Authors:
Kabore, M; Hien, Y. E, Fassinou, L. C, Cisse, K, Ngwasiri, C, Coppieters, Y, Kirakoya-Samadoulougou, F. Abstract: IntroductionA higher number of ideal cardiovascular health (CVH) metrics is associated with a lower risk of cardiovascular-related and all-cause mortality. However, the change in CVH metrics has rarely been studied in sub-Saharan Africa. We investigated the level and changes of CVH metrics and their correlates among Beninese adults between 2008 and 2015.MethodsSecondary analysis was performed on data obtained from Benin’s 2008 and 2015 WHO Stepwise surveys (STEPS). In total, 3617 and 3768 participants aged 25–64 years were included from both surveys, respectively. CVH metrics were assessed using the American Heart Association definition, which categorised smoking, fruit and vegetable consumption, physical activity, body mass index (BMI), blood pressure (BP), total cholesterol (TC) and glycaemia into ‘ideal’, ‘intermediate’ and ‘poor’ CVH. The prevalence of ideal CVH metrics was standardised using the age and sex structure of the 2013 population census.ResultsFew participants met all seven ideal CVH metrics, and ideal CVH significantly declined between 2008 and 2015 (7.1% (95% CI 6.1% to 8.1%) and 1.2% (95% CI 0.8% to 1.5%), respectively). The level of poor smoking (8.0% (95% CI 7.1% to 8.9%) and 5.6% (95% CI 4.8% to 6.3%)) had decreased, whereas that of poor BP (25.9% (95% CI 24.5% to 27.4%) and 32.0% (95% CI 30.0% to 33.5%)), poor total cholesterol (1.5% (95% CI 1.0% to 1.9%) and 5.5% (95% CI 4.8% to 6.2%)) and poor fruit and vegetable consumption (34.2% (95% CI 32.4% to 35.9%) and 51.4% (95% CI 49.8% to 53.0%)) significantly increased. Rural residents and young adults (25–34 years) had better CVH metrics.ConclusionThe proportion of adults with ideal CVH status was low and declined significantly between 2008 and 2015 in Benin, emphasising the need for primordial prevention targeting urban areas and older people to reduce the burden of cardiovascular disease risk factors. Keywords: Open access PubDate: 2023-01-02T04:55:10-08:00 DOI: 10.1136/bmjnph-2021-000417 Issue No:Vol. 5, No. 2 (2023)
Authors:
Lima do Vale, M. R; Johnsen, J. T, Laur, C, Lepre, B, Ray, S. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.editorial Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Wazny, K; Petracchi, C, Laur, C, Broadley, I, Jaffee, A, Buckner, L, Lepre, B, Martin, K, Hewett, L, Macaninch, E, Bhansali, A, Jones, G, Ray, S, Eva, B, Kohlmeier, M, De-Regil, L. M, Rio, D. D, Douglas, P. Abstract: Policies and guidance alone will likely be insufficient to achieve significant changes in nutrition and health outcomes and a global shift in behaviour is needed. Developing workforce capacity to communicate, implement and scale up effective nutrition interventions is crucial. It is important to ensure that frontline workers, who are in contact with thousands of people every day, have the necessary knowledge, skills and competencies to approach nutrition in an informed, integrated and sensitive way. Despite this need, research in the UK has shown that nutrition training for healthcare professionals is limited and medical students and junior doctors lack confidence and feel underprepared to advise patients on nutrition. Gaps in nutrition capacity development for health professionals might not be a problem only in the UK, with a recent literature review showing that only 44% of medical accreditation and curriculum guidance available internationally integrated nutrition as a content area. Limited nutrition education and training represent a missed opportunity for appropriate action on nutrition.Several initiatives led by organisations in the UK and globally to address this gap were discussed during the 7th Summit. The FAO elearning Academy, for example, offers free multilingual elearning courses with the aim to prepare professionals to design policies and programmes targeting agriculture, food, nutrition, and health, and transfer the multi- and trans-disciplinary competencies, that are needed. The Nutrition Education Policy in Healthcare Practice (NEPHELP) was another example discussed. NEPHELP delivers workshops that are sensitive to real-world challenges faced by health professionals and promotes the development of nutrition champions that share their learning with others. Culinary Medicine UK also supports medical students and healthcare professionals. It uses a bespoke kitchen as a classroom to teach nutrition through realistic clinical cases and offers opportunities to practice consultation skills. Advocacy in this area has been campaigned by different groups in the UK, including the Nutrition Implementation Coalition, formed by groups such NNEdPro, Culinary Medicine UK, Nutritank and Education and Research in Medical Nutrition Network (ERimNN). An important step in integrating more nutrition content into medical doctors and allied health professionals’ education training would be the inclusion of nutrition as a mandatory requirement in accreditation standards, which could act as an incentive for education institutions. Nutrition should be integrated as a cross-cutting theme aligned with core competencies and roles already considered in current standards for health professionals. The UK achieved an important milestone in this domain in 2021 with the launch of the Association for Nutrition Undergraduate Curriculum in Nutrition for Medical doctors. An assessment of the needs and barriers will be conducted with relevant stakeholders to facilitate the implementation of the new curriculum across universities in the UK. In addition to formal education and training in nutrition, another way of supporting nutrition best practices is through curation of relevant research being produced in many parts of the world and their publication free of cost in channels such as BMJ Nutrition, Prevention and Health Journal. