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Zelber-Sagi S, Carrieri P, Pericàs JM, Ivancovsky-Wajcman D, Younossi ZM, Lazarus JV. Food inequity and insecurity and MASLD: burden, challenges, and interventions. Nat Rev Gastroenterol Hepatol 2024:10.1038/s41575-024-00959-4. [PMID: 39075288 DOI: 10.1038/s41575-024-00959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/31/2024]
Abstract
Liver disease prevalence, severity, outcomes and hepatic risk factors (for example, unhealthy diet) are heavily affected by socioeconomic status and food insecurity. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally and is likely to co-occur with other liver diseases associated with food insecurity. Though weight reduction and adopting a healthy diet can reverse the course of MASLD, gaps between recommendations and practice transcend individual responsibility and preference. Broader sociocultural determinants of food choices (social nutrition) include food insecurity, community and social norms and the local environment, including commercial pressures that target people experiencing poverty, ethnic minorities and children. Food insecurity is a barrier to a healthy diet, as a low-quality diet is often less expensive than a healthy one. Consequently, food insecurity is an 'upstream' risk factor for MASLD, advanced fibrosis and greater all-cause mortality among patients with liver disease. Intervening on food insecurity at four major levels (environment, policy, community and health care) can reduce the burden of liver disease, thereby reducing social and health inequities. In this Review, we report on the current research in the field, the need for implementing proven interventions, and the role liver specialists can have.
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Affiliation(s)
- Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
- The Global NASH Council, Washington, DC, USA.
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Juan M Pericàs
- Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Dana Ivancovsky-Wajcman
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Zobair M Younossi
- The Global NASH Council, Washington, DC, USA
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA
| | - Jeffrey V Lazarus
- The Global NASH Council, Washington, DC, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA
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Kohanmoo A, Hashemzadeh M, Teymouri M, Zare M, Akhlaghi M. Food insecurity is associated with low diet quality and unhealthy cooking and eating habits in Iranian women. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:42. [PMID: 38486251 PMCID: PMC10941397 DOI: 10.1186/s41043-024-00533-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/02/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Food insecurity affects diet and nutrition intakes. We explored the relationship between food insecurity and dietary intakes in a group of Iranian women. METHODS The cross-sectional study was performed on 190 healthy females aged 20-55 years attending primary healthcare centers in Shiraz. Food insecurity was evaluated by Household Food Insecurity Access Scale, which is a validated tool for assessing food insecurity in developing countries. Diet was assessed using a food frequency questionnaire. The association of dietary patterns and food insecurity was assessed by linear regression. RESULTS Assessment of dietary intakes revealed that consumption of red meat, poultry, fish, dairy, fruits, non-starchy vegetables, and nuts decreased whereas that of grains, processed meats, potato, and sugary foods increased with increasing food insecurity. Among nutrients, carbohydrates, fiber, vitamin A, vitamin C, folic acid, potassium, calcium, and magnesium decreased while fat and sodium increased as food insecurity increased. Three major dietary patterns were detected. Healthy dietary patterns showed inverse associations with food insecurity in the crude (β = -0.422 and - 0.435, P < 0.001) and adjusted (adjusted for age, marital status, and educational level) (β = -0.475 and - 0.341, P < 0.001) models of regression analysis but unhealthy pattern did not show an association with food insecurity. Compared to food secure participants, a higher percentage of food insecure individuals indicated unhealthy eating habits, such as skipping breakfast, lower snack ingestion, more fast and fried food consumption, and using unhealthy cooking methods. CONCLUSION Overall, this study showed that food insecurity was associated with less healthy diet and unhealthy cooking and eating habits.
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Affiliation(s)
- Ali Kohanmoo
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Hashemzadeh
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Teymouri
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Zare
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Akhlaghi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Figueiredo L, Lima JPM, Rocha A. Adherence to the Mediterranean Food Pattern and Carbon Footprint of Food Intake by Employees of a University Setting in Portugal. Nutrients 2024; 16:635. [PMID: 38474763 DOI: 10.3390/nu16050635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The Mediterranean diet is characterized by the predominance of the consumption of fruit, vegetables, cereals, nuts, and pulses; consumption of olive oil as the main source of fat; regular but moderate consumption of win; moderate consumption of fish, dairy products, eggs, and white meats; and low consumption of red meat as well as sugar and sugary products. In addition to the reported health benefits, the Mediterranean diet has also been widely recognized as a sustainable food pattern. The objective of this study was to understand the relationship between the degree of adherence to the Mediterranean diet of employees of the University of Porto and the relationship with the carbon footprint of their food consumption. METHODS An observational, analytical study was carried out, through the analysis of food consumption data collected in the form of a survey in the previous 24 h inserted in the eAT24 software, as well as the analysis of sociodemographic, lifestyle, and health data collected in the questionnaire. The carbon footprint was calculated from the previous 24 h surveys using data available on a website, obtained in carbon dioxide equivalent per kilogram of food. Sociodemographic, eating habit, and lifestyle questions were selected to understand the relationship between these and adherence to the Mediterranean diet and the carbon footprint of food consumption. RESULTS In total, 13.2% of the participants had a Mediterranean diet score equal to or greater than six, and the sample had an average food intake carbon footprint of 8146 ± 3081 CO2eq/Kg of food. A weak, statistically significant positive correlation (r = 0.142, p = 0.006) was observed between Mediterranean diet adherence and the carbon footprint of food intake. CONCLUSIONS Most of the participants had a low adherence to the Mediterranean diet, as well as a high carbon footprint of food intake when compared to other countries. People with higher scores for Mediterranean diet adherence have, on average, a higher carbon footprint from food consumption intake.
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Affiliation(s)
- Lúcia Figueiredo
- Faculty of Nutrition and Food Sciences, University of Porto, 4099-002 Porto, Portugal
| | - João P M Lima
- H&TRC-Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra, 3045-093 Coimbra, Portugal
- GreenUPorto-Sustainable Agrifood Production Research Centre/Inov4Agro, 4169-007 Porto, Portugal
| | - Ada Rocha
- Faculty of Nutrition and Food Sciences, University of Porto, 4099-002 Porto, Portugal
- GreenUPorto-Sustainable Agrifood Production Research Centre/Inov4Agro, 4169-007 Porto, Portugal
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Correia Rodriguez B, Rosendo I, Santos Coelho TI, Duarte Mendes P, Dos Santos Rodrigues G, Faustino Francisco Â, Cerqueira Martins AS, Boto T, Guerra Fernandes F, Figueiredo Costa Â, Lamarão C, Miguéis Ferreira I, Andrade Glória J, Vicente Osório I, Couto Gonçalves TD, Rosas Pereira A, Almeida Guedes AS, Fernandes Mendes C, Pires da Silva S, Carvalhal A, Vasconcelos Costa P, Alves Dos Reis B. [Eating Habits of People with Type 2 Diabetes Mellitus in Portugal: A Cross-Sectional Study]. ACTA MEDICA PORT 2024; 37:27-35. [PMID: 38183233 DOI: 10.20344/amp.19738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/28/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Nutrition is a cornerstone of diabetes mellitus prevention and management; therefore, it is essential to enable patients to adopt healthy eating habits. Previous studies have not yet documented the main errors in the eating habits of Portuguese people with type 2 diabetes mellitus. This study aims to identify the main errors in the eating habits of people living with type 2 diabetes mellitus in Portugal and to evaluate its associations with sociodemographic variables. METHODS Cross-sectional multicentric study in a convenience sample of people with type 2 diabetes mellitus in Primary Health Care Units. The UK Diabetes and Diet Questionnaire (UKDDQ) - translated and adapted, was applied from July to October 2022. Descriptive and inferential statistical analyses were conducted. RESULTS Of the 550 participants, 52.2% were female, 68.3% were 65 years or over, 55.8 % had an education level up to the fourth grade, 24.7% had economic deprivation, and the mean time since diagnosis was 10.60 ± 8.13 years. Only 36.2% of the sample had a healthy UKDDQ score. Less than 50% of the sample had healthy scores for the items "high-fiber rice or pasta", "high-fiber bread", "butter, margarine and vegetable oils" and "vegetables and pulses". Only 8.9% of the sample had a healthy consumption of fiber. About 70.4% reported healthy scores for the consumption of "high-added-sugar foods" and 54.7% for "high-saturated fat". A statistically significant weak positive correlation was found between the UKDDQ score and age (ρ = 0.201, p < 0.001) with a more frequent choice of healthy foods with increasing age. Female respondents reported healthier habits, particularly in the consumption of "high-saturated fat" and "high-fiber foods". CONCLUSION The majority of our sample did not take advantage of the potential benefits of healthy eating habits. The main food groups whose consumption should be emphasized or discouraged were individualized, particularly the need to encourage the consumption of high-fiber foods. Targeted educational actions must focus especially on younger and/or male patients.
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Affiliation(s)
| | - Inês Rosendo
- Faculdade de Medicina. Universidade de Coimbra. Coimbra; Unidade de Saúde Familiar Coimbra Centro. Coimbra. Portugal
| | | | | | | | | | | | - Tânia Boto
- Unidade de Saúde Familiar Infante D. Henrique. Viseu. Portugal
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Esin K, Ayyıldız F. Food insecurity, Mediterranean diet adherence, and psychosocial health among university students in Türkiye. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:649-659. [PMID: 38164907 DOI: 10.1080/09603123.2023.2300405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
The aim was to examine the relationship between food insecurity and adherence to the Mediterranean diet, academic achievement, depression, anxiety, and stress among university students. This cross-sectional study was conducted with 2039 university students studying in Türkiye. Sixty-eight point two per cent of the students were food insecure. Food security (FS) scores were negatively associated with adherence to the MD and academic achievement, and positively associated with depression, anxiety, and stress scores. A 1-unit increase in FS score resulted in a statistically significant increase of 0.458, 0.468, and 0.400 units in depression, anxiety, and stress scores, respectively, and a significant decrease of 0.140 units in the MD adherence screener score. Food insecurity among university students in Türkiye is very common, and students with food insecurity have low adherence to the MD and low academic achievement and high depression, anxiety, and stress scores. Financial support as well as financial and food literacy provided to students play an important role in managing food insecurity.
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Affiliation(s)
- Kubra Esin
- Department of Nutrition and Dietetics, Tokat Gaziosmanpaşa University, Tokat, Türkiye
| | - Feride Ayyıldız
- Department of Nutrition and Dietetics, Gazi University, Ankara, Türkiye
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Aytekin Sahin G, Mengi Celik O. Evaluation of food insecurity and associated factors in women of childbearing age: A community-based study from Turkey. Food Sci Nutr 2024; 12:154-161. [PMID: 38323300 PMCID: PMC10846561 DOI: 10.1002/fsn3.3743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/25/2023] [Accepted: 09/23/2023] [Indexed: 02/08/2024] Open
Abstract
Food security is an important factor in ensuring a healthy diet. However, it has been reported that women are more vulnerable to food insecurity than men in many countries. In addition, there is little evidence that Mediterranean diet (MD) adherence is associated with a lower risk of food insecurity. Therefore, this study aimed to evaluate food insecurity and associated factors in women of childbearing age. In addition, women's adherence to MD and its relationship with food insecurity were evaluated. This descriptive and cross-sectional study was conducted with 2675 adult women aged 18-49. The demographic characteristics, anthropometric measurements, nutritional habits, compliance with the MD, and the level of food insecurity were evaluated using the structured, self-administered, web-based questionnaire form. The mean age of the individuals was 29.5 ± 10.35 years. 21.6% of individuals had food insecurity, and 5.2% had severe food insecurity. 36.4% of the individuals adhere to the MD. There was a statistically significant difference between the individuals with and without food security regarding age, marital status, and income status (p < .05). However, there was no statistically significant difference in terms of the Mediterranean diet adherence score (MEDAS) and MEDAS classification between individuals with and without food security (p > .05). It was determined that age, marital status, and income status affected food insecurity (R 2 = 0.374; p < .001). Also, it was determined that age, number of main meals and snacks, and income status affected adherence to MD (R 2 = 0.286; p < .001). In conclusion, considering the fragility of women in food insecurity, more comprehensive studies should be conducted in this area to better define the factors associated with food insecurity in women and inform policymakers. In addition, the results of this study can shed light on comprehensive intervention studies in this area.
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Affiliation(s)
- Gizem Aytekin Sahin
- Department of Nutrition and Dietetics, Faculty of Health SciencesNuh Naci Yazgan UniversityKayseriTurkey
| | - Ozge Mengi Celik
- Department of Nutrition and Dietetics, Gulhane Faculty of Health SciencesUniversity of Health SciencesAnkaraTurkey
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Qian H, Khadka A, Martinez SM, Singh S, Brenowitz WD, Zeki Al Hazzouri A, Hill-Jarrett TG, Glymour MM, Vable AM. Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older. JAMA Netw Open 2023; 6:e2344186. [PMID: 37988079 PMCID: PMC10663972 DOI: 10.1001/jamanetworkopen.2023.44186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/10/2023] [Indexed: 11/22/2023] Open
Abstract
Importance Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association. Objective To examine whether food insecurity in older adults is associated with later-life cognitive outcomes. Design, Setting, and Participants This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023. Exposure Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure. Main Outcomes and Measures Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights. Results The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline. Conclusions and Relevance In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.
