Assessing the impact of dietary habits on health-related quality of life requires contextual measurement tools

Towards integrated sustainability for China's rural revitalization: an analysis of income inequality and public health

Introduction

Ensuring healthy lives and promoting well-being are paramount among the priorities outlined in the 17 Sustainable Development Goals (SDGs) established by the United Nations. In China, rural revitalization stands as a pivotal national strategy aimed at fostering prosperity and sustainable development in rural areas. Despite its comprehensive evaluation system, which encompasses industry, ecology, culture, organization, and livelihood, the current index system overlooks the critical dimension of public health in rural areas. The existing body of literature predominantly focuses on the correlation between income and health, leaving a gap in understanding the relationship between income inequality and health from the perspective of villagers. This study addresses this gap by utilizing data from 3,771 villager samples and 302 village samples obtained from the 2019 China Rural Revitalization Survey (CRRS) to explore the correlation between income inequality and public health in China's rural areas.

Methods

We employ the Ordered Logistic Regression (Ologit) model in the baseline regression and heterogeneity analysis. Additionally, a mediating effect analysis, using the Sobel test, examines the role of villagers' health awareness as a mediating variable in the correlation between income inequality and villagers' health.

Results

The empirical findings of this study unveil a statistically significant adverse influence of income inequality on public health in China's rural areas. Furthermore, the research identifies that participation in regular exercise and the attainment of higher education levels serve as effective measures to alleviate the detrimental impact of income inequality on the health of rural residents. Additionally, income inequality is observed to shape villagers' health awareness, thereby influencing their overall health status.

Conclusion

The study's outcomes have significant implications for policymakers and governmental authorities, providing valuable insights into some pathways for enhancing public health in rural China. Ultimately, these insights contribute to the broader objective of achieving integrated sustainability in rural China.

Quality of Life of Vegetarians during the COVID-19 Pandemic in Brazil

Health emergencies such as the COVID-19 pandemic can negatively impact quality of life (QoL) due to higher levels of stress, social isolation, and uncertainties. In this scenario, distinct population groups might react differently. Vegetarians, who follow a non-conventional dietary pattern, could be more vulnerable to the abrupt changes in normal life routine and economic instability. Therefore, this study aimed at evaluating if the current pandemic situation somehow affected vegetarians' QoL. A cross-sectional study was carried out in Brazil between 28 July and 14 September 2020 to evaluate the QoL in vegetarians during the pandemic period. Vegetarian adults replied to an online survey that included the VEGQOL and WHOQOL-BREF instruments to evaluate QoL and questions related to the COVID-19 pandemic. A total of 1282 individuals participated. Only 3.8% had tested positive for COVID-19, but 39.9% affirmed having a family member who tested positive for the disease. Almost half (46.3%) of the sample had an income drop due to the pandemic. Results of QoL scores in the different subcategories of vegetarians were similar to previously published data. Individuals who had already tested positive for COVID-19 had lower QoL scores than those who did not test positive, but only in the VEGQOL. QoL was lower for the participants who declared that Sars-Cov-2 had already infected a family member for almost all the parameters evaluated. On the other hand, an income drop affected QoL only partially. Studying how vegetarians are influenced by such conditions contributes to the generation of relevant data that can be used to support healthcare and public policies in the future.

A systematic review of the association between dietary patterns and health-related quality of life

BACKGROUND

Health related quality of life (HRQOL) is a potent indicator of individual's happiness and life satisfaction. The way in which the HRQOL is affected by the diet is a topic of constant interest and debate among researchers. Evaluating the association between single nutrients or foods and HRQOL fails to take into consideration the complex interactions between nutrients. Also, the findings from previous investigations on the relationship between dietary patterns and HRQOL have been inconsistent. Therefore, our aim was to assess the existing evidence regarding the relationship between the dietary patterns and HRQOL by conducting a systematic review.

METHODS

A literature search was conducted in PubMed, Scopus, Web of Sciences and Google scholar databases from inception to March 2020, to identify studies that investigated associations between the dietary patterns (regardless of methods used to define dietary patterns) and HRQOL domains. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised their quality using the Newcastle-Ottawa Scale (NOS).

RESULTS

Thirteen studies (four longitudinal, and nine cross-sectional studies), with a total of 43,445 subjects, were included. Of the studies included in this review, eight studies evaluated the association between "Mediterranean" dietary patterns (MDP) and HRQOL, while five studies examined the association between different dietary patterns ("Healthy", "Unhealthy", "Western", "Fruit and vegetable", "Bread and butter" and etc.) and HRQOL. Excluding three studies which showed no significant association, healthy dietary patterns such as MDP, "Healthy" and "Fruit and vegetable" dietary patterns were associated with better HRQOL in physical and mental components scores. The quality assessment of included studies according to NOS criteria were ranged between medium to high quality.