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.3 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Keaver, L; OCallaghan, N, Douglas, P. Abstract: BackgroundIn Ireland, continuing increases in cancer survivorship rates have placed cancer survivorship care to the forefront in terms of strategic planning and service requirements.1 Nutrition is an important component of the cancer care continuum,2 however despite this those with cancer report poor access to credible nutrition advice.3 AimsThe aim of this research was to investigate 1) current nutritional issues; 2) proportion receiving nutrition advice from a dietitian and 3) additional sources of nutrition advice.MethodsThis cross-sectional study recruited Irish cancer survivors over the age of 18, who were not palliative and had completed active cancer treatment at least six months ago. A questionnaire on Microsoft Forms consisting of open and closed demographic, clinical and nutritional questions was developed and recruitment took place via social media platforms between October and December 2020.ResultsParticipants (n=169) were mainly female (n=145, 85.8%); diagnosed with breast cancer (n=109, 64.5%); living in the Republic of Ireland (n=154, 91.1%) and had completed active treatment in the last five years (n=101, 59.9%). The mean age was 51.4 ± 10.9 years. 3.6% were underweight and 56.5% overweight or obese. One third (n=57, 33.3%) had experienced weight gain in the previous six months, 10.1% (n-17) weight loss and 22.5% (n=38) weight fluctuations. The majority reported decreased energy levels post treatment (n=87, 51.5%) and fatigue (n=129, 76.3%). Other nutrition related impact symptoms were still present: pain (n=61, 36.1%); constipation (n=56, 33.1%); diarrhoea (n=28, 16.6%); dry mouth (n=44, 26%); no appetite (n=23, 13.6%); sore mouth (n=21, 12.4%); taste changes (n=21, 12.4%); smells bothering them (n=18, 10.7%). One-fifth (n=35, 10.7%) had access to a dietitian during treatment, only 11.8% (n=20) had access post treatment. One quarter sought advice elsewhere (n=42, 24.9%); with the main additional source of advice being online (n=16; 9.5% of total cohort).ConclusionThe majority of this cohort were classified as overweight or obese with one third reporting recent weight gain. This can increase risk of recurrence and decrease overall survival in those with cancer (4,5), in particular breast cancer (6,7). The majority were still experiencing fatigue, which has been shown to affect those with cancer more than any other symptom (8). The persistence of other nutrition impact symptoms could further impact quality of life. There is a clear need for the provision of nutrition advice to Irish Cancer Survivors. There is a role for all healthcare professionals to provide basic nutrition advice or signpost to evidence-based nutrition resources.References O’Connor M, O’Donovan B, Drummond F. The Unmet needs of cancer survivors in Ireland: A Scoping Review 2019. Cork: National Cancer Registry Ireland; 2019. 90p. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition. 2017;36(1):11–48. doi:10.1016/j.clnu.2016.07.015. Sullivan ES, Rice N, Kingston E, Kelly A, Reynolds JV, Feighan J, Power DG, Ryan AM. A national survey of oncology survivors: examining nutrition attitudes, problems and behaviours, and access to dietetic care throughout the cancer journey. Clinical Nutrition. 2021;41:331–339. Wright ME, Chang SC, Schatzkin A, et al. Prospective study of adiposity and weight change in relation to prostate cancer incidence and mortality. Cancer 2007;109:675–684. Siegel EM, Ulrich CM, Poole EM, Holmes RS, Jacobsen PB, Shibata D. The effects of obesity and obesity-related conditions on colorectal cancer prognosis. Cancer Control 2010;17:52–57. Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2010;123:627–635. Patterson RE, Cadmus LA, Emond JA, Pierce JP. Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas 2010;66:5. Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N. Cancer-related fatigue: inevitable, unimportant and untreatable' Results of a multi-centre patient survey. Cancer Fatigue Forum. Ann Oncol 2010;11(8):971–5. doi: 10.1023/a:1008318932641. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.15 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Bhat, S; Jain, R, Leung, R, MacAninch, E, Ray, S, Fleming, K. Abstract: BackgroundThe 2006 Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity underscore the importance of nutritional assessment and dietary intervention. Several studies have indicated that medical students receive little education in nutrition. As patients increasingly see physicians as trusted and reliable sources of nutrition information and it is expected that physicians can provide accurate nutrition information. Teaching kitchens have emerged as an education tool and a kind of cooking laboratory that combines culinary instruction using healthful whole ingredients, nutrition education, exercise, mindfulness, and personalized health coaching. ObjectivesTo investigate the feasibility and efficacy of a teaching kitchen session partnered with a community partner to introduce PGY1/PGY2 Family Medicine Residents of a large Academic Hospital to: i) nutrition counselling for patients; ii) methods to manage personal health and wellness to address burnouts, and iii) nutrition community services for patients.MethodsThis study is a participatory intervention pilot consisting of (i) cross-sectional pre- and post-surveys and (ii) a culinary session. The pre-session questionnaire was adapted from the validated NUTCOMP Tool, which measures the self-perceived competence of primary health professionals in providing nutrition care. Open-ended questions were included in the post-session questionnaire to collect data on the experience of the teaching kitchen session. ResultsSeven PGY1/PGY2 Family medicine residents attended the 2hr culinary session led by a Registered Dietitian and Community Chef. Residents learned the rationale behind choosing healthy foods to manage hypertension and cooked a 3-course vegetarian meal based on the DASH diet. 83% of the residents were not confident about their nutrition knowledge; 100% of the residents were not or somewhat confident in determining appropriate food goals for patients with CVD; and 82% of the residents were not confident in communicating with their patient about diet modification. All participants found the session enjoyable and would likely participate in a future similar session. All participants identified (1) lack of formal training and (2) time constraints as barriers in providing nutrition counselling in primary care practice. ConclusionThis pilot teaching kitchen session proved to be an engaging, informational and enjoyable way for Family Medicine Residents to engage with community nutrition partners while learning about healthy eating and cooking. Future Culinary Sessions will be developed based on feedback from this pilot study to support Family Physicians and trainees in providing nutrition advice to patients as well as to instill a practice of healthy eating, cooking and wellness. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.27 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Bohn, J; Nabholz, C, do Vale, M. L, Jarret, H, Buckner, L, Ray, S, Raja, N, Dael, P. V, Crocombe, D, Macaninch, E, McAuliffe, S, Kohlmeier, M, Johnsen, J. T, Anchen, J, Mishra, M, Raman, K, Eva, B, Wazny, K. Abstract: Promoting good nutrition is essential to tackle current and emergent health crisis. For instance, non-communicable diseases (NCDs) are responsible for about 70% of deaths globally, with high intake of sodium, red meat, refined sugars and/or ultra-processed foods and low intake of whole grains, legumes and fruits raking among the top dietary risks for NCDs related deaths. Diet also play an important role in emergent health crises, as illustrated during the Covid-19 pandemic, where those who are malnourished and/or present underlying NCDs have more severe and deadly outcomes. Despite that, limited progress is being made toward the United Nations Sustainable Development Goals (SDGs) on malnutrition and NCDs.Nutrition is linked with other modifiable risk factors for chronic diseases such as physical activity, sleep, mental well-being, substance abuse (e.g., alcohol and smoking) and environmental factors. The complexity of foods and their constituents and the multitude of factors involved in the aetiology of NCDs make dissecting the relative contribution of risk factors and interventions on disease onset and progression a challenging task. Understanding the interrelation between traditional risk factors that are established already and lifestyle risk factors will allow us to offer a more holistic approach to human well-being. Rigorous and innovative research that harnesses the power of large datasets and multiple research methods is needed to support the development of coherent theories in nutrition and risk identification and management. It is also necessary to connect this innovative research with the complex needs of individuals and systems. For example, the Covid-19 pandemic has exacerbated food insecurity (i.e., not being able to access foods that are safe and nutritionally appropriate for one’s health) in multiple ways, including disruptions at the system level, such as interruptions and delays across food chains and increased food prices or individual level, including job losses and lack of access to food. In the UK, research has shown that ethnic minorities groups, those limited by health problems/disabilities, food sector workers and households with children were at increased risk of experiencing food insecurity. In some parts of Africa, conflicts, displacements, and droughts are additional factors contributing to the high prevalence of food insecurity, further exacerbated during the Covid-19 pandemic. The idea that ‘Nobody ever just needs food’ highlights that addressing food insecurity and malnutrition requires multisectoral solutions to resolve underlying causes of the problem.Public and private sectors play an important role in addressing the burden of malnutrition but goals and responsibilities must be transparent, focused on public benefit, and collaborative. Systems-based approaches where nutrition and health are prioritized should be also employed. While changes in systems, policies and services can be triggered by community demand and advocacy, education and training are necessary to promote capacity for change and sustained impact. Quality data on food, nutrition and health can support this behavioural shift through the identification of problems and gaps. There is a need to establish a data foundation which enables the development of a science-based approach upon which statistically backed actions can be derived. This is particularly difficult with nutrition where much is dependent on observational data and longitudinal cohorts are scarce. Advancing our knowledge through research partnerships and data sharing will allow us to provide convincing evidence to policy makers as well as the public. Ultimately, improving data literacy among relevant stakeholders is also needed to enable accurate interpretation and relevant action. Advancing our knowledge through research partnerships and data sharing will allow us to provide convincing evidence to policymakers as well as patients. Programs such as the NNEdPro’s International Knowledge Application Network Hub in Nutrition (iKANN), can facilitate this collaboration, while also curating nutrition data, evidence and training resources. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.1 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