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Affiliation(s)
- Haobing Qian
- Department of Family and Community Medicine, University of California, San Francisco
| | - Aayush Khadka
- Department of Family and Community Medicine, University of California, San Francisco
| | - Suzanna M. Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sonali Singh
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - M. Maria Glymour
- Department of Epidemiology, Boston University, Boston, Massachusetts
| | - Anusha M. Vable
- Department of Family and Community Medicine, University of California, San Francisco
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Tari Selcuk K, Atan RM, Arslan S, Sahin N. Is food insecurity related to sustainable and healthy eating behaviors? ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27694-8. [PMID: 37204579 DOI: 10.1007/s11356-023-27694-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
In this cross-sectional study, it was aimed to investigate the relationship between sustainable and healthy eating behaviors such as nutritional insecurity and a healthy and balanced diet, interest in regional and organic food products, consumption of seasonal food and avoidance of food waste, preference for locally produced foods, reduction of meat consumption, preference for eggs from free-range chickens, and sustainable fishery products, and consumption of low-fat food products in adults. The study included 410 adults who were reached through social media applications. Data were collected through an online questionnaire including the Descriptive Information Form, the Household Food Insecurity Access Scale (HFIAS), and the Sustainable Healthy Eating Behaviors Scale (SHEBS). The proportion of participants determined as mildly food insecure, moderately food insecure, and severely food insecure was 10.2%, 6.6%, and 7.6%, respectively. Linear regression analysis revealed that in Models 1, 2, and 3, there was a statistically significant negative association between food insecurity and the components of sustainable and healthy eating behaviors such as healthy and balanced diet (β - 0.226, p < 0.001), quality labels (β - 0.230, p < 0.001), seasonal foods, which are of avoidance of food waste (β - 0.261, p < 0.001), animal welfare (β - 0.174, p < 0.001), and fat intake (β - 0.181, p < 0.001). In conclusion, food insecurity negatively affects healthy and balanced diet behaviors, interest in regional and organic food products, seasonal food products consumption and avoidance of food waste, consumption of low-fat food products, and the choice of products such as free-range chicken eggs, and sustainable fisheries.
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Affiliation(s)
- Kevser Tari Selcuk
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey.
| | - Ramazan Mert Atan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Sedat Arslan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Nursel Sahin
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
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Militao EMA, Uthman OA, Salvador EM, Vinberg S, Macassa G. Food Insecurity and Associated Factors among Households in Maputo City. Nutrients 2023; 15:nu15102372. [PMID: 37242255 DOI: 10.3390/nu15102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Food insecurity (FI) is a global concern and is one of the main causes of malnutrition in low- and middle-income countries. In Mozambique, the burden of FI and how various factors contribute to FI is not well known. This study aimed to investigate the prevalence of FI and its associated factors in southern Mozambique. Data from 1842 household heads in Maputo City were analyzed in a cross-sectional design. Food insecurity was measured using a modified version of the US Department of Agriculture Household Food Security scale, and its association with socio-demographic factors was assessed through multiple regressions. Altogether, 79% of the households were food insecure; of these, 16.6% had mild FI, 28.1% moderate and 34.4% severe FI. The study revealed that low-income households, those with less educated heads, and those engaged in informal work were significantly more prone to FI. Likewise, dietary diversity and the number of meals were also significant predictors of FI. These findings suggest the need for decent work and job creation, which calls for joint efforts from government, the private sector, and international institutions. Furthermore, these key drivers should be considered in the development of public health policies and programs designed to alleviate household FI and malnutrition in Mozambique.
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Affiliation(s)
- Elias M A Militao
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 801 76 Gävle, Sweden
- Department of Biological Sciences, Faculty of Science, Eduardo Mondlane University, 3453 Julius Nyerere Avenue, Maputo 257, Mozambique
| | - Olalekan A Uthman
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Health Sciences, Stellenbosch University, Francie van Zijl Drive, Cape Town 7505, South Africa
| | - Elsa M Salvador
- Department of Biological Sciences, Faculty of Science, Eduardo Mondlane University, 3453 Julius Nyerere Avenue, Maputo 257, Mozambique
| | - Stig Vinberg
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
| | - Gloria Macassa
- Department of Health Sciences, Faculty of Humanities, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 801 76 Gävle, Sweden
- EPI Unit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
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Rizk R, Haddad C, Sacre H, Malaeb D, Wachten H, Strahler J, Salameh P. Assessing the relationship between food insecurity and lifestyle behaviors among university students: a comparative study between Lebanon and Germany. BMC Public Health 2023; 23:807. [PMID: 37138254 PMCID: PMC10154760 DOI: 10.1186/s12889-023-15694-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Food insecurity is a common public health problem in both developed and developing countries. This study aimed to profile food insecurity among university students in a developed country with stable economic circumstances (Germany) and a developing Mediterranean country undergoing a severe economic and financial crisis (Lebanon) and examine the associations between food insecurity and lifestyle behaviors (i.e., physical activity, sleep, and adherence to a healthy eating pattern, such as the Mediterranean diet), stress, and financial well-being. METHOD This online cross-sectional study was conducted between September 2021 and March 2022. Subjects were recruited through social media platforms (Facebook, WhatsApp, Instagram, and personal email) and in-class announcements by several university professors of various majors and from different universities in Lebanon and Germany. The final sample included 547 participants (197 from Lebanon and 350 from Germany). RESULTS Our findings showed a higher food insecurity rate in Lebanon compared with Germany (59% versus 33%). In the bivariate analysis, food insecurity was associated with insomnia (r = 0.230; p < 0.001) and stress (r = 0.225; p = 0.001); German university students had higher physical activity (p < 0.001), better diet quality (p < 0.001), and lower adherence to the Mediterranean diet (p < 0001) than Lebanese students. In the multivariable analyses, more stress was related to insomnia (B = 0.178; p < 0.001), while financial well-being was not associated with any of the lifestyle behaviors. Physical activity, insomnia, and Mediterranean diet adherence were not associated with the country or food insecurity (p > 0.05); however, living in Germany was associated with better diet quality (B = -7.85; p < 0.001). CONCLUSION The high prevalence of food insecurity reported in this study is alarming, particularly among Lebanese students; German students had better diet quality and higher physical activity but worse adherence to the Mediterranean diet. Moreover, food insecurity was also associated with worse sleep and stress. Further studies are necessary to assess the role of food insecurity as a mediating factor between sociodemographic characteristics and lifestyle behaviors.
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Affiliation(s)
- Rana Rizk
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon.
- School of Medicine, Lebanese American University, Byblos, Lebanon.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon.
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Hanna Wachten
- Sport Psychology, Institute of Sport and Sport Science, Albert-Ludwigs-University Freiburg, Freiburg Im Breisgau, Germany
| | - Jana Strahler
- Sport Psychology, Institute of Sport and Sport Science, Albert-Ludwigs-University Freiburg, Freiburg Im Breisgau, Germany
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus
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Maia I, Oliveira A, Santos AC. Food insecurity is associated with an unhealthy lifestyle score in middle- and older-aged adults: findings from the EPIPorto cohort. Food Secur 2023; 15:661-671. [PMID: 37223752 PMCID: PMC10088709 DOI: 10.1007/s12571-023-01366-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/15/2023] [Indexed: 05/25/2023]
Abstract
The association of food insecurity with the combined effect of lifestyles is still limited. This study evaluated the association between food insecurity and a lifestyle score in middle- and older-aged adults. A cross-sectional study (2013-2016) was performed among 595 individuals (≥ 50 years) from the EPIPorto cohort (Porto, Portugal). Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Information on fruit and vegetable consumption (F&V), physical activity (PA) practice, tobacco smoking, and alcohol consumption were included in a lifestyle score. Those with F&V < five portions/day, < 150 min/week of moderate-intensity PA or < 75 min/week of vigorous-intensity PA, current smokers, consumers of > one drink of alcoholic beverages in women, and > two in men were assigned with one point; all the others had nil points. The score could range from 0 to 4, and was further categorised into three categories. Food insecurity was positively associated with an unhealthy lifestyle profile (OR = 2.272; 95%CI:1.079-4.782), independently of the adjustment variables. Analysing each lifestyle component, food insecurity was associated with low PA practice (OR = 2.365; 95%CI:1.020-5.485). Individuals from food insecure households were more likely to have an unhealthy lifestyle profile. Public health strategies should be developed among food insecure individuals to promote healthy lifestyles.
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Affiliation(s)
- Isabel Maia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Andreia Oliveira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Sohrabi M, Mollanoroozy E, Abbasi H, Mehrabadi S, Zamani F, Ajdarkosh H, Hatamian S, Bahavar A, Safarnezhad Tameshkel F, Gholami A. Household Food Insecurity and Associated Factors among Iranian Patients with Esophageal and Gastric Cancers. Middle East J Dig Dis 2023; 15:76-82. [PMID: 37546504 PMCID: PMC10404090 DOI: 10.34172/mejdd.2023.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background: Household food insecurity (HFI) which has still been one of the major global public health issues is related to adverse health outcomes in individuals. Therefore, this study aimed to determine the prevalence of HFI and its associated factors in Iranian patients with esophageal and gastric cancers. Methods: The data of this cross-sectional study was obtained from 315 patients with esophageal and gastric cancers who were selected from a gastrointestinal cancer-based cohort study conducted in Firoozgar hospital, in Tehran. Food insecurity (FI) was measured using the Iranian version of the HFI questionnaire that was completed by a trained interviewer. The multivariable logistic regression model was used to determine the independent association of each factor with HFI. A P value lower than 0.05 was considered statistically significant. Results: The mean±SD of participants' age was 63.2±12.6 years and 65.4% were men. Most of the patients (75.8%) suffered from gastric cancer and 24.2% from esophageal cancer. The overall prevalence of FI among participants' households was 35.2%. There was an independent significant association between wealth index (WI) and HFI after the use of the multivariable logistic regression model, in such a way that the odds of FI in the poorest, poor, moderate, and rich patients' households were respectively, 6.41, 5.05, 2.74 and 2.04 times higher compared with the richest households. Conclusion: More than a third of participants' households struggled with FI, which was found to have a higher prevalence in loweconomic households. Therefore, health policymakers should intervene in food-insecure households by developing, establishing, and implementing strategies and control programs to improve affordable food access.
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Affiliation(s)
- Masoudreza Sohrabi
- Gastrointestinal and Liver Disease Research Center (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ensiyeh Mollanoroozy
- Epidemiology & Biostatistics Department, School of Public Health, Neyshabur University of Medical, Sciences, Neyshabur, Iran
| | - Hamid Abbasi
- Department of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Shima Mehrabadi
- Student Research Committee, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Disease Research Center (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ajdarkosh
- Gastrointestinal and Liver Disease Research Center (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sare Hatamian
- Gastrointestinal and Liver Disease Research Center (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atefeh Bahavar
- Gastrointestinal and Liver Disease Research Center (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Safarnezhad Tameshkel
- Gastrointestinal and Liver Disease Research Center (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Gholami
- Noncommunicable Diseases Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Epidemiology & Biostatistics Department, School of Public Health, Neyshabur University of Medical, Sciences, Neyshabur, Iran
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Jeżewska-Zychowicz M, Gajda R. Relationship between the Prevalence of Metabolic Disease and Impaired Mobility, Diet, Physical Activity, and Socio-Demographic Characteristics in the Polish Elderly-A Cross-Sectional Study. Life (Basel) 2023; 13:life13040864. [PMID: 37109393 PMCID: PMC10145149 DOI: 10.3390/life13040864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Maintaining good health for as long as possible presents a great challenge for the elderly. As the elderly population is growing, there is an ongoing need to identify health risk factors affecting older individuals. The study aimed to explore relationships between sociodemographic characteristics, diet, physical activity, and prevalence of metabolic diseases and impaired mobility in the Polish elderly. A cross-sectional study was carried out on 417 elderlies in May-July 2021. Cluster analysis was applied to separate four homogeneous clusters based on the prevalence of metabolic disease and impaired mobility. Logistic regression analysis was used to verify associations between variables. Being overweight or having obesity, as well as following a diet, increased the probability of being affected by metabolic disease. Being well educated, having a better financial situation, positive perception of own health, and having at least moderate physical activity decreased the probability of suffering from mobility impairments. Eating behaviors were not found to be predictors of the disease. However, they differentiated the selected clusters. The results confirmed the heterogeneity of factors that may impact healthy aging. Thus, they should be taken into account by public health authorities to develop health promotion actions adjusted to the needs of specific subgroups.
