Meal planning is associated with food variety, diet quality and body weight status in a large sample of French adults

Understanding the experiences of ketogenic metabolic therapy for people living with varying levels of depressive symptoms: a thematic analysis

Background

Evidence suggests that a ketogenic diet (KD) may help to alleviate psychiatric symptoms, including depression and anxiety. Positive changes have been reported such as improvements in cognition, concentration, and sleep, a reduction in hunger, and an increase in well-being, energy, confidence, and resilience. This research aims to understand the impact of a non-calorie-restricted KD on depression and aspects of psychological well-being in those with varying degrees of depressive symptoms. Though there are a few studies directly exploring the experiences of those following a KD, this will be the first study to explore the narrative from a mental health and psychological well-being viewpoint.

Method

A sample of nine participants who had followed a non-calorie restricted KD intervention of 50 g of carbohydrates or less per day for at least 12 weeks were recruited. Participants were split into 'healthy adults' group who had no to low depressive symptoms and 'depressive symptoms' group who had mild to moderate depressive symptoms. A reflexive thematic analysis was considered suitable for this study.

Findings

Five core themes and 24 subthemes were created. These were, (1) Poor health prior to program; (2) Hunger and cravings-the food and mood connection; (3) Psychological well-being improvements; (4) It becomes a lifestyle; and (5) Implementation difficulties. Participants experienced mental health improvements such as increased self-esteem, confidence, motivation, and achievement. Some experienced more control in life and a greater sense of reward. Those with depressive symptoms who initially reported low self-worth and hopelessness later reported increased self-esteem and renewed meaning and purpose in life. The findings from this study reflect the previous reports that the diet implementation can be difficult initially, but soon becomes easy to follow and turns into a lifestyle.

Conclusion

In the literature, there are very few qualitative studies that explore the accounts and lived experiences of those following a KD. From the participants' accounts in this study, it appears that the benefits and positive outcomes of this diet outweigh any negative side-effects experienced. This is encouraging for those who are looking for adjunctive therapies to address and improve their depressive symptoms and overall mental health.

The impact of the cost of living crisis and food insecurity on food purchasing behaviours and food preparation practices in people living with obesity

Lower income households are at greater risk of food insecurity and poor diet quality than higher income households. In high-income countries, food insecurity is associated with high levels of obesity, and in the UK specifically, the cost of living crisis (i.e., where the cost of everyday essentials has increased quicker than wages) is likely to have exacerbated existing dietary inequalities. There is currently a lack of understanding of the impact of the current UK cost of living crisis on food purchasing and food preparation practices of people living with obesity (PLWO) and food insecurity, however this knowledge is critical in order to develop effective prevention and treatment approaches to reducing dietary inequalities. Using an online survey (N = 583) of adults residing in England or Scotland with a body mass index (BMI) of ≥30 kg/m2, participants self-reported on food insecurity, diet quality, perceived impact of the cost of living crisis, and their responses to this in terms of food purchasing behaviours and food preparation practices. Regression analyses found that participants adversely impacted by the cost of living crisis reported experiencing food insecurity. Additionally, food insecurity was associated with use of specific purchasing behaviours (i.e., use of budgeting, use of supermarket offers) and food preparation practices (i.e., use of energy-saving appliances, use of resourcefulness). Exploratory analyses indicated that participants adversely impacted by the cost of living crisis and who used budgeting had low diet quality, whereas use of meal planning was associated with high diet quality. These findings highlight the fragility of food budgets and the coping strategies used by PLWO and food insecurity during the cost of living crisis. Policy measures and interventions are urgently needed that address the underlying economic factors contributing to food insecurity, to improve access to and affordability of healthier foods for all.

Goals, Barriers, and Facilitators of Caregivers Who Participated in an In-Home Intervention to Improve Food Parenting Practices and Child Diet Quality

OBJECTIVE

To explore the goals, barriers, and facilitators set by caregivers of preschool-aged children to improve food parenting practices and household food environments.

DESIGN

Secondary qualitative analysis of collaborative goal sheets completed during in-home and telephone visits as part of a home-based pilot intervention.

PARTICIPANTS

Thirty-three Hispanic/Latinx caregivers, predominantly of low income.

PHENOMENON OF INTEREST

Patterns in goal content and anticipated barriers and facilitators.

ANALYSIS

Thematic analysis of goal sheets with a mixed inductive-deductive approach.

RESULTS

Almost half of the goals were to support a healthy environment (40.7%) by increasing the availability of healthy foods through food shopping and meal planning. Other goals were to increase structure (33.7%) by establishing food-related routines and decreasing distractions. Goals related to autonomy support (25.4%) included involving their children (eg, cooking together). Caregivers' perceived barriers encompass individual (eg, stress, lack of time), interpersonal (eg, other family members' eating behaviors), and environmental-level (eg, food availability) factors. Caregivers only identified facilitators at the individual and interpersonal levels (eg, motivation).

CONCLUSIONS AND IMPLICATIONS

Understanding goals, barriers, and facilitators can be used to tailor key messages to improve food parenting practices and children's diets. Future interventions can target broader environmental barriers while increasing awareness of individual, interpersonal, and environmental-level facilitators.

Influence of health food literacy on willingness to pay for healthier foods: focus on food insecurity

BACKGROUND

The repercussions of food insecurity are widely recognized to negatively impact overall health and are influenced by a complex interplay of physiological, psychological, social, and environmental factors.

METHODS

This study examined the disparities in food consumption and literacy between among food security households and food insecurity households using data from the Korea Rural Economic Institute's 2022 Consumer Behavior Survey for Food, which involved 3,321 respondents.

RESULTS

Food security households had a greater understanding of and better attitude toward healthier food choices than food insecurity households. Economic ability was identified as having the most significant association with food purchasing behavior, with food security households spending more on average than food insecurity households. Structural equation modeling demonstrated the association of knowledge and attitude with dietary implementation and underscored the significance of consumer literacy as a factor related to willingness to pay for healthier foods.

CONCLUSIONS

This study underscores the intertwined relationships among financial capacity, knowledge, and health-conscious dietary choices. It also suggests the need for targeted interventions addressing economic and educational gaps to foster healthier food consumption patterns across different socioeconomic contexts.

Self-identified strategies to manage intake of tempting foods: cross-sectional and prospective associations with BMI and snack intake

OBJECTIVES

Individuals often use self-directed strategies to manage intake of tempting foods, but what these strategies are and whether they are effective is not well understood. This study assessed the frequency of use and subjective effectiveness of self-directed strategies in relation to BMI and snack intake.

DESIGN

A cross-sectional and prospective study with three time points (T1: baseline, T2: 3 months and T3: 3 years). At T1, demographics, frequency of use and subjective effectiveness of forty-one identified strategies were assessed. At T2 and T3, current weight was reported, and at T2 frequency of snack intake was also recorded.

SETTING

Online study in the UK.

PARTICIPANTS

Data from 368 participants (Mage = 34·41 years; MBMI = 25·06 kg/m2) were used for analysis at T1, n = 170 (46·20 % of the total sample) at T2 and n = 51 (13·59 %) at T3.

RESULTS

Two strategy factors were identified via principal axis factoring: (1) diet, exercise, reduction of temptations, and cognitive strategies, and (2) planning, preparation and eating style. For strategy 1, frequency of use, but not subjective effectiveness, was positively related to BMI at T1. Subjective effectiveness predicted an increase in BMI from T1 and T2 to T3. No relationship to snack intake was found. For strategy 2, frequency of use was negatively related to BMI at T1. Neither frequency of use nor subjective effectiveness were related to changes in BMI over time, but subjective effectiveness was negatively correlated with unhealthy snack intake.

CONCLUSION

Self-directed strategies to reduce the intake of tempting foods are not consistently related to BMI or snack intake.

Food consumption by NOVA food classification, metabolic outcomes, and barriers to healthy food consumption among university students

The NOVA food classification system is a simple tool that can be used to assess the consumption levels of different categories of foods based on their level of processing. The degree to which food is processed has a significant impact on health outcomes. In Ghana, no study exists on the consumption of the different NOVA food groups among tertiary students and how it relates to their metabolic outcomes. This study assessed the frequency of food intake according to the NOVA classification and how they relate to body mass index, waist circumference, and blood pressure. The barriers to the consumption of healthy foods among students were also assessed. This was a cross-sectional study conducted among 352 students of the Takoradi Technical University. Questionnaire was used to obtain sociodemographic information as well as data on perceived barriers to healthy food consumption. Food frequency questionnaire was used to obtain data on dietary intake. The weight, height, waist circumference, waist-to-hip ratio, and blood pressure of all participants were measured. Chi-square was used to compare categorical variables between males and females and to determine the association between the frequency of food intake according to the NOVA classification and metabolic indicators. The prevalence of overweight and obesity was 23.8%. More than half (51.1%) of the students had elevated blood pressure. The majority of study participants (54.2%) had a high frequency of consumption of both unprocessed and ultra-processed foods. Male students who frequently consumed ultra-processed foods (1-6 times/day) had significantly high blood pressure. High consumption of both ultra-processed and unprocessed foods was also associated with elevated blood pressure among male students. Limited time to prepare healthy meals and the high cost of unprocessed foods were among barriers to which most students strongly agreed to. Establishment of canteens that provide affordable healthy foods, teaching students time management, and nutrition education can mitigate barriers to healthy food consumption.

