The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable

Concepts of healthy and environmentally sustainable diets clash with a life in transition - Findings from a qualitative study in urban Burkina Faso

BACKGROUND

Sub-Saharan African countries like Burkina Faso face a dietary transition and are experiencing a shift in disease burden.

OBJECTIVE

We explored perceptions of healthy and environmentally sustainable dietary habits in urban Burkina Faso in order to tailor nutritional interventions to the local population and ultimately improve public and planetary health.

METHODS

We conducted an exploratory qualitative study with semi-structured face-to-face interviews in three informal and two formal neighborhoods of Ouagadougou. The sample comprised 36 adult participants. The interviews were conducted in Mooré and French, audio-recorded, and transcribed verbatim. Data were analysed inductively, using thematic analysis.

RESULTS

Participants described their ideal healthy and environmentally sustainable diet as traditional, local, natural, pure, organic, and transparent in terms of food production, processing, and preparation. Perceived barriers to achieve such diets were: limited financial resources, reduced availability of products and limited time for food preparation. Furthermore, participants highlighted discordant food preferences in the family, and a lack of understanding around the interconnection between nutrition, health and the environment as barriers. Most of these barriers were aggravated by the experience of a life in transition due to modernizing lifestyles, globalizing food systems, and a changing environment.

CONCLUSIONS

Participants' ideal of a healthy and environmentally sustainable diet clashed with a life in transition. To improve public and planetary health, interventions should aim to empower individuals, alleviate financial constraints, and shape global and local food environments.

Global food retail environments are increasingly dominated by large chains and linked to the rising prevalence of obesity

Retail food environments influence food purchasing and dietary patterns. A global analysis of the food retail landscape allowing comparisons across geographical regions is therefore needed to tackle diet-related non-communicable diseases. Here we examine trends in retail food environments from 2009 to 2023 across 97 countries, exploring associations with changes in obesity prevalence. Increases were observed in the density of chain outlets, grocery sales from chain retailers, unhealthy food sales per capita and digital grocery sales; non-chain outlet density and the ratio of non-chain to chain outlets declined over time. South Asia and low- and middle-income countries overall experienced the most rapid transformation. Changes in retail environments and the prevalence of obesity were found to be positively correlated. As retail environments become increasingly digital and dominated by large chains, important implications for diets and health should be expected, particularly in lower-income countries.

Beneath the Surface: The Emerging Role of Ultra-Processed Foods in Obesity-Related Cancer

PURPOSEOF REVIEW

Ultra-processed foods (UPFs) are becoming more and more important in daily diets around the world; in some cases, they can account for as much as 60% of daily energy intake. Epidemiological evidence suggests that this shift toward high levels of food processing may be partially responsible for the global obesity epidemic and the rise in the prevalence of chronic diseases.

RECENT FINDINGS

Few prospective studies have examined the relationship between UPF consumption and cancer outcomes. According to currently available information, UPFs may increase the risk of cancer due to their obesogenic properties and exposure to substances that can cause cancer, such as certain food additives and pollution from product processing. The complex relationship between obesity and cancer involves factors such as immune dysregulation, altered adipokine and sex hormone levels, abnormal fatty acid metabolism, extracellular matrix remodeling, and chronic inflammation. Addressing cancer risk associated with UPF consumption could involve a multifaceted approach, including consumer behavior modification programs and robust public health regulations aimed at enhancing food environments. Improved knowledge of the potential dual negative impacts of UPFs on the environment and cancer risk is one of the priority areas we identify for future research and policy implications. Various approaches could be used to prevent cancers associated with UPF consumption, such as consumer behavior change programs and stricter public health regulations needed to improve the food environment. This review examines for the first time the potential role of UPFs in cancer risk associated with obesity, exploring underlying biological mechanisms and identifying key areas for future research and policy action, including the dual environmental and health impact of UPFs.

Ultra-Processed Foods and Type 2 Diabetes Mellitus: What Is the Evidence So Far?

Ultra-processed foods (UPFs) are foods that have undergone extensive industrial processing with the addition of various substances in order to make them more tasty, eye-catching, and easy to consume. UPFs are usually rich in sugars, salt, and saturated fat, whereas they lack essential nutrients. The aim of this review is to elaborate upon the current evidence associating overconsumption of UPFs with the development of type 2 diabetes mellitus (T2DM). We will discuss data interconnecting UPFs and T2DM risk and will further describe specific ingredients that have been suggested to increase this risk. In addition, we will thoroughly explain how additives, such as emulsifiers or sweeteners, or other compounds formed during manufacturing, such as acrylamide and acrolein, and during packaging, such as bisphenol-A, are proposed to be implicated in the pathogenesis of insulin resistance and T2DM.

Exploring socio-demographic determinants of obesity in Jordanian women of reproductive age: insights from a nationwide survey

BACKGROUND

In Jordan, obesity has emerged as a significant public health concern, particularly among females, with a prevalence of 43.1%. This rising trend, exacerbates the burden of non-communicable diseases and places increasing strain on the healthcare system.

AIM

We aimed to explore the predictors associated with obesity among adult ever-married Jordanian women aged 20-49 years based on the Jordanian Population and Family Health Survey (JPFHS).

METHOD

Our study analyzed data from the JPFHS conducted in 2017-18, which initially included 14,689 ever-married women. We performed multivariable analyses to determine the socio-demographic predictors of obesity among these women.

RESULT

We included 4,339 Jordanian women in our study, of whom 2,189 were classified as obese and 2,150 had a normal body mass index (BMI). Multivariable analysis indicated that increasing age and living in Tafilahwere significantly associated with higher odds of developing obesity (p < 0.05). Conversely, factors such as being in the wealthiest category, residing in Ma'an and Aqaba, and smoking every day were significantly linked to reduced odds of obesity (p < 0.05). Additionally, no significant associations were found between obesity development and variables such as the type of place of residence, educational level, frequency of reading newspapers or magazines, radio listening, television watching, or internet use in the past month (p > 0.05).

CONCLUSION

Appropriate and targeted interventions should be developed for Jordanian women to address obesity and its related health issues. Policymakers should adopt a multilevel approach that focuses on high-risk subgroups, including older women, and those living in Tafilh. Efforts should be made to raise awareness and provide preventative measures tailored to these groups to effectively reduce obesity and its associated complications.

Comparison of Complications and Mortality in Patients Undergoing Laparoscopic Sleeve Gastrectomy With and Without Omentopexy

BACKGROUND

Among bariatric surgeries, laparoscopic sleeve gastrostomy (LSG) has gained good global acceptance, but this surgery, like any other invasive procedure, has side effects. Various techniques have been tested to reduce these complications, which are used under the title of stapler line reinforcement (SLR). The purpose of this research is to compare the bleeding, leakage, mortality, food intolerance, re-hospitalization, and post-operative invasive therapeutic interventions in LSG surgery in two groups with and without omentopexy method.

METHODS

In this retrospective cohort study, the patients who underwent LSG were included in the study and were compared in two groups with omentopexy and without omentopexy in terms of complications. The patients were followed up during the first year after the operation, and the patients were examined in terms of complications, including bleeding, leakage, mortality, food intolerance, re-hospitalization, and post-operative invasive therapeutic interventions.

RESULTS

In terms of bleeding (p = 0.263) and the frequency of leak cases (p = 0.286), no significant difference was observed between the two groups, but the treatment measures performed to control the leak had a significant difference between the two groups (p = 0.013). The need for re-admission was significantly higher (p = 0.017) in the group without omentopexy, and the need for re-surgery was also significantly different (p = 0.001) between the two groups. The frequency of food intolerance was significantly higher (p = 0.001) in the group without omentopexy, and the frequency of mortality was no statistically significant difference with the group with omentopexy (p = 0.304).

CONCLUSIONS

The results of this study showed that the need for more aggressive interventions (laparotomy) to control bleeding and leak is less in the group with omentopexy, also the chance of re-hospitalization and re-surgery after omentopexy is reduced, and food intolerance disorder is less in this group. Therefore, the findings of this study show that LSG with omentopexy has fewer side effects than without omentopexy.

Ultra-Processed Food Consumption and Obesity: A Narrative Review of Their Association and Potential Mechanisms

Obesity is a major global health concern, with diet playing a crucial role in its development and treatment. Ultra-processed foods (UPFs) have become prevalent in diets due to changes in the food environment. These foods are energy-dense; high in fat, sugars, or salt; and low in fiber, protein, vitamins, and minerals, raising concerns about their effects on health. In addition to traditional research focused on nutrients, food, and dietary quality, growing evidence has linked UPF consumption to obesity. Therefore, this study provides a comprehensive review of the levels and trends of UPF consumption, current epidemiological evidence on the association between UPF consumption and obesity, and UPFs' potential role in the etiology of obesity and weight gain. Additionally, this study reviews strategies for reducing UPF consumption and outlines future studies of the link between UPF consumption and obesity.

