Public Health Nutrition
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Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil Abstract Objective To assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet. Design Application of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3). Setting Eleven metropolitan areas of Brazil. Subjects Households;n 13 611 in 1987–8,n 16 014 in 1995–5 andn 13 848 in 2002–3. Results Over the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra-processed food products, both overall and in lower- and upper-income groups. In the 2002–3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density. Conclusions The high energy density and the unfavourable nutrition profiling of Group 3 food products, and also their potential harmful effects on eating and drinking behaviours, indicate that governments and health authorities should use all possible methods, including legislation and statutory regulation, to halt and reverse the replacement of minimally processed foods and processed culinary ingredients by ultra-processed food products.
Public Health Nutrition - Tập 14 Số 1 - Trang 5-13
The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing Abstract Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016–2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence ‘ultra-processed’). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.
Public Health Nutrition - Tập 21 Số 1 - Trang 5-17 - 2018
European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection Abstract The European Prospective Investigation into Cancer and Nutrition (EPIC) is an ongoing multi-centre prospective cohort study designed to investigate the relationship between nutrition and cancer, with the potential for studying other diseases as well. The study currently includes 519 978 participants (366 521 women and 153 457 men, mostly aged 35–70 years) in 23 centres located in 10 European countries, to be followed for cancer incidence and cause-specific mortality for several decades. At enrolment, which took place between 1992 and 2000 at each of the different centres, information was collected through a non-dietary questionnaire on lifestyle variables and through a dietary questionnaire addressing usual diet. Anthropometric measurements were performed and blood samples taken, from which plasma, serum, red cells and buffy coat fractions were separated and aliquoted for long-term storage, mostly in liquid nitrogen. To calibrate dietary measurements, a standardised, computer-assisted 24-hour dietary recall was implemented at each centre on stratified random samples of the participants, for a total of 36 900 subjects. EPIC represents the largest single resource available today world-wide for prospective investigations on the aetiology of cancers (and other diseases) that can integrate questionnaire data on lifestyle and diet, biomarkers of diet and of endogenous metabolism (e.g. hormones and growth factors) and genetic polymorphisms. First results of case–control studies nested within the cohort are expected early in 2003. The present paper provides a description of the EPIC study, with the aim of simplifying reference to it in future papers reporting substantive or methodological studies carried out in the EPIC cohort.
Public Health Nutrition - Tập 5 Số 6b - Trang 1113-1124 - 2002
Dietary intake of different types and characteristics of processed meat which might be associated with cancer risk – results from the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC) Abstract Objective There is increasing evidence for a significant effect of processed meat (PM) intake on cancer risk. However, refined knowledge on how components of this heterogeneous food group are associated with cancer risk is still missing. Here, actual data on the intake of PM subcategories is given; within a food-based approach we considered preservation methods, cooking methods and nutrient content for stratification, in order to address most of the aetiologically relevant hypotheses. Design and setting Standardised computerised 24-hour diet recall interviews were collected within the framework of the European Prospective Investigation into Cancer and Nutrition (EPIC), a prospective cohort study in 27 centres across 10 European countries. Subjects Subjects were 22 924 women and 13 031 men aged 35–74 years. Results Except for the so-called ‘health-conscious’ cohort in the UK, energy-adjusted total PM intake ranged between 11.1 and 47.9 g day−1 in women and 18.8 and 88.5 g day−1 in men. Ham, salami-type sausages and heated sausages contributed most to the overall PM intake. The intake of cured (addition of nitrate/nitrite) PM was highest in the German, Dutch and northern European EPIC centres, with up to 68.8 g day−1 in men. The same was true for smoked PM (up to 51.8 g day−1 ). However, due to the different manufacturing practice, the highest average intake of NaNO2 through PM consumption was found for the Spanish centres (5.4 mg day−1 in men) as compared with German and British centres. Spanish centres also showed the highest intake of NaCl-rich types of PM; most cholesterol- and iron-rich PM was consumed in central and northern European centres. Possibly hazardous cooking methods were more often used for PM preparation in central and northern European centres. Conclusions We applied a food-based categorisation of PM that addresses aetiologically relevant mechanisms for cancer development and found distinct differences in dietary intake of these categories of PM across European cohorts. This predisposes EPIC to further investigate the role of PM in cancer aetiology.