De-Regil, L. M; Lima do Vale, M. R, Mahy, L, Rao, N, Andriamahefalison, N, Crew, S, Johnsen, J. T, Collins, J, Haldane, V, Bradfield, J, Nabarro, D. Abstract: Food systems are a complex web of actors and activities involved from farm to fork on aspects of food production, processing, distribution, preparation, consumption and ultimately the management of food waste. Food systems and the choices made by food system actors are contributing to detrimental impacts on animal, human and planetary health including losses in biodiversity, exhaustion of natural resources, zoonoses, foodborne illness and occupational hazards (figure 1). Current food systems are also failing to protect individuals’ and communities’ food security, good nutrition, and health. Health systems also have an impact on climate change and natural resources degradation. For instance, if health systems were a country it would rank among the top 5 in terms of carbon emissions, with an estimated contribution of 4.4%. 2 Figure 1The five interconnected and interrelated impact pathways through which food systems negatively affect human health. Source: WHO (2021). Executive Summary Food systems delivering better health. WHO: GenevaResearch has shown that there is an appetite to connect and transform food and health systems. For example, hospital settings can consider the use of locally grown foods, offer plant-based meals, use water and energy-saving kitchens and divert food waste from landfill. Realizing these activities can be achieved through policy action by making changes in legislation, by ensuring organisational culture and leadership, and by creating networks and champions for environmentally sustainable practices in health system settings. There is also an opportunity to integrate environmental sustainability in health systems teaching and research.Lessons from fighting the Covid-19 pandemic could be applied towards reducing food and health system impacts on climate, such as i) developing a clear understanding of the problem, of potentially effective solutions and identifying those interests are being prioritised, ii) start tackling the problem from areas making the largest contributions or being affected the most, and iii) knowing that shifting people’s behaviour is at the core of any solution. Transformed food and health systems must be contextually relevant, resilient, regenerative, empowering, and with health at their centre. Bold government, community, and business actions that promote interdisciplinarity, collaboration and capacity building are key aspects to be considered. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.2 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Laur, C; Burch, E, Williams, L. T, Ball, L. Abstract: BackgroundHealth research builds evidence to positively impact populations and health systems. However, at the conclusion of individual research projects, the findings may not always indicate a clear direction for pursuing positive impact. Type 2 Diabetes Mellitus (T2DM) is a lifestyle-related chronic disease, with the 2019 global prevalence estimated at 9.3% (463 million people).ObjectivesUsing the Australia 3D study as an example, this work discusses ways forward for researchers when study findings provide multiple options for population and health system impact, rather than one clear direction.MethodsThe 3D longitudinal, case-series study of 225 adult Australians newly diagnosed with T2DM, focused on answering the question: How does Diet Change after Diagnosis with T2DM' All results are published separately, and this work synthesizes findings to plan next steps in pursuing meaningful impact.ResultsOverall, the 3D study found that very few people newly diagnosed with T2DM make meaningful, sustained improvements to diet quality. However, no sociodemographic, health, or behavioural factors were identified as being consistently influential in supporting success in dietary changes. These results provide several options for next steps to support those newly diagnosed with T2DM. To have a tangible health system and population impact, results need to be considered within the wider context (i.e., sociodemographic, and cultural factors), and thus an implementation study is suggested. The next steps for 3D should also be collaborative, such as using an Integrated Knowledge Translation (IKT) approach, which involves knowledge users (i.e., those most impacted, such as patients, community partners, and health system stakeholders). In IKT, researchers and knowledge users work collaboratively to develop priorities and research questions, interpret findings, and put results into practice.ConclusionDetermining the next steps in any research program can be challenging. The 3D study began with lived-experience input and has advanced the evidence regarding diet quality for individuals recently diagnosed with T2DM. Next steps will be driven by a variety of factors, including funding and resources, researcher capacity, and community engagement. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.4 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Thompson, C; Adams, J, Anna Vidgen, H. Abstract: BackgroundWhile many aspects of the food system, such as availability, accessibility, price, and affordability, have been explored and evaluated, there is a limited understanding of the relationship between these factors and people’s food acquisition and consumption. Therefore, the term ‘food literacy’ emerged as the everyday skills, behaviour, and knowledge needed by individuals to navigate the food environment and meet their nutrition and health needs. The term has gained momentum globally, however, a lack of clarity around its definition has resulted in inconsistencies in use of the term.ObjectivesTo conduct a systematic scoping review to describe the use, reach, application, and definitions of the term ‘food literacy’ over time.MethodsLiterature search was conducted using the PRISMA-ScR guidelines in seven research databases without any date limitations up to 31 December, 2019, searching simply for the use of the term ‘food literacy’.Results549 studies were included. The term ‘food literacy’ was used once in 243 articles (44%) and mentioned by researchers working in 41 countries. Original research was the most common article type (n=429, 78%). Food literacy was published across 72 In Cites disciplines, with 456 (83%) articles from the last 5 years. In articles about food literacy (n=82, 15%), review articles were twice as prevalent compared to the total number of articles (n=10, 12% vs. n=32, 6%). 