Impact of fruits and vegetables vouchers on food insecurity in disadvantaged families from a Paris suburb

The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: a systematic review

BACKGROUND

Low-income and middle-income countries (LMICs) experiencing nutrition transition face an increasing double burden of malnutrition (DBM). WHO has urged the identification of risks and opportunities in nutrition interventions to mitigate the DBM, but robust evidence is missing. This review summarises the effect of nutrition-specific and nutrition-sensitive interventions on undernutrition and overnutrition in LMICs.

METHODS

We searched four major databases and grey literature for publications in English, French, Portuguese, and Spanish from Jan 1, 2000, to Aug 14, 2023. Eligible studies evaluated nutrition-specific or nutrition-sensitive interventions on both undernutrition and overnutrition, employing robust study designs (individually randomised, cluster randomised, and non-randomised trials; interrupted time series; controlled before-after; and prospective cohort studies). Studies were synthesised narratively, and classified as DBM-beneficial, potentially DBM-beneficial, DBM-neutral, potentially DBM-harmful, and DBM-harmful, using vote counting. This review is registered with PROSPERO (CRD42022320131).

FINDINGS

We identified 26 studies evaluating 20 nutrition-specific (maternal and child health [MCH] and school-based programmes) and six nutrition-sensitive (conditional cash transfers and other social policies) interventions. Seven of eight MCH interventions providing food-based or nutritional supplements indicated possible DBM-harmful effects, associated with increased maternal or child overweight. Most school-based programmes and MCH interventions that target behavioural change were considered potentially DBM-beneficial. Two studies of conditional cash transfers suggested DBM-beneficial effects in children, whereas one indicated potentially harmful effects on maternal overweight. A study on a family planning service and one on an education reform revealed possible long-term harmful effects on obesity.

INTERPRETATION

There is considerable scope to repurpose existing nutrition interventions to reduce the growing burden of the DBM in LMICs. In settings undergoing rapid nutrition transition, specific policy attention is required to ensure that food-based or supplement-based MCH programmes do not unintentionally increase maternal or child overweight. Consistent reporting of undernutrition and overnutrition outcomes in all nutrition interventions is essential to expand the evidence base to identify and promote interventions maximising benefits and minimising harms on the DBM.

FUNDING

President's Scholarship (Imperial College London) and National Institute for Health and Care Research.

TRANSLATIONS

For the Portuguese, Spanish and French translations of the abstract see Supplementary Materials section.

Community-based fruit and vegetable prescription programs: a scoping review

Identify and categorise different models of community-based fruit and vegetable prescription programs, to determine variation in terms of methodology, target population characteristics, and outcomes measured. Applying the scoping review methodology, ten electronic databases were utilised to identify community-based fruit and vegetable incentive programs. Results were evaluated by two independent reviewers, using Covidence software. All full-text reviews were completed and documented using the PRISMA-ScR guidelines. Search results were stored and reviewed within the Covidence software. Thirty full-text articles were utilised from the 40 206 identified in the search. Target populations were predominantly female, non-white, and low-income. Considerable heterogeneity was found in both study design and quality. Fruit and vegetable vouchers were utilised in 63 % (n 19) of the studies. Prescriptions were primarily provided by community health centres (47 %; n 14) or NGOs (307 %; n 9) and could be redeemed at farmers' markets (40 %; n 12) or grocery stores (27 %; n 8). When measured, diet quality significantly improved in 94 % (n 16), health outcomes significantly improved in 83 % (n 10), and food security status improved in 82 % (n 10) of studies. Providing financial incentives to offset the cost of fresh fruits and vegetables can increase consumption, improve health outcomes, and improve food security status. The majority of studies showed significant improvements in at least one outcome, demonstrating the effectiveness of community-based fruit and vegetable prescription programs. However, the diversity of measurement techniques and heterogeneity of design, dosage, and duration impeded meaningful comparisons. Further well-designed studies are warranted to compare the magnitude of effects among different program methodologies.