An assessment of compliance with proposed regulations to restrict on-package marketing of packaged foods to improve nutrition in South Africa

BACKGROUND

Ultra-processed products (UPPs), high in sugar, fat and sodium, contribute to increasing burdens of obesity and non-communicable diseases in South Africa (SA). Increased consumption and acceptability of UPPs is driven, in part by aggressive marketing. Front of package labelling laws, particularly warning labels (WLs) coupled with marketing restrictions, have been recommended to improve consumer awareness of unhealthy products, incentivise reformulation and underpin other interventions. The SA government published a draft regulation to introduce WLs and restrict marketing, called R3337. This study aims to analyse on-package marketing and create a baseline to evaluate compliance with the proposed R3337.

METHODS

This study is an analysis of a dataset of 6768 packaged food products, collected as pictures of products in four major grocery stores in Cape Town, SA between March and July 2019. A codebook was developed based on R337. The codebook was used to identify and assess child-directed marketing (CDM) and health claims on products potentially subject to front-of-package WLs. Food packages and their nutritional information were coded and analyzed to determine whether the product would be required to carry a WL and whether the package included regulated marketing.

RESULTS

The majority (80.16%) of products analyzed would require WLs under R3337 due to high levels of sugar, sodium, or saturated fat. CDM was prevalent, with 59.26% of products displaying some form of marketing, primarily animated characters and depictions of children. Health claims were also common, with 83% occurring on WL products.

DISCUSSION

Using a WL system in SA could effectively target common forms of on-package marketing of unhealthy products, given the high prevalence of CDM and health claims on products likely to carry WLs. Such interventions may contribute to improving diets and reducing UPP consumption. Some forms of CDM are not regulated under R3337 and we recommend expanding the regulation to include these. This study provides a baseline which should be used for future research to evaluate R3337 when it is implemented.

Dietary Habits and Nutritional Status of Youths Living in Rural and Semi-Urban Albania in the Ongoing Nutrition Transition: Preliminary Results

BACKGROUND

Albania is undergoing a demographic, epidemiological, and nutrition transition leading to an increased prevalence of overweight and obesity among new generations. Comprehensive studies on the nutritional status and dietary patterns of youths in the country are still lacking.

METHODS

A cross-sectional study was conducted on a convenience sample of students (10-18 years) attending secondary schools in rural and semi-urban areas (October-November 2024). Information collected included socio-demographic data, anthropometric measurements (weight, height), and adherence to the Mediterranean Diet (MD) (KIDMED). Factors influencing dietary patterns were investigated, with a multivariate logistic regression performed to identify key drivers for poor MD adherence (AOR 95% CI).

RESULTS

In total, 426 children (47.2% females) were interviewed. Over 20% of the sample was overweight or obese, with the prevalence of these diseases decreasing with age regardless of gender. The KIDMED score highlighted suboptimal MD adherence (4.6 ± 2.5 SD), with significant differences between females and males (4.1 ± 2.4 SD vs. 5.1 ± 2.4 SD, p < 0.001), especially in rural areas (3.9 ± 2.4 SD vs. 4.9 ± 2.5 SD, p = 0.003). Dietary quality tended to decline with age. Female gender was the strongest predictor of poor MD adherence (AOR 2.08 CI: 1.34-3.22; p = 0.001).

CONCLUSIONS

The MD is a cornerstone for ensuring the Albanian population's long-term health and well-being. This study holds significant public health relevance in a country with high mortality rates due to cardiovascular diseases. Future nutrition interventions focused on the poor MD adherence of new generations should take into consideration geographic, cultural, and social dimensions, including gender equality.

Prevalence and Sociodemographic Factors Associated with Overweight and Obesity Among Adults in Colombia: A Pooled Analysis

Given the increased prevalence of overweight and obesity in adults in Colombia, estimating the effect of sociodemographic factors on overweight and obesity is crucial for creating and implementing public health policies. A pooled analysis was performed using a multinomial logistic regression model through Colombian Nutritional Situation Surveys held in 2010 and 2015. The study included Colombian adults between 18 and 64 years old (n = 162,119). Overall, the prevalence of obesity increased from 16.47 percent in 2010 to 18.67 percent in 2015, being higher in women than in men in both surveys. Multinomial logistic regression analysis revealed that the most critical factor of being overweight and obese were older age, having a higher level of education, being engaged in household activities, and living in regions other than the country's capital. Additionally, for obesity, belonging to the Afro Colombian racial-ethnic group and being a woman were associated with an increased probability. In conclusion, these results provide more information on the sociodemographic factors related to overweight and obesity, which will help focus public health policies on higher-risk populations, such as racial-ethnic communities.

Cross-Sectional Study on the Influence of Religion on the Consumption of Ultra-Processed Food in Spanish Schoolchildren in North Africa

(1) Background: The consumption of ultra-processed foods (UPFs) constitutes a public health problem given their high availability and easy accessibility among children and young people and their influence on the development of non-communicable diseases in the long term. In this context, culture and religion may be modulating factors for the consumption of processed food. The aim of this study is to assess the consumption of UPFs in Spanish schoolchildren living in Melilla (North Africa), together with the possible impact of religion on this. (2) Methods: A cross-sectional study of 590 Christian and Muslim schoolchildren aged 15-17 years was conducted. The NOVA food classification was used to identify UPFs. Associations between religion and daily consumption were identified using risk analysis (Odds Ratio). (3) Results: Muslim schoolchildren had a higher consumption of industrial juices [OR = 2.700, 95%CI = 1.830-4.037], milkshakes [OR = 2.925, 95% = 1.850-4.748], industrial pastries [OR = 2.217, 95% = 1.440-3.510], sweets [OR = 2.197, 95%CI = 1.437-3.541], chocolates [OR = 2.272, 95%CI = 1.482-3.606] and savory snacks [OR = 3.431, 95%CI = 1.844-6.579] compared to that observed among Christians. (4) Conclusions: Both Muslim and Christian schoolchildren had a high consumption of UPFs. Regarding the potential impact of religion on the consumption of UPF, we observed that Muslim schoolchildren consumed three to four times more UPF than Christian schoolchildren. These results show a shift away from a healthy eating pattern, especially among Muslim schoolchildren. Thus, it is necessary to implement nutritional education strategies in order to understand and control the consumption of UPF in adolescents, thereby reducing the occurrence of non-communicable diseases in the long term.

The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002-2022)

Background and aim

This study aims to investigate the role of the built environment in terms of urban-rural disparities in cardiovascular disease (CVD) epidemiology, focusing on middle- and long-term CVD risk assessment. Moreover, this study seeks to explore sex-specific differences in urban and rural settings.

Methods

The ATTICA Study is a prospective study conducted from 2002 onwards. At baseline, a random sample of 3,042 CVD-free adults (49.8% men) were randomly drawn from the population of the Attica region, in Greece, with 78% dwelling in urban and 22% in rural municipalities. Follow-up examinations were performed in 2006, 2012, and 2022. Of the total participants, 1,988 had complete data for CVD assessment in the 20-year follow-up.

Results

The 10-year and 20-year CVD incidence was 11.8%, 28.0% in rural municipalities and 16.8%, 38.7% in urban municipalities, respectively (ps < 0.05). Unadjusted data analyses revealed significant differences in clinical, laboratory, and lifestyle-related CVD risk factors between urban and rural residents (ps < 0.05). Additionally, sex-based discrepancies in clinical, anthropometric, circulating, and lifestyle risk factors were observed in stratified analyses of urban and rural settings. Multivariate analyses, including generalized structural equation modeling (GSEM), revealed that the impact of the urban built environment on the long-term (20-year) CVD risk is mediated by lifestyle-related risk factors.

Conclusion

Urban inhabitants exhibit a higher long-term CVD incidence compared to their rural counterparts, which was partially explained by their lifestyle behaviors. Targeted strategic city planning efforts promoting healthier lifestyle-related behaviors at the micro-environment level could potentially mitigate built-environment impacts on CVD health.

Breastfeeding Practices and Food Consumption of Socially Vulnerable Children

Promoting child well-being and development requires a multidimensional approach, including the right to adequate food practices. Socially vulnerable children are more exposed to adverse experiences, such as inadequate food consumption due to poverty. In this context, home-visiting programs are an important strategy for nutritional and health care education to provide relevant guidelines. This study describes breastfeeding and food consumption of children aged 0 to 24 months assisted by the Happy Child Program (Programa Criança Feliz-PCF) and aimed to investigate their association with socioeconomic factors and adherence to the program. This is an observational study, with a cross-sectional design, carried out with children assisted by the PCF in the Federal District, Brazil. Multivariate analysis was performed to identify sociodemographic and income factors, and household visits characteristics associated with breastfeeding, dietary diversity, and the consumption of ultra-processed food. A total of 301 children were assessed, 51.16% of whom were female. In 58.99% of households, the reference person was the mother; 86.20% were unemployed, and 27.08% had a low education degree. About 62.65% of beneficiaries lived on up to USD 200.00 per month and the majority faced food insecurity. The child's age, and the mother's current work situation were independently associated with the current breastfeeding situation, especially higher among women who did not work (p = 0.015). The minimum dietary diversity among children over 6 months old was 62.21% and presented a positive association with adherence to the program (p = 0.005). On the other hand, the consumption of ultra-processed foods was 77.21% and was associated with a longer follow-up time within the program (p = 0.047). The associations observed revealed the need to integrate family food choices and nutritional education into public policies for early childhood.