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Affiliation(s)
- Marzena Jeżewska-Zychowicz
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska 159C, 02-776 Warsaw, Poland
| | - Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
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Wiesmann D, Goldsmith R, Shimony T, Nitsan L, Keinan-Boker L, Shohat T. Food Insecurity in Israeli Elderly is Associated with Sociodemographic Characteristics, Disability, and Depression: Policy Implications. Curr Dev Nutr 2023; 7:100006. [PMID: 37180079 PMCID: PMC10111608 DOI: 10.1016/j.cdnut.2022.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/26/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Food insecurity (FI) and poor health can turn into a vicious cycle with detrimental effects, especially in the elderly, however, few studies have examined the relationship between FI and health in this age group. Objectives We investigated associations of FI with physical and mental health and health behaviors among community-dwelling elderly. Methods We used nationally representative, cross-sectional data from the 2014-2015 Israel National Health and Nutrition Survey of the Elderly (Rav Mabat Zahav) on FI, sociodemographic characteristics, noncommunicable diseases (NCDs), disability, self-assessed physical, oral, and mental health for 1006 individuals aged ≥65 y. Results FI affected 12.3% of all households with elderly and was significantly higher among late immigrants and Arabs. Bivariate associations of FI with the number of NCDs, depression, disability in all 6 domains (vision, hearing, mobility, self-care, remembering, communication), poor self-assessed physical and oral health, chewing and swallowing problems, feelings of loneliness, insufficient physical activity, and smoking were significant (P < 0.05). In a multivariable logistic regression controlling for population group, household size, age and sex, FI was significantly associated (P < 0.05) with lack of formal education (OR: 6.26; 95% CI: 1.66, 23.65), being in the lowest (OR: 23.56; 95% CI: 3.71, 149.76) or second-lowest (OR: 16.75; 95% CI: 2.68, 104.52) per capita household income quartile, having one (OR: 2.11; 95% CI: 1.05, 4.23) or several disabilities (OR: 4.04; 95% CI: 1.72, 9.45), and having ever been diagnosed with depression (OR: 3.34; 95% CI: 1.35, 8.28). Conclusions FI is associated with physical and mental health problems, multiple disabilities, and loneliness among Israeli elderly. Providing income support could reduce FI, and subsidized congregate and home-delivered meal services could be expanded to meet the needs of elderly with disabilities and counter social isolation. Because low education, disability, and depression are particularly prevalent among the food insecure and vulnerable groups face language barriers, assistance with applications for these services should be increased.
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Affiliation(s)
| | - Rebecca Goldsmith
- School of Public Health, The Hebrew University in Jerusalem, Ein Karem, Jerusalem, Israel
| | - Tal Shimony
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Lesley Nitsan
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
- School of Public Health, University of Haifa, Mount Carmel, Haifa, Israel
| | - Tamy Shohat
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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The 'Covid-Trigger': New Light on Urban Agriculture and Systemic Approach to Urbanism to Co-Create a Sustainable Lisbon. SYSTEMIC PRACTICE AND ACTION RESEARCH 2023; 36:87-109. [PMID: 35465099 PMCID: PMC9018248 DOI: 10.1007/s11213-022-09598-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 01/17/2023]
Abstract
In 2018, Lisbon won the title of Green capital of Europe 2020. It was described by the Expert Panel as an inspirational city which had started its journey towards sustainability during a period of economic crisis. A year later, Covid-19 had become a global pandemic. Imposed confinements highlighted the extent to which globalisation has spread the virus, as well as the particular fragility of places like cities where people, living together, were asked to not physically interact anymore. Exploring further that very particular global crisis can help to identify the faults in our economic systems and to ask why Lisbon was neither resilient nor sustainable in the face of that adversity. In addition to highlighting how weak our health is, Covid-19 has exacerbated vulnerabilities in Lisbon such as job losses (especially in the touristic sector), food supply (Portugal imports 70% of its food) and food waste. This paper explores how the activity which, 'par excellence', meets the most basic of our needs (food), through the example of Urban Agriculture (UA), could contribute to discussions on what makes a city sustainable. A literature review on UA in Lisbon highlights its various benefits, complemented by a broader literature review which converges to showing how UA can help to address the vulnerabilities generated or exacerbated by Covid. Having shown its potential contribution to addressing crises, this article then suggests to examine how systems approaches could help to incorporate UA further in a new type of more participatory urbanism aimed at creating sustainable cities.
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Gajda R, Jeżewska-Zychowicz M, Styczyńska M, Jarossová MA. Food Insecurity in the Households of Polish Elderly: Diversity in the Perception of Its Causes by Demographic and Socioeconomic Characteristics. Foods 2022; 11:3222. [PMCID: PMC9601627 DOI: 10.3390/foods11203222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aging of societies and the quality of life of the elderly may be accompanied by food insecurity. The aim of the study was to find the relationships between the perceptions of various causes of food insecurity, i.e., financial, social, health, and spatial, and then between those and the selected sociodemographic characteristics. The survey was conducted in late 2018 and early 2019 among 760 people aged 65 and older in two regions of Poland. Factor analysis with the use of principal component analysis (PCA) was used to identify the main causes of the prevalence of food insecurity. Cluster analysis using Ward’s hierarchical classification and logistic regression analysis were used to assess the relationship between the identified reasons for food insecurity, demographic characteristics, and socioeconomic status (SES). Two groups of causes that favor the experience of food insecurity among the elderly were identified, i.e., economic–social reasons and spatial–health reasons. They relate to such situations of food insecurity as concerns about food shortages, lack of staple foods, limited size or frequency of meals, and skipping meals. The high importance of economic–social (HE-S) reasons was associated with the low importance of spatial–health (LS-H) reasons, and conversely, the high importance of spatial–health (HS-H) causes was associated with the low importance of economic–social (LE-S) causes. HE-S and LS-H reasons were combined with low SES and residence in a city of more than 100,000 inhabitants. HS-H causes, on the other hand, were associated with LE-S causes and living in rural areas or towns of fewer than 100,000 inhabitants, as well as high SES. This specificity should be considered in the development of strategies and interventions aimed at reducing the phenomenon of experiencing food insecurity in the elderly population.
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Affiliation(s)
- Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
- Correspondence:
| | - Marzena Jeżewska-Zychowicz
- Department of Food and Consumption Market Research, Faculty of Human Nutrition, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland
| | - Marzena Styczyńska
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
| | - Małgorzata Agnieszka Jarossová
- Department of Marketing, Faculty of Commerce, University of Economics in Bratislava, Dolnozemská Cesta 1, 852 35 Bratislava, Slovakia
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17
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The effect of non-participation on the prevalence of food insecurity in a population-based cohort in Portugal. J Public Health Policy 2022; 43:391-402. [PMID: 36038767 DOI: 10.1057/s41271-022-00362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/21/2022]
Abstract
Non-participation can be a source of selection bias. We evaluated the effect of non-participation on food insecurity prevalence among 2942 young adults from the EPITeen cohort (Portugal), which we have followed since assembling the cohort in 2003-2004. We conducted a cross-sectional study when the cohort participants were 26 years old. To examine the effect of non-participation, we statistically imputed the missing data on food security status using multivariate imputation by chained equations based on characteristics associated with food insecurity, specifically household income perception, education and household structure from 21 or 24 years of age follow-ups. In our cohort, non-participation caused ~ 2% difference in the food insecurity prevalence: 11.0% (95% CI 9.0-13.0) for 954 participants and 12.6% (95% CI 11.1-14.1) after imputation. These estimates are close to evidence from other European countries and sustain the relevance of developing public health interventions to promote food security, especially considering the negative nutritional and health outcomes associated with food insecurity.
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18
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Alves R, Perelman J. European mature adults and elderly are moving closer to the Mediterranean diet-a longitudinal study, 2013-19. Eur J Public Health 2022; 32:600-605. [PMID: 35712901 PMCID: PMC9341670 DOI: 10.1093/eurpub/ckac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The decreasing adherence in Mediterranean Diet (M.D.) during the last decades has been attributed to social, cultural and economic factors. However, recent efforts to improve dietary habits and the economic improvement might be reversing this trend. We analyze the changes in M.D. adherence between 2013 and 2019 among a sample of European mature adults and the elderly. METHODS Using data from the Survey of Health, Ageing and Retirement in Europe for adults over 50 years old, we designed a longitudinal cohort study with a sample of participants from waves 5 (2013) and 8 (2019/20). Logistic regressions were used to model the consumption of M.D. adherence as a function of the year. We then stratified the analyses by education, age and transitions in economic status, employment and self-perceived health. RESULTS There was in 2019/20 a significant increase in the M.D. adherence (10.8% vs. 14.3%, OR = 1.367, P < 0.01). The rise was mainly related to the decrease of meat and fish (38.4% vs. 30.5%, OR = 0.703, P < 0.01) and growth of legumes and eggs intake (36.3% vs. 41.8%, OR = 1.260 P < 0.01). The results were consistent in all European regions and most sociodemographic groups. Younger people with higher income and education had a greater rise in adherence. CONCLUSIONS Our analysis shows a generalized growth in adherence to the M.D. across most socioeconomic subpopulations and countries in Europe, suggesting a shift to healthier diet patterns. The more noticeable increase among affluent, educated and healthy respondents, may further entrench dietary and health inequalities.
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Affiliation(s)
- Ricardo Alves
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Julian Perelman
- Public Health Research Center, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
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Pequeno NPF, Cabral NLDA, Oliveira ÂGRC, Crispim SP, Rocha C, Marchioni DM, Lima SCVC, Lyra CDO. Chronic diseases and emotional disorders are associated with low perception of quality of life in food insecurity/security. Front Public Health 2022; 10:893601. [PMID: 35923966 PMCID: PMC9340216 DOI: 10.3389/fpubh.2022.893601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Understanding individual perception of Quality of Life (QoL) can help combat social and health inequalities. We aimed to identify factors associated with Low Perceived Quality of Life (LPQoL) in 295 adults and older adults with food security and food insecurity, in the city of Natal, Brazil. A cross-sectional study was conducted from June to December 2019, with collection of data on socioeconomic demographic status, lifestyle information, non-communicable diseases (NCDs) and risk factors, emotional disorders, food (in) security and quality of life. To assess food insecurity, the Brazilian Scale of Food Insecurity—EBIA was used, and the WHOQOL-Bref questionnaire was used to assess quality of life. Poisson's Regression was used to verify associations between variables and LPQoL, stratifying the sample into food secure (FS) and food insecure (FI) groups. In the FI group, being overweight, older adult, having no partner, drinking alcoholic beverages twice a week or more, and not having daily availability of water were associated with LPQoL, and in the FS group, having diabetes, monthly family income in the 1st and 2nd tertiles, and never having studied was associated with LPQoL. Reporting emotional disorders and sleeping < 7 h/day were associated with LPQoL in both FI and FS groups. LPQoL was associated with the occurrence of NCDs and risk factors, and emotional disorders, regardless of the food security measure. However, the lack of adequate access to water highlights the social vulnerability of the FI group.
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Affiliation(s)
- Nila Patrícia Freire Pequeno
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
- *Correspondence: Nila Patrícia Freire Pequeno
| | - Natália Louise de Araújo Cabral
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Federal Institute of Education, Science and Technology of Sertão Pernambucano, Petrolina, Brazil
| | | | | | - Cecília Rocha
- School of Nutrition, Centre for Studies in Food Security, Ryerson University, Toronto, ON, Canada
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Clélia de Oliveira Lyra
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
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Coping Strategies for Household Food Insecurity, and Perceived Health in an Urban Community in Southern Mozambique: A Qualitative Study. SUSTAINABILITY 2022. [DOI: 10.3390/su14148710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In low- and middle-income countries, food insecurity (FI) is a living reality for many households, particularly among the most vulnerable groups. The burden of household FI in Mozambique and how FI and coping strategies relate to perceived health are unknown. This study investigated the lived experiences and coping strategies of food-insecure households, along with their perceived health. Altogether, 16 in-depth interviews were performed, audio-recorded, and transcribed verbatim. A qualitative content analysis was carried out and five themes emerged: lived experiences of FI, coping strategies used in situations of FI, food choices, climate change and food security, and FI and perceived health. A wide range of lived experiences and coping strategies were reported, including cooking whatever is available, skipping meals, receiving money or food from friends and relatives, eating unsafe and low-quality foods, taking on additional work, cooking least-preferred foods, and having a monotonous and less-nutritious diet. Furthermore, the participants reported emotional distress, anxiety and depression, substance use, and other negative health outcomes. Some had diagnoses of hypertension, diabetes or HIV/AIDS. The findings suggest the need for employment creation and women’s empowerment, as well as the implementation of appropriate policies and programmes to alleviate household FI.
