers' awareness of nutritional food quality. The European Commission has explicitly called for such a nutrition information system to be part of the European "strategy on nutrition, overweight and obesity-related issues" to "facilitate consumer understanding of the contribution or importance of the food to the energy and nutrient content of a diet". Some European countries have adopted the popular French proposal Nutri-Score. However, many critical limits and inadequacies have been identified in this system. As an alternative, we endorse a new enriched informative label-the NutrInform Battery-promoted by the Italian Ministry of Health and deeply studied by the Center for Study and Research on Obesity, Milan University. Therefore, the present position paper limits comparing these two FOP nutritional labels, focusing on the evidence suggesting that the NutrInform Battery can help consumers better than the Nutri-Score system to understand nutritional information, potentially improving dietary choices. LEVEL OF EVIDENCE: II. Evidence was obtained from well-designed controlled trials without randomization.
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Affiliation(s)
- Michele O Carruba
- Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Milan, Italy.
| | - Antonio Caretto
- Endocrinology, Metabolic Diseases and Clinical Nutrition, Hospital of Brindisi, Brindisi, Italy
| | - Antonino De Lorenzo
- Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | | | | | | | - Claudio Maffeis
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alexis Malavazos
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giuseppe Malfi
- Department of Dietetics and Clinical Nutrition, San Giovanni Battista Hospital, Turin, Italy
| | - Enrica Riva
- Italian Society of Paediatric Nutrition, Milan, Italy
| | - Chiara Ruocco
- Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Milan, Italy
| | - Ferruccio Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Marco Silano
- Unità Operativa Alimentazione, Nutrizione e Salute, Dipartimento Sicurezza Alimentare, Nutrizione e Sanità Pubblica Veterinaria, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Valerio
- Department of Molecular and Translational Medicine, Brescia University, Brescia, Italy
| | - Andrea Vania
- Department of Paediatrics and Paediatric Neuropsychiatry, La Sapienza" University of Rome, Rome, Italy
| | - Enzo Nisoli
- Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Milan, Italy.
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Children's School-Day Nutrient Intake in Ontario: A Cross-Sectional Observational Study Comparing Students' Packed Lunches from Two School Schedules. Nutrients 2022; 14:nu14091966. [PMID: 35565933 PMCID: PMC9104756 DOI: 10.3390/nu14091966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
This study compared the caloric and nutrient values of packed lunch contents and consumption in the Balanced School Day (BSD) (two 20 min eating periods) versus the Traditional Schedule (TS) (one 20 min lunch). Foods consumed during school were assessed by direct food observation in 321 grade 3 and 4 students, aged 7−10 years, at 9 BSD and 10 TS elementary schools in Ontario. Packed lunch contents in the BSD were significantly higher than the TS in energy (3128.14 ± 1100.36 vs. 2658.98 ± 951.34 kJ, p < 0.001, respectively). Similarly, carbohydrates, total sugar, protein, fat, saturated fatty acids (SFA), calcium, iron, and sodium were significantly higher in the BSD versus TS packed lunches. Correspondingly, students in the BSD consumed significantly more energy, carbohydrates, total sugar, and SFA compared to the TS. Overall, lunches brought by students in the BSD schedule provided more energy across all macronutrients, with only a few micronutrients showing increased amounts, suggesting two 20 min eating opportunities could contribute to excess caloric intake during school, potentially contributing to the prevalence of childhood overweight and obesity in Canada. Furthermore, packed lunches in both schedules had excess amounts of nutrients of concern and much work is needed to ensure that children in Canada receive nutritious lunches at school.