CONCLUSION

According to the current evidence, "Healthy" dietary patterns and "Mediterranean" dietary patterns are associated with better dimension scores of HRQOL in both physical and mental summaries. While, unhealthy dietary patterns and "Western" dietary patterns are associated with lower scores of HRQOL. Further longitudinal studies are required to clarify the association between dietary patterns and HRQOL.

Brazilian Vegetarian Population-Influence of Type of Diet, Motivation and Sociodemographic Variables on Quality of Life Measured by Specific Tool (VEGQOL)

The adoption of a vegetarian diet has been associated with positive health outcomes. However, few studies evaluate the effect of this eating pattern on quality of life. Moreover, no specific instrument for the vegetarian population to measure the quality of life is available worldwide. Therefore, this study aimed to elaborate and validate a specific questionnaire to measure the quality of life in vegetarians. The Specific Vegetarian Quality of Life Questionnaire (VEGQOL) was constructed based on other instruments and studies related to vegetarianism. The content and semantic validation were performed by a group of experts, followed by a pilot study to evaluate the questionnaire acceptability and reproducibility. Discriminant validation was tested using the WHOQOL as the gold standard measure (Pearson correlation ranging from 0.302 of the domain 3 to 0.392 of the domain 2). Afterward, a nationwide survey was conducted using VEGQOL. Content and semantic validation selected 19 of the initial 30 items. VEGQOL presented good reproducibility (Cohen's Kappa coefficient ranging from 0.361 to 0.730 and intraclass correlation coefficient of 0.820) and internal consistency (0.708), both adequate to evaluate the quality of life in vegetarians. The sample size (n = 5014 individuals, error of 3% at a level of significance of 5%) and distribution was representative of the Brazilian vegetarian population. In general, the quality of life of Brazilian vegetarians was considered satisfactory (VEGQOL cut off points 70-80). Among different types of vegetarians, the vegans showed better results with a VEGQOL mean value of 79.2 ± 10.7. Older individuals, the ones who adopted the diet for a longer time (VEGQOL mean value of 75.8 ± 12.7) and the ones who had other vegetarians in their social network (VEGQOL mean value of 74.6 ± 12.2) also had a better quality of life score. Individuals who adopted it for ethical or health reasons had a higher quality of life score. The questionnaire produced in this study is a useful tool for future research in this area. Results were better for vegans and for the ones who adopt the diet for ethical or health reasons.

Brazilian Community Restaurants’ Low-Income Food Handlers: Association between the Nutritional Status and the Presence of Non-Communicable Chronic Diseases

This cross-sectional study aimed primarily to determine the association between the nutritional status and the presence of non-communicable chronic diseases (NCDs) among community restaurants’ food handlers, since their access to food can influence their body mass index (BMI). The study discusses the socio-demographic status of participants, dietary intake, the prevalence of overweightness/obesity, and self-reported diagnosed NCDs. In 36 Community Restaurants (CRs) from all of the Brazilian regions, we collected data from 559 food handlers. We used a questionnaire to collect socio-demographic data and the reported diagnosed chronic diseases. For the anthropometric evaluation with Body Mass Index calculation, we measured the weight and the height of the individuals. They were all weighed before having lunch at the CR, without shoes and coats. Associations between variables were analyzed by the chi-square test and Poisson regression at a significance level of 5%, considering health as the outcome variable. Most of the food handlers were female (63.1%), married or with a partner (51.7%), and overweight (59.9%). Among the food handlers that presented diagnosed NCDs (n = 96, 17.2% of food handlers), 45.8% (n = 44) presented hypertension and 12.5% (n = 12) type 2 diabetes mellitus. There was a significant association between BMI and NCD status in the studied population. The total daily sodium intake of food handlers was higher than the recommendations of the World Health Organization (WHO), especially from the CR lunch, which may raise the risk of chronic diseases such as hypertension (the most prevalent non-communicable disease found in our study). Despite that, in general, the CRs provide access to cheap and adequate meals to their workers, considering energy intake and the proportion of macronutrients. In this population, overweightness and obesity were prevalent; there was an association of obesity with chronic disease in the study population. Therefore, it is necessary for better menu planning for CRs to guarantee sodium reduction throughout time.