Types of fish consumption differ across socioeconomic strata and impact differently on plasma fish-based omega-3 fatty acids: a cross-sectional study

PURPOSE

We investigated the associations of socioeconomic position (SEP) with total and type of fish intake in a large general population and validated whether types of fish intake were differently associated with plasma EPA and DHA in a subset of the population.

METHODS

From the Lifelines Cohort Study, 94,246 participants aged 44 ± 13 years old were included to test the association of two SEP indicators, i.e., education level and household income level, with dietary intakes of total, oily, lean, fried, and other types of fish. In a subset of 575 participants (mean age: 50 ± 13 years), EPA and DHA levels were measured in plasma phospholipids and triglycerides. Dietary fish intake was assessed using Food Frequency Questionnaire. Linear regressions were applied and adjusted for relevant covariates.

RESULTS

Compared to the high education level, lower education levels were negatively associated with total, oily, lean, and other fish intake (p < 0.001 for all), and positively associated with fried fish intake (β (SE): 0.04 (0.04), p < 0.001 for middle education; 0.07 (0.04), p < 0.001 for low education), independently of relevant covariates. Similar results were observed for income levels. In the subset population, total and oily fish intakes were positively associated with plasma EPA and DHA (p < 0.02 for all). Lean and other fish intakes were positively associated with only DHA (p < 0.008 for all), but not EPA, while fried fish was not associated with either EPA or DHA in plasma (p > 0.1 for all).

CONCLUSION

Lower SEP was associated with a lower total intake of fish, and of oily and lean fish, but with higher intake of fried fish. Fried fish was not associated with the fish-based EPA and DHA in plasma. Hence, SEP-related differences in fish consumption are both quantitative and qualitative.

The Prevalence of Weight Gain After Obtaining Employment: A Cross-Sectional Survey of Employees at the Ministry of National Guard Health Affairs, Eastern Region, Saudi Arabia

Background and objective Even though obesity is a major global health concern, few studies in the literature have discussed obesity in the workplace. In light of this, we aimed to explore obesity in the workplace and its contributing factors. Methodology An online survey was distributed via official work emails. The survey assessed demographic variables and work environment-related factors, such as physical and mental well-being, lack of time, and social and personal habits. The total sample included 380 full-time employees, of which 16.67% were excluded for not meeting the inclusion criteria. Data were analyzed by using descriptive and inferential statistics. Results Of note, 79.87% of the participants reported an increase in weight after getting employed. The average weight gain was 10.4 kg for 8.2 years of experience. The physical and mental items and time-related items had the highest average scores of 3.24 and 3.44, respectively. The multivariable logistic regression showed a significant association between work experience (p = 0.0259) and time (p = 0.0363), as well as physical and mental domains (p = 0.0007). Conclusions Based on our findings, greater work experience, a lack of time, and negative mental and physical well-being are risk factors for weight gain among employees.

Examining Changes in Food Security, Perceived Stress, and Dietary Intake in a Cohort of Low-Wage Workers Experiencing an Increase in Hourly Wage

OBJECTIVE

To determine whether an increase in hourly wages was associated with changes in food security and perceived stress among low-wage workers. We also determined whether changes in food security and stress were associated with changes in diet.

SETTING

Wages is a prospective cohort study following 974 low-wage workers in Minneapolis, MN, where an ordinance is incrementally increasing minimum wage to US$15/hr from 2018 to 2022, and a comparison community with no minimum wage ordinance (Raleigh, NC). Interaction models were estimated using generalized estimating equations.

PARTICIPANTS

Analyses used two waves of data (2018 [baseline], 2019) and included 219 and 321 low-wage workers in Minneapolis and Raleigh (respectively).

RESULTS

Average hourly wages increased from US$9.77 (SD US$1.69) to US$11.67 (SD US$4.02). Changes in wages were not associated with changes in food security (odds ratio = 1.05, 95% confidence interval [CI] [0.89, 1.23], p = .57) or stress (β = -0.01, 95% CI [-0.04, 0.03], p = .70) after 1 year of policy implementation. Changes in food security were not associated with changes in diet. However, we found significant changes in the frequency of fruit and vegetable intake across time by levels of stress, with decreased intake from Wave 1 to 2 at low levels of stress, and increased intake at high levels of stress (incidence rate ratio = 1.17, 95% CI [1.05, 1.31], p = .01).

CONCLUSIONS

Changes in wages were not associated with changes in food security or stress in a sample of low-wage workers. Future research should examine whether full implementation of a minimum wage increase is associated with changes in these outcomes.

Delighting Palates with AI: Reinforcement Learning's Triumph in Crafting Personalized Meal Plans with High User Acceptance

Eating, central to human existence, is influenced by a myriad of factors, including nutrition, health, personal taste, cultural background, and flavor preferences. The challenge of devising personalized meal plans that effectively encompass these dimensions is formidable. A crucial shortfall in many existing meal-planning systems is poor user adherence, often stemming from a disconnect between the plan and the user's lifestyle, preferences, or unseen eating patterns. Our study introduces a pioneering algorithm, CFRL, which melds reinforcement learning (RL) with collaborative filtering (CF) in a unique synergy. This algorithm not only addresses nutritional and health considerations but also dynamically adapts to and uncovers latent user eating habits, thereby significantly enhancing user acceptance and adherence. CFRL utilizes Markov decision processes (MDPs) for interactive meal recommendations and incorporates a CF-based MDP framework to align with broader user preferences, translated into a shared latent vector space. Central to CFRL is its innovative reward-shaping mechanism, rooted in multi-criteria decision-making that includes user ratings, preferences, and nutritional data. This results in versatile, user-specific meal plans. Our comparative analysis with four baseline methods showcases CFRL's superior performance in key metrics like user satisfaction and nutritional adequacy. This research underscores the effectiveness of combining RL and CF in personalized meal planning, marking a substantial advancement over traditional approaches.

Is the adherence to the food practices recommended by the dietary guidelines for the Brazilian population associated with diet quality?

PURPOSE

The Brazilian Food Guide (BFG)'s messages are mostly qualitative and focused on food practices, such as meal planning, cooking, and eating modes. This study sough to investigate whether the adherence to these food practices is aligned with diet quality.

METHODS

A quota-based subsample of the NutriNet-Brasil Cohort (n = 2052) completed the Food Practices Brazil Scale (FPBr), a 24-item scale assessing the adherence to healthy eating practices recommended by the BFG. Four possible frequency-based answers are given and a score ranging from 0 to 72 is calculated by summing them (FPBr-score). Data from web-based 24-h recalls were used for calculating the usual percentage of energy intake (%energy) of ten food groups based on the level of food processing: plant-based unprocessed or minimally processed foods; processed foods; ultra-processed foods; fruits; vegetables; whole grains; beans and other legumes; nuts; red meat; and table sugar. The association between quartiles of the FPBr-score and food groups' %energy was analysed through crude and adjusted linear regression models.

RESULTS

Except for red meat, all the other food groups were linearly associated with the FPBr-score in the expected direction. For example, adjusted means for the %energy of plant-based unprocessed or minimally processed foods were 26.7% (CI95% 25.9-27.5) and 36.8% (CI95% 36.0-37.6) among those classified in the first and fourth quartiles of the FPBr-score, respectively. For ultra-processed foods, these percentages were 27.0 (CI95% 26.3-27.8) against 17.5 (CI95% 16.7-18.3).

CONCLUSIONS

These results support the use of messages based on practices and behaviors in Food-Based Dietary Guidelines. At the same time, they call attention to the importance of policies that enable people to adopt healthier food practices.

