Dietary behaviour and socioeconomic position: the role of physical activity patterns

Unhealthy diets increase the likelihood of being overweight or obese among African migrant students in China, but not among African non-migrant students: a cross-sectional study

Background

The impact of non-communicable diseases (NCDs) is disproportionately felt by immigrants from low- to medium-income countries (LMICs), partly due to their dietary habits. To thrive in their new environment, migrants either omit or consume certain food items, which could lead to nutritional deficits. As a result, most migrants experience more NCDs than their compatriots in their native countries. Therefore, we evaluated the difference in dietary habits, quality, and the influencing factors of overweight or obesity among African migrant students in Nanjing (China) and non-migrant students in Africa using cross-sectional data.

Methods

The researchers used the food frequency questionnaire and the global diet quality score metrics to assess food intake and quality, respectively. Then, cross-tabulation was employed to explore the differences between the groups in meal skipping, eating habits, and diet quality. Finally, the factors associated with overweight or obesity were assessed with binary logistic regression stratified by African students in Nanjing and students in their native countries.

Results

Approximately 678 responses were received, mainly between 18-25 years (46.7%) and 26-36 years (45.4 %). The majority of them (52.3%) were international students. The non-migrant African students' diets lacked citrus fruits (22.2%), deep orange fruits (15.4%), deep orange vegetables (18%), cruciferous vegetables (24.6%), and dark leafy vegetables (26.5%). While the African migrant students consumed more high-fat dairy (50.7%), processed meats (23.9%), sweets and ice creams (51.3%), sugar-sweetened beverages (40.5%), and juice (61.5%), p < 0.001. Furthermore, consuming late-night meals constantly [Exp (B) = 39.607, p = 0.049], eating twice a day [Exp (B) = 6.527, p = 0.036], consuming red meat [Exp (B) = 29.287, p = 0.001], processed meats [Exp (B) = 719.979, p = 0.0011], refined grains and baked foods [Exp (B) = 15.752, p = 0.013], and sweets and ice cream [Exp (B) = 193.633, p = 0.006] were factors inducing overweight or obesity among only African migrant students.

Conclusion

Controlling the what (Western diet and nature of late-night meals) and the when of eating can drastically reduce their influence on obesogenic condition formation in African migrant students in China and elsewhere.

The Link between Overweight/Obesity and Noncommunicable Diseases in Ethiopia: Evidences from Nationwide WHO STEPS Survey 2015

Background

Noncommunicable diseases (NCDs) are the leading cause of death worldwide. Each year, 15 million adults die from NCDs; more than 85% of these premature deaths occur in low- and middle-income nations. Evidence indicates that overweight and obesity are the main risk factors for NCDs. Although the literature indicates that the burden of NCDs is increasing in Ethiopia, no research has been conducted to demonstrate a link between overweight/obesity and NCDs. Therefore, the aim of this study is to examine the association between overweight/obesity and the common NCDs while adjusting for other important factors.

Methods

We analysed data from the 2015 Ethiopia WHO STEPS survey, which was conducted in 2015. A total weighted sample of 9,800 participants (15-69 years) was included. The relationship between nutritional status and NCDs was assessed using bivariate and multivariable logistic regression models while adjusting for covariates.

Results

Among the 9,800 participants, 2053 (21% with (95% CI: 19.8-22.1) had hypertension and 1368 (14% with (95% CI: 13.1-15.0) had high cholesterol levels. According to the multivariable logistic regression analysis, being overweight/obese (AOR = 2.0; 95% CI: 1.7-2.3), alcohol consumption, received lifestyle advice, being female, living in urban areas, increased age, having government occupation, and living in SNNP region were positively associated with hypertension. While being underweight (AOR = 0.6; 95% CI: 0.5-0.7), living in the Afar, Somali, and Tigray regions were negatively associated with hypertension. Being overweight/obese (AOR = 1.4; 95% CI: 1.1-1.7), being female, having older age, and living in Somali region were positively associated with a high cholesterol level. Whereas being underweight (AOR = 0.7; 95% CI: 0.6-0.9), received lifestyle advice, reside in rural areas, being farmer, student, and housewife, and living in Gambela region were negatively associated with a high cholesterol level.

Conclusion

This study found a statistically positive association between the common NCDs, namely, overweight/obesity, hypertension, and high cholesterol levels. Our findings imply that there is a need for effective interventions to prevent overweight/obesity by encouraging people to increase physical activity, minimize sedentary behavior, and maintain a healthy dietary pattern in order to reduce the risk of hypertension and high cholesterol levels.

Independent and combined effect of income and education attainment on the incidence of stroke events: a large-scale cohort study from rural communities in China

OBJECTIVES

Few studies have longitudinally evaluated income and education, and their combined effect on incident of stroke in China.

METHODS

The present study was based on a cohort with a baseline survey in China. A total of 15,913 participants were finally included. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated to evaluate the association of income, education, and their combination with stroke risk by Cox proportional hazard model.

RESULTS

Lower income and less years of education was significantly associated with an increased risk of total stroke [income: adjusted HR: 1.54 (95% CI: 1.22-1.95); education: adjusted HR: 1.59 (95% CI: 1.11-2.28)]. Notably, the highest risk for total stroke was seen among those with lower income and higher education (adjusted HR: 2.46, 95% CI: 1.36-4.47). Sensitivity analysis by excluding the first year of follow-up showed similar findings with the primary analysis.

DISCUSSION

Lower income and education attainment were associated with an increased risk of stroke in Chinese countrysides. A joint effect of income and education existed on the risk of developing stroke. Special attention should be paid for rural community residents, especially for people with low income levels.