Public Health Nutrition - Tập 9 Số 4 - Trang 449-464 - 2006
<b>Vitamin B</b><sub><b>12</b></sub><b>serostatus in Colombian children and adult women: results from a nationally representative survey</b> Abstract Objective Vitamin B12 deficiency is associated with many adverse health outcomes and is highly prevalent worldwide. The present study assesses the prevalence of vitamin B12 deficiency and marginal deficiency in Colombian children and women and examines the sociodemographic correlates of serum vitamin B12 concentrations in these groups. Design Cross-sectional, nationally representative survey. Setting Colombia. Subjects Children <18 years old (n 7243), pregnant women (n 1781), and non-pregnant women 18–49 years old (n 499). Results The overall prevalence of vitamin B12 deficiency (serum vitamin B12 <148 pmol/l) and marginal deficiency (serum vitamin B12 =148–221 pmol/l) was, respectively, 6·6 % (95 % CI 5·2 %, 8·3 %) and 22·5 % (95 % CI 21·1 %, 23·9 %). Pregnant women had the highest prevalence of deficiency (18·9 %; 95 % CI 16·6 %, 21·5 %) compared with non-pregnant adult women (18·5 %; 95 % CI 4·4 %, 53·1 %) and children (2·8 %; 95 % CI 2·3 % %, 3·3 %). In multivariable analyses among children, mean serum vitamin B12 was positively associated with female sex (12 pmol/l higher compared with males;P =0·004), secondary or higher education of the household head (12 pmol/l higher compared with primary or less;P =0·009) and food security (21 pmol/l higher compared with severe food insecurity;P =0·003). In multivariable analyses among pregnant women, mean serum vitamin B12 was positively associated with education of the household head and inversely associated with living in the National territories, Eastern or Pacific regions. Conclusions The prevalence of vitamin B12 deficiency and marginal deficiency in Colombian women and children is substantial. The burden falls largely on adult women, those with lowest education and those living in the poorest, most rural regions of the country.
Public Health Nutrition - Tập 18 Số 5 - Trang 836-843 - 2015
Impact of neighbourhood food environment on diet and obesity in China: a systematic review Abstract Objective: This study systematically reviewed literature on the neighbourhood food environment in relation to diet and obesity among residents in China. Design: A keyword search of peer-reviewed articles was performed in Cochrane Library, PubMed, and Web of Science. Eligibility criteria include study designs: longitudinal/cohort studies or cross-sectional studies; study participants: people of all ages; exposures: neighbourhood food environment (e.g. restaurants, supermarkets, wet markets, fast-food restaurants, or convenience stores); outcomes: diet and/or body weight status; and country: China. Results: Seventeen studies met all criteria and were included. Among the eight studies that assessed the neighbourhood food environment in relation to diet, six reported at least one statistically significant relationship in the expected direction, whereas the remaining two exclusively reported null effects. Among the eleven studies that assessed the neighbourhood food environment in relation to body weight or overweight/obesity, ten reported a significant association whereas the remaining one reported a null relationship. Variety, density, and proximity of food outlets were positively associated with local residents’ dietary diversity, portion size, and daily caloric intake. Density and proximity of fast-food restaurants and convenience stores were positively associated with local residents’ adiposity in some but not all studies. Evidence linking any specific food outlet type to diet/obesity remains lacking due to the small number of studies and heterogeneities in food environment measures, geographical locations, and population subgroups. Conclusions: The neighbourhood food environment may influence diet and obesity among Chinese residents but the evidence remains preliminary. Future studies adopting an experimental study design and objective/validated environment and dietary measures are warranted.
Public Health Nutrition - Tập 23 Số 3 - Trang 457-473 - 2020
Selenium level is associated with<i>apoE ε4</i>in rural elderly Chinese Abstract Objective Se is an essential trace element in human nutrition associated with antioxidant activity. Previous studies on predictors of toenail Se or serum Se have mostly concentrated on demographic factors such as age and gender. The present paper examines the association betweenapoE genotype and Se levels in nail samples in a rural elderly Chinese cohort. Design Two thousand Chinese aged 65 years and over from four counties in China were enrolled in a cohort to study the association of Se with cognitive decline. Nail samples were collected from each participant and analysed for Se levels. Dietary Se intake was estimated from an FFQ using Se contents measured in food items collected from each village. Blood samples on filter cards were collected and analysed forapoE genotype. Mixed-effect models were constructed with nail Se level as the dependent variable and each village as the random effect, which controlled for the potential confounding effect from correlation in Se measures obtained from participants residing in the same village. Results In this elderly Chinese cohort, carriers of theapoE ε4 allele had significantly lower Se levels measured in nail samples than non-carriers after adjusting for other significant covariates and controlling for estimated dietary Se intake. There was no significant difference between the two genotypes on estimated Se dietary intake (P = 0·6451). Conclusions Future studies are needed to examine the mechanism underlying the association between theapoE ε4 allele and Se levels, including the role of oxidative stress and that of reduced lipid metabolism in theapoE ε4 carriers.