Consumption frequency of ultra-processed foods and beverages among 6- to 36-month-olds in Kampala, Uganda

The nutrition transition in sub-Saharan Africa has led to increased consumption of ultra-processed foods in infancy, especially sweet foods. This has heightened the risk for nutrition-related non-communicable diseases, including dental caries and overweight/obesity, and promotes poor food choices later in life. The present study used a cross-sectional design to investigate the consumption frequency of ultra-processed foods and beverages among urban 6- to 36-month-olds attending four selected health facilities in Kampala using a standardised questionnaire and 24-h diet recall record. The primary outcome was the consumption of at least one ultra-processed food or beverage (UPFB) the previous day, and frequency of UPFB consumption of the week before was the secondary outcome. Four hundred and ten caregiver-child pairs were randomly recruited, 94% of caregivers being mothers with a mean age of 30.7 (±5.3) years. Fifty-nine per cent of mothers and 73% of fathers had attained a college education. The median age of children was 18 months and 51% were female. Most children (57%) consumed at least one UPFB the previous day. In the week before, 69% had consumed UPFB frequently (4-7 days) which was significantly positively associated with maternal education (odds ratio [OR] = 2.85, 95% confidence interval [CI]: 1.02-7.96, p = 0.045) and child's age ([OR = 2.87, 95% CI: 1.62-5.08, p < 0.001], [OR = 3.68, 95% CI: 1.88-7.20, p < 0.001]). In conclusion, the dietary habits of the surveyed Ugandan population were unhealthy, characterised by the frequent consumption of UPFB with added sugar. There is an urgent need to re-enforce existing Ugandan food regulation guidelines and policies and to build strong nutritional education programmes to enhance health-promoting environments in early childhood.

Luteolin alleviates muscle atrophy, mitochondrial dysfunction and abnormal FNDC5 expression in high fat diet-induced obese rats and palmitic acid-treated C2C12 myotubes

Obesity is associated with a series of skeletal muscle impairments and dysfunctions, which are characterized by metabolic disturbances and muscle atrophy. Luteolin is a phenolic phytochemical with broad pharmacological activities. The present study aimed to evaluate the protective effects of Luteolin on muscle function and explore the potential mechanisms in high-fat diet (HFD)-induced obese rats and palmitic acid (PA)-treated C2C12 myotubes. Male Sprague-Dawley (SD) rats were fed with a control diet or HFD and orally administrated 0.5% sodium carboxymethyl cellulose (vehicle) or Luteolin (25, 50, and 100 mg/kg, respectively) for 12 weeks. The results showed that Luteolin ameliorated HFD-induced body weight gain, glucose intolerance and hyperlipidemia. Luteolin also alleviated muscle atrophy, decreased ectopic lipid deposition and prompted muscle-fiber-type conversion in the skeletal muscle. Meanwhile, we observed an evident improvement in mitochondrial quality control and respiratory capacity, accompanied by reduced oxidative stress. Mechanistic studies indicated that AMPK/SIRT1/PGC-1α signaling pathway plays a key role in the protective effects of Luteolin on skeletal muscle in the obese states, which was further verified by using specific inhibitors of AMPK and SIRT1. Moreover, the mRNA expression levels of markers in brown adipocyte formation were significantly up-regulated post Luteolin supplementation in different adipose depots. Taken together, these results revealed that Luteolin supplementation might be a promising strategy to prevent obesity-induced loss of mass and biological dysfunctions of skeletal muscle.

Non-communicable disease mortality and economic costs attributable to high body mass index in Argentina

OBJECTIVES

Non-communicable diseases (NCDs) such as cardiovascular diseases, respiratory diseases, and cancer represent a significant public health challenge in Argentina. This study aimed to estimate the burden of NCD mortality attributable to a high body mass index (BMI) in Argentina in 2018 and assess the associated economic costs.

STUDY DESIGN

Comparative risk assessment modeling study.

METHODS

Potential impact fractions and preventable deaths were calculated under three counterfactual scenarios. Theoretical Minimum Risk Exposure Level (TMREL; mean BMI of 22.0 kg/m2), 1.0 kg/m2 reduction in BMI, and returned to 2005 BMI levels. The years of life lost (YLLs) and economic costs in terms of productivity loss were also estimated.

RESULTS

In 2018, nearly two-thirds of Argentina's adult population were overweight or obese. In the TMREL scenario, 24 % of major NCD deaths and 20 % of all-cause deaths could have been prevented if the population had a mean BMI of 22 kg/m2. If a 1.0 kg/m2 reduction in BMI was achieved, 1.92 % of major NCD deaths and 3.48 % of all-cause deaths could have been avoided. Reducing the average BMI to the 2005 levels (25.8 kg/m2) could have prevented 6 % of major NCD deaths and 8.8 % of all-cause deaths. The economic costs associated with high BMI-related mortality were estimated to be 0.37 % and 0.62 % of Argentina's GDP for major NCDs and all-cause mortality, respectively.

CONCLUSION

The burden of NCD mortality and associated economic costs attributable to high BMI in Argentina are substantial, highlighting the urgent need for multi-sectoral interventions to address the increasing prevalence of overweight and obesity.

Impact of fish intake on dyslipidemia likelihood by cooking method: Results from the Hellenic National Nutrition and Health Survey

Nutritional guidelines emphasize fish consumption due to its reported health benefits, although the potential differential effects based on the cooking method used have not been well investigated. Hypothesizing that fish consumption and preparation method may affect lipid concentrations, we aimed to examine fish consumption per dietary guidelines adherence and assess the association between fish intake and dyslipidemia likelihood in Greek adults. Fish consumers were identified using 24-hour recalls and a validated Food Propensity Questionnaire from 3742 adults (aged ≥19 years, 59.3% females). Dyslipidemia likelihood was estimated using adjusted logistic regression models, for total intake, and for nonfried and fried-fish consumers. Prevalence of fish consumers was 17.9% (n = 668), and 20.8% (n = 139) reported frying it. Based on the Food Propensity Questionnaire, and in combination with the two 24-hour recalls, 67.7% of fish consumers and 66.9% of fried-fish consumers consumed it less than once per month, resulting in a median weekly intake of 23.7 (13.7, 56.7) g and 26.2 (15.0, 70.4) g, respectively. For each gram of total fish intake, the odds of dyslipidemia decreased by 3% but consuming fried fish 1 to 3 times /month compared to <1 per month, increased the odds by 3.6% (odds ratio, 3.6; 95% confidence interval, 1.19-10.70). Greek adults do not adhere to the dietary guidelines for fish consumption in terms of weekly intake and a large proportion consume it fried. Both factors may lead to a further increased likelihood of dyslipidemia and not to a protective effect. Public health educational awareness programs are required to increase the frequency of fish consumption, with emphasis given on cooking methods.

Children's exposure to unhealthy food advertising on Philippine television: content analysis of marketing strategies and temporal patterns

BACKGROUND

This study conducted an exploratory content analysis of TV food advertisements on the top three most popular channels for Filipino children aged two to 17 during school and non-school days.

METHODS

Data were collected by manually recording of aired advertisements from 16 non-school days (July to September 2020) and 16 school days (January to April 2021). Descriptive and inferential statistical analyses were used to assess children's rates of exposure to food advertisements (mean ± SD of advertisements aired per channel per hour), the healthiness of promoted foods (as permitted (healthier) or not permitted (unhealthy) according to nutrient profiling models from the World Health Organization), and persuasive techniques used in food advertisements, including promotional characters and premium offers.

RESULTS

The results show that the rates of exposure to food advertisements were higher during school days (14.6 ± 14.8) than on non-school days (11.9 ± 12.0) (p < 0.01). Both periods yield a similarly higher proportion of non-permitted food advertisements (e.g. 9.3 ± 9.7 ads/channel/hour for school days and 8.3 ± 8.5 ads/channel/hour for non-school days) than permitted ones. More non-permitted food advertisements during children's peak viewing times were observed than non-peak viewing times (e.g. 11.8 ± 10. vs. 8.3 ± 9.2 ads/channel/hour for school days). Non-permitted food advertisements employed persuasive techniques more frequently, accounting for 64-91% of all food ads during peak viewing times.