Personalized dietary advices provided by a dietitian increase calcium intake in outpatients with multiple sclerosis-Results from a randomized, controlled, single-blind trial

Background and aims

Multiple sclerosis (MS) is associated with osteoporosis, possibly due to neurological disability and decreased calcium intake. The objective of this study was to evaluate the efficacy of a personalized nutritional advice program by a dietitian compared to the delivery of a standard advice form to optimize dietary calcium intake in outpatients with MS.

Methods

We performed a randomized, controlled, parallel trial comparing the efficacy of a personalized dietary advice (PDA) program to standard advice form (SAF) to increase daily calcium intake in MS patients. The study population was composed by patients with relapsing-remitting MS aged 18-69 years old. PDA program consisted in dietary advice delivered by a dietitian at baseline, 1 month, and 3 months. Calcium and nutrient intake in patients from both groups was evaluated at baseline and 6 months using a dietary survey.

Results

Of the 194 patients screened for inclusion, 182 patients were included (79% female, median age of 42 years, and median EDSS of 2.0), and randomized to SAF (n = 92) or PDA (n = 90). At 6 months, median calcium intake increased by 241 mg/day in the PDA group and decreased by 120 mg/day in the SAF group (p < 0.0001). However, the median calcium intake was 947 mg/day in the SAF group and 778 mg/day in the PDA group at baseline (p = 0.0077), potentially favoring the effect of dietary advice. Complementary analyses focusing on patients with insufficient calcium intakes at baseline revealed comparable values in both groups (p = 0.69). Of those, patients included in the PDA group obtained significantly higher calcium intakes at 6 months than patients from the SAF group (p = 0.0086) independently of EDSS, PASAT, HADS and EQ-5D scores.

Conclusion

This work shows the efficacy of dietary management based on personalized advice program over 3 months to durably increase calcium consumption in MS patients with insufficient calcium intake.

Clinical trial registration

clinicaltrials.gov, identifier NCT02664623.

Association between depressive symptoms and bone density in elderly patients with non-dialysis dependent chronic kidney disease

BACKGROUND

Depression is a disease that is commonly accompanied by elderly chronic kidney disease (CKD) patients, but when the two diseases are accompanied, etiology or combination are not well known. We aimed to evaluate the etiology of CKD and comorbid depression by investigating bone disorders that are observed in persons affected by both CKD and depression.

METHODS

We conducted a cross-sectional study with a total of 646 patients with CKD. We compared the sociodemographic factors, kidney function, markers for CKD-Mineral and Bone Disorder (CKD-MBD) and bone mineral density according to the depressive symptoms. We conducted a univariate and multivariate logistic regression analysis to calculate odd ratios (95 % confidence interval) between depressive symptoms and low bone mineral density.

RESULTS

Individuals with CKD and depressive symptoms were associated with lower level of education attained, living alone, exercising less, low 24-hour urine phosphorus, and low bone density. Depressive symptoms were significantly associated with low bone density in lowest parts (1.55 [1.06-2.29]) and in total hip (1.72 [1.17-2.53]) even after adjusting for diabetes mellitus, hypertension, kidney function, proteinuria, age, sex, smoking, and body mass index.

LIMITATIONS

A cross-sectional design was used in this study and the bone biopsy for diagnosis of CKD-MBD was not done because of invasiveness and practical difficulties.

CONCLUSION

Low bone density was associated with depressive symptoms in elderly patients with non-dialysis chronic kidney disease.

Changes in dietary habits and eating behaviors during COVID-19 induced confinement: A study from Jordan

Objective

This study aimed to evaluate dietary habits (DH) and eating behaviors (EB) among adults during confinement induced by COVID-19 in Jordan.

Method

In this cross-sectional study, an online survey designed to assess the change in DH and EB during April and May 2020 was distributed using various social media platforms.

Results

The survey was completed by a total of 1844 adult (18-72 years) participants from the public in Jordan. The results indicated an increase (42.5-61.8%) in most of the DH and EB examined in the current study in the majority of participants. Among these changes, they have increased (p < 0.05) the prevalence of fruit and vegetable, immune boosters, water, and hot beverage consumption, as well as decreased (p < 0.05) eating in restaurants and fatty food consumption, indicating a positive change. Conversely, a larger (p < 0.05) proportion of participants reported increased consumption of high-calorie food and late-night eating, indicating a risky behavior for obesity and subsequent chronic complications. Additionally, age, sex, obesity, education, income, and type of job appeared to contribute (p < 0.05) to changes in DH and EB. Overall, confinement caused by COVID-19 appears to compel adults to adopt a specific DH and EB. Although most of these changes were positive, some were negative.

Conclusion

This study provides essential information for designing subpopulation recommendations and developmental programs for adults under such conditions.

Identifying dietary patterns across age, educational level and physical activity level in a cross-sectional study: the Tromsø Study 2015 - 2016

Background

A healthy diet can decrease the risk of several lifestyle diseases. From studying the health effects of single foods, research now focuses on examining complete diets and dietary patterns reflecting the combined intake of different foods. The main goals of the current study were to identify dietary patterns and then investigate how these differ in terms of sex, age, educational level and physical activity level (PAL) in a general Nordic population.

Methods

We used data from the seventh survey of the population-based Tromsø Study in Norway, conducted in 2015-2016. The study included 21,083 participants aged \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$40-99$$\end{document}40-99 years, of which \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$72\%$$\end{document}72% completed a comprehensive food frequency questionnaire (FFQ). After exclusion, the study sample included 10,899 participants with valid FFQ data. First, to cluster food variables, the participants were partitioned in homogeneous cohorts according to sex, age, educational level and PAL. Non-overlapping diet groups were then identified using repeated hierarchical cluster analysis on the food variables. Second, average standardized diet intake scores were calculated for all individuals for each diet group. The individual diet (intake) scores were then modelled in terms of age, education and PAL using regression models. Differences in diet scores according to education and PAL were investigated by pairwise hypothesis tests, controlling the nominal significance level using Tukey’s method.