Effect of the COVID-19 Pandemic on Healthy Components of Diet and Factors Associated with Unfavorable Changes among University Students in France

Introduction: The COVID-19 pandemic and the lockdowns have affected many aspects of university students’ daily lives, including their dietary habits. This study aimed to evaluate the change of diet quality of university students before and during the COVID-19 period, and the factors associated with unfavorable changes in diet quality. Methods: An online cross-sectional study was performed in May 2021 among Rouen (France) university students. Socio-demographic characteristics, body mass index, depression, academic stress, risk of eating disorders and food security were collected. The French “Programme National Nutrition Santé-Guidelines Score 2” (PNNS-GS2) was used to access diet quality. Results: A total of 3508 students were included, 74.4% were female, the mean age was 20.7 (SD = 2.3), and 7.0% were in a situation of food insecurity. The PNNS-GS2 score decreased between the pre- and the COVID-19 pandemic period for 33.1% of university students. The associated factors with the decrease in the PNNS-GS2 score were food insecurity, financial insecurity, not living with parents, depression, academic stress, eating disorders, being in the two first years of study and having been infected by COVID-19. Conclusions: Diets with healthy components decreased for one-third of university students since the COVID-19 pandemic, and this was shown to be associated with food insecurity, poor mental health and eating disorder. This study provides important information to help public health authorities and universities give better support to student health feeding programs during pandemics and lockdowns.

Non-attitudinal and non-knowledge based factors constrain households from translating good nutritional knowledge and attitude to achieve the WHO recommended minimum intake level for fruits and vegetables in a developing country setting: evidence from Gulu district, Uganda

BACKGROUND

The high level of incidence of mortality attributed to non-communicable diseases such as cancer, diabetes and hypertension being experienced in developing countries requires concerted effort on investment in strategies that can reduce the risks of development of such diseases. Fruits and vegetables (FV) contain natural bioactive compounds, and if consumed at or above 400 g per day (RDMIL) as recommended by World Health Organization (WHO) is believed to contribute to reduced risk of development of such diseases. The objective of this study was to determine in a developing country set-up, the extent to which rural and urban households conform to RDMIL, the status of nutritional attitude (NA) and knowledge (NK) associated with consumption of FV, and to delineate non-attitudinal and non-knowledge-based factors (NANK) that hinder achievement of RDMIL.

METHOD

A cross-sectional survey of 400 randomly selected households and 16 focus group discussions (FGD) were conducted using Gulu district of Uganda as a microcosm for a developing country setting. Level of consumption of FV was assessed using 24-h dietary recall and compared to RDMIL as a fraction (%). The status of NK and NA were determined using sets of closed-ended questions anchored on a three-point Likert scale. Further quantitative statistical analyses were conducted using t-test, chi-square, Pearson's correlation and multiple linear regression. FGD provided data on NANK factors and were analysed using qualitative content analysis procedure.

RESULTS

Urban and rural inhabitants met up to 72.0 and 62.4% of the RMDIL, respectively, with absolute intake being higher among urban than rural households by 37.54 g. NK and NA were good but the intensity of NK was higher among urban respondents by 11%. RDMIL was positively correlated with NA while socio-demographic predictors of RDMIL varied with household location. FGD revealed that primary agricultural production constraints, market limitations, postharvest management limitations, health concerns, social discomfort and environmental policy restrictions were the major NANK factors that hindered achievement of the RDMIL.

CONCLUSIONS

These results indicate that NANK factors constrain households from translating good NA and NK to achieve the RMDIL.