Health-related quality of life of Portuguese children and adolescents according to diet quality and food intake

PURPOSE

The implication of adolescence diet quality and of certain specific foods' intake on HRQoL remain underexplored, and little importance has been given to biological changes (e.g. growth, maturation, dimorphism, body composition), that remarkably increase the variability of diet and physical activity behaviours. The aim of this study was to analyse the relationship between diet quality and food intake with HRQoL in adolescents, considering maturity, body composition, and physical activity level.

METHODS

In total 669 Portuguese adolescents aged 10-17 years, attending three secondary schools, were enrolled in this cross-sectional study. Diet quality was assessed by Diet Quality International-Index (DQI-I), physical activity level was self-reported, and the HRQoL was assessed by the KIDSCREEN-52 questionnaire. The KIDSCREEN-52 includes ten dimensions (physical well-being, psychological well-being, moods and emotions, self-perception, autonomy, parent relations and home life, social support and peers, school environment, social acceptance and bullying and financial resources) and it allowed to compute a general index of the HRQoL (KIDSCREEN-10 index) through a selection of 10 items out of the KIDSCREEN-52 list. Fat mass was obtained by skinfold thickness. Maturity was objectively measured. The level of significance was set at α = 0.05.

RESULTS

Boys scored higher in HRQoL and in physical well-being, self-perception, autonomy, parent relations and home life than girls. Intakes of unhealthy foods were negatively correlated with physical well-being, self-perception, and social acceptance and bullying, while healthy foods were positively correlated with psychological well-being, moods and emotions, self-perception, and school environment. The DQI-I showed to be positively correlated with physical well-being. Participants who reported to have a higher DQI-I (≥ 60) perceived better their school environment and social acceptance and bullying. However, those results were not determined by diet quality but rather by bone age and physical activity level.

CONCLUSION

Our results showed that boys reported higher HRQoL and higher scores in the majority of HRQoL dimensions, compared to girls. The intake of unhealthy foods was negatively correlated with some HRQoL dimensions, whilst healthy foods showed positive correlations with some HRQoL dimensions. Biological maturity and physical activity level revealed to be important confounders in the study of diet quality and perception of school environment and social acceptance and bullying in adolescents.

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.

Health-related quality of life, temperament, and eating behavior among formula-fed infants in the Philippines: a pilot study

BACKGROUND

The rising prevalence of childhood obesity in Asia has led to interest in potential risk factors such as infant health-related quality of life (HRQoL), temperament and eating behaviors. This pilot study evaluated the utility of administering parent-reported outcome measures (PROMs) to explore these factors in Filipino infants and examined the relationships between these factors and infant sex, formula intake and weight, over time.

METHODS

Forty healthy, 4-week-old, formula-fed infants (n = 20 males) were enrolled in this 6-week, prospective, uncontrolled study during which infants were exclusively fed a standard term infant formula enriched with alpha-lactalbumin. On Day-1 and 42, anthropometrics were measured and mothers completed a 97-item measure of HRQoL [Infant Toddler Quality of Life Questionnaire (ITQOL)] covering 6 infant-focused and 3 parent-focused concepts and a 24-item measure of infant temperament [Infant Characteristics Questionnaire (ICQ)]. At Day-42, mothers also completed an 18-item measure of infant appetite [Baby Eating Behaviour Questionnaire (BEBQ)]. A 3-day formula intake diary was completed before Day-42. Nonparametric statistics were used to evaluate correlations among outcomes and compare outcomes by visit and sex.

RESULTS

Thirty-nine infants completed the study; similar results were observed in males and females. Completion of PROMs was 100% with no missing responses, but Cronbach's α was low for many concept scales scores. ITQOL scores [range 0 (worst)-100 (best)] were generally high (median ≥ 80) except for Day-1 and Day-42 Temperament and Mood and Day-1 General Health Perceptions scores. ITQOL but not ICQ temperament scores improved significantly between Day-1 and Day-42 (P < 0.01). Mean ± standard deviation BEBQ scores (range 1-5) were high for Enjoyment of Food (4.59 ± 0.60) and Food Responsiveness (3.53 ± 0.81), and low for Satiety Responsiveness (2.50 ± 0.73) and Slowness in Eating (1.71 ± 0.60). Better HRQoL scores were significantly (P < 0.05) associated with high General Appetite scores (3 ITQOL concepts, r = 0.32 to 0.54), greater Enjoyment of Food (4 ITQOL concepts, r = 0.35 to 0.42) and low levels of Slowness in Eating (7 ITQOL concepts, r = - 0.32 to - 0.47).

CONCLUSION

Findings demonstrated the utility of the ITQOL, ICQ and BEBQ for measuring HRQoL, temperament and eating behavior, and the need for further adaptations for use in Filipino infants.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02431377; Registered May 1, 2015.