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Rico-Sapena N, Galiana-Sánchez ME, Moncho J. Validation of a Questionnaire of Food Education Content on School Catering Websites in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3685. [PMID: 35329372 PMCID: PMC8954418 DOI: 10.3390/ijerph19063685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to design and validate a questionnaire on quality and food education on catering company websites. For the validation of the questionnaire, its reliability, feasibility and content validity characteristics were determined. For content validity, a panel of experts was used and the overall and item-wise Content Validity Index (CVI) of the experts' responses was calculated. Reliability was determined by the inter-judge agreement method with the analysis of 30 websites using the intraclass correlation coefficient (ICC) and the Bland and Altman plot. Adequate content validity was verified by obtaining a very high CVI (above 0.80) in the analysis of the expert panel's responses and excellent inter-observer agreement with a very high global ICC (above 0.90) value in the determination of test-retest reliability. The questionnaire is a valid instrument for the evaluation of the quality of school catering websites and their content in food education, as it has good feasibility, high content validity and excellent reliability.
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Affiliation(s)
- Nuria Rico-Sapena
- Unidad Técnica Agroalimentaria, Departamento Servicio Territorial de Agricultura de Alicante, Dirección Territorial de Alicante—Consejería de Agricultura, Desarrollo Rural, Emergencia Climática y Transición Ecológica, 03690 Alicante, Spain;
| | - María Eugenia Galiana-Sánchez
- Balmis Research Group in History of Science, Health Care and Food, NISALdes, University of Alicante, 03009 Alicante, Spain
| | - Joaquín Moncho
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain;
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Impacts of School Nutrition Interventions on the Nutritional Status of School-Aged Children in Asia: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14030589. [PMID: 35276948 PMCID: PMC8839996 DOI: 10.3390/nu14030589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 01/22/2023] Open
Abstract
This review aims to describe school nutrition interventions implemented in Asia and quantify their effects on school-aged children’s nutritional status. We searched Web of Science, Embase, Ovid MEDLINE, Global Health, Econlit, APA PsycInfo, and Social Policy and Practice for English articles published from January 2000 to January 2021. We quantified the pooled effects of the interventions on the changes in body mass index (BMI) and body mass index z score (BAZ), overall and by type of intervention. In total, 28 articles were included for this review, of which 20 articles were multi-component interventions. Twenty-seven articles were childhood obesity studies and were included for meta-analysis. Overall, school nutrition interventions reduced school-aged children’s BMI and BAZ. Multi-component interventions reduced the children’s BMI and BAZ, whereas physical activity interventions reduced only BMI and nutrition education did not change BMI or BAZ. Overweight/obesity reduction interventions provided a larger effect than prevention interventions. Parental involvement and a healthy food provision did not strengthen school nutrition interventions, which may be due to an inadequate degree of implementation. These results suggested that school nutrition interventions should employ a holistic multi-component approach and ensure adequate stakeholder engagement as well as implementation to maximise the effects.
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31