51 different definitions of food literacy were cited.Conclusion‘Food Literacy’ has been used frequently and broadly across differing article types and disciplines in academic literature internationally. However, agreement on a standardized definition of food literacy endorsed by a peak international agency is needed in order to progress the field. Additionally, the Food and Agriculture Organization of the United Nations (FAO) has identified consumer behaviours as a driver of the food system; however, there have been no measures reported for assessing food acquisition, preparation, meal practices and storage: all key components of food literacy. Therefore, the development of measures to assess components of the food system also relies on progressing international consensus and indicators. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.5 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Inan-Eroglu, E; Buyuktuncer, Z. Abstract: BackgroundWith the range of nutrition information online, assessing the resources that public access may improve the reliability and quality of the nutritional related COVID-19 information. The quality and reliability of the nutritional information in COVID-19 available on video sharing websites such as YouTube is unknown.ObjectivesTo evaluate whether the popularity of the videos correlated with the reliability and quality as determined by using the recognized quality scoring systems.MethodsYouTube was searched using the terms ‘nutrition and COVID-19’ in Turkish on February 1st, 2021. Videos were subsequently filtered according to relevancy, and first 280 videos were analyzed. Videos in other languages, duplicate videos, and live videos were excluded. A total of 218 videos were reviewed. Video demographics including number of views, likes, and dislikes were recorded. The upload source of each video was classified as news channel, health professionals, health centers, TV channels, government organisations, educational organisations and independent individual channels based on the information given at ‘about’ section of their YouTube profile. The transparency, utility, reliability and accuracy of video content was assessed using the Journal of the American Medical Association benchmark criteria (JAMA score). Quality of the videos were assessed with Global Quality Score (GQS).ResultsAccording to the video source, 30.7% of the videos were shared by health professionals including doctors, dietitians, and nurses, whereas 18.7% of them shared by independent users. Educational organisations only shared 5% of the videos. Videos shared by health centers had the highest JAMA score (2.2 ± 0.8) followed by government organisations (2.1 ± 0.7). The independent users and TV channels’ videos had the lowest JAMA score (1.7 ± 0.7). GQS was the highest for government organisations’ videos (3.5 ± 01.1) whereas it was lowest for TV channels’ videos (2.8 ± 01.1). There was a significant positive correlation between JAMA score and GQS of the videos (r=0.201, p=0.05). According to the assessment of the relationship between length, number of views, likes, dislikes, view and like ratio, there was a correlation between the length of the video, like ratio and GQS (r=0.193, p=0.004 and r=0.140, p=0.039 respectively). There were not any significant associations between quantitative variables and JAMA score.ConclusionHealth professionals, educational and government organisations need to more engage in the spread of nutrition-related COVID-19 information to internet platforms such as YouTube. This will be an effective and immediately implementable public health strategy to effectively spread the right information. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.6 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Basdani, E; Kyprianidou, M, Chrysostomou, S, Giannakou, K. Abstract: BackgroundIntuitive Eating is an adaptive dietary behavior characterized by a reliance on internal hunger and satiety cues instead of situational and emotional cues. The construct of intuitive eating is most often measured using the 23-item Intuitive Eating Scale-2 (IES-2).ObjectivesTo develop the Greek version of the IES-2 questionnaire and to examine its psychometric properties with data collected from 379 participants aged 18–74 years.MethodsForward translations to Greek and backward translation to English were performed. The finalized translated version was administered to a sample of 379 adult, Greek speaking participants in Cyprus for psychometric validation, which included assessment of internal consistency, construct, and concurrent validity. Explanatory Factor Analysis (EFA) was applied to better understand the underlying factor structure of the 23 items in IES-2. Internal consistency was assessed by Cronbach’s alpha test in terms of the overall and sub-scales. The concurrent validity was assessed by evaluating the correlation among the IES-2 and the Eating Altitudes Test – 26 item (EAT-26) questionnaire.ResultsA total of 379 participants completed the IES-2, EAT-26 questionnaire, and a demographic questionnaire. The median age of the participants was 31 (Q1=25, Q3=42) years old. About 49.7% of the participants were from the capital of Cyprus, Nicosia, 48.8% were unmarried, 92.9% had completed a higher education and about 40% were categorized as having a medium monthly average salary. Among the 379 participants of the study, 50.1% had normal Body Mass Index (BMI) category, while 24% and 21.4% were categorized as overweight or obese, respectively. EFA gave a three-factor structure with the total variance explained being 54.41%. Cronbach’s alpha as a measure of internal consistency was 0.87 for the IES-2 total score, as well as 0.90, 0.84, and 0.70 for the IES-2 subscale scores. The revised IES-2 total score was significantly correlated with EAT-26 total score (rs=-0.46, p Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.8 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Ertus, G; Satilmis, M, Inan-Eroglu, E. Abstract: BackgroundThe increasing health and environmental concerns related to food production and consumption within the process of food globalization have emerged the sustainable diet concept.ObjectivesThis study aimed to compare the