Results

The cluster analysis revealed three dietary patterns, here named the Meat and Sweets diet, the Traditional diet, and the Plant-based- and Tea diet. Women had a lower intake of the Traditional diet and a higher preference for the Plant-based- and Tea diet compared to men. Preference for the Meat and Sweets diet and Traditional diet showed significant negative and positive trends as function of age, respectively. Adjusting for age, the group having high education and high PAL compared favourably with the group having low education and low PAL, having a significant lower intake of the Meat and Sweets and the Traditional diets and a significant higher intake of the Plant-based- and Tea diet.

Conclusions

Three dietary patterns (Meat and Sweets, Traditional, and Plant-based- and Tea) were found by repeated clustering of randomly sampled homogeneous cohorts of individuals. Diet preferences depended significantly on sex, age, education and PAL, showing a more unhealthy dietary pattern with lower age, low education and low PAL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00599-4.

Dietary diversity and impact of Moringa oleifera Lam. leaves supplemented - Diet on the nutritional status and CD4 cell counts of patients receiving antiretroviral therapy in Nigeria: A double - Blind randomized trial

Background

To maintain an optimal nutritional status and immunological function in PLHIV, a diet with adequate nutrients is of utmost importance. This is a major challenge among poor populations in developing worlds like Nigeria, where malnutrition and food insecurity are endemic. This study aimed to assess the type of regular diet consumed and assess the impact of supplementation of the diet with Moringa oleifera Lam. leaves on the nutritional status and CD4 cell counts of PLHIV that are on ART in Nigeria.

Method

A double-blind, randomized trial was conducted. Two hundred consented patients were randomly allocated to either the Moringa oleifera Lam. group (MOG) or the control group (COG). The FAO individual dietary diversity questionnaire was used. The regular diets of participants at baseline and six months were monitored. The measurements of weight, BMI, MUAC, and CD4 cell counts were obtained from baseline to six months of Moringa oleifera Lam. leaves supplementation.

Results

One hundred and seventy-seven patients completed the six-month follow-up (89 MOG versus 88 COG). At both baseline and sixth month, the foods most commonly consumed by the participants in both MOG and COG were cereals, spices and condiments, oils, fats and palm oil, and dark green vegetables. At baseline, significantly higher consumption of legumes, nuts & seeds (p = 0.001) was observed in the MOG and higher consumption of other vegetables (p = 0.024) in COG. Consumption of cereals, roots, and tubers was significantly higher (p = 0.024; 0.045) in the COG in the sixth month. In both groups, participants were in the medium or low dietary diversity tercile. Throughout the study period, all the nutritional status variables observed were not significantly different between the two study groups [(p > 0.0001); weight; p = 0.5556; BMI; p = 0.5145; MUAC; p = 0.6456]. Over the study period, the treatment by time interaction shows a significant difference in CD4 counts by treatment group (p < 0.0001) and an estimate of fixed effects 10.33 folds greater in the MOG than COG. All tests were conducted at 95CI.

Conclusion

This study revealed a poor dietary diversity amongst PLHIV. Supplementation of regular diet with Moringa oleifera Lam. leaves did not affect the nutritional status but could improve the immune response of HIV-positive adults attending the antiretroviral treatment centre in the present study area.

Tracking of dietary patterns between pregnancy and 6 years post-pregnancy in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study

PURPOSE

Few studies have described adherence to dietary patterns over time in women of childbearing age. This study aims to describe, examine the stability and changes in dietary patterns between pregnancy and 6 years post-pregnancy and the sociodemographic and lifestyle factors influencing the adherence over time.

METHODS

During pregnancy and at 6 years post-pregnancy, 24-h recalls and food frequency questionnaires were collected, respectively, from 709 women. Data on sociodemographic and lifestyle factors were collected via questionnaires. Dietary patterns were identified using principal component analysis and stability assessed using Pearson's correlation coefficients (r) and Cohen's weighted kappa (κ). Associations with sociodemographic characteristics were assessed by multiple logistic regression.

RESULTS

The 'Fruits, Vegetables and Legumes' (FVL) and 'Seafood, Noodle, Soup' (SNS) patterns were identified at both time points, with low correlation for the dietary pattern z scores (r 0.2 and 0.3, respectively) and modest agreement in tertile assignment, suggesting poor stability. An 'unhealthy' pattern was only observed at 6 years post-pregnancy. Women who showed increased adherence to FVL pattern had higher educational attainment and exhibited healthy lifestyle behaviours. Women who had gestational diabetes during pregnancy were less likely to decrease adherence to FVL pattern over time. Women who adhered more closely to the 'unhealthy' pattern at 6 years post-pregnancy tended to be younger, of Malay ethnicity, had lower socioeconomic status, were less physically active and had additional pregnancies.

CONCLUSIONS

Dietary habits of women became less healthy during the transition from pregnancy to 6 years post-pregnancy. However, results should be interpreted with caution due to the different dietary assessment tools used at the two time points.