A qualitative evaluation of the specific carbohydrate diet for juvenile idiopathic arthritis based on children's and parents' experiences

BACKGROUND

Insights into the immunological role of the gastrointestinal tract in autoimmune conditions have led to the investigation of diet as a potential adjunctive treatment option for juvenile idiopathic arthritis (JIA). The specific carbohydrate diet (SCD) has shown promising results. However, studies on participants' experiences of dietary interventions in JIA are rare. In this study we investigated the experiences of children and parents' who had participated in a four-week intervention with SCD aiming to examine the potential anti-inflammatory effects.

OBJECTIVES

To conduct a qualitative evaluation exploring children's and parents' experiences of the dietary intervention, how they navigated challenges, and their support requirements.

METHODS

Semi-structured interviews were conducted with 12 children and 15 parents from 13 families, who were interviewed individually and together. The transcripts were analysed using systematic text condensation.

RESULTS

Most participants interviewed found the intervention beneficial, with 12 out of 13 reporting positive effects, such as reduced pain and morning stiffness, and improved gastrointestinal function. Many participants reported being willing to repeat the intervention in the current form. Despite facing challenges, all children followed the diet for one to three months, with some continuing to follow a modified version. Facing the socio-emotional consequences of adhering to the diet was challenging for children. These were handled by focusing on the positive aspects and by relying on the supportive environment available. Parents struggled with practical issues since the diet required hard work, time, and money. Areas identified as requiring additional support include finding simple, quick, and child-friendly solutions, strengthening organizational food skills such as meal planning, and preparation prior to starting the intervention regarding socio-emotional aspects.

CONCLUSION

Navigating the dietary treatment was considered challenging, practically for the parents and socio-emotionally for the children. Based on the reported challenges and participants' suggestions the intervention could be optimised by providing support and solutions in relation to the practical issues and better preparation regarding dealing with the socio-emotional consequences. Despite the difficulties, the participants reported overall positive experiences of, and attitudes towards, the current setup. Consequently, dietary interventions, such as the SCD, may be regarded as suitable targets for further research.

Association of stress on eating competence in mothers during pregnancy and six months postpartum

BACKGROUND

Perceived stress is related to poor diet quality and unhealthy dietary patterns in women of reproductive age. Eating competence represents a variety of contextual skills reflecting a comfortable and flexible approach to eating and is associated with diet quality and health related behavior. In non-pregnant samples, perceived stress is negatively associated with eating competence. Given that pregnancy and the postpartum period can be periods of high stress, we hypothesized that higher stress in pregnancy would result in lower pregnancy eating competence.

METHODS

Women (n = 296, mean BMIbaseline pregnancy = 26.3 ± SD 6.0) in the Pregnancy Eating Attributes Study (PEAS) were recruited from the Chapel Hill, North Carolina area. Perceived stress was assessed using the Perceived Stress Scale and eating competence using the ecSatter Inventory at their first trimester and 6-month postpartum visits. We used a mixed effect model to assess the effect of stress by time on eating competence, controlling for baseline pregnancy BMI, race and ethnicity, poverty to income ratio, and WIC status.

RESULTS

Perceived stress was negatively associated with eating competence (b= -0.23, SE = 0.06, p < 0.001). The interaction of stress by time was negatively associated with eating competence (b = -0.15, SE = 0.08, p = 0.03), indicating that the association of stress with eating competence was stronger in postpartum than in pregnancy.

CONCLUSIONS

Perceived stress may adversely impact eating competence during both pregnancy and postpartum. Future studies intervening upon stress or eating competence during pregnancy and postpartum may inform potential causal relations.

Factors Associated with Adherence to the Brazilian Food Guide in Food Service Workers

The present study aimed to evaluate factors associated with adherence to the Food Guide for the Brazilian Population (GAPB) among food service workers. A cross-sectional study was conducted with 421 employees from 43 food service establishments located in a capital of Brazil. Health and lifestyle data were collected, including the continuous use of medication, smoking, physical activity, and alcohol consumption. An instrument based on the GAPB was utilized, covering the domains of planning, household organization, eating habits, and food choices, according to GAPB recommendations. The findings revealed a direct association between the quality of life scores and the total GAPB adherence score (β = 1.17; p < 0.001), as well as the domains of planning (β = 0.53; p < 0.001), household organization (β = 0.22; p = 0.001), and eating habits (β = 0.38; p < 0.001). Adherence to the GAPB among food service workers was strongly linked to their perception of quality of life, in addition to other factors such as gender, age, education, type of work activity, and variables of lifestyle. Therefore, the eating practices of these employees need to be assessed comprehensively, and enhancing their quality of life can encourage proper and healthy eating.

Women Consumers' Views on Legislation to Restrict Prominent Placement and Multibuy Promotions of High Fat, Sugar, and Salt Products in England: A Qualitative Perspective

BACKGROUND

As part of the childhood obesity strategy, the UK Government has introduced regulations to restrict the ways high fat salt and sugar (HFSS) products can be promoted in retail settings from October 2022. This study explored (i) consumers' views on the likely impact of the UK legislation restricting the placement and promotion of HFSS products on their shopping behaviours and (ii) consumers' beliefs about who is responsible for healthy eating.

METHODS

Using a cross-sectional study design, qualitative semi-structured telephone interviews were conducted with a purposive sample of women who shopped at a discount supermarket. Thematic analysis was employed to identify key themes.

RESULTS

Participants' (n = 34) had a median age of 35 years and over half were in paid employment. Five themes were identified: (1) The legislation is acceptable, but people can still (and should be able to) buy HFSS items; (2) The legislation is likely to have more impact on shoppers who do not plan their shopping; (3) Affordability of healthy food is just as, or more, important than the legislation; (4) It's up to the individual to eat healthily; and (5) Government and retailers can better support consumers to make healthy choices.

CONCLUSION

Most participants were optimistic about the incoming regulations and believed that it would support consumers to make healthier food choices. Many raised concerns, however, that the high price of healthy foods and continued availability of unhealthy foods within the stores could undermine the legislation's benefits. Coupling the legislation with interventions to promote and reduce the costs of healthier products would go some way to ensure its success. Raising awareness about marketing strategies that play into consumer concerns for cost and autonomy could further increase acceptance of the policy.

Supporting home-based meal preparation improves lunchtime habits and self-assessed work performance of interns at a tertiary hospital

There is ample evidence that doctors frequently miss meals at work, which negatively impacts concentration, decision-making and overall patient care. Junior doctors are particularly vulnerable given their heavy workload. We report on the impact of a pilot programme supporting home-based meal preparation on the dietary habits and energy levels of interns at a tertiary hospital and demonstrate this is one strategy healthcare organisations can adopt to promote a healthier workforce.

Food prescription pilots: feasibility, acceptability and affordability of improving diet through menu planning and grocery delivery

BACKGROUND

Lack of adherence is a primary reason people fail to maintain a healthy diet or lose weight. Multiple environmental factors, including aggressive marketing and convenience of nutrient-poor food, undermine people's best intentions. The aim was to assess the feasibility, acceptability and impact of food prescriptions in which participants' exposure to commercial food outlets is reduced, because the groceries are delivered with weekly menu plans and recipes.

METHODS

This is a series of pre-post pilot proof-of-concept studies. We recruited 37 members of Kaiser Permanente interested in improving their diet or losing weight. Weekly meal plans meeting more than 90% of recommended dietary allowances were designed to be low cost, in line with Supplemental Nutrition Assistance Program (SNAP) allowances. Five separate pilots targeted different populations. Participants were required to provide 24-h dietary recalls (ASA24) before and during the interventions. Weight management pilot participants had height, weight and blood pressure measured before and after 4-week pilots and followed sustainability guidelines, limiting meat and dairy.

RESULTS

Across pilots, the healthy eating index improved (+21.1 points; 95% CI [confidence interval] 15.9, 26.3). For the weight management pilots, most participants lost weight (average 10.3 lbs for men, 5.7 lbs for women; 95% CI -10.2, -5.4). The majority of participants liked the programme and considered it the easiest weight loss programme they ever tried.

CONCLUSIONS

These pilots suggest that meal planning and grocery delivery can be affordable and acceptable and could ultimately have a major impact on diet-related chronic diseases. Longer-term studies are needed to confirm how long compliance will endure.

Introduction to the dietary management of obesity in adults

Obesity is a multifaceted and complex condition that requires holistic management. It currently affects nearly one in four adults in the UK, with the UK ranked 10th globally for the highest obesity rates. Obesity is projected to have an economic burden of ∼£2 billion per year by 2030 in the UK.1 Excess weight gain can coincide with myriad health concerns and multiple health conditions, which can be physical, metabolic or psychosocial. This includes type 2 diabetes mellitus (T2DM), hypertension, coronary heart disease, osteoarthritis, obstructive sleep apnoea, reproductive disorders, depression and cancer2; hence, there has been a significant emphasis on obesity prevention. Obesity is often associated with weight stigma, impacting psychological wellbeing and quality of life. This can influence an individual's likelihood of seeking support, delaying appropriate input from healthcare professionals, with a knock-on effect on pre-existing health conditions. This review explores the management of obesity from a nutritional perspective, because modifying dietary intake is essential to reduce the risk of non-communicable diseases, including those associated with obesity.