nutritional value and price between the locally grown and imported legumes and seeds.MethodsWe searched 2 chain markets of Turkey and online stores of the food brands and included 15 legumes and seeds including locally grown (chickpeas, cannellini bean, green lentils and red lentils) and imported foods (red beans, black beans, quinoa (black, red and white), buckwheat, mung beans, teff seeds, amaranth, chia seed and flaxseed). Nutritional value (energy, protein, carbohydrate, fat, saturated fat, fiber and sodium) of the food per 100 gram was analyzed. We also compared the price of the foods.ResultsAmong the imported foods, flaxseed has the highest energy (534 kcal) and aft (42 g) content and the lowest carbohydrate content (29 g). Chickpeas have the highest energy (334 kcal) and fat (5.3 g) content whereas green beans has the highest protein content 923 g) in the locally grown foods group. Imported mung beans and locally grown cannellini beans have similar nutritional value. For instance, both mung bean and the cannellini beans have the same amount of energy content (281 kcal). Protein values were also similar (22.2 g for mung beans and 21.8 g for cannellini beans). The most expensive food was the imported quinoa (6.5 Turkish liras per 100 g) and the cheapest food was the locally grown bulgur (1.5 Turkish liras per 100 g).ConclusionWe showed that the nutritional value of locally grown foods and imported foods are similar. However, the price difference between these foods is significantly high. While access to locally grown legumes and seeds are easy and slightly cheaper, consumption of imported foods has been increasing due to different factors that push people to consume these foods such as the perception of health value and advertisements of these foods. It is also important to emphasize that uses of the locally grown foods and imported foods are different from each other. Locally grown foods are generally used in traditional Turkish cuisine, whereas imported foods are mostly put into salads to increase the nutritional value. In parallel with increasing use of the imported foods as a part of healthy balanced diet, Turkey has started to grow its own crops such as buckwheat and amaranth in the recent years. This will not only make access easier to these foods but will also provide sustainability in the diet. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.9 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Conway, H; Chawke, J, Keane, M, Douglas, P, Kelly, D, Griffin, A. Abstract: BackgroundDietary factors are responsible for a considerable share of the global disease burden; therefore, nutrition should be viewed as an important component in the treatment and prevention of chronic illness by all healthcare professionals. Physiotherapists are ideally positioned to provide nutrition-related advice to individuals at risk of developing chronic disease.ObjectivesTo determine physiotherapists’ self-perceived nutrition competence using the validated NUTCOMP tool and to investigate the relationship between previous nutrition education and the self-perceived nutrition competence of physiotherapists in Ireland.MethodsThe NUTCOMP tool was used to evaluate the self-perceived nutrition competence of members of the Irish Society of Chartered Physiotherapists (n=447). Participants’ scores across four constructs of nutrition care were combined to provide a self-perceived nutrition competence score. Pearson’s Chi Square tests were used to determine whether associations existed between demographic variables and participants’ competence scores.ResultsThe majority of participants were female (81.4%, n=364) and 80.9% (n=362) of those who responded were aged between 25–54 years. On average, participants were practicing as physiotherapists for 17.37±11.22 years, with a range of 0–50 years. 55.1% (n=246) of participants had completed a degree, certificate or other non-degree course that did not include nutrition content while 6% (n=27) had completed an education program that was predominantly focused on nutrition. Physiotherapists were very confident in their ability to provide nutrition care and attitudes towards nutrition were positive. However, their self-perceived competence with respect to nutrition-related knowledge and skills was relatively low. Most participants (70.5%) agreed they required further nutrition education to support them in their future role. Previous nutrition education did not significantly influence participants confidence across the constructs whereas age and years of practice significantly influenced self-perceived competence to provide nutrition care (P Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.10 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:
Mota, I. B; Maldonado, I, Teixeira, D, Calhau, C, Sousa, M. Abstract: BackgroundPhysicians have a critical role in promoting healthy behaviors, a cost-effective intervention that results in reduction of disease morbidity and mortality. It is essential that medical students have a nutritional education that allows them to correctly inform their patients. At NOVA Medical School (NMS), NOVA University of Lisbon, nutrition and metabolism is a required curricular unit in the 1st year of the medical curriculum. In 2021, for the final-year medical students we developed a hands-on nutrition course (8 hours of contact time) based on the Mediterranean Diet (MD) principles and its association with cardiovascular and metabolic protection.ObjectivesTo determine the impact of a nutrition practical course on nutritional knowledge, self-reported cooking skills, confidence on future dietary counselling, and adherence to the MD of the 6th year medical students at NMS.MethodsThis was an observational study approved by the Ethics Committee of NMS (38/2021/CEFCM). All the registered students (n=48) were invited to complete a self-administered online questionnaire at the beginning and at the end of the course.ResultsAt the beginning and at the end of the course students reported good nutrition knowledge, having 83% of the answers correct (15 questions). After the course there was an increase in self-report skills to cook legumes (p Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.11 Issue No:Vol. 5, No. Suppl_2 (2022)