CONCLUSION

Children are exposed to a large volume of television advertisements for foods that should not be permitted to be marketed to children based on authoritative nutrient criteria.

Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples

Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches (‘ultra-processed/ultraprocessed’ and ‘ultra-processing/ultraprocessing’) until 7 September 2022 retrieved 1131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Fifty-five papers were included, spanning thirty-two countries. All thirteen sociodemographic variables identified were significantly associated with UPF intake in one or more studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10–20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5·7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.

Exploring lifestyle components and associated factors in newly injured individuals with spinal cord injury

STUDY DESIGN

Cross-sectional analysis from the Inception Cohort of the Swiss Spinal Cord Injury Study (SwiSCI).

OBJECTIVES

To describe five lifestyle components in newly injured individuals with spinal cord injury (SCI), explore co-occurrence of these components, and identify associated personal and clinical factors.

SETTINGS

Initial rehabilitation stay following traumatic and non-traumatic SCI.

METHODS

Lifestyle components including overweight/obesity, low diet score, physical inactivity, smoking, and alcohol consumption were used independently and to calculate a composite lifestyle score. Analyses were conducted using descriptive statistics, co-occurrence analysis, and multivariate logistic regression.

RESULTS

We included 251 individuals, of whom 77.7% were male, 73.7% suffered from traumatic SCI, and 59.8% had paraplegia. The median age was 51 years (IQR 36-64). Approximately twelve weeks after the injury, more than two-thirds of the study population met the criteria for overweight/obesity, and consumed insufficient amounts of fruits and vegetables, and excessive amounts of meat. Alcohol was consumed by 85.3% of individuals, and 26.8% were current smokers. Almost all study participants met the physical activity guidelines (90 min of moderate to strenuous activity physical activity per week). One-quarter of study participants experienced the co-occurrence of overweight/obesity, low diet score and alcohol consumption. Female sex, younger age and higher education were associated with healthier lifestyle components.

CONCLUSION

Despite methodological limitations, this study underscores the complexities of healthy lifestyle adherence among individuals newly injured with SCI. It highlights the necessity of improving and implementing screening strategies throughout the continuum of SCI care as early as possible following the trauma.

Recognizing the ethical complexity of food policies and the role of the food industry

Restrictive food policies are often contentious and controversial. Supporters of these policies view them as imperative for achieving public health aims while some opponents view them as overly paternalistic, infringing on consumer choice and potentially inequitable. As a consequence, their ethical status and permissibility are both contested and of importance in decision-making for policy. Traditional ethical analysis of these interventions has examined the ethical implications of the policies according to a direct, linear view of the relationships between government and consumer and the impact of government policy on the consumer. However, this approach to ethical analysis fails to take into account the role of the food industry as the subjects of the policies and intermediaries between government and consumers in the implementation and effectiveness of the policies. The actions of the food industry in response to a policy substantially determine how the policy translates to changes in the food supply and thus, the effect of the policy on consumers. This has significant implications for the ethical status of the policy. As a result, this article calls for complicating the common ethical approach to restrictive food policies by adopting a framing that recognizes the role of the food industry in the implementation of these policies. We then discuss three implications this framing has for ethical analysis: first that ethical analysis must be more nuanced and recognize the potentially complex outcomes of a policy, second that it must be dynamic and ongoing and third that underlying assumptions about policies' effects on choice, effectiveness and equity need to be reconsidered.

Prevalence of Self-Reported Chronic Non-Communicable Diseases among Adults in Addis Health and Demographic Surveillance System (Addis-HDSS), Addis Ababa, Ethiopia

Background

Chronic non-communicable diseases (NCDs) are a global health challenge, causing millions of deaths annually and contributing significantly to the global disease burden. Despite their prevalence in low- and middle-income countries (LMICs), NCDs receive limited global health financing. Ethiopia, like other LMICs, is experiencing a rising burden of NCDs. This study aimed to assess the self-reported prevalence of chronic NCDs and identify associated sociodemographic factors.

Methods

A population-based cross-sectional study was conducted at the Addis Health Demographic Surveillance System (Addis-HDSS) site in Addis Ababa, Ethiopia. All adults (≥18 years) living in the Addis-HDSS sites were included. Data were collected using a structured electronic questionnaire on self-reported NCDs and sociodemographic variables. Binomial regression model was used to identify sociodemographic factors associated with self-reported NCDs.

Results

Overall, 11.5% (95% CI: 11.3%-11.7%) of adults reported at least one NCD. The most prevalent conditions were hypertension (5.9%; 95% CI: 5.7%-6.1%) and diabetes mellitus (3.4%; 95% CI: 3.3%-3.5%). Older age (Adjusted Incidence Rate Ratio (AIRR): 5.47; 95% CI: 5.17-5.79), no formal education (AIRR: 1.58; 95% CI: 1.45-1.72), being formerly married (AIRR: 2.68; 95% CI: 2.47-2.91), and higher wealth quintiles (AOR: 1.16; 95% CI: 1.07-1.26) were statistically significant risk factors associated with NCDs.

Conclusion

This study highlights the high burden of chronic NCDs among adults in Addis Ababa. The findings highlight the importance of addressing NCDs as a significant public health challenge. Expanding access to early prevention, diagnosis, and care is critical in urban settings.

Economic Disadvantage During Childhood, Obesity, and Diabetes Across Three Birth Cohorts of Older Mexicans

OBJECTIVES

Diabetes prevalence has increased markedly in Mexico. We examined the individual and joint contributions of economic disadvantage during childhood (EDDC) and elevated body weight on diabetes prevalence in 3 cohorts of Mexican adults.

METHODS

Data on those 60-69 years old from the 1930-1939, 1940-1949, and 1950-1959 birth cohorts in Waves 1 (2001), 3 (2012), and 5 (2018) of the Mexican Health and Aging Study were used. EDDC was defined as the absence of a toilet in the household before age 10. Body mass status was defined using self-reported perceived body image at age 50. Diabetes was based on respondent reports. Supplementary analyses using HbA1c as a criterion for diabetes were conducted. A regression-decomposition approach was implemented. Logistic regression models included adjustments for sociodemographic characteristics and access to medical care.

RESULTS

Diabetes prevalence was 23% overall and 11%, 25%, and 26% in the 1930-1939, 1940-1949, and 1950-1959 cohorts, respectively. EDDC declined across successive cohorts, whereas the prevalence of overweight/obesity at age 50 increased. EDDC and overweight/obesity were associated with higher odds of reporting diabetes. A scenario that eliminates disadvantaged EDDC reduced diabetes prevalence by 11% in a pooled sample, while eliminating overweight/obesity reduced it by 30%. Overweight/obesity explained 42% of the rise in diabetes prevalence between the 1930-1939 and 1950-1959 cohorts. Improvement in EDDC explained 18% of the rise in diabetes prevalence between 1930-1939 and 1950-1959 cohorts.

DISCUSSION

High body weight across Mexican birth cohorts seemed to offset the potential benefits from improvements in childhood conditions on adult diabetes risk.

Lifestyle interventions for cardiometabolic health

Unhealthy lifestyle behaviors such as poor diets and physical inactivity account for most of the cardiometabolic disease (CMD) burden, including type 2 diabetes and cardiovascular diseases. Much of this burden is mediated by the effects of unhealthy lifestyle behaviors on overweight and obesity, and disproportionally impacts certain population groups-including those from disadvantaged socioeconomic backgrounds. Combined lifestyle interventions (CLIs), which target multiple behaviors, have the potential to prevent CMD, but their implementation, reach and effectiveness in routine practice are often limited. Considering the increasing availability of effective but expensive pharmaceutical options for weight loss, we review the short-term and long-term benefits and cost-effectiveness of CLIs on overweight, obesity and associated CMDs, in controlled studies and in routine care. Against the backdrop of changing living environments, we discuss the effective components of CLIs and the many challenges associated with implementing them. Finally, we outline future directions for research and implications for policy and practice to improve lifestyle behaviors and cardiometabolic health at the population level.

Description and performance of two diet quality scores based on the Nova classification

OBJECTIVE

To describe two low-burden diet quality scores and evaluate their performance in reflecting the dietary share of the least and most processed foods defined within the Nova food system classification.

METHODS

This cross-sectional study included data from the NutriNet-Brasil cohort. Participants answered the Nova24hScreener, a 3-minute self-administered questionnaire measuring the consumption of a set of foods on the day before. Food items included in this tool belong to two main groups of the Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 items) and ultra-processed foods (UPF, 23 items). Two scores were obtained by summing the number of items checked: the Nova-WPF and the Nova-UPF. We compared the scores, respectively, with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods obtained from a full self-administered web-based 24-hour recall performed on the same day.