Predictors of food variety and food consumption scores of adolescents living in a rural district in Ghana

INTRODUCTION

There is a dearth of information about the food variety and consumption scores of adolescents in Ghana. This study assessed predictors of food variety and consumption scores of adolescents living in a rural district in Ghana.

METHOD

In this cross-sectional study, a multi-stage sampling method was used to select one hundred and thirty-seven (137) adolescents from the Asante-Akim South Municipality of Ghana. A structured questionnaire was used to collect data on sociodemographic, food practices and dietary intakes of study participants. Descriptive, chi-square, T-test, partial correlation and binary logistic regression were used for the data analysis.

RESULTS

The mean food variety score was 25.8±6.4 (range 7-42) and food consumption score was 35±5.1 (range 18.6-49.9). Food variety score was significantly (p<0.05) associated with guardian income status. A significant and positive partial correlation existed between food variety score and calcium intake (r = 0.236, p<0.05). About 49% and 51% of adolescents were food insecure and food secure, respectively. Food consumption score had significant association (p<0.05) with gender (X2 = 6.1), residence (X2 = 7.0), frequency of meal (X2 = 6.8) and food variety score (X2 = 5.4). Adolescent male (AOR = 2.3, 95% CI (1.2-4.6), p = 0.017), peri-urban residency (AOR = 2.1, 95%CI (1.0-4.4), p = 0.036), having three or more meals per day (AOR = 4.2, 95% CI (1.3-13.6), p = 0.018), and a high food variety score (AOR = 2.1, 95%CI (1.0-4.2), p = 0.041) significantly predicted food consumption scores.

CONCLUSION

Moderate income status was associated with food variety score in our study participants. Linear relationship existed between food variety and calcium intake. Adolescent males, peri-urban residency, frequency of meals and high food variety score were the predictors of food consumption score. Nutrition-specific and nutrition sensitive programmes aimed at promoting adolescent health should involve guardians.

Characterizing the Course of Loss of Control Eating and Prognostic Factors Following Bariatric Surgery: an Exploratory Analysis

PURPOSE

Postoperative loss of control eating (LOCE) has detrimental associations with weight outcomes and mental health following bariatric surgery. However, little is known regarding LOCE course following surgery and preoperative factors that predict remittance, continuance, or development of LOCE. The present study aimed to characterize LOCE course in the year following surgery by identifying four groups: individuals with (1) postoperative de novo LOCE, (2) maintained LOCE (endorsed at pre- and post-surgery), (3) remitted LOCE (endorsed only at pre-surgery), and (4) those who never endorsed LOCE. Exploratory analyses examined group differences in baseline demographic and psychosocial factors.

MATERIALS AND METHODS

A total of 61 adult bariatric surgery patients completed questionnaires and ecological momentary assessment at pre-surgery and 3-, 6-, and 12-month postoperative follow-ups.

RESULTS

Results showed that 13 (21.3%) never endorsed LOCE prior to or after surgery, 12 (19.7%) developed LOCE after surgery, 7 (11.5%) evidenced remittance from LOCE after surgery, and 29 (47.5%) maintained LOCE prior to and after surgery. Relative to those who never endorsed LOCE, all groups who evidenced LOCE before and/or after surgery reported greater disinhibition; those who developed LOCE reported less planned eating; and those with maintained LOCE reported less satiety sensitivity and greater hedonic hunger.

CONCLUSION

These findings highlight the importance of postoperative LOCE and need for longer-term follow-up studies. Results also suggest a need to examine the longer-term impact of satiety sensitivity and hedonic eating on LOCE maintenance, and the extent to which meal planning may buffer risk for de novo LOCE following surgery.

Involvement of Brazilian adolescents in home cooking: An exploratory analysis (EVA-JF Study)

OBJECTIVE

The aim of this study was to investigate the involvement of Brazilian adolescents in home cooking, estimating its associations with sex and socioeconomic status.

METHODS

This cross-sectional study involved a probabilistic sample of 14- to 19-y-olds enrolled in 29 public schools in the municipality of Juiz de Fora, MG, Southeast Brazil (n = 835). To assess involvement in home cooking, a 12-question questionnaire was used. The content was based on the Brazilian Food Guide, which encourages the acquisition, development, and sharing of culinary skills. Pearson's χ test and Poisson regression models were carried out, without and with adjustments.

RESULTS

Most of the adolescents did not usually participate in meal planning (61%), and in the choice/purchase of food and culinary ingredients (67%). Boys were less likely to know how to cook "from scratch", positively self-evaluate their culinary skills, enjoy cooking, wish to learn more about cooking and meal preparation, and to participate frequently in the planning and preparation of meals. Belonging to a lower socioeconomic status represented a greater probability of preparing meals alone for the family.

CONCLUSIONS

We verified an alarming prevalence of adolescents with behaviors unaligned with Brazilian Food Guide recommendations; that is, most of them, especially boys, were not involved in home cooking. Adolescence may present a window of opportunity for the development of culinary skills, resulting in long-term benefits for the population's diet quality. Furthermore, to change a historical pattern that overloads women's daily lives, it is necessary to encourage, from an early age, the presence of boys in the kitchen.

SnackTrack-An App-Based Tool to Assess the Influence of Digital and Physical Environments on Snack Choice

As food choices are usually processed subconsciously, both situational and food environment cues influence choice. This study developed and tested a mobile app to investigate the association between physical and digital environments on snack choices. SnackTrack was designed and used to collect data on the snack choices of 188 users in real-life settings during an 8-week feasibility trial. The app asks users to take a photo of the food they are planning to consume and to provide additional information regarding the physical environment and context in which this food was eaten. The app also displayed various user interface designs (i.e., different background images) to investigate the potential effects of images on snack choice. Preliminary results suggest that the time of snack obtainment did not have a significant effect on the healthfulness of the snacks chosen. Conversely, it was found that unhealthy background images appeared to encourage healthier snack choices. In conclusion, despite consumers having the knowledge to make healthy choices, environmental cues can alter food choices. SnackTrack, a novel tool to investigate the influence of physical and digital environments on consumers' food choices, provides possibilities for exploring what encourages (un)healthy eating behaviours.

Optimizing Fertility Treatment With Nutrition Guidance: Exploring Barriers and Facilitators to Healthful Nutrition Among Female Cancer Survivors With Fertility Challenges

INTRODUCTION

Young women diagnosed with cancer are at an increased risk for infertility compared to women without a cancer diagnosis. Consuming a healthful diet comprised of whole grains, fruits, vegetables, and unsaturated fats has been found to improve both fertility and cancer survivorship. Given this reason, dietary interventions tailored to support female cancer survivors with fertility challenges are of immense importance. Therefore, the aim of this study was to explore barriers and facilitators to healthful nutrition among female cancer survivors with fertility challenges, to inform the development of dietary interventions for this population.

METHODS

Using a formative research design, interview, survey, and dietary intake data were collected from 20 female cancer survivors of reproductive age. Participant-check focus group discussions were conducted to validate findings. All interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a thematic analysis approach. Quantitative data were analyzed using means, standard deviations, ranges, frequencies, and percentages.

RESULTS

The average age of respondents was 31.47 ± 3.5 years and the average BMI was 24.78 ± 4.1 kg/m2. All participants were college educated, 45% identified as White, 50% as Black, and 10% as Hispanic or Latinx. Cancer diagnoses included breast, thyroid, ovarian, leukemia, and gastrointestinal cancers. The following themes were identified: (1) Lack of nutrition-related resources and detailed guidance, (2) Work-life balance, (3) Perceived rigidity of dietary guidance, (4) Treatment-related fatigue, (5) Having trust in healthcare providers, (6) Higher motivation to change nutrition behavior, and (7) Recognizing the additional benefits of nutrition.

CONCLUSION

These findings indicate a sought-after yet unmet need for post-cancer treatment fertility nutrition recommendations. Interventions should be tailored to women's needs and focus on improving their self-efficacy to make healthful dietary choices.

Challenges of diet planning for children using artificial intelligence

BACKGROUND/OBJECTIVES

Diet planning in childcare centers is difficult because of the required knowledge of nutrition and development as well as the high design complexity associated with large numbers of food items. Artificial intelligence (AI) is expected to provide diet-planning solutions via automatic and effective application of professional knowledge, addressing the complexity of optimal diet design. This study presents the results of the evaluation of the utility of AI-generated diets for children and provides related implications.