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Chawke, J; Conway, H, Keane, M, Douglas, P, Kelly, D, Griffin, A. Abstract: BackgroundCommunity pharmacies provide an ideal setting to address diet and nutrition-related issues and promote positive eating habits among the public. However, there is limited evidence of the expertise among pharmacists to deliver evidence-based nutrition information. In Ireland, there is a lack of existing literature relating to self-perceived nutrition competencies of practising pharmacists.ObjectivesThe aim of this study was to assess registered Irish pharmacists’ knowledge and confidence when delivering nutrition care to the public.MethodsCross-sectional study using mixed methods design consisting of an anonymous online survey delivered to registered pharmacists with the Pharmaceutical Society of Ireland (PSI). The pharmacists’ self-perceived confidence in knowledge, skills, communication and counselling, and attitudes in nutrition care were assessed using the validated NUTCOMP questionnaire. Qualitative responses to nutrition knowledge requirements of pharmacists were also gathered. Data in the free text narratives was coded into themes and subthemes. Responses were analysed using descriptive statistics. A p-value of Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.12 Issue No:Vol. 5, No. Suppl_2 (2022)
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Bradfield, J; Jaffee, A, Broadley, I, Ray, S. Abstract: BackgroundThe COVID-19 pandemic brought food and nutrition security to the fore in many sectors like never before. It altered purchasing behaviours in the United Kingdom, including that of food and other essential products. This survey sought to identify how the pandemic changed behaviours of specific populations. The primary targets were healthcare professionals working in the National Health Service (NHS) while a secondary target were students training to work in the NHS.ObjectivesTo assess how the first wave of the COVID-19 pandemic affected food choices and eating behaviours of frontline healthcare staff and students.MethodsA semi-qualitative, online survey was conducted to gain an understanding of the challenges faced during the pandemic, in a manner that can inform a future blueprint on occupational nutrition education for healthcare professionals. As a semi-qualitative survey, it sought to describe subjective experiences and recognise patterns or recurring themes. The participants were either healthcare professionals in the NHS or students training to be healthcare professionals in the NHS.ResultsMany in the survey commented on choosing quick options that would save them time while others made use of techniques such as batch cooking and freezing meals for later. They called for an end to stockpiling of materials, a trend seen frequently in the first wave of the pandemic. This survey indicated that overall, frontline workers and healthcare students have significantly changed their food choices and eating behaviours during the course of the first wave of the pandemic. Based on these insights, an educational intervention can be designed to educate such workers on the importance of good nutrition as well as practical tips to achieve this in times of pressure. This may be evaluated using a knowledge, attitudes and practices (KAP) before and after design.ConclusionThese members of the healthcare community would benefit from micro-training emphasizing how to make simple, nutritious meals quickly, for use when external circumstances alter their habits and access to food. Furthermore, they would benefit form a comprehensive governmental occupational health strategy to optimize nutrition and pandemic resilience. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.13 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:Guzanic J. Abstract: BackgroundThe UN Food Systems Summit (UNFSS) was convened by UN Secretary-General António Guterres, and held in September 2021. The purpose was to shape global commitments and to raise global awareness of food systems, how they might be transformed to reduce diet-related diseases, resolve hunger, and restore planetary health.1 ObjectivesThis international survey aimed to narrow the already existing Chefs’ Manifesto Action Plan (2), formed from the UN SDGs, to a much more succinct, 8 point practical action pledge, which could begin to be immediately implemented by existing and future chefs (62%), cooks (7%), students (3%) and food professionals (24%) from more than 50 countries worldwide.Study Design and MethodsThe aim was to conduct an analytical surveys, questionnaires and multiple global, inclusive dialogues across the culinary and food sector, the reports of which were submitted to the UN FS Summit 2021. The survey was translated into several languages, The preliminary results were published in June 2021 as part of the preparations for the 2021 UN Food Systems Pre-Summit Event.2 Results38% of asked would choose ingredients for menus with the lowest impact on the environment. 31,8% use different plants, grains, and proteins to champion ‘wild’ variants and avoid monoculture and 27% use a purchasing power to choose only fish and seafood that is abundant and sourced sustainably. Only 13% support more farmers to access marketplaces through choosing to buy from small-scale producers. Using training to chefs, students was chosen by 15.8% of the respondents. Setting targets to reduce and prevent food waste was a priority of 26,9% of the asked. Being more creative through pickling, preserving, dehydrating, and freezing was a current and ongoing commitment by 11% of the survey participants. 