RESULTS

The approximate quintiles of each score had a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend < 0.001). We found a substantial agreement between the intervals of each score and the corresponding % of energy intake (Nova-WPF score: Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) 0.72, 95%CI 0.64-0.81; Nova-UPF score: PABAK 0.79, 95%CI 0.69-0.88).

CONCLUSIONS

These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can be used to evaluate and monitor diet quality.

Biocultural determinants of overweight-obesity among adult women experiencing the nutritional transition in the Democratic Republic of Congo

Introduction

The African Great Lakes region is experiencing rapid urbanization, which is leading to a nutritional transition and its related chronic diseases. Similar to other Great Lakes countries, the nutritional transition in the Democratic Republic of Congo (DRC) is reflected by increased non-communicable diseases, including morbid obesity. The 2014 Demographic Health Survey (DHS) revealed a rising incidence of overweight among women, ranging from 10% in 2001 to 16% in 2014. Furthermore, over 20% of individuals in several provinces of the DRC are classified as overweight-obese. This study aimed to investigate the prevalence as well as the main biocultural determinants of overweight-obesity among adult women in the DRC.

Methods

In a cross-sectional survey, including a representative sample of adult Congolese women living in the South Kivu province, participants were randomly recruited using a two-stage cluster sampling technique after an initial urban-rural stratification. The estimation of the was based on previous results from DHS. Thus, a total of 495 individuals were selected, including 325 urban and 170 rural subjects. Data were collected from households by dietitians who were specifically trained for this survey.

Results

In this study population, the prevalence of overweight-obesity was 33.6%, with 7.1% classified as obese. The prevalence of obesity was significantly higher among urban people, while all subjects with obesity were from the older age group (>35 years). Using binomial logistic regressions, it was observed that overweight-obesity had a significant positive correlation with the duration of urban residence, namely, Migrants' status: "New residents" 4.6 [1.9-11.7] p < 0.003, "Long term residents" 8.7 [3.5-21.5] p < 0.001; Socio-economic status (SES): "High" 2.4 [1.1-5.3] p < 0.03, and Stoutness valorization: "Yes" 6.1 [3.4-10.9] p < 0.001. In a pathway analysis conducted based on a structural equation model (SEM), we discovered that urban residence and SES were associated with an increase in overweight-obesity, with a positive correlation with processed food consumption and a negative correlation with physical activity. Age was associated with an increase in overweight-obesity through a negative association with physical activity, whereas stoutness valorization directly increased overweight-obesity.

Discussion

In order to properly guide public health policies, public authorities in the DRC should consider the main findings of this original study, which identify how socio-demographic and socio-ecological factors contribute jointly to the rising prevalence of overweight-obesity in the country.

Beyond the Scale: Exploring the Endocannabinoid System's Impact on Obesity

PURPOSE OF REVIEW

This review explores the role of the endocannabinoid system (ECS) in regulating energy balance, food intake, and metabolism, with a focus on how ECS dysregulation contributes to obesity. The goal is to provide insights into the mechanisms underlying obesity and its associated metabolic disorders.

RECENT FINDINGS

Recent research indicates that the ECS significantly influences food intake, fat storage, insulin sensitivity, and inflammation, all of which are central to the development and progression of obesity. New research areas include the interaction between the ECS and gut microbiota, circadian rhythms of the ECS, and the impact of genetic and epigenetic factors on ECS function. Interest in the therapeutic potential of targeting the ECS has grown, with earlier treatments like CB1 receptor antagonists showing mixed results in efficacy and safety. Evidence from both animal and human studies highlight the impact of elevated levels of the endocannabinoids anandamide and 2-AG on food intake, insulin resistance, visceral fat accumulation, and metabolic disturbances associated with obesity. The review explores the interaction between the ECS and other physiological systems, including gut-brain communication, circadian rhythms, as well as leptin and ghrelin signaling. Additionally, genetic and epigenetic factors influencing ECS function are examined, emphasizing their contribution to obesity susceptibility. While therapeutic approaches targeting the ECS, particularly CB1 receptor antagonism, have shown potential in managing obesity, the review acknowledges the challenges posed by central nervous system side effects in earlier treatments like rimonabant. However, recent advancements in peripherally restricted CB1 antagonists offer renewed hope for safer and more effective obesity treatments. The review concludes by addressing future research directions and therapeutic strategies to combat this global health challenge.

Adolescents' dietary patterns, their drivers and association with double burden of malnutrition in adolescents: a cross-sectional study in Kenya's urban slums

BACKGROUND

The double burden of malnutrition (DBM) during adolescence is associated with growth and developmental impairment and risk of non-communicable diseases. There is limited evidence on adolescent's dietary patterns (DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPs of adolescents, their drivers and association with DBM in Kenya's urban slums.

METHODS

Anthropometric, socio-demographic and dietary-intake data were collected through a cross-sectional survey of 621 adolescents from three major urban slums in Nairobi, Kenya. DPs were derived using principal component analysis. Multinomial-logistic-regression was used to assess the association between the DPs, individual and environmental factors and DBM.

RESULTS

Two DPs were identified: traditional DP (whole grains/cereals, rice, fruits, legumes/nuts, and water) and transitioning DP (refined cereals (maize/wheat), vegetables, meat, tea/coffee, sweet ultra-processed/deep fried snacks). Adolescents from Mathare (the largest slum) were more likely to adhere to the traditional DP (RRR = 3.43; 95% CI 1.85-6.37). Cultural background (Luo) had a positive association (RRR = 4.28; 95% CI 1.97-9.32), while longer residency in the slum (> 10 years) had a negative association (RRR = 0.47; 95% CI 0.25-0.90) with transitioning DP. The transitioning DP had a positive (non-linear) association with overweight/obesity in girls (RRR = 2.79; 95% CI 1.16-6.71). The DPs were not associated with thinness or stunting.

CONCLUSION

The DPs indicate various stages of nutrition transition of adolescent diets, which are influenced by cultural background, neighbourhood and duration of stay in the slum. Transitioning DP may expose adolescents to the risks of overweight/obesity in the long-term.

Explaining the role of socioeconomic, healthcare access and infrastructural shifts in nutritional transition among women in Bangladesh between 2004 and 2018

OBJECTIVES

Shifts in socioeconomic factors, healthcare access, lifestyle and infrastructure facilities have resulted in increased body mass index (BMI) of populations in developing countries. These shifts result in a large increase in overweight and obese individuals, with a corresponding decline in the number of those who are underweight. Although this nutritional transition among women in Bangladesh is evident, studies elucidating such change are scarce. This study aimed to explain how socioeconomic, healthcare access and infrastructural shifts contributed to the nutritional transition among women of childbearing age in Bangladesh between 2004 and 2018.

STUDY DESIGN

Repeated cross-sectional study of respondents who participated in the latest five rounds of Bangladesh Demographic Health Surveys (BDHS) from 2004 to 2017-18.

METHODS

Applying counterfactual decomposition techniques to data from the latest five rounds of BDHS, this study examined how variations in observed nutrition-related determinants, and returns to them across rounds, contributed to the nutritional transition among women of childbearing age.

RESULTS

Shifts in nutritional outcomes were primarily attributed to gains in partner's education, improved access to healthcare, a decline in breastfeeding practice and the number of births. Wealth accumulation, contraception and improved sanitation facilities appeared as secondary contributing factors. Additionally, this study identified that the BMI gap widened between the lower and the upper quantile of the distribution over the study period.

CONCLUSIONS

Addressing the rise in BMI and the prevalence of overnutrition is imperative for the future health of the population in Bangladesh. Considering the study findings and existing national nutrition policies and programmes, it is evident that targeted policy interventions, programmatic approaches and multisectoral collaborations are essential.

Psychological Theoretical Frameworks of Healthy and Sustainable Food Choices: A Systematic Review of the Literature

BACKGROUND

Non-sustainable diets are associated with several environmental and health-related problems. Psychology research is interested in the study of food choice determinants, and several theoretical frameworks have been applied to study mechanisms underlying behavioral change and to develop theory-based interventions. The present systematic review is aimed at reviewing the existing literature on the psychological theoretical frameworks used to study sustainable and/or healthy food choices and their application for the development of interventions promoting such food choices, both in general and clinical populations.

METHODS

A systematic search of PubMed, PsycInfo, and Scopus was conducted according to PRISMA criteria.

RESULTS

Forty-five articles met the inclusion criteria and thirty-five theoretical frameworks emerged, mostly pertaining to social psychology and with the most widely used being the Theory of Planned Behavior. The majority of studies had a cross-sectional design, were conducted in general populations, and focused on healthy food choices. Only a few studies tested theory-based interventions. Internal (i.e., self-efficacy, personal values, and motivation) and external (i.e., peers, family, and social media influence) factors emerged as relevant healthy and sustainable eating determinants.