MATERIALS/METHODS

We developed 2 AI solutions for children aged 3-5 yrs using a generative adversarial network (GAN) model and a reinforcement learning (RL) framework. After training these solutions to produce daily diet plans, experts evaluated the human- and AI-generated diets in 2 steps.

RESULTS

In the evaluation of adequacy of nutrition, where experts were provided only with nutrient information and no food names, the proportion of strong positive responses to RL-generated diets was higher than that of the human- and GAN-generated diets (P < 0.001). In contrast, in terms of diet composition, the experts' responses to human-designed diets were more positive when experts were provided with food name information (i.e., composition information).

CONCLUSIONS

To the best of our knowledge, this is the first study to demonstrate the development and evaluation of AI to support dietary planning for children. This study demonstrates the possibility of developing AI-assisted diet planning methods for children and highlights the importance of composition compliance in diet planning. Further integrative cooperation in the fields of nutrition, engineering, and medicine is needed to improve the suitability of our proposed AI solutions and benefit children's well-being by providing high-quality diet planning in terms of both compositional and nutritional criteria.

Analysis of Recipes Shared as 'Healthy' in a Popular Brazilian Website: A Cross-Sectional Study

Cooking is crucial to the achievement of healthy eating habits, and the internet, as host of culinary recipes websites, is a medium for the dissemination of cooking-related content. Research has revealed that most recipes available on internet sites do not have healthy characteristics when compared to recommendations for healthy eating, even the ones promoted as 'healthy'. This study investigated culinary recipes available on the 'healthy eating' section of a popular Brazilian recipe-sharing website. Recipes (n = 814) were analyzed with a validated framework based on national dietary guidelines. Ingredients (n = 5887) were classified according to the extension and purpose of their industrial processing. The recipes' titles were content analyzed to identify the health-related words and phrases used. Recipes contained ultra-processed foods and not enough unprocessed or minimally processed foods, such as legumes (4.7%, n = 380), nuts and seeds (18.4%, n = 150), and fruits (n = 32.7%, n = 263). The recipes' titles mentioned 564 health-related terms, appealing to physical characteristics, including weight loss, and fads, such as gluten-free, dukan, low-carb, detox, fitness, ripped body, and belly burner. Therefore, the 'healthy' recipes available on the Brazilian recipe-sharing website presented many aspects not in accordance with national dietary guidelines.

Parental Perspectives of the Impact of COVID-19 Lockdown on Food-Related Behaviors: Systematic Review

Home confinement during the COVID-19 pandemic has been accompanied by dramatic changes in household food dynamics that can significantly influence health. This systematic literature review presents parental perspectives of the impact of COVID-19 lockdown (up to 30 June 2022) on food preparation and meal routines, as well as other food-related behaviors, capturing both favorable and unfavorable changes in the household food environment. Themes and trends are identified and associations with other lifestyle factors are assessed. Overall, families enjoyed more time together around food, including planning meals, cooking, and eating together. Eating more diverse foods and balanced home-cooked meals (e.g., fresh fruit and vegetables) was combined with overeating and increased snacking (e.g., high-calorie snacks, desserts, and sweets), as parents became more permissive towards food; however, food insecurity increased among families with the lowest income. Adoption of meal planning skills and online shopping behavior emerged alongside behaviors aimed at self-sufficiency, such as bulk purchasing and stockpiling of non-perishable processed foods. These results are an important first step in recognizing how this pandemic may be affecting the family food environment, including low-income families. Future obesity prevention and treatment initiatives, but also ongoing efforts to address food management, parental feeding practices, and food insecurity, can account for these changes moving forward.

The Validated Features of Psychological Interventions for Weight Loss: An Integration

Many psychological inclinations, such as maladaptive beliefs, can diminish the capacity of individuals to manage their weight effectively and sustainably. Yet, interventions that purportedly address these psychological inclinations and improve weight management are not always beneficial. To be effective, these interventions should offer participants several choices, should be devoid of features that have not been validated in isolation, and should arrange the various activities in an efficient and effective sequence. Few if any programs fulfill these criteria. The aim of this paper was to construct an intervention that assimilates all the validated features of interventions that overcome the psychological impediments to weight loss. To achieve this goal, we blended a technique called intervention component analysis with thematic analysis. Specifically, we extracted refereed journal articles about weight loss from PsycInfo, distilled the practical recommendations from these articles, excluded recommendations that had not been validated in isolation of other features, integrated overlapping recommendations, and applied several principles to arrange these recommendations into the most effective sequence. This procedure generated an intervention that could comprise up to 43 features and activities, including self-affirmation to foster openness to change, anecdotes about dramatic improvements, ambitious rather than modest targets, an emphasis on strategies rather than targets, rewards for attempts, implementation intentions with partners, self-hypnosis, cognitive reframing, and distancing. If these features are unsuccessful, practices that demand more resources-such as group disclosure, virtual environments, motivational interviewing, and customized programs-were also recommended.

Gender, work-family conflict, and weight gain: four-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

This study sought to analyze the effect of work-to-family conflict (demands from work that affect one's family/personal life), family-to-work conflict (demands from family/personal life that affect work), and lack of time for self-care and leisure due to professional and domestic demands on the incidence of weight gain and increase in waist circumference by gender in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Our study included 9,159 ELSA-Brasil participants (4,413 men and 4,746 women) who attended baseline (2008-2010) and the first follow-up visit (2012-2014). Weight gain and increase in waist circumference were defined as an annual increase ≥ 75th percentile, i.e., ≥ 1.21kg/year and ≥ 1.75cm/year, respectively for women; and ≥ 0.96kg/year and ≥ 1.41cm/year respectively for men. Associations were estimated by Poisson regression applying robust variance with the R software. Analyses were stratified by gender and adjusted for socioeconomic variables. Adjusted models showed a higher risk of weight gain among women who reported family-to-work conflict frequently and sometimes (relative risk - RR = 1.37 and RR = 1.15, respectively) and among those who reported frequent lack of time for self-care and leisure (RR = 1.13). Among men, time-based work-to-family conflict (RR = 1.17) and strain-based work-to-family conflict (RR = 1.24) were associated with weight gain. No associations were observed between work-family conflict domains and increase in waist circumference. These findings suggest that occupational and social health promotion programs are essential to help workers balance work and family life to reduce weight gain.

Development of Reliable and Valid Questions to Assess Food Resource Management Behaviors in Adults With Limited Income

OBJECTIVE

Develop reliable, valid questions to assess changes in food resource management (FRM) behaviors in adults with limited incomes.

DESIGN

Questionnaire development using a mixed-methods approach: content validity (subject matter and curricula), face validity, temporal reliability (test-retest), sensitivity to change, and exploratory factor analysis (EFA).

SETTING

Community settings in 12 states.

PARTICIPANTS

Convenience samples of English-speaking Expanded Food and Nutrition Education Program (EFNEP) or EFNEP-eligible adults: 105 (cognitive interviews), 181 (test-retest), 185 (sensitivity), and 389 (EFA) adults.

VARIABLES MEASURED

Behaviors related to FRM skills: planning, shopping, and budgeting.

ANALYSIS

Consistency and agreement in cognitive interviews and temporal reliability; sensitivity at posttest (paired t tests, Wilcoxon signed-rank tests); internal consistency of scales identified in EFA (Cronbach α). P < 0.5.

RESULTS

All questions had acceptable temporal reliability ranges for the intraclass correlation coefficient (0.48-0.74) and Spearman rank-order correlation (0.48-0.73). All questions were sensitive to change at posttest (P < 0.001). Planning and saving scales, revealed by EFA, demonstrated internal consistency (> 0.80 Cronbach α).

CONCLUSIONS AND IMPLICATIONS

The 9 FRM behavior questions have acceptable temporal reliability and content and face validity and can be used nationally by EFNEP to assess participants' self-reported behavior changes. Other nutrition programs with similar audiences and content could use these questions to measure changes in FRM behaviors.

Nutritional self-care practices and skills of patients with diabetes mellitus: A study at a tertiary hospital in Ghana

Introduction

Nutritional management decreases and/or prevents the complications and deaths associated with diabetes mellitus. However, the majority of patients living with diabetes do not engage in optimal nutritional management of diabetes because they see it as the most difficult aspect of managing the condition. This study aimed to explore and describe the practices and skills on nutritional management of diabetes mellitus among patients living with diabetes attending a Ghanaian hospital.