The Measurement of Food Insecurity in High-Income Countries: A Scoping Review

The measurement of food insecurity is essential to monitor the prevalence, risk factors, consequences and effects of food insecurity and the interventions and policies implemented to tackle it. Yet, how best to apply it remains an unsettled issue due to the multifaceted and context-dependent nature of food insecurity. We report a scoping review of measures of food insecurity at the individual and household level in high-income countries with the final purpose of facilitating a catalogue of instruments to be used by both researchers and practitioners. The scoping review was conducted following the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute guidelines. We included all types of documents published between 2000-2020 using instruments that estimate food insecurity at both individual and household level in high-income countries, and with respondents including adolescents, adults, and elderly. We identified a total of 23 measurement strategies being used in 33 peer-reviewed publications and 114 documents from the grey literature. Our results show that most measures focus on the access dimension of food insecurity and that further research is required to develop measures that incorporate aspects of quality of dietary intake and relevant individual, household and social conditions related to food insecurity.

Changes in Food Consumption During the COVID-19 Pandemic: Analysis of Consumer Survey Data From the First Lockdown Period in Denmark, Germany, and Slovenia

This paper focuses on changes in food consumption that occurred during the COVID-19 pandemic. Its objective is to map changes at individual consumer level and identify the influence of different factors related to the COVID-19 pandemic on changes in individual food consumption. We conducted a cross-sectional online survey among 2,680 residents of Denmark (DK), Germany (DE), and Slovenia (SI) using quota sampling for gender, age and regional distribution. Data on consumption frequencies before and during the pandemic were collected with a food frequency questionnaire in the spring of 2020 (during the first lockdown period) for important types of fresh food and non-perishable food. Our results showed that, depending on the type of food, 15–42% of study participants changed their consumption frequency during the pandemic, compared to before. In all the study countries, the food categories with the highest rates of change were frozen food, canned food, and cake and biscuits; among the food categories with lower rates of change were bread, alcoholic drinks, and dairy products. People across all three countries shopped less frequently during lockdown and there was an overall reduction in the consumption of fresh foods, but an increase in the consumption of food with a longer shelf life in Denmark and Germany. Interestingly though, we observed diverging trends in all food categories analyzed, with some people decreasing and others increasing their consumption frequencies, demonstrating that the pandemic had different impacts on people's lifestyles and food consumption patterns. Using the method of multinomial regression analysis, we identified factors significantly (p < 0.01, p < 0.05, p < 0.1) related to increases and decrease in individuals' consumption frequencies in different food categories. The factors include restrictions put in place in response to the pandemic (i.e., closure of physical workplaces, canteens, cafés and restaurants, schools, and childcare institutions), changes in households' grocery shopping frequency, individuals' perceived risk of COVID-19, income losses due to the pandemic, and socio-demographic factors. Interesting differences between the countries were detected, allowing insights into the different food cultures. Conclusions include implications for policy-makers and actors in the food supply chain on the issues of healthy diets, food system resilience, and behavior change.

Money, Vouchers, Public Infrastructures? A Framework for Sustainable Welfare Benefits

While the social consequences of environmental policies are extensively evaluated in sustainability research, few studies exist on the ecological impact of social benefits and the welfare state. Sustainable welfare is a novel research field that seeks to close this knowledge gap and develop integrated eco-social policies. Within this, researchers are starting to ask how citizen’s needs can be guaranteed in an environmentally sustainable way and how their welfare benefits should be delivered. Should citizens receive a universal basic income, be given vouchers for ecologically beneficial or socially needed goods and services, or be provided with access to socio-ecological infrastructures and services? This article develops a framework for sustainable welfare benefits with six criteria of sustainable welfare and nine different types of welfare benefits that belong to the domains of universal basic income (UBI), universal basic services (UBS), and universal basic vouchers (UBV). Using this framework, existing policy proposals are categorized and evaluated. The advantages and disadvantages of the different types of welfare benefits are discussed and new application areas highlighted. The analysis shows that a successful policy will likely include all forms of welfare benefits, with certain types being more adequate for certain fields and societal circumstances. The framework for sustainable welfare benefits can serve as a starting point for further research on integrated policy design and inform policymakers on the selection of eco-social policies.