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Øvrebø B, Stea TH, Bergh IH, Bere E, Surén P, Magnus P, Juliusson PB, Wills AK. A nationwide school fruit and vegetable policy and childhood and adolescent overweight: A quasi-natural experimental study. PLoS Med 2022; 19:e1003881. [PMID: 35041660 PMCID: PMC8765663 DOI: 10.1371/journal.pmed.1003881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND School free fruit and vegetable (FFV) policies are used to promote healthy dietary habits and tackle obesity; however, our understanding of their effects on weight outcomes is limited. We assess the effect of a nationwide FFV policy on childhood and adolescent weight status and explore heterogeneity by sex and socioeconomic position. METHODS AND FINDINGS This study used a quasi-natural experimental design. Between 2007 and 2014, Norwegian combined schools (grades 1-10, age 6 to 16 years) were obligated to provide FFVs while elementary schools (grades 1-7) were not. We used 4 nationwide studies (n = 11,215 children) from the Norwegian Growth Cohort with longitudinal or cross-sectional anthropometric data up to age 8.5 and 13 years to capture variation in FFV exposure. Outcomes were body mass index standard deviation score (BMISDS), overweight and obesity (OW/OB), waist circumference (WC), and weight to height ratio (WtHR) at age 8.5 years, and BMISDS and OW/OB at age 13 years. Analyses included longitudinal models of the pre- and post-exposure trajectories to estimate the policy effect. The participation rate in each cohort was >80%, and in most analyses <4% were excluded due to missing data. Estimates were adjusted for region, population density, and parental education. In pooled models additionally adjusted for pre-exposure BMISDS, there was little evidence of any benefit or unintended consequence from 1-2.5 years of exposure to the FFV policy on BMISDS, OW/OB, WC, or WtHR in either sex. For example, boys exposed to the FFV policy had a 0.05 higher BMISDS (95% CI: -0.04, 0.14), a 1.20-fold higher odds of OW/OB (95% CI: 0.86, 1.66) and a 0.3 cm bigger WC (95% CI: -0.3, 0.8); while exposed girls had a 0.04 higher BMISDS (95% CI: -0.04, 0.13), a 1.03 fold higher odds of OW/OB (95% CI: 0.75, 1.39), and a 0-cm difference in WC (95% CI: -0.6, 0.6). There was evidence of heterogeneity in the policy effect estimates at 8.5 years across cohorts and socioeconomic position; however, these results were inconsistent with other comparisons. Analysis at age 13 years, after 4 years of policy exposure, also showed little evidence of an effect on BMISDS or OW/OB. The main limitations of this study are the potential for residual confounding and exposure misclassification, despite efforts to minimize their impact on conclusions. CONCLUSIONS In this study we observed little evidence that the Norwegian nationwide FFV policy had any notable beneficial effect or unintended consequence on weight status among Norwegian children and adolescents.
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Affiliation(s)
- Bente Øvrebø
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Tonje H. Stea
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
- Department of Child and Adolescence Mental Health, Sørlandet Hospital, Kristiansand, Norway
| | - Ingunn H. Bergh
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
| | - Elling Bere
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Surén
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Petur B. Juliusson
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Andrew K. Wills
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
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Verga SMP, Mazza VDA, Teodoro FC, Girardon-Perlini NMO, Marcon SS, Rodrigues ÉTDAF, Ruthes VBTNM. The family system seeking to transform its eating behavior in the face of childhood obesity. Rev Bras Enferm 2022; 75:e20210616. [DOI: 10.1590/0034-7167-2021-0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/11/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: to understand families’ behaviors and eating practices in the face of childhood obesity. Methods: a qualitative study, which used the Grounded Theory as a methodological framework and the Complexity Theory as a theoretical framework. Twenty-six informants participated in the study, who were part of two sample groups. Data were collected through intensive interviews, using a semi-structured script. Results: “The family system seeking to change eating behavior patterns in the face of childhood obesity” emerged as a central concept, relating three conceptual categories: “Recognizing its behavior patterns and eating practices”; “Reorganizing in the face of childhood obesity”; “Responding to change”. Final Considerations: the family influences children’s eating behavior and contributes to changes that occur in it, which highlights the relevance of the family approach in childhood obesity care, raising reflection on the current nursing practice together with families who experience the same problem.