A Comparison of Dietary Patterns and Factors Influencing Food Choice among Ethnic Groups Living in One Locality: A Systematic Review

Globally, the number of minority ethnic groups in high-income countries is increasing. However, despite this demographic change, most national food consumption surveys are not representative of ethnically diverse populations. In consequence, many ethnic minorities' dietary intakes are underreported, meaning that accurate analysis of food intake and nutrient status among these groups is not possible. This systematic review aims to address these gaps and understand differences in dietary intakes and influencers of dietary habits of ethnic groups worldwide. A systematic search was conducted through three databases (Pubmed, Web of Science and Scopus) and manual searches, generating n = 56,647 results. A final search of these databases was completed on 13 September 2021, resulting in a total of 49 studies being included in this review. Overall, food group intakes-particularly fruit, vegetable and fish intake-and diet quality scores were seen to differ between ethnicities. Overall Black/African American groups were reported to be among the poorest consumers of fruit and vegetables, whilst Asian groups achieved high diet quality scores due to higher fish intakes and lower fat intakes compared to other groups. Limited data investigated how nutrient intakes, dietary and meal patterns compared between groups, meaning that not all aspects of dietary intake could be compared. Socioeconomic status and food availability appeared to be associated with food choice of ethnic groups, however, confounding factors should be considered more closely. Future work should focus on comparing nutrient intakes and meal patterns between ethnicities and investigate potential targeted interventions which may support adherence to food-based dietary guidelines by all ethnic groups.

Association of education levels with the risk of hypertension and hypertension control: a nationwide cohort study in Chinese adults

BACKGROUND

Education attainment can improve life expectancy and guide healthy behaviours throughout an entire lifetime. A nationwide longitudinal study of the association of education status with the risk of hypertension and its control in China is lacking.

METHODS

The China Cardiometabolic Disease and Cancer Cohort Study is a multicentre, population-based, prospective cohort study. We performed the baseline survey from 2011 to 2012. A follow-up visit was conducted during 2014-2016. 101 959 subjects were included in the final data analyses. Cox proportional hazards regression was used to examine the associations of education levels with the risk of hypertension and uncontrolled hypertension.

RESULTS

During follow-up, 11 189 (19.9%) participants had developed hypertension among subjects without hypertension at baseline. Among the participants with hypertension at baseline, only 40.6% had controlled hypertension. Compared with the participants' education level at elementary school and below, the multivariable-adjusted HR for incident hypertension was 0.76 (95% CI, 0.72 to 0.80) in those with a middle school education level and 0.67 (95% CI, 0.63 to 0.70) in those with a high school degree or above. Correspondingly, multivariable-adjusted HRs associated with uncontrolled hypertension were 0.90 (95% CI, 0.87 to 0.92) in participants with a middle school education level and 0.85 (95% CI, 0.82 to 0.88) in participants with a high school degree or above level.

CONCLUSION

Participants with education attainment at elementary school and below exhibited excess risks of newly diagnosed hypertension and worse blood pressure control compared with individuals with education attainment at middle school or above.

Exploring the Impact of COVID-19 Pandemic on Eating and Purchasing Behaviours of People Living in England

Consumers' eating habits have changed significantly due to the anxiety and boredom from the reported cases and deaths of COVID-19, the change in work patterns, controlled food shopping, and the inability to meet loved ones during the lockdown. The magnitude of these changes in the eating behaviours and purchasing habits of consumers varies across different groups of people. This study provides empirical evidence of the effects of COVID-19 on the eating and purchasing behaviours of people living in England, which was assessed based on sociodemographic variables. A total of 911 participants were recruited by a market research company, while only 792 useable responses were included in this study. The participants, aged between 18 and 91 years, completed an online questionnaire, and the data were analysed using ordinal regression. Data were collected between October and December 2020. Male participants constituted 34.60%, females 63.89%, and others (other gender and those who prefer not to declare their gender) were 0.63%. The majority of participants' ages fell into the ranges of 23-38 and 39-54. Participants aged 23 to 38 years had the greatest effect of COVID-19 on their purchasing decision of healthier foods, while participants in the age groups 55-73 and 74-91 were least affected. The amount of foods purchased during the pandemic decreased with increasing age. The amount of foods purchased by students, people in employment, and people from minority ethnic groups were greatly affected by the pandemic. All participants who stated that taking food supplements is not important during the pandemic were from the White ethnic group. The effects of the pandemic on purchasing healthier foods were greater in younger generations and participants in full- or part-time employment than participants who were retired and who were aged above 55. The participants with higher educational qualifications and those from minority ethnic groups were also more affected by the pandemic. We suggest further studies to monitor any changes in the effects of the ongoing COVID-19 pandemic on the eating and purchasing behaviours of consumers.

Dietary Intake Among Members of a Volunteer Fire Department Compared With US Daily Dietary Recommendations

OBJECTIVE

To characterize the diet of volunteer firefighters compared with the United States recommended dietary intake.

METHODS

A survey was administered to members of volunteer fire department which collected information on demographics, behavioral risks, fire service history, and dietary intake using the Dietary Screener Questionnaire. Dietary intake was compared with US recommendations; associations between dietary intake and years of firefighting, were assessed using bi- and multivariate analysis.

RESULTS

The 122 male study participants were majority non-Hispanic white (96.4%), and over 90% were overweight or obese. Participants had lower mean intakes of fruit and vegetables, whole grains, and dietary fiber, and a higher mean intake of added sugars compared with the US recommended dietary intake.

CONCLUSION

Volunteer firefighters in our study had suboptimal daily dietary intake of fruits and vegetables, dietary fiber, whole grains, and added sugars.

Validation of the Arabic version of the Eating Attitude Test in Lebanon: a population study

OBJECTIVES

To validate an Arabic version of the Eating Attitude Test (EAT-26) and identify factors (such as depression, stress, anxiety and body dissatisfaction) that might be associated with disordered eating among a sample of the Lebanese population.

DESIGN

Cross-sectional study.

SETTING

All Lebanese governorates.