Materials and methods

This study employed an exploratory, descriptive qualitative research design. Fifteen participants were recruited using purposive sampling, and interviewed with a semi-structured interview guide. Content analysis was performed on the data gathered, following which three main themes emerged.

Results

More than two-thirds of the participants of this study had adequate meal planning skills, ate the right quantity of foods, engaged in healthy eating habits, and consumed healthy sources of carbohydrates, fats and protein when eating. However, more than half of the participants had insufficient knowledge and skills in the reading and usage of food labels.

Conclusions

The participants of this study largely engaged in optimal nutritional management of diabetes due to their healthy dietary practices and preferences. It is recommended that health care professionals in Ghana find practical and robust ways to factor the reading and usage of food labels into the care and management of patients with diabetes.

Teaching a Man to Fish: An Evaluation of a Chronic Disease Management Men's Cooking Class

There is limited data on the effects of cooking classes on male participants. The LiveWell Chronic Disease Management program's Men's Cooking Class (MCC) aims to help participants gain skills and confidence with food to manage chronic diseases more independently and improve their health. This paper evaluates whether, and how, the program is effective in achieving its goals.A qualitative process was used to collect data from past program participants. Data collection included telephone interviews conducted with a sample of 27 past MCC attendees and a focus group held with a subsample of seven participants. Thematic analysis was performed on collected data.Five major themes emerged, including (i) practical and applicable content, (ii) kinesthetic teaching and learning, (iii) catering to the interests of participants, (iv) tailoring to the demographic, and (v) enjoyment and engagement. Findings indicate the current LiveWell MCC program is effective in meeting its goals. The themes identified are aspects of the program that contribute to this effectiveness.The thematic findings indicate areas in which to continuously adapt and monitor the effectiveness of this program and serve as recommendations for other programming. Further research on the long-term impact of MCC for self-management of chronic disease is needed.

Barriers, Attitudes, and Influences Towards Dietary Intake Amongst Elite Rugby Union Players

Background: Dietary intakes can impact an athletes health and performance. Although evidence exists about what an athlete should eat, an athlete's nutritional intake is influenced by many factors. The limited research available suggests the main barriers preventing optimal nutritional intakes reported by athletes are lack of time, food accessibility, poor cooking skills, costs, taste, and time spent in “off-season.” Although these factors have been shown to influence dietary intake they remain relatively unexplored in Rugby Union. This study aimed to describe the nutritional influences on dietary intake amongst Rugby Union player's.

Methods: This was a qualitative study utilising in person individual interviews with all participants. Participants were Rugby Union players (n = 30) for either a Super Rugby franchise or one of their development squads in New Zealand. Participant's undertook recorded face to face interviews, which were later transcribed. A thematic approach was used to code the transcripts by the primary coder and the themes were subsequently evaluated by the research team.

Results: Childhood upbringing, organisational skills, time and food security also emerged as barriers. Body composition and sport nutrition knowledge emerged as both barriers and enablers to nutritional intake. Influence on performance was an enabler to optimal dietary intake. Fully professional rugby players have access to dietitians, whereas development and semi-professional rugby players only have limited if any access, and they were more likely to seek nutritional information via social media.

Conclusion: This study suggests a need for greater nutrition education at developmental levels with an emphasis on affordable food choices, meal planning and skills for interpreting online nutrition information.

Perceptions of Weight Loss in Older Adults Following a 6-Month Weight Loss Program: A Qualitative Research Study

BACKGROUND

Obesity in older adults contributes to increasing comorbidities and decreased quality of life. There is limited research that includes older adults' perspectives on weight loss.

OBJECTIVE

The purpose of this qualitative study was to gain a better understanding of older adults' perceptions and experiences related to weight loss immediately after a 6-month weight loss intervention.

DESIGN

A qualitative research design using semi-structured interviews conducted as part of a larger research study exploring weight loss and/or aerobic exercise on muscle inflammation.

PARTICIPANTS/SETTING

A sample of community-based older adults (n = 11) in Southwestern Ohio were recruited from September 2018 through August 2019 after completion of a 6-month weight loss intervention. Eligible participants were older than 58 years, with a body mass index (calculated as kg/m²) >27, and sedentary with no cognitive deficits. Exclusions included cancer, heart disease, diabetes, and tobacco use.

ANALYSIS

Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Descriptive statistics were used for demographic data.

RESULTS

Three emergent themes included barriers and challenges to weight loss, which included caregiving roles, challenges with increasing protein intake, and ambivalence to change; personal strategies for success (eg, portion control and meal flexibility); and external strategies for success (eg, visual graphs as feedback measures, alternate measures of success, and social support).

CONCLUSIONS

The results of this qualitative study provide insight into older adults' experiences with weight loss, which may be considered when designing weight management interventions. However, more research is needed to examine strategies to address the challenges identified by participants in this research study. Future qualitative research should also focus on weight loss perspectives of older adults in other racial and ethnic groups.

Food Skills: Associations With Diet Quality and Food Waste Among Canadian Parents

OBJECTIVE

To examine the association between self-reported food skills and diet quality along with measured food waste among a sample of Canadian parents.

DESIGN

Cross-sectional data from surveys to assess food skills, 3-day food records to assess the Healthy Eating Index (HEI)-2015, and food waste measured by household waste audits.

SETTING

Guelph-Wellington, Ontario.

PARTICIPANTS

Parents (n = 130) with children aged 2-8 years.

MAIN OUTCOME MEASURES

HEI-2015 scores, daily per capita avoidable and unavoidable food waste (grams).

ANALYSIS

Linear regression using generalized estimating equations to determine unstandardized β estimates of associations between food skills and dependent variables. Models were adjusted for multiple testing, gender, and level of education.

RESULTS

Food safety knowledge for cooking hot foods (β = 4.3, P = 0.05), planning (β = 4.5, P = 0.001), and conceptualizing food (β = 4.0, P = 0.03) were positively associated with HEI-2015 scores. Knowledge related to best before dates (β = 25.3, P = 0.05; β = 12.1, P = 0.04), conceptualizing food (β = 34.1, P = 0.01; β = 13.8, P = 0.02), and mechanical techniques (β = 39.2, P = 0.01; β = 20.5, P = 0.004) were associated with more avoidable and unavoidable food waste, respectively.

CONCLUSIONS AND IMPLICATIONS

Addressing higher-level food skills with a focus on efficient food preparation practices that make use of all edible portions of foods could play an important role in minimizing food waste and improving diet quality. Additional research in other countries and in a larger, more socioeconomically diverse sample is needed to confirm these findings.

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

A healthy postpartum lifestyle is vital for the promotion of optimal maternal health, return to pre-pregnancy weight and prevention of postpartum weight retention, but barriers exist. We performed a systematic review that aimed to describe the barriers and facilitators to a healthy lifestyle in the first 2 years postpartum from the perspectives of women and healthcare providers. Databases were searched for eligible studies published up to 26 August 2019. Following thematic analysis, identified themes were mapped to the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour model. We included 28 qualitative and quantitative studies after screening 15,643 citations and 246 full texts. We identified barriers and facilitators relating to capability (e.g., lack of knowledge regarding benefits of lifestyle behaviours; limitations in healthcare providers' skills in providing lifestyle support), opportunity (e.g., social support from partners, family, friends and healthcare providers; childcare needs) and motivation (e.g., identifying benefits of exercise and perception of personal health; enjoyment of the activity or food). We suggest intervention components to include in lifestyle interventions for postpartum women based on the identified themes. Our findings provide evidence to inform the development of interventions to support postpartum women in adopting and maintaining a healthy lifestyle.

Cooking at Home and Adherence to the Mediterranean Diet During the COVID-19 Confinement: The Experience From the Croatian COVIDiet Study

Introduction: The primary aims of this study were to evaluate the changes in dietary behavior among the Croatian adult population during the COVID-19 outbreak and to explore the impact of confinement on cooking habits.

Methods: The study was based on results from COVIDiet_Int cross-sectional study—a part of COVIDiet project (NCT04449731). A self-administered online questionnaire was used to assess the frequency of food consumption, eating habits, and sociodemographic information. A total number of 4,281 participants (80.5% females and 19.4% males) completed the questionnaire.