CONCLUSIONS

The current review underlines that an integrative perspective combining prompts from different psychology fields is needed in order to identify the psychological factors influencing food choices and to develop psychological interventions for the promotion of more sustainable diets.

Time of Energy Intake: Association with Weight Status, Diet Quality, and Sociodemographic Characteristics in Brazil

This study aimed to estimate the association of time of energy intake with weight status, diet quality, and sociodemographic characteristics in Brazil. This cross-sectional study used data from a nationally representative survey with 44.744 individuals (≥10 years old). Food consumption was assessed by 24 h recall. The evening/morning energy intake ratio was calculated, standardized, and categorized in tertiles. The association between the evening/morning energy intake ratio and weight status was estimated using polynomial logistic regression models, and differences across diet quality and sociodemographic categories were estimated considering the non-overlapping 95% confidence intervals. Men, adolescents, adults, and individuals in the higher income level had greater evening energy intake. Those with a higher evening-to-morning energy intake ratio were 15% more likely to be obese (OR = 1.15; 95% CI = 1.02 to 1.28), 21% less likely to be underweight (OR = 0.79; 95% CI = 0.64 to 0.98), and reported greater total energy, protein, and lipid intake, as well as higher consumption of low-quality diet markers. Higher evening energy intake relative to morning intake was associated with obesity, low-quality diet markers, and sociodemographic characteristics. The characterization of the time of energy intake can be useful for tailoring and targeting diet promotion actions and for controlling the obesity epidemic.

The promotion of ultra-processed foods in modern retail food outlets in rural and urban areas in Kenya

OBJECTIVE

To assess the availability and marketing of ultra-processed foods (UPF) in modern retail food outlets (supermarkets and minimarts) in Kenya and associated factors.

DESIGN

This cross-sectional study was conducted in Kenya from August 2021 to October 2021. Variables included the geographic location and the socio-economic status (SES) levels, the food items displayed for sale and advertised in the stores, and locations in the stores such as the entrance.

SETTING

Three counties in Kenya (Nairobi - urban, Mombasa - coastal tourist and Baringo - rural). Each county was stratified into high and low SES using national poverty indices.

PARTICIPANTS

Food outlets that offered a self-service, had at least one checkout and had a minimum of two stocked aisles were assessed.

RESULTS

Of 115 outlets assessed, UPF occupied 33 % of the cumulative shelf space. UPF were the most advertised foods (60 %) and constituted 40 % of foods available for sale. The most commonly used promotional characters were cartoon characters (18 %). UPF were significantly more available for sale in Mombasa (urban) compared to Baringo (rural) (adjusted prevalence rate ratios (APRR): 1·13, 95 % CI 1·00, 1·26, P = 0·005). UPF advertisements were significantly higher in Mombasa ((APRR): 2·18: 1·26, 3·79, P = 0·005) compared to Baringo and Nairobi counties. There was a significantly higher rate of advertisement of UPF in larger outlets ((APRR): 1·68: 1·06, 2·67 P = 0·001) compared to smaller outlets.

CONCLUSIONS

The high marketing and availability of UPF in modern retail outlets in Kenya calls for policies regulating unhealthy food advertisements in different settings in the country.

Prevalence and key determinants of the triple burden of childhood malnutrition in Southeast Asian countries: a systematic review and meta-analysis within an adapted socio-ecological framework

The triple burden of malnutrition (TBM) is increasing globally, but significant evidence gaps exist regarding its burden and drivers among children in Southeast Asian (SEA) countries. We systematically searched four databases (PROSPERO-CRD42023420129) and Google Scholar through February 2024. We assessed stunting and overweight prevalence among children aged 0-18 years old across four SEA countries (Indonesia, Malaysia, Thailand, and Vietnam) from recent national surveys. We conducted random-effect meta-analyses to estimate the pooled prevalence of micronutrient deficiencies, and the pooled odds ratio for TBM-associated determinants using an adapted socio-ecological framework. 176 studies were included for systematic review, with 132 studies eligible for meta-analysis. Our findings illustrate significant variation in TBM across countries, dependent on region, age, and sex. Pooled prevalence [95% CI] of anemia, iron, vitamin A, and D deficiencies were 25% [22, 29], 14% [10, 18], 6% [4, 8], and 40% [32, 48], respectively (I2>90%). Determinants of the TBM included child-individual factors, poor early-life nutrition, and family household characteristics including maternal nutrition and education, socioeconomic, family size, sanitation, and food security. However, macro-level environmental impacts were less documented. Our findings emphasize the need for robust, timely monitoring of TBM data, including micronutrient biomarkers, and targeted policy intervention in SEA countries.

Food acquisition and consumption by NOVA food classification and lived poverty index among rural and urban households in South Africa and Ghana

OBJECTIVE

This study aimed to determine differences in food consumption by the NOVA food categories in South Africa and Ghana and how they relate to poverty and food supply systems.

DESIGN

This study used a cross-sectional design to assess household food acquisition and lived poverty index.

SETTING

The study was conducted in Khayelitsha and Mount Frere, urban and rural communities in South Africa, respectively, and Ahodwo and Ejuratia, urban and rural communities in Ghana, respectively.

PARTICIPANT

An adult in charge of or knowledgeable about household food acquisition and consumption was selected to participate in the study.

RESULTS

A total of 1299 households participated in the study. Supermarkets were a prominent source of ultra-processed foods for households in South Africa, while informal outlets were an important source of ultra-processed foods in Ghana. Consumption of unprocessed foods was higher among South African households (58·2 %) than Ghanaian households (41·8 %). In South Africa, deprivation was associated with increased odds of infrequent consumption of both unprocessed foods (OR 3·431 P < 0·001) and ultra-processed foods (OR 2·656 P < 0·001) compared with non-deprivation. In Ghana, no significant differences were observed between deprived households and non-deprived households in relation to the consumption of the NOVA food classes.

CONCLUSION

Different food supply systems and poverty are associated with household acquisition of the different NOVA food classes. Policies should be geared towards formal shops in South Africa and informal shops in Ghana to reduce the consumption of key obesogenic foods.

Food consumption markers and sociodemographic factors associated with obesity among adult women registered in the Food and Nutrition Monitoring System (SISVAN) in Brazil: a cohort study, 2015-2019

Introduction

Carrying out studies using data from Food and Nutritional Monitoring is crucial given the current epidemiological scenario. This scenario reveals a coexistence of malnutrition and nutritional deficiencies alongside overweight and obesity, particularly among adult women in Brazil. Analyzing the microdata generated by the system is essential for accurately representing food and nutrition indicators in the country.

Objective

To analyze the association of food consumption markers and sociodemographic factors with changes in the Body Mass Index (BMI) among adult women.

Methodology

A cohort study with a final sample of 30,354 women evaluated through individual records between the years 2015 and 2019. Nutritional status was assessed using body mass index (BMI). Food consumption markers used were the ones available in the system, which referred to foods consumed the previous day. Linear regression was used to evaluate factors associated with BMI and multiple Poisson regression was used to estimate the relative risk of obesity incidence.

Results

There was an increase in BMI between 2015 and 2019. The average increase in BMI was lower in women who consumed, in the previous day, beans (β = -0,25; CI95%: -0.36; -0.13) and vegetables and/or legumes (β = -0.12; CI95%: -0.21; -0.04) and the increase was greater when they consumed hamburgers and/or sausages (β = 0.1; CI95%: 0.02; 0.19) adjusted by age, region and skin color. There was a 14% lower incidence of obesity in the group that consumed beans (RR = 0.86; 95% CI: 0.79; 0.93), and a 9% lower incidence when they consumed filled cookies, candies or treats (RR = 0.91; 95% CI 0.86; 0.96). The incidence of obesity was 11% higher in the group that consumed sweetened drinks (RR = 1.11; 95% CI: 1.05; 1.18) and 9% higher in the group that consumed instant noodles, packaged snacks or savory biscuits on the day before the 2015 registration (RR = 1.09; 95% CI: 1.03; 1.15).

Conclusion

There was an increase in BMI in the population of adult women, rising nationally between 2015 and 2019, with the notable influence of diet on this change.

Fluctuations in Mediterranean Diet Adherence Pre- and Post-Pandemic: A Study of Portuguese Cohorts 2019-2024

BACKGROUND/OBJECTIVES

The Mediterranean Diet (MD) is a lifestyle offering numerous health benefits. Nevertheless, the adherence to the MD is moderate even in Mediterranean countries. While sociodemographic factors influence MD adherence, additional impacts occurred due to the COVID-19 pandemic. This cross-sectional longitudinal study with three cohorts of Portuguese adults analyzes MD adherence before, during, and after the COVID-19 pandemic, and explores the effect of sociodemographic variables.

METHODS

Sociodemographic factors, lifestyle habits, and MD adherence were assessed in the years 2019, 2021, and 2024 with an online self-filled questionnaire. MD adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS).