PARTICIPANTS

A total of 811 participants randomly selected participated in this 5-month study (January-May 2018).

RESULTS

The EAT-26 scale items converged over a solution of six factors that had an eigenvalue over 1, explaining a total of 60·07 % of the variance (Cronbach's α = 0·895). The prevalence of disordered eating attitudes was 23·8 %. Higher EAT-26 scores (disordered eating attitudes) were significantly associated with higher depression (β = 0·325), higher emotional eating (β = 0·083), daily weighing (β = 3·430), higher physical activity (β = 0·05), starving to reduce weight (β = 4·94) and feeling pressure from TV/magazine to lose weight (β = 3·95).

CONCLUSIONS

The Arabic version of EAT-26 can be a useful instrument for screening and assessing disordered eating attitudes in clinical practice and research. Some factors seem to be associated with more disordered eating attitudes among participants for whom psychological counseling may be needed. Yet, our findings are considered preliminary, and further studies are warranted to confirm them.

Less Animal-Based Food, Better Weight Status: Associations of the Restriction of Animal-Based Product Intake with Body-Mass-Index, Depressive Symptoms and Personality in the General Population

Restricting animal-based products from diet may exert beneficial effects on weight status; however, less is known about such a diet and emotional health. Moreover, personality traits, for example high neuroticism, may contribute to restrictive eating habits and potentially confound diet-health associations. We aim to systematically assess if restrictive dietary intake of animal-based products relates to lower weight and higher depressive symptoms, and if differences in personality traits play a significant role. Cross-sectional data from the baseline LIFE-Adult study were collected from 2011–2014 in Leipzig, Germany (n = 8943). Main outcomes of interest were dietary frequency of animal-derived products in the last year measured using a Food Frequency Questionnaire (FFQ), body-mass-index (BMI) (kg/m²), and the Center of Epidemiological Studies Depression Scale (CES-D). Personality traits were assessed in a subsample of n = 7906 using the Five Factor Inventory (NEO-FFI). Higher restriction of animal-based product intake was associated with a lower BMI, but not with depression scores. Personality, i.e., lower extraversion, was related to higher frequency of animal product intake. Moreover, personality traits were significantly associated with depressive symptoms, i.e., higher neuroticism, lower extraversion, lower agreeableness, lower conscientiousness, and with higher BMI. These findings encourage future longitudinal studies to test the efficacy of restricting animal-based products as a preventive and therapeutic strategy for overweight and obesity.

Factors Associated with Frequency of Peanut Consumption in Korea: A National Population-Based Study

Household peanut exposure via skin in infants with impaired skin barrier function is a risk factor for peanut allergy development. The aim of this study is to investigate the peanut consumption of Koreans using national representative data. We used data from the Korean National Health and Nutrition Examination Survey 2012-2016, consisting of data from 17,625 adults who complete the survey. Peanut intake was assessed using a 24-h recall method. Of the study population, 10,552 (59.9%), 6726 (38.2%), and 347 (1.9%) subjects were categorized into non-intake, intermittent intake, and frequent intake group, respectively. Ordered logistic regression models were used to examine the association between sociodemographic and dietary factors and the frequency of peanut intake. After adjusting for confounders, increasing age (adjusted odds ratio (aOR) 1.03; 95% confidence interval (CI) 1.03-1.04), higher education (high school graduates: aOR 1.75, 95 CI 1.39-2.19; higher than college: aOR 2.11, 95% CI 1.65-2.70), and prudent dietary scores in the second (aOR 1.71; 95% CI 1.47-1.99), third (aOR 2.53; 95% CI 2.16-2.97) and the fourth quartiles (aOR 3.72; 95%CI 3.16-4.40) were associated with a high frequency of peanut consumption. This information may be helpful not only in public health research for nutrition but also in personal management for the prevention of peanut allergy in Korea.

The effectiveness of a proven chronic disease prevention and screening intervention in diverse and remote primary care settings: an implementation study on the BETTER 2 Program

Background

The Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER) randomised control trial (RCT) showed that the BETTER Program improved chronic disease prevention and screening (CDPS) by 32.5% in urban team-based primary care clinics.

Aim

To evaluate outcomes from implementation of BETTER in diverse clinical settings.

Design & setting

An implementation study was undertaken to apply the CDPS intervention from the BETTER trial to diverse settings in BETTER 2. Patients aged 40–65 years were invited to enrol in the study from three clinics in Newfoundland and Labrador, Canada.

Method

At baseline, eligibility for 27 CDPS actions (for example, cancer, diabetes and hypertension screening, lifestyle) was determined. Patients then met with a trained provider and prioritised goals to address their eligible CDPS actions. Providers received training in behaviour change theory and practice. Descriptive analysis of clinical outcomes and success factors were reported.

Results

A total of 154 patients (119 female and 35 male) had a baseline visit; 106 had complete outcome assessments, and the remainder had partial outcome assessments. At baseline, patients were eligible for a mean of 12.3 CDPS actions and achieved a mean of 6.0 (49%, 95% confidence intervals [CI] = 24% to 74%) at 6-month follow-up, including reduced hypertension (86% of eligible patients, 95% CI = 67% to 96%), weight control (51% of eligible patients, 95% CI = 42% to 60%), and smoking cessation (36% of eligible patients, 95% CI = 17% to 59%). Male, highly educated, and lower income individuals achieved a higher proportion of CDPS manoeuvers than their counterparts.

Conclusion

Clinical outcomes from this implementation study were comparable with those of the prior BETTER RCT, providing support for the BETTER Program as an effective approach to CDPS in more diverse general practice settings.