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Nury E, Stadelmaier J, Morze J, Nagavci B, Grummich K, Schwarzer G, Hoffmann G, Angele CM, Steinacker JM, Wendt J, Conrad J, Schmid D, Meerpohl JJ, Schwingshackl L. Effects of nutritional intervention strategies in the primary prevention of overweight and obesity in school settings: systematic review and network meta-analysis. BMJ MEDICINE 2022; 1:e000346. [PMID: 36936562 PMCID: PMC9951385 DOI: 10.1136/bmjmed-2022-000346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/04/2022] [Indexed: 12/25/2022]
Abstract
Objective To examine the effects of different nutritional intervention strategies in the school setting on anthropometric and quality of diet outcomes by comparing and ranking outcomes in a network meta-analysis. Design Systematic review and network meta-analysis. Data sources PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Education Resources Information Centre (ERIC), PsycInfo, CAB Abstracts, Campbell Library, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) BiblioMap, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice (JBI EBP) database, Practice-based Evidence in Nutrition (PEN) database, ClinicalTrials.gov, Current Controlled Trials, and World Health Organization International Clinical Trials Registry Platform. Eligibility criteria for selecting studies A systematic literature search was performed from inception to 2 May 2022. Cluster randomised controlled trials meeting these study criteria were included: generally healthy school students aged 4-18 years; intervention with ≥1 nutritional components in a school setting; and studies that assessed anthropometric measures (eg, body mass index, body fat) or measures related to the quality of diet (eg, intake of fruit and vegetables), or both. Random effects pairwise meta-analyses and network meta-analyses were performed with a frequentist approach. P scores, a frequentist analogue to surface under the cumulative ranking curve, ranging from 0 to 1 (indicating worst and best ranked interventions, respectively) were calculated. Risk of bias was assessed with Cochrane's RoB 2 tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to rate the certainty of evidence. Results 51 cluster randomised controlled trials involving 75 954 participants and seven intervention nodes were included. Inconsistency could not be assessed (except for intake of fruit and vegetables) because the network meta-analyses were based mainly on star shaped networks with no direct evidence for specific pairs of nutritional interventions. Overall, little or no evidence was found to support a difference in body mass index, body weight, body fat, or waist circumference and moderate improvements in intake of fruit and vegetables with nutritional interventions in a school setting. Low to moderate certainty of evidence further suggested that multicomponent nutritional interventions likely reduced the prevalence (odds ratio 0.66, 95% confidence interval 0.55 to 0.80) and incidence (0.67, 0.47 to 0.96) of overweight compared with a control group. Based on low certainty of evidence, nutrition education and multicomponent interventions may be more effective than a control group (ie, usual practice) for increasing intake of fruit and vegetables. Multicomponent nutritional interventions were ranked the most effective for reducing body mass index (P score 0.76) and intake of fat (0.82). Nutrition education was ranked as best for body mass index z score (0.99), intake of fruit and vegetables (0.82), intake of fruit (0.92), and intake of vegetables (0.88). Conclusions The findings suggest that nutritional interventions in school settings may improve anthropometric and quality of diet measures, potentially contributing to the prevention of overweight and obesity in childhood and adolescence. The findings should be interpreted with caution because the certainty of evidence was often rated as low. The results of the network meta-analysis could be used by policy makers in developing and implementing effective, evidence based nutritional intervention strategies in the school setting. Systematic review registration PROSPERO CRD42020220451.
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Affiliation(s)
- Edris Nury
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakub Morze
- Department of Cardiology and Internal Diseases, University of Warmia and Mazury, Olsztyn, Poland
- Department of Human Nutrition, University of Warmia and Mazury, Olsztyn, Poland
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Hoffmann
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Claudia M Angele
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Centre for Teacher Education, University of Vienna, Vienna, Austria
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Johanna Conrad
- Science Department, German Nutrition Society, Bonn, Germany
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews. Nutrients 2021; 13:nu13114113. [PMID: 34836368 PMCID: PMC8618558 DOI: 10.3390/nu13114113] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Schools are identified as a key setting to influence children’s and adolescents’ healthy eating. This umbrella review synthesised evidence from systematic reviews of school-based nutrition interventions designed to improve dietary intake outcomes in children aged 6 to 18 years. We undertook a systematic search of six electronic databases and grey literature to identify relevant reviews of randomized controlled trials. The review findings were categorised for synthesis by intervention type according to the World Health Organisation Health Promoting Schools (HPS) framework domains: nutrition education; food environment; all three HPS framework domains; or other (not aligned to HPS framework domain). Thirteen systematic reviews were included. Overall, the findings suggest that school-based nutrition interventions, including nutrition education, food environment, those based on all three domains of the HPS framework, and eHealth interventions, can have a positive effect on some dietary outcomes, including fruit, fruit and vegetables combined, and fat intake. These results should be interpreted with caution, however, as the quality of the reviews was poor. Though these results support continued public health investment in school-based nutrition interventions to improve child dietary intake, the limitations of this umbrella review also highlight the need for a comprehensive and high quality systematic review of primary studies.