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21
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Influence of Social Adversity on Perceived Health Status and Depressive Symptoms among Portuguese Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116355. [PMID: 35681940 PMCID: PMC9180494 DOI: 10.3390/ijerph19116355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 02/01/2023]
Abstract
This study aims to investigate how exposure to poverty, food insecurity, and abuse at older ages relates to health outcomes. A questionnaire collecting data on sociodemographic and economic characteristics, health status, depressive symptoms, food insecurity, and abuse was administered to a sample of 677 older adults. Logistic regression was used to quantify the association of poverty, food insecurity, and abuse with perceived health status and depressive symptoms. If the older person only reported experiences of abuse, it was more likely to report the presence of depressive symptoms, even after adjustment for covariates. If it was only reported the experience of food insecurity, it was more likely to report a worse health status. Older people exposed to at least two factors of vulnerability were significantly more likely to report (very) poor perceived health status (OR: 7.11, 95% CI: 2.77–18.25) and the presence of relevant depressive symptoms (OR: 4.34; 95% CI: 2.04–9.22). Thus, the combined effect of vulnerabilities was significantly associated with worse health among older people. Public health policies to mitigate these adverse exposures should be developed to promote health and well-being in this population.
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Aggeli C, Patelida M, Grammatikopoulou MG, Matzaridou EA, Berdalli M, Theodoridis X, Gkiouras K, Persynaki A, Tsiroukidou K, Dardavessis T, Tzimos C, Goulis DG, Vassilakou T. Moderators of Food Insecurity and Diet Quality in Pairs of Mothers and Their Children. CHILDREN 2022; 9:children9040472. [PMID: 35455516 PMCID: PMC9031801 DOI: 10.3390/children9040472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/16/2022]
Abstract
Research has suggested that maternal diet and characteristics may influence the diet of offspring during childhood. The present cross-sectional study aimed to assess the influence of distinct maternal characteristics and the diet quality of mothers on the prevalence of household food insecurity (FI) and the diet quality of children. A total of 179 mother–child pairs were recruited from two primary schools in the metropolitan area of Thessaloniki. The children were aged between 10 and 12 years old. Diet quality was assessed as the level of adherence to the Mediterranean diet (MD), with the use of the KIDMED for the children and the MedDietScore for the mothers. The household FI and the social and demographic characteristics of the mothers were also recorded, and anthropometric measures of both the mothers and their children were collected. Approximately ¼ (26.3%) of the pairs reported some degree of FI, with a greater prevalence (64.7%) within single-mother families. Moreover, FI affected the level of maternal MD adherence (p = 0.011). On the other hand, FI was decreased in households with a greater maternal educational level (OR: 0.25; 95% CI: 0.10–0.63) and conjugal family status (OR: 0.15; 95% CI: 0.87–0.52). Maternal adherence to the MD was inversely related to the respective adherence of their offspring (OR: 0.93; 95% CI: 0.86–0.997), suggesting that during periods of financial constraints, maternal diet quality is compromised at the expense of affording a better diet for the minors in the family.
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Affiliation(s)
- Christine Aggeli
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (C.A.); (X.T.); (K.G.)
| | - Maria Patelida
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57400 Thessaloniki, Greece; (M.P.); (E.-A.M.); (M.B.); (A.P.)
| | - Maria G. Grammatikopoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57400 Thessaloniki, Greece; (M.P.); (E.-A.M.); (M.B.); (A.P.)
- Correspondence: (M.G.G.); (T.V.)
| | - Ekaterini-Avrakomi Matzaridou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57400 Thessaloniki, Greece; (M.P.); (E.-A.M.); (M.B.); (A.P.)
| | - Marina Berdalli
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57400 Thessaloniki, Greece; (M.P.); (E.-A.M.); (M.B.); (A.P.)
| | - Xenophon Theodoridis
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (C.A.); (X.T.); (K.G.)
| | - Konstantinos Gkiouras
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece; (C.A.); (X.T.); (K.G.)
| | - Angeliki Persynaki
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57400 Thessaloniki, Greece; (M.P.); (E.-A.M.); (M.B.); (A.P.)
| | - Kyriaki Tsiroukidou
- 3rd Department of Pediatrics, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Theodore Dardavessis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece;
| | - Christos Tzimos
- Northern Greece Statistics Directorate, Hellenic Statistical Authority, 218 Delfon Str., GR-54646 Thessaloniki, Greece;
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, GR-11521 Athens, Greece
- Correspondence: (M.G.G.); (T.V.)
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Mendonça N, Gregório MJ, Salvador C, Henriques AR, Canhão H, Rodrigues AM. Low Adherence to the Mediterranean Diet Is Associated with Poor Socioeconomic Status and Younger Age: A Cross-Sectional Analysis of the EpiDoC Cohort. Nutrients 2022; 14:nu14061239. [PMID: 35334895 PMCID: PMC8954252 DOI: 10.3390/nu14061239] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/10/2023] Open
Abstract
The Mediterranean diet (MD) is recognized as one of the healthiest dietary patterns as it has been consistently associated with several beneficial health outcomes. Adherence to the MD pattern has been decreasing in southern European countries for the last decades, especially among low socioeconomic groups. The aim of this study was to assess the adherence to the MD in Portugal, to evaluate regional differences, and explore associated factors (sociodemographic, economic, and lifestyles behaviors). This study used the third data collection wave of the Epidemiology of Chronic Diseases Cohort Study (EpiDoC 3). MD adherence was assessed using the Portuguese-validated MD adherence score (MEDAS) questionnaire. Non-adjusted and adjusted logistic regression models were used to assess the risk factors for low MD adherence and individual MEDAS items. In this cross-sectional evaluation of the EpiDoC 3 cohort study (n = 5647), 28.8% of the Portuguese population had low adherence to a MD. Azores and Madeira had lower adherence to the MD than the rest of the country. Younger individuals in lower income categories (e.g., ORfinding it very difficult = 1.48; 95% CI 1.16-1.91) and with a lower educational level (e.g., OR0-4 years = 2.63; 95% CI 2.09-3.32) had higher odds of having a lower adherence to the MD. Portuguese adults have a high prevalence of low adherence to the MD, especially among those who are younger and have lower socioeconomic status. Public health policies to promote adherence to the MD should pay special attention to these groups.
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Affiliation(s)
- Nuno Mendonça
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
- EpiSaúde Sociedade Científica, 7005-837 Évora, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4200-465 Porto, Portugal
- Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, 1049-005 Lisboa, Portugal
| | - Clara Salvador
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, 1049-005 Lisboa, Portugal
| | - Ana Rita Henriques
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
- EpiSaúde Sociedade Científica, 7005-837 Évora, Portugal
| | - Ana M. Rodrigues
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1099-085 Lisboa, Portugal; (N.M.); (M.J.G.); (C.S.); (A.R.H.); (H.C.)
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1150-082 Lisboa, Portugal
- EpiSaúde Sociedade Científica, 7005-837 Évora, Portugal
- Rheumatology Unit, Hospital dos Lusíadas, 1500-458 Lisboa, Portugal
- Correspondence: ; Tel.: +351-218803000
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Silva MRG, Machado-Rodrigues AM, Rodrigues D, Nogueira H, Rosado-Marques V, Gama A, Padez C. Household Food Security and Associated Factors among Portuguese Children. Ecol Food Nutr 2021; 61:407-421. [PMID: 34936530 DOI: 10.1080/03670244.2021.2018311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study investigated the household food insecurity (HFI) among Portuguese children following the last world financial crisis. A cross-sectional study was conducted on 4737 Portuguese children (3-11 yrs). Socio-demographics, food insecurity, and household geographic location were assessed via questionnaire. Nutritional status was measured. Following the economic crisis, 14.2% of school children and 12.0% of preschool children experienced HFI. Preschool children having parents with low and medium parental education (paternal: OR = 4.4; 95% CI 2.7-7.1 and OR = 2.4; 95% CI 1.5-3.6; maternal: OR = 2.2; 95% CI 1.4-3.5 and OR = 1.6; 95% CI 1.1-2.3), living in the south (OR = 1.4; 95% CI 1.0-2.0) and being overweight/obese (OR = 1.1; 95% CI 0.7-1.3) were more likely to experience HFI than food secure household peers. Higher OR of belonging to a food insecure household were observed in school-aged children with low and medium parental education (paternal: OR = 2.9; 95% CI 1.9-4.6 and OR = 1.7; 95% CI 1.1-2.5; maternal: OR = 2.5; 95% CI 1.6-3.9 and OR = 2.3; 95% CI 1.6-3.3), living in Coimbra (OR = 1.7; 95% CI 1.1-2.6) and being overweight/obese (OR = 1.3; 95% CI 0.8-1.5) compared to food secure household peers. Data are instructive and support the need to increase awareness of HFI, reduce its incidence in overweight/obese children from low socio-economic status families and specific geographic areas, and increase food availability based on local ecology.
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Affiliation(s)
- Maria-Raquel G Silva
- CIAS - Research Centre for Anthropology and Health - Human Biology, Health and Society, University of Coimbra, Coimbra, Portugal.,Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal.,CHRC - Comprehensive Health Research Centre-Group of Sleep, Chronobiology and Sleep Disorders-Nova Medical School, University of Lisbon, Lisbon, Portugal
| | - Aristides M Machado-Rodrigues
- CIAS - Research Centre for Anthropology and Health - Human Biology, Health and Society, University of Coimbra, Coimbra, Portugal.,High School of Education, Polytechnic Institute of Viseu, Viseu, Portugal
| | - Daniela Rodrigues
- CIAS - Research Centre for Anthropology and Health - Human Biology, Health and Society, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Portugal, Coimbra, Portugal
| | - Helena Nogueira
- CIAS - Research Centre for Anthropology and Health - Human Biology, Health and Society, University of Coimbra, Coimbra, Portugal
| | - Vítor Rosado-Marques
- CIAS - Research Centre for Anthropology and Health - Human Biology, Health and Society, University of Coimbra, Coimbra, Portugal.,Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Augusta Gama
- CIAS - Research Centre for Anthropology and Health - Human Biology, Health and Society, University of Coimbra, Coimbra, Portugal.,Department of Animal Biology, Faculty of Sciences of the University of Lisbon, Portugal
| | - Cristina Padez
- CIAS - Research Centre for Anthropology and Health - Human Biology, Health and Society, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Portugal, Coimbra, Portugal
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Adherence to the Mediterranean Diet and Its Association with the Level of Physical Activity in Fitness Center Users: Croatian-Based Study. Nutrients 2021; 13:nu13114038. [PMID: 34836293 PMCID: PMC8625296 DOI: 10.3390/nu13114038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/03/2023] Open
Abstract
The Mediterranean diet (MD) is based on the traditional cuisine of south European countries, and it is considered one of the healthiest dietary patterns worldwide. The promotion of combined MD and physical activity has shown major benefits. However, the association between physical activity and the MD in regular fitness center users is still insufficiently investigated. This cross-sectional survey-based study was conducted on 1220 fitness center users in Croatia. The survey consisted of three parts: general information, the Mediterranean Diet Serving Score (MDSS) and the International Physical Activity Questionnaire Short Form (IPAQ-SF). The results showed that 18.6% of fitness center users were adherent to the MD, and there was a significant positive correlation between the level of physical activity and the MDSS score (r = 0.302, p < 0.001). Moreover, after dividing the sample into tertiles based on the IPAQ-SF score, the third tertile (MET > 3150 min/wk) had the most fitness center users (34.4%) adherent to the MD, while the first tertile (MET < 1750 min/wk) had the least (6.1%). These outcomes emphasize the importance of physical activity as they imply that, with higher levels of physical activity, people are also possibly more aware of the importance that a healthy and balanced diet has on their well-being.
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Abstract
Scientific evidence has been reporting the health and environmental benefits of the Mediterranean diet. However, countries of the Mediterranean region, Portugal included, are gradually abandoning this traditional food pattern. The aim of the present work was to develop the Portuguese Mediterranean diet wheel. Three main steps were followed: (1) establishment of the most relevant Mediterranean diet and lifestyle principles to improve this pattern among the Portuguese population; (2) converting those principles into a captivating and easy to understand tool and (3) obtaining experts' opinion. By a matter of consistency, the preservation and transmission of the Mediterranean heritage was represented through an upgrade of the current Portuguese food wheel guide. This complementary tool highlights the Mediterranean diet enlarged character that encompasses a healthy lifestyle and reinforces sociocultural and environmental features. It was launched at the end of 2016 and was nationally disseminated with the support of the Portuguese Health Directorate. Initially it was presented in a poster format image that was subsequently spread in different communication formats. This newly developed Mediterranean food guide is a complementary educational tool that will support health and education professionals in the never ending mission of promoting healthy food choices.