Behavioral Predictors of Weight Regain in Postmenopausal Women: Exploratory Results From the Breast Cancer and Exercise Trial in Alberta

OBJECTIVE

This secondary analysis assessed associations between changes in energy balance and sleep behaviors and the risk of weight regain following exercise-induced weight loss.

METHODS

Of 400 participants initially randomized in the Breast Cancer and Exercise Trial in Alberta (BETA), 227 lost weight following the moderate- to vigorous-intensity exercise intervention (-4.2 ± 3.6 kg) and were included in this analysis. Self-reported energy intake (EI), sleep duration, quality and timing, and objective measurements of physical activity (PA) and sedentary time were collected at the end of the intervention and the end of follow-up. Linear regression models assessed associations between changes in these behaviors and risk of weight regain during follow-up.

RESULTS

Participants regained 43% of the weight lost during follow-up. Reductions in moderate to vigorous PA (β = -1.00; 95% CI = -1.74 to -0.25 h/d; P = 0.01) and steps per day (β = -0.0003; 95% CI = -0.0005 to -0.0001 steps/d; P = 0.004); increases in sedentary time (β = 0.54; 95% CI = 0.67 to 1.02 h/d; P = 0.03), EI (β = 0.001; 95% CI = 0.0003 to 0.002 kcal; P = 0.01), and fat intake (β = 0.004; 95% CI = 0.001 to 0.006 kcal; P = 0.002); and delayed sleep timing midpoint (β = 0.02; 95% CI = 0.004 to 0.03 min; P = 0.01) were associated with weight regain during follow-up.

CONCLUSIONS

These exploratory results suggest that reductions in moderate to vigorous PA; increases in EI, fat intake, and sedentary time; and delayed sleep timing midpoint were significantly associated with risk of weight regain.

Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A Systematic Review and Meta-Analysis Based on the Theory of Planned Behaviour

BACKGROUND

Dietary behaviours are strongly patterned by socioeconomic status (SES). However, the role of SES in the self-regulation of health promoting dietary behaviours is not fully understood. This systematic review with meta-analysis investigated whether four individual-level measures of SES (income, occupation, education, and ethnicity) moderate the relationships between Theory of Planned Behaviour (TPB) variables and different health promoting dietary behaviours in adults.

METHODS

A systematic literature search identified 106 studies from 77 articles providing information on TPB variables, SES, and health promoting dietary behaviours-choosing health promoting foods and restricting health compromising foods. Random-effects meta-analyses were conducted to generate pooled correlations corrected for sampling and measurement error, and meta-regression was used to test moderating effects of study-level SES.

RESULTS

All TPB variables were significantly and positively associated with both health promoting dietary behaviours, with intention having the strongest correlation with behaviour. However, none of the relationships between TPB variables and health promoting dietary behaviours were significantly moderated by study-level SES.

CONCLUSIONS

Results suggest robust associations between TPB predictors and healthy dietary behaviour that are not patterned by individual-level SES measures.

Mental health status and dietary intake among California adults: a population-based survey

California Health Interview Survey (2005-2015) data were used to examine the association between dietary intake frequencies and mental health - Kessler-6 scores categorised as no/low (NLPD), moderate (MPD) or serious psychological distress (SPD). The 245,891 surveys represented 27.7 million adults annually, with 13.2% having MPD and 3.7% SPD. Survey-adjusted regression adjusting for gender, age, race, education, poverty, marital status, BMI, geography and year found MPD and SPD associated with lower consumption of fruits (adjusted odds ratio 0.79 and 0.65, respectively), vegetables (AOR 0.81 and 0.68), and increased consumption of French fries (AOR 1.24, 1.30), fast food (AOR 1.32, 1.27), soda (AOR 1.23, 1.26) and variance-adjusted daily teaspoons of sugar (coefficients 3.05, 4.21), all p-values less than 0.001. In this large population-based sample, moderate and SPD were independently associated with unhealthy diet. Targeted public health interventions could focus on young adults and those with less than 12 years of education.

Mediterranean diet and quality of life: Baseline cross-sectional analysis of the PREDIMED-PLUS trial

We assessed if a 17-item score capturing adherence to a traditional Mediterranean diet (MedDiet) was associated with better health-related quality of life among older Spanish men and women with overweight or obesity harboring the metabolic syndrome. We analyzed baseline data from 6430 men and women (age 55-70 years) participating in the PREDIMED-Plus study. PREDIMED-Plus is a multi-centre randomized trial testing an energy-restricted MedDiet combined with promotion of physical activity and behavioral therapy for primary cardiovascular prevention compared to a MedDiet alone. Participants answered a 36-item questionnaire about health-related quality of life (HRQoL) and a 17-item questionnaire that assessed adherence to an MedDiet. We used ANCOVA and multivariable-adjusted linear regression models to compare baseline adjusted means of the quality of life scales according to categories of adherence to the MedDiet. Higher adherence to the MedDiet was independently associated with significantly better scores in the eight dimensions of HRQoL. Adjusted differences of > = 3 points between the highest and the lowest dietary adherence groups to the MedDiet were observed for vitality, emotional role, and mental health and of > = 2 points for the other dimensions. In conclusion, this study shows a positive association between adherence to a MedDiet and several dimensions of quality of life.

Habit strength and between-meal snacking in daily life: the moderating role of level of education

Objective

Recent research emphasizes the importance of habit in explaining patterns of energy intake and choices of consumption. However, the nature of the association between habit strength and snacking has not been explored for all types of between-meal snacks.

Design

Multilevel linear techniques were used to: (i) examine the association between habit strength and moment-to-moment energy intake (kilocalories) from snacks in daily life; and (ii) determine whether gender, age, level of education and BMI moderate the association between habit strength and moment-to-moment energy intake from snacks. A smartphone application based on the experience sampling method was used to map momentary between-meal snack intake in the context of daily life. Demographics and habit strength were assessed with an online composite questionnaire.