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Abstract
AbstractFood systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.
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Assessment of Food Quality in School Canteens: A Comparative Quantitative Study between Primary and Secondary Schools in Malaysia. Nutrients 2021; 13:nu13093009. [PMID: 34578887 PMCID: PMC8471405 DOI: 10.3390/nu13093009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/11/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
Schools are an important food environment to cultivate and promote healthy food choices and practices among children and adolescents. The aim of the present study was to assess the type and quality of food and beverages sold in school canteens in public primary and secondary schools in Kelantan, Malaysia. Eligible schools were randomly selected from the list of all schools and detailed information of all food and beverage items sold in the school canteens were collected during school days. Food and beverages were classified based on food groups derived from the Malaysian Food Dietary Guideline and the Recommended Foods for Healthy Cafeteria Guideline. An assessment of the traffic-light nutrition food-labelling system of the total sugar content in all pre-packaged foods was also undertaken. A total of 568 food items were identified, with secondary school canteens selling a greater proportion of food items than the primary schools (55.5% vs. 44.5%). In terms of the main food groups, grains and cereal products represented the largest food group served (33–36%), followed by beverages (21–25%) and confectionary and sweet foods (12–13%). In contrast, the vegetable and fruit group represented the smallest proportion of food items sold (1–3%). Comparisons between primary and secondary schools showed a similar trend and pattern of food types and quality of foods sold, except for animal-based foods. A greater percentage of food items in this category was found among secondary schools (12.1%) versus primary schools (6.7%). When total sugar content of all pre-packaged foods was quantified based on the traffic-light nutrition-labelling system, almost one-third of foods and beverages were classified as high (29.1%). Confectionary (19.1%) and flavoured milk and fruit drinks (10.0%) both exceeded the recommended sugar levels of >22.5 g per 100 g and >11.25 mL per 100 m L, respectively. Only one of these packaged foods and beverages (0.9%) was classified as a healthy food choice. About a quarter of the food items available in school canteens were classified as prohibited based on a new revised list of prohibited food and beverage items. These findings indicate that, despite the Guidelines, a large number of unhealthy food items are being sold in school canteens. Hence, interventions such as sustainable healthy school canteen menus should be implemented to promote healthy food choices amongst school-aged children.
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Wang Y, Zhao L, Gao L, Pan A, Xue H. Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol 2021; 9:446-461. [PMID: 34097869 DOI: 10.1016/s2213-8587(21)00118-2] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022]
Abstract
China has experienced many drastic social and economic changes and shifts in people's lifestyles since the 1990s, in parallel with the fast rising prevalence of obesity. About half of adults and a fifth of children have overweight or obesity according to the Chinese criteria, making China the country with the highest number of people with overweight or obesity in the world. Assuming that observed time trends would continue in the future, we projected the prevalence of and the number of people affected by overweight and obesity by 2030, and the associated medical costs. The rising incidence of obesity and number of people affected, as well as the related health and economic consequences, place a huge burden on China's health-care system. China has made many efforts to tackle obesity, including the implementation of relevant national policies and programmes. However, these measures are inadequate for controlling the obesity epidemic. In the past decade, China has attached great importance to public health, and the Healthy China 2030 national strategy initiated in 2016 provides a historical opportunity to establish comprehensive national strategies for tackling obesity. China is well positioned to explore an effective model to overcome the obesity epidemic; however, strong commitment and leadership from central and local governments are needed, as well as active participation of all related society sectors and individual citizens. TRANSLATION: For the Chinese translation of the paper see Supplementary Materials section.
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Affiliation(s)
- Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China.
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Liwang Gao
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA
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