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Gomes LA, Gregório MJ, Iakovleva TA, Sousa RDD, Bessant J, Oliveira P, Branco JC, Canhão H, Rodrigues AM. A Home-Based eHealth Intervention for an Older Adult Population With Food Insecurity: Feasibility and Acceptability Study. J Med Internet Res 2021; 23:e26871. [PMID: 34463638 PMCID: PMC8459887 DOI: 10.2196/26871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/19/2021] [Accepted: 05/06/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users. OBJECTIVE This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity. METHODS A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet). RESULTS A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean -3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean -0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean -1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet. CONCLUSIONS The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants' fatigue and physical function. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.6626.
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Affiliation(s)
- Luís Antunes Gomes
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | | | - Rute Dinis de Sousa
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - John Bessant
- University of Exeter Business School, Exeter, United Kingdom
| | - Pedro Oliveira
- Copenhagen Business School, Copenhagen, Denmark.,NOVA School of Business and Economics, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jaime C Branco
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Serviço de Reumatologia do Hospital Egas Moniz - Centro Hospitalar Lisboa Ocidental (CHLO-EPE), Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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Al-Sunaid FF, Al-Homidi MM, Al-Qahtani RM, Al-Ashwal RA, Mudhish GA, Hanbazaza MA, Al-Zaben AS. The influence of a gluten-free diet on health-related quality of life in individuals with celiac disease. BMC Gastroenterol 2021; 21:330. [PMID: 34433427 PMCID: PMC8390240 DOI: 10.1186/s12876-021-01908-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background Adherence to a gluten-free diet (GFD) and food insecurity (FI) may influence health-related quality of life (HRQOL) in individuals with celiac disease (CD). This study aimed to investigate the association between adherence to a GFD, FI, and HRQOL in individuals with CD. Methods This cross-sectional study included 97 adults (mean age: 34 ± 9 years) diagnosed with CD. The participants were on a GFD for more than 6 months. Sociodemographic characteristics and medical history were assessed. Adherence to a GFD, FI, and HRQOL were assessed using validated questionnaires. Results Most participants (73%) adhered to a GFD, and 62% were experiencing FI. Individuals with CD faced difficulty in accessing GF foods due to the high cost (90%) and limited availability (79%). The mean overall HRQOL score was 60. Scores on the physical and mental health domains were 69 and 47, respectively. Adherence to a GFD was significantly associated with FI (P = 0.02), while there was no association between adherence to a GFD and HRQOL measures (P > 0.05). Participants facing FI had lower scores in emotional well-being and mental health domains, and overall HRQOL (P < 0.05). Conclusions The findings of the present study demonstrate that FI influences adherence to a GFD, and that FI is associated with HRQOL in terms of both emotional well-being and mental health.
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Affiliation(s)
- Fahdah F Al-Sunaid
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University (PNU), PO Box 84428, Riyadh, Kingdom of Saudi Arabia
| | - Maha M Al-Homidi
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University (PNU), PO Box 84428, Riyadh, Kingdom of Saudi Arabia
| | - Rawan M Al-Qahtani
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University (PNU), PO Box 84428, Riyadh, Kingdom of Saudi Arabia
| | - Reema A Al-Ashwal
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University (PNU), PO Box 84428, Riyadh, Kingdom of Saudi Arabia
| | - Ghada A Mudhish
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University (PNU), PO Box 84428, Riyadh, Kingdom of Saudi Arabia
| | - Mahitab A Hanbazaza
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia
| | - Abeer S Al-Zaben
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University (PNU), PO Box 84428, Riyadh, Kingdom of Saudi Arabia.
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Silva MN, Gregório MJ, Santos R, Marques A, Rodrigues B, Godinho C, Silva CS, Mendes R, Graça P, Arriaga M, Freitas G. Towards an In-Depth Understanding of Physical Activity and Eating Behaviours during COVID-19 Social Confinement: A Combined Approach from a Portuguese National Survey. Nutrients 2021; 13:2685. [PMID: 34444845 PMCID: PMC8399723 DOI: 10.3390/nu13082685] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
Rapid worldwide decreases in physical activity (PA), an increase in sedentary behaviour (SB) and poorer dietary patterns have been reported during COVID-19 confinement periods. However, as national variability has been observed, this study sought to describe PA, SB and eating patterns, and to explore their gender as well as other socio-demographic correlates and how they interrelate in a representative sample of Portuguese adults during the COVID-19 first mandatory social confinement. The survey was applied online and by telephone to 5856 adults (mean age = 45.8 years; 42.6% women). The majority reported high (46.0%) or moderate (20.5%) PA levels. Men, younger participants, those with higher education levels and a favourable perception of their financial situation reported higher PA levels, with the opposite pattern for SB. Physical fitness activities and household chores were more reported by women, with more strength training and running activities reported by men. Regarding eating behaviours, 45.1% reported changes, positive (58%) and negative (42%), with 18.2% reporting increases in consumption of fruit, vegetables, and fish and other seafood consumption, while 10.8% (most with lower educational level and less comfortable with their income) reported an increase in consumption of ready-to-eat meals, soft drinks, savoury snacks, and take-away and delivered meals. Two clusters-a health-enhancing vs. risky pattern-emerged through multiple correspondence analysis characterized by co-occurrence of high vs. low PA levels, positive vs. negative eating changes, awareness or not of the COVID-19 PA and dietary recommendations, perceived financial situation, higher vs. lower educational level and time in social confinement. In conclusion, while in social confinement, both positive and negative PA and eating behaviours and trends were displayed, highlighting the role of key sociodemographic correlates contributing to healthy vs. risky patterns. Results may inform future health interventions and policies to be more targeted to those at risk, and also advocate the promotion of PA and healthy eating in an integrated fashion.
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Affiliation(s)
- Marlene Nunes Silva
- Programa Nacional para a Promoção da Atividade Física, Direção-Geral da Saúde, 1049 Lisboa, Portugal; (R.S.); (A.M.); (B.R.); (C.G.); (C.S.S.); (R.M.)
- CIDEFES, Faculdade de Educação Física e Desporto, Universidade Lusófona de Humanidades e Tecnologias, 1749 Lisboa, Portugal
| | - Maria João Gregório
- Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, 1049 Lisboa, Portugal;
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4150 Porto, Portugal;
| | - Rute Santos
- Programa Nacional para a Promoção da Atividade Física, Direção-Geral da Saúde, 1049 Lisboa, Portugal; (R.S.); (A.M.); (B.R.); (C.G.); (C.S.S.); (R.M.)
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050 Porto, Portugal
| | - Adilson Marques
- Programa Nacional para a Promoção da Atividade Física, Direção-Geral da Saúde, 1049 Lisboa, Portugal; (R.S.); (A.M.); (B.R.); (C.G.); (C.S.S.); (R.M.)
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495 Lisboa, Portugal
| | - Bruno Rodrigues
- Programa Nacional para a Promoção da Atividade Física, Direção-Geral da Saúde, 1049 Lisboa, Portugal; (R.S.); (A.M.); (B.R.); (C.G.); (C.S.S.); (R.M.)
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200 Porto, Portugal
| | - Cristina Godinho
- Programa Nacional para a Promoção da Atividade Física, Direção-Geral da Saúde, 1049 Lisboa, Portugal; (R.S.); (A.M.); (B.R.); (C.G.); (C.S.S.); (R.M.)
- Católica Research Centre for Psychological, Family and Social Wellbeing, Universidade Católica Portuguesa, 1649 Lisbon, Portugal
| | - Catarina Santos Silva
- Programa Nacional para a Promoção da Atividade Física, Direção-Geral da Saúde, 1049 Lisboa, Portugal; (R.S.); (A.M.); (B.R.); (C.G.); (C.S.S.); (R.M.)
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495 Lisboa, Portugal
| | - Romeu Mendes
- Programa Nacional para a Promoção da Atividade Física, Direção-Geral da Saúde, 1049 Lisboa, Portugal; (R.S.); (A.M.); (B.R.); (C.G.); (C.S.S.); (R.M.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050 Porto, Portugal
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, 4050 Porto, Portugal
- Northern Region Health Administration, 4000 Porto, Portugal
| | - Pedro Graça
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, 4150 Porto, Portugal;
| | - Miguel Arriaga
- Divisão de Literacia, Saúde e Bem-Estar, Direção-Geral da Saúde, 1049 Lisboa, Portugal;
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Leung CW, Wolfson JA. Food Insecurity Among Older Adults: 10-Year National Trends and Associations with Diet Quality. J Am Geriatr Soc 2021; 69:964-971. [PMID: 33403662 PMCID: PMC8341441 DOI: 10.1111/jgs.16971] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Food insecurity has emerged as a critical health issue for older adults. Food insecurity has been shown to disrupt healthy eating patterns, but these associations have not been widely studied among older adults. The objectives of the present study were to: (1) examine national trends in food insecurity across a 10-year period, and (2) evaluate the associations between food insecurity and multiple diet quality indices in a recent and nationally representative sample of adults aged 60 or older. DESIGN Cross-sectional analysis of the 2007-2016 National Health and Nutrition Examination Surveys. SETTING Nationally representative sample of the United States. PARTICIPANTS The analytic sample was comprised of 5,097 adults aged 60 or older, with household incomes at or below 300% of the federal poverty level. MEASUREMENTS Household food security was measured using the 18-item US Household Food Security Survey Module. Diet was assessed using two 24-hour dietary recalls. Multivariate linear and logistic regression models examined the associations between household food security and three evidence-based diet quality indices, adjusting for sociodemographic and health characteristics. RESULTS Across the 10-year period, food insecurity increased significantly from 5.5% to 12.4% among older adults; this increase was more pronounced among lower-income older adults. From the linear regression models, food insecurity was associated with lower scores on the Healthy Eating Index (β = -1.90, 95% confidence interval (CI) = -3.70, -0.09), the Alternate Healthy Eating Index-2010 (β = -1.47, 95% CI = -2.51, -0.44), and the Mediterranean Diet Score (β = -0.54, 95% CI = -1.06, -0.01) after multivariate adjustment. Further adjustment for the presence of chronic medical conditions did not attenuate these results. CONCLUSION Food insecurity is associated with lower overall diet quality among older adults, supporting the need for clinical efforts to identify those at risk of food insecurity and public health efforts to alleviate food insecurity and promote healthy eating behaviors among older adults.
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Affiliation(s)
- Cindy W Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Julia A Wolfson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Gajda R, Jeżewska-Zychowicz M. The importance of social financial support in reducing food insecurity among elderly people. Food Secur 2021. [DOI: 10.1007/s12571-021-01151-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractThe growing number of elderly people who are at increased risk of food insecurity for a variety of reasons, including financial ones, requires the current situation to be monitored. The purpose of this research was therefore to determine: (1) how older people perceive their situation in terms of food security; (2) whether older people use any form of external financial support; and (3) the relationship between people’s perception of their food security and the use of financial support from social services and their family. The survey was conducted on a group of 1150 people aged 65 years and above at the end of 2018 and the beginning of 2019. In total, 762 questionnaires were analysed for the study. The study was conducted in the Świętokrzyskie and Śląskie voivodeships (provinces). Multivariate correspondence analysis (MCA) and the chi-square test were used to compare qualitative variables describing food security, financial assistance and socio-demographic features. Over two thirds of the respondents declared that they had no need of financial assistance from the social services or their family. Two categories of variables were selected using the MCA method: people who declared that their household had food security and that they had no need for financial assistance from social services or their family, and people who said they did not have food security and simultaneously used financial assistance or did not use such assistance but had financial problems. Place of residence and household composition were features that significantly distinguished the opinions about the lack of food security. Financial social programmes and the social education of families should be improved to minimize the risk of food insecurity in households of elderly people, especially those not benefiting from financial social support.
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Andrade V, Jorge R, García-Conesa MT, Philippou E, Massaro M, Chervenkov M, Ivanova T, Maksimova V, Smilkov K, Ackova DG, Miloseva L, Ruskovska T, Deligiannidou GE, Kontogiorgis CA, Pinto P. Mediterranean Diet Adherence and Subjective Well-Being in a Sample of Portuguese Adults. Nutrients 2020; 12:E3837. [PMID: 33339084 PMCID: PMC7765516 DOI: 10.3390/nu12123837] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022] Open
Abstract
The Mediterranean diet (MD) and other lifestyle characteristics have been associated with well-being, a broad multiparameter concept that includes individual's subjective assessment of their own well-being (SWB). Some studies have suggested that diet influences SWB, thus, this work aimed to add novel information on the association of MD and SWB in a sample of Portuguese adults. Data on sociodemographic, economic, lifestyle, diet, and SWB were collected through a self-filled online questionnaire. MD adherence was assessed by the Mediterranean Diet Adherence Screener (MEDAS) score ]. Results showed a moderate adherence to the MD in 490 Portuguese adults (mean MEDAS of 7.4 ± 2.1). A higher MD adherence was found to be significantly positively associated with women, employed individuals, a higher number of meals per day, and those with frequent contact with nature (p-value < 0.0025, using Bonferroni adjustment). As a novelty, this study divided the participants into low SWB, medium SWB, and medium to high SWB profiles (3.9 ± 1.0; 6.2 ± 1.0; 8.2 ± 1.3, respectively; p-value < 0.05), which reported significantly increasing MEDAS scores (6.5 ± 2.1; 7.3 ± 2.1; 7.8 ± 1.9; respectively, p-value < 0.05).