Setting

This research was performed in the Netherlands in the natural environment of participants’ daily life.

Subjects

Adults (n 269) aged 20–50 years.

Results

Habit strength was significantly associated with moment-to-moment energy intake from between-meal snacks in daily life: the higher the strength of habit to snack between meals, the higher the amount of momentary energy intake from snacks. The association between habit strength and moment-to-moment energy intake from snacks was moderated by education level. Additional analyses showed that habit strength was significantly associated with moment-to-moment energy intake from between-meal snacks in the low to middle level of education group.

Conclusions

It is recommended to address habitual between-meal snacking in future interventions targeting low- to middle-educated individuals.

A cross-sectional investigation into the occupational and socio-demographic characteristics of British police force employees reporting a dietary pattern associated with cardiometabolic risk: findings from the Airwave Health Monitoring Study

Purpose

The aims of this study were to (1) determine the association between diet quality using the Dietary Approaches to Stop Hypertension (DASH) score and cardiometabolic risk in a British working population and (2) identify employee characteristics associated with reporting a poorer quality dietary pattern.

Methods

British police employees enrolled (2007–2012) into the Airwave Health Monitoring Study (n = 5527) were included for sex-specific cross-sectional analyses. Dietary intakes were measured using 7-day food records. DASH score was calculated to determine diet quality. Logistic regression evaluated associations between (1) diet quality and increased cardiometabolic risk (defined as ≥ 3 risk markers: dyslipidaemia, elevated blood pressure, waist circumference, CRP or HbA1c), and (2) poor diet quality (lowest fifth of DASH score distribution) and employee characteristics.

Results

Employees recording a poor diet quality had greater odds (OR) of increased cardiometabolic risk independent of established risk factors (demographic, lifestyle and occupational) and BMI: men OR 1.50 (95% CI 1.12–2.00), women: OR 1.84 (95% CI 1.19–2.97) compared to the healthiest diet group. Characteristics associated with reporting a poor quality diet were employment in Scotland vs. England: men OR 1.88 (95% CI 1.53–2.32), women: OR 1.49 (95% CI 1.11–2.00), longer working hours (≥ 49 vs. ≤40 h) men: OR 1.53 (95% CI 1.21–1.92) women: OR 1.53 (95% CI 1.12–2.09). For men, job strain (high vs. low) was associated with reporting a poor diet quality OR 1.66 (95% CI 1.30–2.12).

Conclusions

The general population disparities in diet quality between England and Scotland were reflected in British police employees. The association of longer working hours and job strain with diet quality supports the targeting of workplace nutritional interventions.

Electronic supplementary material

The online version of this article (doi:10.1007/s00394-017-1562-4) contains supplementary material, which is available to authorized users.

Folate intake in a Swedish adult population: Food sources and predictive factors

Introduction: Folate plays an important role in cell metabolism, but international studies show that intake is currently below recommendations, especially among women. The study objective was to identify folate food sources by food group, gender, and age group, and to identify factors influencing folate intake, based on food consumption data for Swedish adults in the 2010–11 Riksmaten study.

Methods: The sample included a representative Swedish population aged 18–80 years (n = 1657; 56.3% female). Food and nutrient intakes were estimated from self-reported food records during 4 consecutive days. Food consumption was categorized into 26 food groups. Stepwise regression was used to analyze food groups as folate sources for participants. Factors predicting the highest folate intake (third tertile) were determined by logistic regression analysis.

Results: Vegetables and pulses represented the most important folate source for all age groups and both genders, especially in women aged 45–64 years (49.7% of total folate intake). The next folate source in importance was dairy products for the youngest group (18–30 years), bread for men, and fruit and berries for women. The likelihood of being in the highest tertile of folate intake (odds ratio = 1.69, 95% confidence interval 1.354–2.104) was higher for men. Influencing factors for folate intake in the highest tertile were low body mass index and high educational level in the men, and high educational level, vegetarian diet, organic product consumption, non-smoking, and alcohol consumption within recommendations in the women.

Conclusion: This study describes the folate intake per food group of Swedish adults according to the 2010–11 Riksmaten survey, identifying vegetables and pulses as the most important source. Data obtained on factors related to folate consumption may be useful for the development of specific nutrition education programs to increase the intake of this vitamin in high-risk groups.

[Socioeconomic differences in physical activity in the middle-aged working population: The role of education, occupation, and income]

BACKGROUND

Regular physical activity has positive effects on health at all ages. This study aims to investigate how far physical activity and regular sports engagement, as a more specific type of physical activity, are associated with socioeconomic factors in the middle-aged working population.

METHODS

Data were obtained from 21,699 working men and women aged between 30 and 64 years who participated in the 2009 and 2010 population-based national German Health Update (GEDA) surveys conducted by the Robert Koch Institute. Besides a multi-dimensional index of socioeconomic status (SES), three single dimensions of SES (education, occupation, and income) were used to analyse socioeconomic differences in total physical activity and regular sports engagement.

RESULTS

While the prevalence of total physical activity increased with lower SES, the proportion of people with regular sports engagement decreased with lower SES. These associations remained after adjusting for age in men and women. After mutual adjustment of the three single socioeconomic dimensions, physical activity was independently associated with lower education and lower occupational status. Regular sports engagement was observed to be independently associated with higher education, higher occupational status, as well as higher income after mutual adjustment.

CONCLUSIONS

This study demonstrates significant socioeconomic differences in physical and sports activity in the middle-aged working population. Education, occupation, and income show varying independent associations with physical activity behaviour. Such differences need to be considered when identifying target groups for health-enhancing physical activity interventions.