Public Health Nutrition - Tập 12 Số 12 - Trang 2371-2376 - 2009
Low-income consumers' attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables Abstract Objective: To determine low-income consumers' attitudes and behaviour towards fruit and vegetables, in particular issues of access to, affordability of and motivation to eat fruit and vegetables. Design and setting: Questionnaire survey mailed to homes owned by a large UK housing association. Participants: Participants were 680 low-income men and women, aged 17–100 years. Results: Age, employment, gender, smoking and marital status all affected attitudes towards access, affordability and motivation to eat fruit and vegetables. Few (7%) participants experienced difficulty in visiting a supermarket at least once a week, despite nearly half having no access to a car for shopping. Fruit and vegetables were affordable to this low-income group in the amounts they habitually bought; purchasing additional fruits and vegetables was seen as prohibitively expensive. Less than 5% felt they had a problem with eating healthily and yet only 18% claimed to eat the recommended 5 or more portions of fruit and vegetables every day. Conclusions: Supported by research, current UK Government policy is driven by the belief that low-income groups have difficulties in access to and affordability of fruit and vegetables. Findings from this particular group suggest that, of the three potential barriers, access and affordability were only a small part of the ‘problem’ surrounding low fruit and vegetable consumption. Thus, other possible determinants of greater consequence need to be identified. We suggest focusing attention on motivation to eat fruit and vegetables, since no dietary improvement can be achieved if people do not recognise there is a problem.
Public Health Nutrition - Tập 6 Số 2 - Trang 159-168 - 2003
Social, economic, health and environmental determinants of child nutritional status in three Central Asian Republics Abstract Objective To investigate the comparative effect of social, economic, health and environmental characteristics on the nutritional status of children aged <3 years in Central Asia. Design Cross-sectional analysis using data from Demographic and Health Surveys. Setting Uzbekistan, Kyrgyzstan and Kazakhstan. Subjects Information on demographic health was gathered by Macro International Inc., Uzbekistan, Kyrgyzstan and Kazakhstan governments from a random sample of 14 067 households in the three countries. Anthropometric measurements were performed using standardized procedures on all children <3 years of age (n 2358). Only children with plausible Z -scores (n 1989) were selected for subsequent analyses. Results The main results indicated that country of residence, number of people in household, household wealth, birth weight, age of child, knowledge of oral rehydration therapy, maternal education, number of children <5 years of age and source of drinking water were strong predictors of child nutritional status in these countries. Furthermore, chronic malnutrition was most prevalent in all three countries but at varied levels. An unexpected finding was that fully vaccinated children were more likely to be malnourished than children who were partially vaccinated. A further unexpected finding was that breast-feeding especially in children >6 months old had a strong negative association with stunting and underweight. Conclusions In summary, the results from both the descriptive and binary logistic regression analysis are similar in terms of the explanatory variables and the statistical significance in the models.
Public Health Nutrition - Tập 12 Số 10 - Trang 1871-1877 - 2009
Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in rural Northern Ethiopia Abstract Objective To identify specific cultural and behavioural factors that might be influenced to increase colostrum feeding in a rural village in Northern Ethiopia to improve infant health. Design Background interviews were conducted with six community health workers and two traditional birth attendants. A semi-structured tape-recorded interview was conducted with twenty mothers, most with children under the age of 5 years. Variables were: parental age and education; mother's ethnicity; number of live births and children's age; breast-feeding from birth through to weaning; availability and use of formula; and descriptions of colostrum v . other stages of breast milk. Participant interviews were conducted in Amharic and translated into English. Setting Kossoye, a rural Amhara village with high prevalence rates of stunting: inappropriate neonatal feeding is thought to be a factor. Subjects Women (20–60 years of age) reporting at least one live birth (range: 1–8, mean: ∼4). Results Colostrum (inger ) and breast milk (yetut wotet ) were seen as different substances. Colostrum was said to cause abdominal problems, but discarding a portion was sufficient to mitigate this effect. Almost all (nineteen of twenty) women breast-fed and twelve (63 %) reported ritual prelacteal feeding. A majority (fifteen of nineteen, 79 %) reported discarding colostrum and breast-feeding within 24 h of birth. Prelacteal feeding emerged as an additional factor to be targeted through educational intervention. Conclusions To maximize neonatal health and growth, we recommend culturally tailored education delivered by community health advocates and traditional health practitioners that promotes immediate colostrum feeding and discourages prelacteal feeding.
Public Health Nutrition - Tập 14 Số 11 - Trang 2029-2036 - 2011
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