Results: The Mediterranean Diet Adherence Screener (MEDAS) score before the confinement was 5.02 ± 1.97, while during the confinement, the MEDAS score increased to 5.85 ± 2.04. Participants who had higher adherence to the Mediterranean diet (MedDiet) during the confinement were mostly females (88.8%), aged between 20 and 50 years, with the highest level of education (66.3%) and normal BMI (70.6%). The majority of participants maintained their dietary behavior as it was before COVID-19 confinement, while 36.9% decreased their physical activity. Participants with higher MEDAS score were more eager to increase their physical activity. Additionally, higher median values of MEDAS score were noted for participants with body mass index values below 24.9 kg/m² (6.0 vs. 5.0 for participants with BMI above 25 kg/m²). Participants in all residence places increased their cooking frequency during the confinement (53.8%), which was associated with an increase in vegetables, legumes, as well as fish and seafood consumption.

Conclusions: According to our findings, Croatian adults exhibited medium adherence to the MedDiet during the COVID-19 confinement. The results suggest that cooking frequency could be positively associated with overall dietary quality, which is of utmost importance in these demanding times.

A three-year longitudinal study on the use of pre-ordering in a university canteen

Meal pre-planning is considered a cost-effective behavioral strategy that can improve eating habits, reduce food waste and benefit food operators. This work aimed to offer new insights on the use of meal pre-ordering systems, in particular with regard to younger generations' booking habits and their evolution over time. Our data included observations from 946 students who visited a university canteen over the course of three years. We tried to address questions that were not previously explored in a real setting, namely we analyzed how widespread the use of pre-ordering can be, how much in advance and for how many days users plan their meals, whether there exists a compensation effect for those who order in advance and if increased familiarity with this booking system influences its adoption over time. We found that the adoption of pre-ordering was highest among graduate female students (odds ratio 1.67, p <0.001), who also planned their lunches further in advance and for more consecutive days compared to their peers. Our data also suggested that pre-ordering may increase the amount of uncollected orders, a potential source of collateral waste previously not identified in the literature. Although the generalizability of our findings is limited by the unique characteristics of the setting, the results obtained provide novel cues upon which future literature may build.

Understanding Mothers' Perceptions of Food Skills: A Qualitative Study

BACKGROUND

Food skills are behaviors surrounding the planning, purchasing, and preparing of food. Food skills have been identified as important for promoting diet quality. Little work has investigated specific food skills perceived by parents to promote a healthy diet or parents' perceived barriers to implementing food skills.

OBJECTIVE

Our aim was to determine current food skills that parents identify as helpful behaviors for consuming a healthy diet and the perceived barriers to implementing food skills.

DESIGN

We conducted a qualitative study using focus groups with mothers (18 years or older) who reported being primarily responsible for acquiring and preparing food.

PARTICIPANTS/SETTING

Thirty mothers with at least 1 child under the age of 18 years were asked to attend 1 of 5 focus groups held in a university setting.

MAIN OUTCOMES

Outcomes included emergent themes and subthemes within the domains of food skill behaviors identified as helpful and perceived barriers to implementing food skills.

ANALYSIS

Focus groups were audio-recorded and transcribed. Thematic analysis was used to analyze transcripts and descriptive statistics were used to characterize participant demographics.

RESULTS

Food skill themes identified as helpful behaviors for consuming a healthy diet included mothers' resourcefulness, overall planning behaviors, and child involvement and influence. Themes for barriers to implementing food skills included limited time, cooking for multiple needs and tastes, exposure to food and sales while shopping, and food cost.

CONCLUSIONS

Qualitative findings indicated that mothers need behavior strategies for time management, meeting multiple family needs, dealing with exposure to food and sales, and food resource management rather than being provided solely with education. These findings can inform future behavior-based interventions to improve the diet quality of families.

An Evaluation of the COVID-19 Pandemic and Perceived Social Distancing Policies in Relation to Planning, Selecting, and Preparing Healthy Meals: An Observational Study in 38 Countries Worldwide

Objectives

To examine changes in planning, selecting, and preparing healthy foods in relation to personal factors (time, money, stress) and social distancing policies during the COVID-19 crisis.

Methods

Using cross-sectional online surveys collected in 38 countries worldwide in April-June 2020 (N = 37,207, Mage 36.7 SD 14.43, 73.6% women), we compared changes in food literacy behaviors to changes in personal factors and social distancing policies, using hierarchical multiple regression analyses controlling for sociodemographic variables.

Results

Increases in planning (4.7 SD 1.2, 4.9 SD 1.3), selecting (3.8 SD 1.7, 3.8 SD 1.7), and preparing (4.6 SD 1.3, 4.7 SD 1.3) healthy foods were found for women and men, and positively related to perceived time availability among women and stay-at-home policies for planning and preparing in women. Psychological distress was a barrier for women, and an enabler for men. COVID-19 induced financial stress was a barrier depending on various sociodemographic variables (all p < 0.01).

Conclusion

Stay-at-home policies and feelings of having more time during COVID-19 seem to have improved food literacy among women. Stress and other social distancing policies relate to food literacy in more complex ways, highlighting the necessity of a health equity lens.

Development of a Lebanese food exchange system based on frequently consumed Eastern Mediterranean traditional dishes and Arabic sweets

Background: The important role of Mediterranean diet was elucidated in various clinical and epidemiological studies underlying its impact on reducing the burden of non-communicable diseases in Mediterranean and non-Mediterranean populations.

Objective: The aim of this study was to convert the recipes of the Lebanese traditional dishes into meal planning exchange lists whose items are expressed in grams and adjusted to Lebanese household measures (cups and spoons) that could be used by healthcare professionals.

Methodology: Thirty traditional Lebanese dishes were collected in which the carbohydrate, fat and protein were analyzed using Association of Official Analytical Chemists procedures then followed by a calculation of exchange lists of foods per serving using Wheeler method.

Results:  The variations in macronutrients and fiber content were found among the Lebanese dishes. Carbohydrate was lowest (1.1g/100g) and protein was highest (29.7g/100g) in Shawarma Dajaj whereas fat content ranged between 0.5 and 22.4 g/100 g in the dishes. For each dish and according to each serving size, carbohydrate, milk (whole milk, reduced fat or skim), fat and protein (lean meat, medium fat meat and high fat meat) exchanges were calculated.

Conclusion: This study provides healthcare professionals, dietitians and consumers the chance to proficiently plan traditional-type dishes, ensuring prominent dietetic and medical nutritional therapy practices and patient's self-control.

Associations Between Weight Loss Attempts, Food Planning, and the Home Food Environment

OBJECTIVE

To evaluate whether food planning behaviors mediate the relationship between a reported weight loss attempt and the home food environment (HFE).

DESIGN

Secondary data analysis of 4 home visits, included collecting an objective home food inventory of the HFE and self-reported food planning behaviors.

PARTICIPANTS

There were 196 participants (mean age, 44.4 years; 83.7% female).

MAIN OUTCOME MEASURES

The percentage of obesogenic foods and fruits and vegetables (FV).

ANALYSIS

Four regression analyses to test mediation.

RESULTS

Meal planning and grocery list use did not explain the relationship between a weight loss attempt and obesogenic foods or FV in the home (P > 0.05). Post hoc analyses that examined participants with a body mass index of >25, >28, and >30 found that a weight loss attempt was associated with fewer obesogenic foods. In contrast, mediation analyses with planning behaviors and associations with FV in the home were nonsignificant (P > 0.05).

CONCLUSIONS AND IMPLICATIONS

Obesity was more indicative of the HFE than making a weight loss attempt. A weight loss attempt was not associated with food planning behaviors, which may be used for multiple reasons, including organization and time management. Future studies should evaluate individual differences in strategies to create a healthy HFE in the context of a weight loss attempt.

Psychometric Analyses of the Eating and Food Literacy Behaviors Questionnaire with University Students

OBJECTIVES

This study developed and validated a questionnaire to measure young adults' perceived food literacy and behaviors toward food and created an explanatory model.

DESIGN

Cross-sectional.

SETTING

Large southeastern US university.

PARTICIPANTS

A total of 1,896 students, aged 18-30 years, were recruited. Data from 1,813 were analyzed.

VARIABLES MEASURED

Health and nutrition, taste, food preparation, planning and decision-making, and convenience.

ANALYSIS

Exploratory factor analysis, test-retest reliability, confirmatory factor analysis, and structural equation modeling were performed.

RESULTS

Exploratory factor analysis returned 5 factors with acceptable internal structure. Test-retest reliability coefficients ranged from 0.63 to 0.92. Confirmatory factor analysis suggested that a 5-factor model was an appropriate fit for the data (χ² = 588.05; degrees of freedom = 142; root mean square error of approximation = 0.06; comparative fit index = 0.98; Tucker-Lewis Index = 0.97; standardized root mean square residual = 0.05). Structural equation modeling revealed relationships from health and nutrition to food preparation (0.25, P < 0.001), planning and/or decision-making (0.57, P < 0.001), taste (-0.14, P < 0.001), and convenience (-0.31, P < 0.001). The structural equation model demonstrated adequate fit (adjusted goodness of fit = 0.91; comparative fit index = 0.93; non-normed fit index = 0.91; root mean square error of approximation = 0.06; and standardized root mean square residual = 0.07) and a significant chi-square test (χ² = 628.92; degrees of freedom = 171, P < 0.001).