Factors associated with quality of life in patients undergoing coronary angioplasty

OBJECTIVE

Percutaneous coronary intervention has been effective in increasing longevity of patients with cardiovascular disease. However, the evidence shows that the quality of life after the intervention is still lower than optimal level. The quality of life can be affected by various factors. The aim of this study is to determine the quality of life and its related factors in patients undergoing coronary angioplasty.

METHODS

This cross-sectional study was performed on 106 patients undergoing coronary angioplasty during 2015-2016. This study population included all patients who referred to a cardiac clinic in Rasht, Iran, were passed 3 months after their angioplasty. Research samples met the inclusion criteria and were willing to participate to the study, were selected gradually (continually). Research tools were a self-structured questionnaire regarding factors associated with the quality of life and the MacNew quality of life questionnaire. Data were collected through asking patients questions and using patient's medical records. Data analysis was conducted using descriptive and inferential statistics.

RESULTS

The results of multivariate linear regression analysis showed that independent variables of age (P = 0.0001), the number of diseased vessels (P = 0.0001), and the number of comorbidities (P < 0.05) were the most important factors associated with the quality of life.

CONCLUSION

Health-care professionals can play an effective role in promoting the quality of life of patients undergoing coronary angioplasty by modifying lifestyle based on the related factors and to provide comprehensive care programs, especially for elderly.

Involvement of IL-1 in the Maintenance of Masseter Muscle Activity and Glucose Homeostasis

Physical exercise reportedly stimulates IL-1 production within working skeletal muscles, but its physiological significance remains unknown due to the existence of two distinct IL-1 isoforms, IL-1α and IL-1β. The regulatory complexities of these two isoforms, in terms of which cells in muscles produce them and their distinct/redundant biological actions, have yet to be elucidated. Taking advantage of our masticatory behavior (Restrained/Gnawing) model, we herein show that IL-1α/1β-double-knockout (IL-1-KO) mice exhibit compromised masseter muscle (MM) activity which is at least partially attributable to abnormalities of glucose handling (rapid glycogen depletion along with impaired glucose uptake) and dysfunction of IL-6 upregulation in working MMs. In wild-type mice, masticatory behavior clearly increased IL-1β mRNA expression but no incremental protein abundance was detectable in whole MM homogenates, whereas immunohistochemical staining analysis revealed that both IL-1α- and IL-1β-immunopositive cells were recruited around blood vessels in the perimysium of MMs after masticatory behavior. In addition to the aforementioned phenotype of IL-1-KO mice, we found the IL-6 mRNA and protein levels in MMs after masticatory behavior to be significantly lower in IL-1-KO than in WT. Thus, our findings confirm that the locally-increased IL-1 elicited by masticatory behavior, although present small in amounts, contributes to supporting MM activity by maintaining normal glucose homeostasis in these muscles. Our data also underscore the importance of IL-1-mediated local interplay between autocrine myokines including IL-6 and paracrine cytokines in active skeletal muscles. This interplay is directly involved in MM performance and fatigability, perhaps mediated through maintaining muscular glucose homeostasis.

Is Healthier Nutrition Behaviour Associated with Better Self-Reported Health and Less Health Complaints? Evidence from Turku, Finland

We examined nutrition behaviour, self-reported health and 20 health complaints of undergraduates in Finland. Students at the University of Turku in Finland participated in a cross-sectional online survey (N = 1189). For nutrition behaviour, we computed two composite food intake pattern scores (sweets, cakes and snacks; and fruits and vegetables), a dietary guideline adherence index and the subjective importance of healthy eating. Multinomial logistic regression assessed the association of students' nutrition behaviour with three levels of self-reported health, controlling for many potential confounders (age, sex, living with partner, economic situation, moderate physical activity, Faculty and BMI). Factor analysis of the 20 health complaints revealed three components (psychological, pains/aches and circulatory/breathing symptoms). Multiple linear regression tested the association of students' eating habits with the three components of health complaints, controlling for the same confounders. Fruits and raw and cooked vegetable consumption, dietary guideline adherence index and subjective importance of healthy eating were highest among students with excellent/very good self-reported health, exhibiting a decreasing trend for those individuals with poor/fair self-reported health. High levels of psychological symptoms were associated with decreased consumption of fruits and vegetables, less dietary guideline adherence and less subjective importance of healthy eating. Pain/aches symptoms were associated with a higher consumption of sweets, cookies and snacks and a lower adherence to dietary guidelines. More healthy nutrition behaviour was consistently associated with better self-reported health and less health complaints. Of the four nutrition behaviour indicators we employed, the dietary guideline adherence index was the best indicator and exhibited the most consistent associations with self-reported health and health complaints.