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Affiliation(s)
- Vanda Andrade
- Polytechnic Institute of Santarém, School of Agriculture, 2001-904 Santarém, Portugal; (V.A.); (R.J.)
| | - Rui Jorge
- Polytechnic Institute of Santarém, School of Agriculture, 2001-904 Santarém, Portugal; (V.A.); (R.J.)
- Life Quality Research Centre (CIEQV), IPSantarém/IPLeiria, 2040-413 Rio Maior, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Monte de Caparica, Portugal
| | - María-Teresa García-Conesa
- Research Group on Quality, Safety and Bioactivity of Plant Foods, Campus de Espinardo, Centro de Edafologia y Biologia Aplicada del Segura-Consejo Superior de Investigaciones Científicas (CEBAS-CSIC), P.O. Box 164, 30100 Murcia, Spain;
| | - Elena Philippou
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia 1700, Cyprus;
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Marika Massaro
- National Research Council (CNR), Institute of Clinical Physiology, 73100 Lecce, Italy;
| | - Mihail Chervenkov
- Slow Food in Bulgaria, 9 Pierre De Geytre St. bl. 3, 1113 Sofia, Bulgaria;
- Faculty of Veterinary Medicine, University of Forestry, 1797 Sofia, Bulgaria;
| | - Teodora Ivanova
- Faculty of Veterinary Medicine, University of Forestry, 1797 Sofia, Bulgaria;
- Department of Plant and Fungal Diversity and Resources, Institute of Biodiversity and Ecosystem Research, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Viktorija Maksimova
- Faculty of Medical Sciences, University Goce Delcev, str. Krste Misirkov, No. 10-A, POB 201, 2000 Stip, Republic of North Macedonia; (V.M.); (K.S.); (D.G.A); (L.M.); (T.R.)
| | - Katarina Smilkov
- Faculty of Medical Sciences, University Goce Delcev, str. Krste Misirkov, No. 10-A, POB 201, 2000 Stip, Republic of North Macedonia; (V.M.); (K.S.); (D.G.A); (L.M.); (T.R.)
| | - Darinka Gjorgieva Ackova
- Faculty of Medical Sciences, University Goce Delcev, str. Krste Misirkov, No. 10-A, POB 201, 2000 Stip, Republic of North Macedonia; (V.M.); (K.S.); (D.G.A); (L.M.); (T.R.)
| | - Lence Miloseva
- Faculty of Medical Sciences, University Goce Delcev, str. Krste Misirkov, No. 10-A, POB 201, 2000 Stip, Republic of North Macedonia; (V.M.); (K.S.); (D.G.A); (L.M.); (T.R.)
| | - Tatjana Ruskovska
- Faculty of Medical Sciences, University Goce Delcev, str. Krste Misirkov, No. 10-A, POB 201, 2000 Stip, Republic of North Macedonia; (V.M.); (K.S.); (D.G.A); (L.M.); (T.R.)
| | - Georgia Eirini Deligiannidou
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Dragana, Alexandroupolis, Greece; (G.E.D.); (C.A.K.)
| | - Christos A. Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Dragana, Alexandroupolis, Greece; (G.E.D.); (C.A.K.)
| | - Paula Pinto
- Polytechnic Institute of Santarém, School of Agriculture, 2001-904 Santarém, Portugal; (V.A.); (R.J.)
- Life Quality Research Centre (CIEQV), IPSantarém/IPLeiria, 2040-413 Rio Maior, Portugal
- Research Unit of Polytechnic Institute of Santarém, 2001-904 Santarém, Portugal
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Elderly Perception of Distance to the Grocery Store as a Reason for Feeling Food Insecurity-Can Food Policy Limit This? Nutrients 2020; 12:nu12103191. [PMID: 33086560 PMCID: PMC7603094 DOI: 10.3390/nu12103191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 01/10/2023] Open
Abstract
The sense of food insecurity in a group of elderly people may be determined by the perception of distance to food outlets. The aim of the study was to assess the relationship between the perception of food insecurity by the elderly and their perception of the distance between the places of residence and food purchase. A cross-sectional quantitative survey was carried out in 2019–2020 amongst 762 Polish elderly living in Świętokrzyskie and Śląskie Voivodeship. The assessment of the relationships between the perceived food insecurity due to living too far away from the grocery shops and socio-demographic features was performed using multiple correspondence analysis (MCA), chi-square tests, and Phi and Cramér’s V coefficients. Too great a distance to the place of food purchase was the cause of a lack of a sense of food security in 20.5% of the study sample, especially in men, people aged 75 and more, people living in a rural environment and people living alone. People reporting a lack of food due to the distance to the place of purchase showed socio-demographic characteristics similar to those of people declaring a lack of a sense of food security. Reduced food consumption due to the distance from the place of sale, including of fish (24.8%), some fruits (18.9%) and vegetables (15.4%) and beef (17.3%), may contribute to the deterioration of the diet and, as a result, health conditions. Including access to places of the sale of food in food policy as a factor contributing to ensuring the food security of older people can help to maintain a better quality of life and avoid exclusion. Especially in a situation of limited independence, food insecurity in elders due to causes other than financial limitations should be a focus of food policy.
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Timóteo AT, Dias SS, Rodrigues AM, Gregório MJ, Sousa RD, Canhão H. Quality of life in adults living in the community with previous self-reported myocardial infarction. Rev Port Cardiol 2020; 39:367-373. [PMID: 32616368 DOI: 10.1016/j.repc.2019.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/13/2019] [Accepted: 09/29/2019] [Indexed: 11/29/2022] Open
Abstract
AIM Quality of life (QoL) is one of the most important patient-reported outcomes in chronic diseases. Using a population-based cohort, our objective was to assess health-related QoL in individuals with a previous myocardial infarction (MI). METHODS This study was conducted on a large database representative of the adult Portuguese population aged 18 years or over, living in the community. Participants were assessed through telephone interview. A standardized questionnaire was applied to every individual about self-reported chronic diseases, including previous MI. QoL was assessed with the EQ-5D-3L version of EuroQol. The prevalence of previous MI was calculated and linear regression analysis was performed. RESULTS The estimated prevalence of previous MI in the adult Portuguese population was 1.1%. These patients were older and more often male, had lower income and lower education levels, and were more often from urban areas. Respondents with self-reported MI assigned a lower self-perception to their health status in all domains, particularly in mobility and anxiety/depression. The mean EQ-5D-3L score in patients with MI was 0.73±0.34, significantly lower than in patients without MI (0.78±0.29). Also, the number of chronic diseases was significantly higher in patients with MI (5.0±2.2 vs. 1.7±1.8). Previous MI was not independently associated with QoL, which was related to age, gender and number of comorbidities. CONCLUSIONS Adults with previous MI have a worse self-perceived health status and QoL. Previous MI was not an independent predictor of health-related QoL after controlling for age, gender and associated chronic diseases.
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Affiliation(s)
- Ana Teresa Timóteo
- EpiDoC Unit - CEDOC, Nova Medical School - Universidade Nova de Lisboa, CHRC, Comprehensive Health Research Unit, Lisbon, Portugal.
| | - Sara Simões Dias
- EpiDoC Unit - CEDOC, Nova Medical School - Universidade Nova de Lisboa, CHRC, Comprehensive Health Research Unit, Lisbon, Portugal; ciTechCare - Center for Innovative Care and Health Technology, School of Health Sciences, Polytechnic of Leiria, Leiria ESSLei-IPLeiria, Leiria, Portugal
| | - Ana Maria Rodrigues
- EpiDoC Unit - CEDOC, Nova Medical School - Universidade Nova de Lisboa, CHRC, Comprehensive Health Research Unit, Lisbon, Portugal
| | - Maria João Gregório
- EpiDoC Unit - CEDOC, Nova Medical School - Universidade Nova de Lisboa, CHRC, Comprehensive Health Research Unit, Lisbon, Portugal
| | - Rute Dinis Sousa
- EpiDoC Unit - CEDOC, Nova Medical School - Universidade Nova de Lisboa, CHRC, Comprehensive Health Research Unit, Lisbon, Portugal
| | - Helena Canhão
- EpiDoC Unit - CEDOC, Nova Medical School - Universidade Nova de Lisboa, CHRC, Comprehensive Health Research Unit, Lisbon, Portugal
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Timóteo AT, Dias SS, Rodrigues AM, Gregório MJ, Sousa RD, Canhão H. Quality of life in adults living in the community with previous self-reported myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Na M, Dou N, Ji N, Xie D, Huang J, Tucker KL, Gao X. Food Insecurity and Cognitive Function in Middle to Older Adulthood: A Systematic Review. Adv Nutr 2020; 11:667-676. [PMID: 31711095 PMCID: PMC7231583 DOI: 10.1093/advances/nmz122] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/10/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023] Open
Abstract
Food insecurity (FI) may limit cognitive functioning during aging. The goal of this systematic review was to summarize existing evidence linking FI and general or specific cognitive functions in middle and older adulthood. A systematic search of human studies published between 1 January 2000 and 30 April 2018 was conducted in PubMed, PsycINFO, and CAB Direct. Four independent reviewers assessed the eligibility of identified articles and conducted data extraction and data quality assessment. Ten studies were included in the review, including 1 cluster-randomized controlled trial, 2 longitudinal studies, and 7 cross-sectional studies. Three studies reported the association between early-life FI experience and a global cognitive function measure. Nine studies reported later-life FI experience in relation to global or specific cognitive functions. The results suggest an adverse association between FI experienced in early or later life and global cognitive function; and between later-life FI and executive function and memory. Findings from the review are preliminary because of sparse data, heterogeneity across study populations, exposure and outcome assessments, and potential risk of bias across studies. Future studies are recommended to better understand the role of FI in cognitive function, with the goal of identifying possible critical windows for correction of FI in vulnerable subpopulations to prevent neurocognitive deficit in adulthood.
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Affiliation(s)
- Muzi Na
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA,Address correspondence to MN (e-mail: )
| | - Nan Dou
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Naiwen Ji
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Dixin Xie
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Jie Huang
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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Abstract
OBJECTIVE Food security has been suggested to be a risk factor for depression, stress and anxiety. We therefore undertook a systematic review and meta-analysis of available publications to examine these associations further. DESIGN Relevant studies were identified by searching Web of Science, Embase, Scopus and PubMed databases up to January 2019. SETTING OR was pooled using a random-effects model. Standard methods were used for assessment of heterogeneity and publication bias. PARTICIPANTS Data were available from nineteen studies with 372 143 individual participants from ten different countries that were pooled for the meta-analysis. RESULTS The results showed there was a positive relationship between food insecurity (FI) and risk of depression (OR = 1·40; 95 % CI: 1·30, 1·58) and stress (OR = 1·34; 95 % CI: 1·24, 1·44) but not anxiety. Subgroup analysis by age showed that subjects older than ≥65 years exhibited a higher risk of depression (OR = 1·75; 95 % CI: 1·20, 2·56) than younger participants (OR = 1·34; 95 % CI: 1·20, 1·50), as well as a greater risk of depression in men (OR = 1·42; 95 % CI: 1·17, 1·72) than women (OR = 1·30; 95 % CI: 1·16, 1·46). Finally, subgroup analysis according to geographical location illustrated that food insecure households living in North America had the highest risk of stress and anxiety. CONCLUSIONS The evidence from this meta-analysis suggests that FI has a significant effect on the likelihood of being stressed or depressed. This indicates that health care services, which alleviate FI, would also promote holistic well-being in adults.
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Determinants of Food Insecurity in Rural Households: The Case of the Paute River Basin of Azuay Province, Ecuador. SUSTAINABILITY 2020. [DOI: 10.3390/su12030946] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Eliminating food insecurity is one of humanity’s greatest global challenges. Thus, the purpose of this research was to analyze the factors that determine food insecurity in households in the rural area of the Paute River Basin, Azuay Province, Ecuador. Stratified sampling was used as the sampling method, with proportional affixation. Moreover, we employed the Latin American and Caribbean Household Food Security Measurement Scale (ELCSA). We estimated the main determinants of household food insecurity using two binomial logit models and one ordered logit model. For the analysis of the data, the respective statistical and econometric tests were employed. The results show that housing size and access to food security information are the most important determinants of food insecurity in the three predictive models applied in this research. This research contributes to the existing literature on food insecurity and provides important information for policymakers, especially regarding food insecurity in rural areas, which has profound economic and social implications.