RESULTS

MEDAS score increased significantly (p < 0.05) from 2019 to 2021 (6.2 ± 0.7 to 7.7 ± 0.1), followed by a significant (p < 0.05) decrease in 2024 (7.2 ± 0.1) relative to 2019, which was more pronounced in participants with higher income. Accordingly, a trend in healthier food choices was observed followed by a decline in 2024. Of note is the significant increase in red meat consumption (p < 0.05) in 2024 relative to 2021. Respondents who consumed more red meat were mostly men, employed, or in a stable relationship. Most respondents practiced sport "Never or occasionally" in 2019 and 2021 (59.4 and 55.2%, respectively); in 2024, this category was significantly (p < 0.05) reduced (40.9%); men or higher-income participants were more likely to meet the recommended activity levels.

CONCLUSIONS

This study reveals that the improvements in MD lifestyle during the pandemic were not sustained in 2024, as healthier habits formed during confinement were not fully integrated into long-term behavior. These findings strengthen the need for targeted public health interventions to promote the MD.

Improving urban health through primary health care in south Asia

South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities. Health and its social determinants vary considerably across south Asian cities and substantial socioeconomic inequities are present. Although cities offer easy geographical access to PHC services, financial hardship associated with health care use and low quality of care are a concern, particularly for low-income residents. Providing better PHC in south Asia requires a multi-sectoral response, with effective and resourced urban local bodies; increased public financing for health care; and new service delivery models aimed at low-income urban communities that involve strengthening public sector services, strengthening government engagement with private providers where necessary, and engaging with low-income communities and the PHC providers that serve them.

Diosmetin Ameliorates HFD-induced Cognitive Impairments via Inhibiting Metabolic Disorders, Mitochondrial Dysfunction and Neuroinflammation in Male SD Rats

Currently, accumulating evidence has indicated that overnutrition-associated obesity may result in not only metabolic dysregulations, but also cognitive impairments. This study aimed to investigate the protective effects of Diosmetin, a bioflavonoid compound with multiple biological functions, on cognitive deficits induced by a high fat diet (HFD) and the potential mechanisms. In the present study, oral administration of Diosmetin (25, 50 and 100 mg/kg) for 12 weeks significantly reduced the body weight, restored glucose tolerance and normalized lipid profiles in the serum and liver in HFD-induced obese rats. Diosmetin also significantly ameliorated depression-like behaviors and impaired spatial memory in multiple behavioral tests, including the open field test, elevated plus-maze and Morris water maze, which was in accordance with the decreased pathological changes and neuronal damage in different regions of hippocampus as suggested by H&E and Nissl staining. Notably, our results also indicated that Diosmetin could significantly improve mitochondrial dysfunction induced by HFD through upregulating genes involved in mitochondrial biogenesis and dynamics, increasing mitochondrial ATP levels and inhibiting oxidative stress. Moreover, the levels of key enzymes involved in the TCA cycle were also significantly increased upon Diosmetin treatment. Meanwhile, Diosmetin inhibited HFD-induced microglial overactivation and down-regulated inflammatory cytokines both in the serum and hippocampus. In conclusion, these results indicated that Diosmetin might be a novel nutritional intervention to prevent the occurrence and development of obesity-associated cognitive dysfunction via metabolic regulation and anti-inflammation.

Association between ultraprocessed food consumption and excess adiposity in children and adolescents: A systematic review

Ultraprocessed foods (UPF) consumption is associated with excess adiposity in adults, but this linkage remains unclear among children and adolescents. The present systematic review sought to address this research gap. Publications up to November 2023 were retrieved from PubMed, Web of Science, and Scopus databases. Outcomes included overweight/obesity anthropometric and body composition indicators; the exposure was UPF consumption based on the NOVA classification system. The review included 23 studies (i.e., 8 cohort and 15 cross-sectional); approximately half were carried out in Brazil. Inconclusive and heterogeneous evidence exists as few cohort studies found positive/mixed associations between UPF consumption and excess adiposity in pediatric populations, whereas most cross-sectional studies reported null associations. Such inconsistencies may be attributed to underlying methodological issues, especially heterogeneity in the outcomes assessed and UPF consumption operationalization and/or categorization. Future studies should adopt longitudinal designs with sufficiently extended follow-up periods, account for relevant confounding factors, employ validated and standardized measurement tools to assess dietary exposure, ensure consistent operationalization of variables, and encompass diverse geographic contexts. Ultimately, strengthening the quality of existing research evidence may better inform current and forthcoming policy and practice interventions aimed at mitigating the increasing prevalence of overweight/obesity in childhood and across the life course.

National Policies to Limit Nutrients, Ingredients, or Categories of Concern in School Meals: A Global Scoping Review

The school food environment is a key intervention point for influencing children's and adolescents' diets. As more countries establish school meal programs to provide critical nourishment to students, establishing standards for the foods served can increase the consumption of key nutrients and limit the consumption of foods that do not build health. This global scoping review explores the prevalence and basic characteristics of national policies that regulate food served through school meals across 193 countries, particularly by restricting the provision of categories, nutrients, or ingredients of nutritional concern. We gathered evidence from policy databases, grey literature, peer-reviewed literature, and primary policy documents. We included nationally mandated policies that included restrictions on categories, nutrients, or ingredients of concern served in school meals. Policies that were sub-national, voluntary, and/or did not include restrictive language were excluded from this review. Data was collected in research electronic data capture then extracted into Microsoft Excel and analyzed for policy frequency, prevalence by world region or country income group, and prevalence of certain policy characteristics. Globally, only 15% of countries were found to have a national-level policy restricting foods served through school meals in some capacity, including either nutritional or categorical restrictions. The majority of these policies were found in high-income countries, and no low-income countries had a policy meeting inclusion criteria. Policies in Latin-American and Caribbean countries limited the content of more nutrients of concern than in other regions. Although many policies included explicit guidelines to monitor implementation, few outlined mechanisms for policy enforcement. Future research should evaluate the impact of various school meal regulatory approaches, including implementation of similar policies at sub-national levels, and other elements that affect the impact of school meal programs, such as procurement, infrastructure, costs to school and to students and their families, and acceptability and consumption of foods provided.

Connecting precision nutrition with the Food is Medicine approach

Two initiatives are reshaping how we can approach and address the persistent and widely prevalent challenge of malnutrition, the leading global risk factor for morbidity and mortality. First is the focus on precision nutrition to identify inter- and intra-individual variation in our responses to diet, and its determinants. Second is the Food is Medicine (FIM) approach, an umbrella term for programs and services that link nutrition and health through the provision of food (e.g., tailored meals, produce prescriptions) and access to healthcare services. This article outlines how interventions and programs using FIM can synergize with precision nutrition approaches to make individual- or population-level tailored nutrition accessible and affordable, help to reduce the risk of metabolic diseases, and improve quality of life.

Socioeconomic Status and Obesity

Obesity is a pervasive public health problem that causes debilitating complications across the life course. One opportunity for preventing the onset of obesity is to focus on its social determinants. Socioeconomic status (SES), which includes factors such as income, educational attainment, occupational prestige, and access to resources, is a key determinant of obesity. In this scoping mini-review, we summarized review articles and meta-analyses of the SES-obesity association. From the 1980s to the present, cross-sectional studies have demonstrated a persistent socioeconomic gradient in obesity in which the association is negative in developed countries and positive in developing countries. Longitudinal studies have revealed the bidirectionality of the SES-obesity association; some studies demonstrate that socioeconomic adversity precedes the onset of obesity, while others provide evidence of reverse causality. While earlier studies relied on anthropometric assessments of weight and height to define obesity, the use of modern technologies like dual-energy x-ray absorptiometry and bioelectrical impedance have demonstrated that the socioeconomic gradient in obesity is robust across multiple indicators of body composition, including direct measures of lean and fat mass. More recently, examination of mediators and moderators of the SES-obesity association have highlighted causal pathways and potential intervention targets, with a focus on health behaviors, environmental conditions, psychological factors, and biological processes. We describe current gaps in knowledge and propose opportunities for future innovation to reduce the burden of obesity and related socioeconomic disparities.

Double burden of malnutrition among women and children in Zimbabwe: a pooled logistic regression and Oaxaca-Blinder decomposition analysis

Background

The double burden of malnutrition (DBM) is a public health issue characterised by the coexistence of undernutrition and overnutrition within the same population, household, or individual. Undernutrition, manifesting as stunting, wasting, or being underweight, results from insufficient nutrient intake while overnutrition, manifesting as overweight or obesity, results from excessive caloric intake, poor diet quality, and sedentary lifestyles. This dual burden poses significant challenges for health systems due to lost productivity and increased healthcare expenditure.