Dietary Patterns and Socioeconomic Status in the Very Old: The Newcastle 85+ Study

Background

Dietary patterns (DP) are associated with health outcomes in younger adults but there is a lack of evidence in the very old (aged 85+) on DP and their association with sociodemographic factors, lifestyle, health and functioning measures. Higher socioeconomic status (SES) has been linked with healthier DP but it is not known whether these associations are sustained in the very old.

Objective

We aimed to (a) characterise DP in the very old and (b) assess the relationships between three SES indicators (education, occupational class and area-deprivation index [IMD]) and DP.

Methods

Complete dietary data at baseline (2006/07) for 793 participants in the Newcastle 85+ Study were established through 24-hr multiple pass recall. We used Two-Step clustering and 30 food groups to derive DP, and multinomial logistic regression models to assess the association with SES.

Results

We identified three distinct DP (characterised as ‘High Red Meat’, ‘Low Meat’, and ‘High Butter’) that varied with key sociodemographic, health and functioning measures. ‘Low Meat’ participants were more advantaged (i.e. higher education and occupational class, and lived in more affluent areas in owned homes), were least disabled, cognitively impaired, and depressed, and were more physically active than those in the other DP. After adjusting for other lifestyle factors, cognitive status and BMI, lower educational attainment remained a significant predictor of ‘High Red Meat’ and ‘High Butter’ membership compared with ‘Low Meat’ (‘High Red Meat’: OR [95% CI] for 0–9 and 10–11 years of education vs. ≥12 years: 5.28 [2.85–9.79], p<0.001 and 3.27 [1.65–6.51], p = 0.001, respectively; ‘High Butter’: 3.32 [1.89–5.82], p<0.001 and 2.83 [1.52–5.28], p = 0.001).

Conclusions

In this cohort of very old adults, we detected a favourable DP (‘Low Meat’), which was associated with better health and functioning and higher SES.

Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS)

Background

The positive association between parental socioeconomic position (PSEP) and health among adolescents may be partly explained by dietary behaviour. We investigated the associations between fruit intake, vegetable intake, energy-dense food intake, the Healthy Nutrition Score for Kids and Youth (HuSKY) and parental education in a nationwide, cluster-randomized sample of adolescents in Germany.

Methods

The German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS) included 17,641 individuals aged 0–17 years and their parents. Complete information on relevant variables was available for 6359 individuals in the 11–17 age group. The associations between nutrition indicators and parental education were analysed separately for boys and girls, using multivariate logistic regression analysis. Odds ratios (ORs) adjusted for age, region, income, occupation, physical activity and weight status related variables, were calculated for the associations between parental education and nutrition indicators.

Results

After full adjustment, higher parental education level was associated with lower energy-dense food intake – with an OR of 1.3 (95 % CI 1.0–1.7) for boys with secondary educated parents and 1.8 (1.4–2.3) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.2 (0.9–1.5) and 1.6 (1.2–2.2). Higher parental education was associated with higher fruit intake – with an OR of 1.3 (1.0–1.7) for boys with secondary educated parents and 2.0 (1.5–2.7) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.0 (0.8–1.4) and 1.5 (1.0–2.1). Among boys and girls with tertiary educated parents compared to those with primary educated parents an OR of 1.3 (CI boys: 1.0–1.7, CI girls: 1.0–1.6) was observed for high vegetable intake. Among boys with tertiary educated parents compared to boys with primary educated parents an OR of 1.6 (1.2–2.2) was observed for a high HuSKY; the corresponding OR for girls was 1.5 (1.1–1.9).

Conclusions

A high PSEP is associated with consumption of less energy-dense food, more fruits and vegetables and more favourable overall dietary behaviour. Preferably school-based interventions are needed to promote healthy dietary behaviour among German adolescents and a special effort is needed to reach adolescents from low-PSEP families.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1830-2) contains supplementary material, which is available to authorized users.

Protein supplementation and dietary behaviours of resistance trained men and women attending commercial gyms: a comparative study between the city centre and the suburbs of Palermo, Italy

Background

It is anecdotally recognized that commercial gym users assume supplements in order to improve performance or health. However, dietary behaviours of people and athletes attending commercial gyms have been poorly studied. The exact amount and frequency of dietary supplements consumption are still needed to be investigated. The main purpose of this study is to understand the quantity and quality of food intake, as well as dietary supplementation in people attending commercial gyms. Secondly to compare the city centre and the suburbs of Palermo, Italy.

Methods

A face-to-face questionnaire was administered to 561 subjects, 207 from the city centre (CC) and 354 from the suburbs (SB) of Palermo, Italy. Frequency of protein supplements use and association with dietary behaviours were investigated. Subsequently, the frequency distribution was used for demographic assessment.

Results

Frequency of protein consumption was similar in both groups (30% for CC and 28.8% for SB). Males show greater consumption percentages than females (30.5% in males and 6.9% in females). Milk and chicken are the most frequently consumed foods. Data show that non-supplement users (NSU) consume significantly more snacks and bakery products than supplement users (SU) (P < 0.001). While, SU consume significantly higher quantities of vegetables, nuts, fresh fish, eggs and canned tuna (P < 0.001). SU consume less low protein food and higher protein foods than NSU. No differences were found between CC and SB.

Conclusions

Protein consumption among commercial gym users is 30% for the CC and 28.8% for the SB. Significant differences were found between CC and SB females, underlining an interesting discrepancy, indicating to dietary supplement industries regarding regional implications. Subjects that use protein supplements also consume larger quantities of high protein food compared to NSU. NSU also eat higher proportions of unhealthy food compared to SU.