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Santulli G, Pascale V, Finelli R, Visco V, Giannotti R, Massari A, Morisco C, Ciccarelli M, Illario M, Iaccarino G, Coscioni E. We are What We Eat: Impact of Food from Short Supply Chain on Metabolic Syndrome. J Clin Med 2019; 8:E2061. [PMID: 31771147 PMCID: PMC6947359 DOI: 10.3390/jcm8122061] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022] Open
Abstract
Food supply in the Mediterranean area has been recently modified by big retail distribution; for instance, industrial retail has favored shipments of groceries from regions that are intensive producers of mass food, generating a long supply chain (LSC) of food that opposes short supply chains (SSCs) that promote local food markets. However, the actual functional role of food retail and distribution in the determination of the risk of developing metabolic syndrome (MetS) has not been studied hitherto. The main aim of this study was to test the effects of food chain length on the prevalence of MetS in a population accustomed to the Mediterranean diet. We conducted an observational study in Southern Italy on individuals adhering to the Mediterranean diet. We examined a total of 407 subjects (41% females) with an average age of 56 ± 14.5 years (as standard deviation) and found that being on the Mediterranean diet with a SSC significantly reduces the prevalence of MetS compared with the LSC (SSC: 19.65%, LSC: 31.46%; p: 0.007). Our data indicate for the first time that the length of food supply chain plays a key role in determining the risk of MetS in a population adhering to the Mediterranean diet.
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Affiliation(s)
- Gaetano Santulli
- Dept. of Medicine, Division of Cardiology, and Dept. of Molecular Pharmacology, Montefiore University Hospital, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine (AECOM), New York, NY 10461, USA
- Dept. of Advanced Biomedical Science, Federico II University, 80131 Naples, Italy;
- International Translational Research and Medical Education Consortium (ITME), 80131 Naples, Italy
| | - Valeria Pascale
- Dept. of Medicine, Surgery and Dentistry, University of Salerno, 8408 Baronissi, Italy; (V.P.); (R.F.); (V.V.); (R.G.); (M.C.)
| | - Rosa Finelli
- Dept. of Medicine, Surgery and Dentistry, University of Salerno, 8408 Baronissi, Italy; (V.P.); (R.F.); (V.V.); (R.G.); (M.C.)
| | - Valeria Visco
- Dept. of Medicine, Surgery and Dentistry, University of Salerno, 8408 Baronissi, Italy; (V.P.); (R.F.); (V.V.); (R.G.); (M.C.)
| | - Rocco Giannotti
- Dept. of Medicine, Surgery and Dentistry, University of Salerno, 8408 Baronissi, Italy; (V.P.); (R.F.); (V.V.); (R.G.); (M.C.)
| | - Angelo Massari
- “San Giovanni di Dio e Ruggi d’Aragona” University Hospital, 84131 Salerno, Italy; (A.M.); (E.C.)
| | - Carmine Morisco
- Dept. of Advanced Biomedical Science, Federico II University, 80131 Naples, Italy;
| | - Michele Ciccarelli
- Dept. of Medicine, Surgery and Dentistry, University of Salerno, 8408 Baronissi, Italy; (V.P.); (R.F.); (V.V.); (R.G.); (M.C.)
| | - Maddalena Illario
- Health’s Innovation, Campania Regional Government, 80132 Naples, Italy;
- Dept. of Public Health, Federico II University, 80131 Naples, Italy
| | - Guido Iaccarino
- Dept. of Advanced Biomedical Science, Federico II University, 80131 Naples, Italy;
- International Translational Research and Medical Education Consortium (ITME), 80131 Naples, Italy
| | - Enrico Coscioni
- “San Giovanni di Dio e Ruggi d’Aragona” University Hospital, 84131 Salerno, Italy; (A.M.); (E.C.)
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Abstract
OBJECTIVE Food insecurity (FI) is defined as uncertain access to healthy food in quantity and quality. We hypothesize that FI may be associated with greater health-care use and absenteeism because it may amplify the effect of diseases; also, FI may be associated with reduced health-care access because it reflects economic vulnerability. The present study estimates the association between FI and health-care use and access, and absenteeism. DESIGN Cross-sectional data collected in 2015-2016. Health-care use was measured as the number of consultations, taking any drug and having been hospitalized in the past year. Health-care access was measured by the suspension of medication and having fewer consultations due to financial constraints. Absenteeism was measured by the weeks of sickness leave. Binary variables were modelled as a function of FI using logistic regressions; continuous variables were modelled as a function of FI using negative binomial and zero-inflated negative binomial regressions. Covariates were included sequentially. SETTING Portugal. PARTICIPANTS Non-institutionalized adults from the EpiDoc3 cohort (n 5648). RESULTS FI was significantly associated with health-care use before controlling for socio-economic conditions and quality of life. Moderate/severe FI was positively related to the suspension of medicines (adjusted OR = 4·68; 95 % CI 3·11, 6·82) and to having fewer consultations (adjusted OR = 3·98; 95 % CI 2·42, 6·37). FI and absenteeism were not significantly associated. CONCLUSIONS Our results support the hypothesis that FI reflects precariousness, which hinders access to health care. The greater use of health care among food-insecure people is explained by their worse quality of life and lower socio-economic condition, so that the specific role of poor nutrition is unclear.
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Maia I, Monjardino T, Frias B, Canhão H, Cunha Branco J, Lucas R, Santos AC. Food Insecurity in Portugal Among Middle- and Older-Aged Adults at a Time of Economic Crisis Recovery: Prevalence and Determinants. Food Nutr Bull 2019; 40:504-513. [PMID: 31272218 DOI: 10.1177/0379572119858170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND To characterize the scenario of food insecurity in Portugal at a time of economic crisis recovery is of the utmost relevance. OBJECTIVE This study aimed to estimate the prevalence and to identify the determinants of food insecurity during economic crisis recovery in a population-based urban sample of middle- and older-aged Portuguese adults. METHODS A cross-sectional study including 604 participants of the EPIPorto cohort was conducted. Data on sociodemographic characteristics and on food security status were collected. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Logistic regression models, crude and adjusted for sex, age, education, and household income perception, were performed. RESULTS The prevalence of food insecurity was 16.6%. Women (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.09-3.54), those less educated (OR = 5.46; 95% CI: 2.84-10.46), and those who had the perception of an insufficient household income (OR = 10.39; 95% CI: 5.00-21.56) were more likely to belong to a food insecure household. Unmarried individuals (OR = 1.79; 95% CI: 1.05-3.06) and lower white-collar workers (OR = 2.22; 95% CI: 1.03-4.77) were also more prone to live within a food insecure household, regardless of sex, age, education, and household income perception. CONCLUSIONS The obtained information is valuable for the development of intervention strategies to reduce food insecurity in middle- and older-aged adults, suggesting that women, unmarried, less educated individuals, less skilled workers, and lower income families should be targeted.
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Affiliation(s)
- Isabel Maia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Teresa Monjardino
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Brenda Frias
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Helena Canhão
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
| | - Jaime Cunha Branco
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Sociedade Portuguesa de Reumatologia, Lisboa, Portugal.,Serviço de Reumatologia do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Raquel Lucas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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Kana MA, Peleteiro B, Correia S, Barros H. Trends in sociodemographic and health care factors in Portuguese and non-Portuguese mothers giving birth in Portugal, 1995-2014. Paediatr Perinat Epidemiol 2019; 33:249-259. [PMID: 31347725 DOI: 10.1111/ppe.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/26/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Time-trend disparity in adverse pregnancy outcomes according to maternal nationality or immigration status has been well documented. In this study, we investigated time changes in individual-level risk factors for adverse pregnancy outcomes that have not been given the needed attention. OBJECTIVE To compare 20-year trends in sociodemographic, obstetric, health care factors, and adverse pregnancy outcomes in Portuguese and non-Portuguese women. METHODS We studied 2 105 497 livebirths from Portuguese national birth registry (1995-2014). We compared maternal sociodemographic characteristics (age, education, employment, and marital status), obstetric, and health care factors (parity, number of foetuses, place and type of delivery) in Portuguese and non-Portuguese at four periods (1995-1999, 2000-2004, 2005-09, and 2010-2014). Time-trend analysis using joinpoint regression method was performed to identify trends (joinpoints) and compare time changes in the prevalence of sociodemographic, obstetric, and health care factors expressed as annual percentage change (APC). RESULTS The proportion of livebirths in non-Portuguese mothers increased between 1995 and 1999 (2.9%), 2000-2004 (6.3%), 2005-2009 (9.5%), and 2010-2014 (9.8%). The proportion of women aged ≥ 35 years among Portuguese mothers varied from 11.1% (1995-1999), 14.4% (2000-2004), 18.6% (2005-2009) to 25.5% (2010-2014); among non-Portuguese women, the corresponding proportions were 15.7% (1995-1999), 14.6% (2000-2004), 16.1% (2005-2009), and 19.0% (2010-2014), respectively. The rate of change in maternal age ≥ 35 years had 2 joinpoints in both Portuguese (APC = 6.5%, 95% confidence interval [CI] 6.2, 6.9; 2005-2014) and non-Portuguese (3.3%, 95% CI 2.5, 4.0; 2002-2014). Increase in caesarean rate was higher for non-Portuguese (24.0%-36.1%) than the Portuguese (30.6%-31.6%) between 1995 and 2014. CONCLUSIONS Sociodemographic, obstetric, and health care factors have divergent time trends and rate of change for Portuguese and non-Portuguese.
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Affiliation(s)
- Musa Abubakar Kana
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna, Nigeria
| | - Barbara Peleteiro
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Sofia Correia
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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44
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Dias SS, Rodrigues AM, Gregório MJ, de Sousa RD, Branco JC, Canhão H. Cohort Profile: The Epidemiology of Chronic Diseases Cohort (EpiDoC). Int J Epidemiol 2019; 47:1741-1742j. [PMID: 30212889 PMCID: PMC6280929 DOI: 10.1093/ije/dyy185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sara Simões Dias
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Ana Maria Rodrigues
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Maria João Gregório
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Rute Dinis de Sousa
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Jaime Cunha Branco
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal.,Serviço de Reumatologia, CHLO, EPE
- Hospital Egas Moniz, Lisboa, Portugal
| | - Helena Canhão
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal
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45
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Household food insecurity and socio-demographic determinants in young adults: findings from a Portuguese population-based sample. Int J Public Health 2019; 64:887-895. [PMID: 30993351 DOI: 10.1007/s00038-019-01243-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 02/28/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study evaluated the prevalence and the socio-demographic determinants of food insecurity among young adults at a time of economic crisis recovery. METHODS A cross-sectional study including 954 young adults (26 years old) from the EPITeen cohort (Porto, Portugal) was conducted. Food security status was evaluated using the US Household Food Security Survey Module: Six-Item Short Form. Associations between socio-demographic characteristics (sex, education, occupation, household size and structure and household income perception) and food insecurity were estimated using logistic regression. RESULTS At a time of economic crisis recovery, 11.0% of young adults experienced food insecurity. A higher odds of belonging to a food insecure household was observed in participants reporting an insufficient household income (OR = 23.3; 95% CI 11.3-47.8), those with less education (OR = 1.7; 95% CI 1.0-2.8), lower white-collar workers (OR = 2.3; 95% CI 1.2-4.2) and those living within a nuclear family including a partner and/or children (OR = 2.0; 95% CI 1.1-3.7). CONCLUSIONS Our findings support the need for interventions targeting those from lower income, from nuclear families of young adults with a partner and/or descendants, less educated and with non-manual unskilled occupations, to reduce food insecurity, particularly in economic vulnerable settings.
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Graça P, Gregório MJ, de Sousa SM, Brás S, Penedo T, Carvalho T, Bandarra NM, Lima RM, Simão AP, Goiana-da-Silva F, Freitas MG, Araújo FF. A new interministerial strategy for the promotion of healthy eating in Portugal: implementation and initial results. Health Res Policy Syst 2018; 16:102. [PMID: 30376876 PMCID: PMC6208124 DOI: 10.1186/s12961-018-0380-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the implementation, main intervention areas and initial results of the Integrated Strategy for the Promotion of Healthy Eating (EIPAS) in Portugal. METHODS EIPAS was published as a Law, in December of 2017, as a result of a collaboration between several ministries, including the Finance, Internal Affairs, Education, Health, Economy, Agriculture, and Sea Ministries, aiming at improving the dietary habits of the Portuguese population. The working group, led by the Ministry of Health, developed this strategy for over a year. The framework produced was based on WHO and European Commission recommendations as well as on relevant data from the last Portuguese dietary intake survey (2015/2016). EIPAS also reflects the results of a public hearing, including the food industry, among others, and the experience gathered, since 2012, through the National Programme for the Promotion of Healthy Eating. It considers the 'health in all policies' challenge set by WHO and has four different strategic areas, namely (1) creation of healthier food environments, (2) improvement of the quality and accessibility of healthy food choices for consumers, (3) promotion and development of literacy, in order to encourage healthy food choices, and (4) promotion of innovation and entrepreneurship. In order to achieve these goals, a set of 51 actions was established and assigned to the seven ministries involved. RESULTS Under the scope of this strategy, Portugal has already implemented several actions, including (1) definition of standards for food availability at all public healthcare institutions; (2) implementation of a sugar tax on sweetened beverages; (3) implementation of a voluntary agreement with the food industry sector for food reformulation (work in progress); (4) design of a proposal for an interpretative model of front-of-pack food labelling; (5) improvement of the nutritional quality of food aid programmes for low-income groups; and (6) regulation of marketing of unhealthy foods to children. CONCLUSIONS For the first time, Portugal has a nutrition policy based on the WHO concept of 'health in all policies' and on the national data on food intake. The implementing process of all 51 actions and the inherent complexities and difficulties found so far have made this process be an authentic political and social laboratory that deserves to be followed.