Methods

This study utilised data from the Demographic and Health Surveys (DHS) conducted in Zimbabwe for 2010-2011 and 2015, which provided information on women's and children's health and nutritional status, household characteristics, and socio-economic status. Pooled logistic regression was used to analyse the association between various sociodemographic factors and DBM among women and children. The Oaxaca-Blinder decomposition method explored differences in DBM between 2010-2011 and 2015.

Results

The average age of mothers was approximately 31 years, and children's ages averaged around 32 months. From 2010 to 2015, there was a notable socio-economic improvement, with a decrease in the percentage of mothers in the poorest quartile from 20 to 16% and an increase in the richest quartile from 22 to 23%. The study found a slight decrease in overall household DBM among women from 34% in 2010 to 32% in 2015, while DBM among children increased from 12 to 14%. Pooled logistic regression analysis indicated that children in rural areas had statistically significantly higher odds of experiencing DBM than their urban counterparts. The Oaxaca-Blinder decomposition showed that changes in residence status significantly impacted the increase in DBM among children. At the same time, the coefficient effect accounted for most of the unexplained differences in DBM among women.

Conclusion

The growing DBM among women and children in Zimbabwe is significantly influenced by changes in residence status. The findings highlight the need for targeted public health interventions to address urban-rural disparities and emphasise the importance of considering socio-economic, environmental, and behavioural factors. Context-specific public health strategies, aligned with WHO's Double Duty Actions, are essential to improve the nutritional health of Zimbabwe's population.

Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity-MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2-19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted.

A cross-sectional study on the dietary patterns of multiethnic Malaysian preschoolers and their sociodemographic determinants

Early childhood is a critical developmental stage where established dietary patterns can impact lifelong health outcomes. This study investigates dietary patterns and their relationships with sociodemographic factors among Malaysian preschoolers. A total of 643 preschoolers of Malay, Indian, Chinese and other ethnicities participating in South East Asian Nutrition Surveys (SEANUTS II) were included. Dietary intake was assessed using a single triple-pass 24-h dietary recall method. Dietary patterns were derived using principal component analysis and their association with sociodemographic factors was determined using complex sampling logistic regressions. Five dietary patterns were identified: "healthy eating," "wholegrains and starchy vegetables," "high salt and sugar," "Western food," and "sugary drinks and legumes". Having older siblings was inversely associated with a "healthy eating" pattern (adjusted OR: 0.54, 95% CI: 0.33-0.87). Malay ethnicity was associated with higher odds of adhering to the "high salt and sugar" pattern (adjusted OR: 4.12, 95% CI: 2.20-7.75). Meanwhile, children living in urban areas (adjusted OR: 1.76, 95% CI: 1.03-3.01), those from middle-income families (adjusted OR: 3.20, 95% CI: 1.38-7.40) and whose fathers were overweight (adjusted OR: 2.79, 95% CI: 1.58-4.94) showed a higher association with "Western food" pattern. Conversely, children whose mothers had overweight were less likely to adhere to the "Western food" pattern (adjusted OR: 0.50, 95% CI: 0.30-0.83). Older age was significantly associated with a greater likelihood of the "sugary drinks and legumes" pattern (adjusted OR: 3.99, 95% CI: 1.75-9.06). There was no significant association between "wholegrains and starchy vegetables" pattern with sociodemographic characteristics (all p > 0.05). These findings suggest that ethnicity, age, residence area, having older siblings, parental weight status and household income level are associated with dietary patterns among multiethnic preschoolers in Malaysia. Thus, these sociodemographic characteristics should be considered when designing targeted dietary strategies and interventions for preschoolers.

Evaluating Phthalates and Bisphenol in Foods: Risks for Precocious Puberty and Early-Onset Obesity

Recent scientific results indicate that diet is the primary source of exposure to endocrine-disrupting chemicals (EDCs) due to their use in food processing, pesticides, fertilizers, and migration from packaging to food, particularly in plastic or canned foods. Although EDCs are not listed on nutrition labels, their migration from packaging to food could inadvertently lead to food contamination, affecting individuals by inhalation, ingestion, and direct contact. The aim of our narrative review is to investigate the role of phthalates and bisphenol A (BPA) in foods, assessing their risks for precocious puberty (PP) and early-onset obesity, which are two clinical entities that are often associated and that share common pathogenetic mechanisms. The diverse outcomes observed across different studies highlight the complexity of phthalates and BPA effects on the human body, both in terms of early puberty, particularly in girls, and obesity with its metabolic disruptions. Moreover, obesity, which is independently linked to early puberty, might confound the relationship between exposure to these EDCs and pubertal timing. Given the potential public health implications, it is crucial to adopt a precautionary approach, minimizing exposure to these EDCs, especially in vulnerable populations such as children.

Mapping the existing evidence of the effects of school food policies on health, acceptance and affordability of secondary school children in Europe: a scoping review protocol

INTRODUCTION

Unhealthy diets pose a significant public health risk among European children, contributing to the increasing prevalence of overweight and non-communicable diseases. Children spend a substantial amount of time at school daily, including lunchtime, so the school setting becomes crucial for promoting healthy diets and lifestyle habits. While there is a large body of literature on the impact of school food policies on health and non-health outcomes, it is essential to identify which policies are effective and can be recommended for implementation to ensure the efficient use of resources. This article presents a protocol for a scoping review that aims to map the current published literature on the effects of school food policies on health outcomes, acceptance and affordability in secondary school children in Europe. Moreover, the scoping review will map the measurements used to assess health outcomes, acceptance and affordability.

METHODS AND ANALYSIS

The scoping review protocol and review follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. To identify eligible studies, we will search MEDLINE, PsycINFO, CINAHL and Web of Science. The reference lists of the included articles will be checked for additional studies. In addition, country-specific ministry reports from Member States of the European Union, the UK, Norway, Iceland and Switzerland will be identified. The WHO and European Commission websites will also be searched for relevant reports. The scoping review will include literature published until 20 September 2023. No restrictions to study design and language will be applied. Screening and data extraction will be carried out independently by three reviewers. Disagreements will be resolved by discussion. A pretested data charting table will be used to extract key information. Findings will be presented in tabular and visualised summaries and a narrative summary.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval. Our dissemination strategy comprises peer-reviewed publications, conference presentations and recommendations to policy-makers.

Malnutrition among Children under Age Five in Panama: Results of the ENSPA 2019

Background: Malnutrition has important short- and long-term consequences in children under age five. Malnutrition encompasses undernutrition, overnutrition, and the coexistence of both of them, known as the double burden of malnutrition (DBM). Objective: The aim of this study was to estimate the prevalence of undernutrition, overnutrition, and the DBM among these children at the national level and by living area in Panama. Methods: Data from the National Health Survey of Panama (ENSPA, Spanish acronym), a population-based, cross-sectional study carried out in 2019 were used. Stunting, wasting, overweight, and obesity were defined according to the cut-off points of the World Health Organization Growth Standards. Undernutrition was defined as being stunted only, wasted only or both; overnutrition was defined as being overweight only or obese only; and the DBM was defined as the co-occurence of stunting and overweight/obesity in the same child. Prevalence and general characteristics at the national level and by living area were weighted. Findings: The prevalence of undernutrition was 15.3% (95% confidence interval (CI) 13.4-17.3) at the national level and 36.6% (CI: 30.1-43.5) in indigenous areas. The prevalence of overnutrition was 10.2% (8.2-12.6) at the national level and 11.9% (CI: 8.5-16.3), 8.4% (CI: 6.5-10.7) and 8.7% (CI: 5.2-14.3) in urban, rural and indigenous areas, respectively. The DBM prevalence was 1.4% (CI: 1.0-2.1) at the national level and 2.7% (CI: 1.4-5.1) in indigenous areas. Conclusions: Undernutrition is still the most prevalent malnutrition condition in our country. Panama has the highest prevalence of overnutrition in Central America. The highest prevalence of undernutrition and DBM was found among children living in indigenous areas.

Food allergy in a changing dietary landscape: A focus on the Asia Pacific region

Recent studies have provided compelling evidence to suggest that various environmental factors play a significant role in the development of food allergies. As our society experiences rapid economic growth, increased urbanization, and a shift towards a more Westernized diet, the incidence of food allergies is also on the rise and the pattern is gradually evolving. This review will delve into the changes in the epidemiology of food allergies within the Asia-Pacific region and the various dietary practices and factors that are postulated to play a role in the rise in food allergies over the years. Although there have been important advancements in the field of food allergies, there are still numerous uncertainties regarding the intricate relationship between diet and food allergies. Specifically, the role of epigenetic factors in influencing the susceptibility to food allergies, as evidenced by studies that assessed the impact of migration and rural-urban dynamics, is not fully understood. Addressing this knowledge gap presents an opportunity to develop more effective prevention and treatment strategies that could greatly benefit individuals living with food allergies.