CONCLUSIONS AND IMPLICATIONS

Young adults consider food literacy-related factors and behavioral concerns when making food choices.

Cooking Frequency and Perception of Diet among US Adults Are Associated with US Healthy and Healthy Mediterranean-Style Dietary Related Classes: A Latent Class Profile Analysis

Background: Meal habits are associated with overall dietary quality and favorable dietary patterns determined by the Healthy Eating Index (HEI). However, within dietary patterns, complexities of food combinations that are not apparent through composite score determination may occur. Also, explorations of these food combinations with cooking and perceived diet quality (PDQ) remain unknown. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 were utilized to determine the frequency of cooking at home and PDQ, along with sociodemographic variables. Latent class profile analysis was performed to determine person-centered data-driven analysis using the dietary index, HEI-2010, at both the daily and dinner meal-time levels. Multinomial logistic regression analysis was utilized to evaluate the association of dietary patterns with all covariates. Results: For daily HEI, five distinct dietary classes were identified. For dinner HEI, six classes were identified. In comparison to the standard American diet classes, home cooking was positively associated with daily (p < 0.05) and dinner (p < 0.001) dietary classes that had the highest amounts of total vegetable and greens/beans intake. PDQ was positively associated with these classes at the daily level (p < 0.001), but negatively associated with healthier classes at the dinner level (p < 0.001). Conclusion: The use of latent class profile analysis at the daily and dinner meal-time levels identified that food choices coalesce into diverse intakes, as shown by identified dietary classes. Home cooking frequency could be considered a positive factor associated with higher vegetable intake, particularly greens/beans, at the daily and dinner levels. At the same time, the perception of diet quality has a positive association only with daily choices.

The impact of intuitive eating v. pinned eating on behavioural markers: a preliminary investigation

Two promising strategies to manage eating behaviour are intuitive eating (IE; following hunger) and pinned eating (PE; ignoring hunger/eating at specific times of the day). This study compared IE and PE on behavioural markers. Participants (n 56) were randomly assigned to IE (n 28) or PE (n 28) and given instructions to follow for 1 week. Drive to eat, behaviour, behavioural intentions and self-efficacy were measured at baseline and follow-up. Participants also evaluated their specific intervention. Comparable changes over time were found for both conditions for many measures. Significant conditions by time interactions were found for healthy snacking, total self-efficacy and self-efficacy for weight loss: those following IE showed an increase in each of these outcomes compared to those following PE who showed no change. The IE group found their intervention more useful than those following PE. Further research is needed to build on these preliminary findings.

Diet and cognitive function in cancer survivors with cancer-related cognitive impairment: A qualitative study

OBJECTIVE

To identify cancer survivors' perceptions of the role diet plays in their cognitive function, and how their cancer-related cognitive changes influence their diet.

METHODS

Cancer survivors diagnosed with cancer in the past 5 years, not on active treatment, and with self-reported cognitive changes since diagnosis were recruited from the general population. Semi-structured interviews were conducted with 15 Australian breast (n = 13) and colorectal (n = 2) survivors (mean time since diagnosed: 27.0 months ± SD=16.8). Questions related to how their diet and cognitive changes influenced each other. Interviews were recorded, and transcripts were analysed using thematic analysis.

RESULTS

Four themes related to how diet impacted cognition: (a) directly (e.g. healthy diet improves cognition), (b) indirectly (e.g. diet affects tiredness which affects cognition); (c) no impact; and (d) potentially (e.g. poorer diet quality would worsen cognition). Three themes emerged for how cognitive changes were thought to impact survivors' diets: (a) planning meals is harder; (b) cooking is more difficult and complex; and, (c) choosing healthy is more challenging.

CONCLUSIONS

Many cancer survivors perceived a bidirectional influence between diet and cognition that has cognitive and behavioural consequences. Diet could be investigated as a modifiable lifestyle behaviour to improve cancer-related cognitive impairment and fatigue. Survivors may benefit from dietary guidance with meal planning and preparing.

Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study

Background

Digital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity.

Objective

The objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory.

Methods

We included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95% CI of achieving 5% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score.

Results

Over a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3% achieved 5% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95% CI 1.02-1.03; P<.001), baseline Healthy Diet Score (OR 1.06, 95% CI 1.05-1.08; P<.001), greater change in Healthy Diet Score (OR 1.12, 95% CI 1.11-1.14; P<.001), and enrollment length (OR 1.28, 95% CI 1.23-1.32; P<.001) were all significantly associated with higher odds of achieving at least 5% weight loss.

Conclusions

This study found that a digital app that provides personalized nutrition recommendations and change in one’s food purchasing environment appears to be successful in meaningfully reducing weight among individuals with obesity.

Intended and Unintended Consequences of a Community-Based Fresh Fruit and Vegetable Dietary Intervention on the Flathead Reservation of the Confederated Salish and Kootenai Tribes

Tribal communities in the United States face disparities to accessing healthy foods including high-quality produce. A six-week fresh fruit and vegetable (FV) dietary intervention, Eat Fresh, was co-designed with a Community Advisory Board of local food and nutrition stakeholders on the Flathead Reservation of the Confederated Salish and Kootenai Tribes in Montana. Eat Fresh was implemented as a pilot study with low-income participants (n = 19) enrolled in the Food Distribution Program on Indian Reservations toward improving dietary quality and perceptions of well-being. We evaluated Eat Fresh at pre- and post-intervention on the basis on food procurement practices, dietary quality using the Healthy Eating Index (HEI), Body Mass Index (BMI), blood pressure, and participant perceptions of health. Participants reported consuming a greater number of types of FVs daily during the intervention (p < 0.005 for fruits and p > 0.19 for vegetables). Overall, participants found Eat Fresh moderately challenging to adhere to with the main barriers being access to ingredients in recipes (39.51% of responses), time constraints to cook (35.80%), and lack of financial resources (33.33%). Dietary quality improved during the intervention from a mean HEI score of 48.82 (± 11.88) out of 100-56.92 (± 11.88; (p > 0.12). HEI scores for fruit consumption significantly increased (p < 0.05) from 1.69 (out of 5 points) during the pre-intervention to 2.96 during the post-intervention. BMI and blood pressure increased for several participants, highlighting an unintended consequence. Most participants responded that FV consumption made them feel either very good (51.16%) or good about their health (43.02%) with the majority (83%) perceiving an improvement in energy. Findings of this pilot study highlight both intended and unintended consequences of a dietary intervention that provide lessons in co-designing community-based programs.

The Metabolic Concept of Meal Sequence vs. Satiety: Glycemic and Oxidative Responses with Reference to Inflammation Risk, Protective Principles and Mediterranean Diet

With increasing exposure to eating opportunities and postprandial conditions becoming dominant states, acute effects of meals are garnering interest. In this narrative review, meal components, combinations and course sequence were questioned vis-à-vis resultant postprandial responses, including satiety, glycemic, oxidative and inflammatory risks/outcomes vs. protective principles, with reference to the Mediterranean diet. Representative scientific literature was reviewed and explained, and corresponding recommendations discussed and illustrated. Starting meals with foods, courses and/or preloads high in innate/added/incorporated water and/or fibre, followed by protein-based courses, delaying carbohydrates and fatty foods and minimizing highly-processed/sweetened hedonic foods, would increase satiety-per-calorie vs. obesogenic passive overconsumption. Similarly, starting with high-water/fibre dishes, followed by high-protein foods, oils/fats, and delayed/reduced slowly-digested whole/complex carbohydrate sources, optionally closing with simpler carbohydrates/sugars, would reduce glycaemic response. Likewise, starting with foods high in innate/added/incorporated water/fibre/antioxidants, high monounsaturated fatty acid foods/oils, light proteins and whole/complex carbohydrate foods, with foods/oils low in n-6 polyunsaturated fatty acids (PUFA) and n-6:n-3 PUFA ratios, and minimal-to-no red meat and highly/ultra-processed foods/lipids, would reduce oxidative/inflammatory response. Pyramids illustrating representative meal sequences, from most-to-least protective foods, visually communicate similarities between axes, suggesting potential unification for optimal meal sequence, consistent with anti-inflammatory nutrition and Mediterranean diet/meal principles, warranting application and outcome evaluation.