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Affiliation(s)
- Pedro Graça
- National Programme for the Promotion of Healthy Eating, Directorate-General of Health, Lisbon, Portugal.,Faculty of Nutrition and Food Sciences of University of Porto, Porto, Portugal
| | - Maria João Gregório
- National Programme for the Promotion of Healthy Eating, Directorate-General of Health, Lisbon, Portugal. .,Faculty of Nutrition and Food Sciences of University of Porto, Porto, Portugal. .,EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC) da NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisbon, Portugal.
| | - Sofia Mendes de Sousa
- National Programme for the Promotion of Healthy Eating, Directorate-General of Health, Lisbon, Portugal
| | - Sónia Brás
- Technical Experts of the Cabinet of the Secretary of State for local Administration, Lisbon, Portugal
| | - Tatiana Penedo
- Technical Experts of the Cabinet of the Secretary of State for local Administration, Lisbon, Portugal
| | - Telmo Carvalho
- Department of Sea and Marine Resources, Portuguese Institute for the Sea and Atmosphere (IPMA, IP), Rua Alfredo Magalhães Ramalho, 1495-006, Lisbon, Portugal.,Ministry of Sea, Lisbon, Portugal
| | - Narcisa M Bandarra
- Department of Sea and Marine Resources, Portuguese Institute for the Sea and Atmosphere (IPMA, IP), Rua Alfredo Magalhães Ramalho, 1495-006, Lisbon, Portugal
| | | | - Ana Paula Simão
- Legal Advisor to the Secretary of State of Industry, Lisbon, Portugal
| | - Francisco Goiana-da-Silva
- Department of Surgery and Cancer, Imperial College Medical School, London, United Kingdom.,Invited Assistant of Management and Leadership on Health, Health Sciences Faculty of Beira Interior University, Covilhã, Portugal
| | | | - Fernando Ferreira Araújo
- Secretário de Estado Adjunto e da Saúde, XXI Governo Constitucional, Lisbon, Portugal.,Invited Professor of Faculty of Medicine of University of Porto, Porto, Portugal
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Baptista FM, Rodrigues AM, Gregório MJ, de Sousa R, Cruz E, Canhão H. Functional Status and Quality of Life Determinants of a Group of Elderly People With Food Insecurity. Front Nutr 2018; 5:99. [PMID: 30410883 PMCID: PMC6209666 DOI: 10.3389/fnut.2018.00099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/04/2018] [Indexed: 01/02/2023] Open
Abstract
Background: A good functionality is appointed by the elderly as one of the most important factors for a good quality of life, since it is associated with independency and autonomy. Studies show that elderly with food insecurity have greater limitations in daily living activities (DLA) when compared to food security elderly. Moreover, food insecure elderly are 60% more likely to be diagnosed with depression. We aimed to investigate the potential determinants of functional status (HAQ) and quality of life (EQ-5D-3L) in a sample of elderly with food insecurity. Methods: Forty-one participants with food insecurity were evaluated by a multidisciplinary team, in April and May of 2016 (a baseline cross-sectional study prior to the intervention program). Results: This study demonstrates correlations of functional status and quality of life to such aspects of elderly assessment as age, BMI, manual strength, among others. It was found that manual strength, gender, family income, anxiety, and depression were correlated to quality of life; and that mobility, manual strength, anxiety and gender were correlated to the functional status. After multivariable adjustment, only mobility (β = −0.220; p ≤ 0.01) and quality of life (β = −1.457; p ≤ 0.01) remained significantly associated with higher levels of functional disability. With regard to quality of life, only the functional status (β = −0.242; p ≤ 0.01), the presence of depression (β = −0.169; p ≤ 0.05), and family income (β = 0.185; p ≤ 0.05) remained significantly associated with health-related quality of life. Conclusions: The study aims to verify the potential determinants of functional status (HAQ) and quality of life (EQ-5D-3L) in a sample of elderly with food insecurity. Even in a small cohort, the study demonstrated that in an elderly population with food insecurity, functional status is associated with mobility and quality of life, and that health-related quality of life is also associated with symptoms of depression and family income. Larger studies in other populations may be useful to confirm these observations.
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Affiliation(s)
| | - Ana Maria Rodrigues
- CEDOC, EpiDoc Unit - Unidade de Epidemiologia em Doenças Crónicas, Nova Medical School, Lisbon, Portugal.,Associação EpiSaúde, Évora, Portugal.,Sociedade Portuguesa de Reumatologia, Lisbon, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Maria João Gregório
- CEDOC, EpiDoc Unit - Unidade de Epidemiologia em Doenças Crónicas, Nova Medical School, Lisbon, Portugal.,Associação EpiSaúde, Évora, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Rute de Sousa
- CEDOC, EpiDoc Unit - Unidade de Epidemiologia em Doenças Crónicas, Nova Medical School, Lisbon, Portugal.,Associação EpiSaúde, Évora, Portugal
| | - Eduardo Cruz
- Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Helena Canhão
- CEDOC, EpiDoc Unit - Unidade de Epidemiologia em Doenças Crónicas, Nova Medical School, Lisbon, Portugal.,Associação EpiSaúde, Évora, Portugal.,Sociedade Portuguesa de Reumatologia, Lisbon, Portugal.,Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
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48
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Endeweld M, Goldsmith R, Endevelt R. The demographic and morbidity characteristics of a population receiving food support in Israel. Isr J Health Policy Res 2018; 7:54. [PMID: 30165905 PMCID: PMC6389190 DOI: 10.1186/s13584-018-0238-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/20/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Food supply to poor populations is a big challenge, particularly in periods of economic stress and in an era of chronic diseases epidemics. In Israel more than 4000 poor families are currently receiving food support. Many of the food support products given to the family have low nutrient values, therefore not appropriately ensuring food security of the population. The aim of the current study was to examine for the first time the demographic, nutritional and chronic diseases profiles of food support beneficiaries, so as to aid in planning future food support components in Israel. In addition, the study examined associations between levels of food insecurity status and selected morbidities among food support recipients. METHODS In 2016, 3000 families (classified as very poor) in 24 municipalities received food support in Israel from the "National Food Security Project" (NFSP), under the guidance of the National Food Security Council. The 400 new families who joined the program in 2016 were requested to complete a questionnaire regarding the demographic and health characteristics of their families. Three hundred sixty-two of them completed the questionnaire for a response rate of 90%. The current study includes these families only. RESULTS The disposable income per capita of the surveyed families was very low - less than NIS 1100 a month ($280). About half the families were working families and 40% of them were in debt. Of the 362 responding families, about 82% of them were food insecure, with more than half severely food-insecure; this, despite receiving food support. About one-third of the families had at least one member with anemia, and a quarter of the families had a member with hyperlipidemia. Hypertension is present in about 22% of the families, diabetes in 17%, and there is a 12% incidence of at least one family member with heart disease. These rates are markedly higher than those in the general population. Higher levels of food insecurity were associated with higher levels of hyperlipidemia, heart disease and hypertension. DISCUSSION AND CONCLUSIONS The nutrition and medical status of the population receiving food support is much worse than in the general population. There is a need to improve the nutritional value of food support; this could include greater emphasis on whole grains, fruits and vegetables. There is also a need for a nationwide education program to focus on healthy nutrition and to subsidize healthy foods. Many health and nutrition promotion models show that in order to effect changes in dietary habits and behaviors related to improving nutrition, there is a need for nutrition education (Kamp et al., J Nutr Educ Behav 42:72-82, 2010).
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Affiliation(s)
- M Endeweld
- The Israel National Insurance Institute, Jerusalem, Israel.,The Hebrew University in Jerusalem, Jerusalem, Israel
| | - R Goldsmith
- The Israel Ministry of Health, Nutrition Division, Jerusalem, Israel.
| | - R Endevelt
- The Israel Ministry of Health, Nutrition Division, Jerusalem, Israel.,University of Haifa, School of Public Health, Haifa, Israel
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Household Food Insecurity and Mental Health Among Teenage Girls Living in Urban Slums in Varanasi, India: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081585. [PMID: 30049971 PMCID: PMC6121584 DOI: 10.3390/ijerph15081585] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 11/16/2022]
Abstract
This study was undertaken to investigate the relation between household food insecurity and mental health problems in teenage girls living in urban slums. This community-based cross-sectional study was conducted in 5 urban slums in Varanasi, India, between September 2016 and July 2017. A probability proportion to size (PPS) method was employed to select 5 of 210 urban slums at a first stage, and in the second stage, 418 teenage girls were chosen randomly from selected households. The Household Food Insecurity Access Scale (HFIAS) and mental health inventory tools were employed to assess food insecurity and mental health status. Multivariable logistic regression analysis with at a 95% confidence interval (CI) was used to assess the association between household food insecurity and mental health status. Of 418 respondents, 47.6% were food insecure; 64.1%, 57.7%, and 58.4% had high levels of anxiety, depression, or psychological distress, respectively; and 57.2% exhibited a medium level of loss of behavioral control. Furthermore, teenage girls from food insecure households were more likely to have high levels of anxiety, depression, loss of behavioral control and psychological distress than those living in food secure households. This study shows food insecurity is independently associated with mental health problems among teenage girls. Food insecurity in Indian slums should be addressed by specific public health intervention programs that provide access to sufficient safe, nutritious food.
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50
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Fernandes SG, Rodrigues AM, Nunes C, Santos O, Gregório MJ, de Sousa RD, Dias S, Canhão H. Food Insecurity in Older Adults: Results From the Epidemiology of Chronic Diseases Cohort Study 3. Front Med (Lausanne) 2018; 5:203. [PMID: 30050904 PMCID: PMC6052142 DOI: 10.3389/fmed.2018.00203] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: The public health problem of food insecurity also affects the elderly population. This study aimed to estimate the prevalence of household food insecurity and its associations with chronic disease and health-related quality of life characteristics in individuals ≥65 years of age living in the community in Portugal. Methods: The data were collected from the Epidemiology of Chronic Diseases Cohort Study 3 (EpiDoC3)-Promoting Food Security Study (2015-2016), which was the third evaluation wave of the EpiDoC and represented the Portuguese adult population. Food insecurity was assessed using a psychometric scale adapted from the Brazilian Food Insecurity Scale. The data on sociodemographic variables, chronic disease, and management of chronic disease were self-reported. Health-related quality of life were assessed using the European Quality of Life Survey (version validated for the Portuguese population). Logistic regression models were used to determine crude and adjusted odds ratios (for age group, gender, region, and education). The dependent variable was the perceived level of food security. Results: Among older adults, 23% were living in a food-insecure household. The odds of living in a food-insecure household were higher for individuals in the 70-74 years age group (odds ratio (OR) = 1.405, 95% confidence interval (CI) 1.392-1.417), females (OR = 1.545, 95% CI 1.534-1.556), those with less education (OR = 3.355, 95% CI 3.306-3.404), low income (OR = 4,150, 95% CI 4.091-4.210), and those reporting it was very difficult to live with the current income (OR = 16.665, 95% CI 16.482-16.851). The odds of having a chronic disease were also greater among individuals living in food-insecure households: diabetes mellitus (OR = 1.832, 95% CI 1.818-1.846), pulmonary diseases (OR = 1.628, 95% CI 1.606-1.651), cardiac disease (OR = 1.329, 95% CI 1.319-1.340), obesity (OR = 1.493, 95% CI 1.477-1.508), those who reduced their frequency of medical visits (OR = 4.381, 95% CI 4.334-4.428), and who stopped taking medication due to economic difficulties (OR = 5.477, 95% CI 5.422-5.532). Older adults in food-insecure households had lower health-related quality of life (OR = 0.212, 95% CI 0.210-0.214). Conclusions: Our findings indicated that food insecurity was significantly associated with economic factors, higher values for prevalence of chronic diseases, poor management of chronic diseases, and decreased health-related quality of life in older adults living in the community.
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Affiliation(s)
- Simone G. Fernandes
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana M. Rodrigues
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Osvaldo Santos
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Maria J. Gregório
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rute Dinis de Sousa
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sara Dias
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Helena Canhão
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
- CEDOC, EpiDoc Unit – Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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