11% would like to become a community food champion and re-distribute surplus food through community (digital) sharing. More than 24% of chefs were committed to promote kitchen gardens and urban farming. Incorporating plant-based options and proteins on menus was a priority by 41,2% of the surveyed. Finally, promoting new ideas and implemented actions through educating dinners, community and online events, annual conferences and would be welcomed by 38% of all participants.3 ConclusionThe survey resulted in 8 practical actions that were deemed the most likely to accelerate food systems transformation. According to the last follow-up of dialogues and interviews having been conducted since June 2021, more than 82% of respondents confirmed their commitments and already implemented actions. References UN Food Systems Summit. [internet]. 2021 [cited 2022 August 18]. Available from: https://www.un.org/en/food-systems-summit/news/un-food-systems-summit The chefs’ manifesto. Chefs as agents of change. [internet]. N.d. [cited 2022 August 18]. Available from: https://sdg2advocacyhub.org/chefs-manifesto/chefsagents The chefs’ manifesto. Chef’s pledge – the results are in. [internet]. N.d. [cited 2022 August 18]. Available from: 4 https://sdg2advocacyhub.org/chefs-manifesto/actions/chefs-pledge-results-are Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.14 Issue No:Vol. 5, No. Suppl_2 (2022)
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Choudhary, M; Choudhary, M. Abstract: Background and ObjectivesToday mankind is confronting a novel corona virus pandemic which has an oral–faecal route of contamination in which food serves as a potential carrier. Wrapping of food products in food packaging films embedded with clove oil can help the packaged food to fight against corona virus in its active form as antiviral properties of clove oil has already proven against COVID-19 virus.MethodsThis study was conducted in Gujarat, India, wherein a low cost active food packaging film was developed, in which clove oil was embedded in polysaccharides (extracted from banana peels) based film (at 0, 0.5, 1, 1.5, 2% w/w) by solvent casting method.ResultsThe findings showed that increasing the concentration of clove oil (p Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.16 Issue No:Vol. 5, No. Suppl_2 (2022)
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Raja, N; do Vale, M. L, Ray, S. Abstract: BackgroundHigh-risk groups for COVID-19, such as ethnic minorities, also experience the greatest risk for micronutrient deficiencies including Vitamin D. Vitamin D may positively impact COVID-19 prevention and treatment, however, further studies are needed to understand its role.ObjectivesTo guide further studies exploring Vitamin D and COVID-19, this study aimed to identify national nutrition surveys containing information regarding Vitamin D status, deficiency or supplementation intake.MethodsSystematic searches were performed on MedLine and an extraction template was used to collect information on surveys; country, year of data collection, Vitamin D indicators and access.Results27 national nutrition surveys were identified as collecting Vitamin D data across global countries; 8 were publicly available (open-access), 9 required applications and raw-data was not accessible (N/A) for 10. Table 1 displays survey information, including the Vitamin D indicators used. Surveys recorded either serum 25-hydroxyvitamin D (25-OHD) concentration (nmol/L) or estimated Vitamin D intake from interviews/food diaries.Additionally, Vitamin D data was rarely collected in low-income countries such as Africa. Data mapping has outlined disease reporting standards in countries and has emphasised the systematic differences between healthcare systems. 14 Table 1National nutrition surveys collecting vitamin D data Country Nutrition Survey Vitamin D Indicator Access Europe UK PHE National Diet & Nutrition Survey (NDNS) [2008–19] Serum 25-OHD concentration Supplement intake Open France French national dietary survey (INCA1, INCA2, INCA3) [1998–2017] Serum 25-OHD concentration Supplement intake Open Finland The Finnish National Dietary Survey in Adults and Elderly (FinDiet 2017) Serum 25-OHD concentration Estimated intake (microgram) Application Germany Nationale Verzehrsstudie II: Estimated intake (microgram) Supplement usage Application Israel Mabat First Israeli National Health and Nutrition Survey Estimated intake (microgram) Application Netherlands Dutch National Food Consumption Survey Supplement usage Application Belgium Belgium Health Examination survey (BELHES) Estimated intake (microgram) Application Austria Austrian Nutrition Report (OSES) [2017] Serum 25-OHD concentration N/A Denmark National Survey of Dietary Habits and Physical Activity (DANSDA) Serum 25-OHD concentration Supplement intake N/A Spain National Food Survey in the adult population, the elderly and pregnant women. (ENALIA) [2012–15] Supplement usage N/A Italy Italian National Food Consumption Survey (INRAN-SCAI) [2005–06] Estimated intake (microgram) N/A Greece The Greek National Survey on Health and Nutrition (the HYDRIA Project) Serum 25-OHD concentration N/A Greenland Inuit Health in Transition Greenland survey 2005–2010 Serum 25-OHD concentration N/A Nordic Countries Nordic dietary surveys: Study designs, methods, results and use in food-based risk assessments Serum 25-OHD concentration Estimated intake (microgram) N/A North America USA CDC National Health and Nutrition Examination Survey (NHANES) [1999–2018] Estimated intake (microgram) Supplementation usage Open Canada CRDCN Canadian Community Health Survey (CCHS) [2004–15] Estimated intake Open South America Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.17 Issue No:Vol. 5, No. Suppl_2 (2022)
Authors:Rahman Disu T. Abstract: BackgroundThe world witnessed a dramatic disruption in our daily lives due to COVID-19 pandemic and Bangladesh is no exception. Such kind of public health crisis instigated by pandemics & its repercussion can elicit significant negative emotions, in line with stress, changed dietary patterns and weakened immune system. All these are inter-linked. As there were merely such studies in Bangladesh, this study aimed to find out association between dietary patterns and perceived stress level of urban adults during COVID-19 pandemic.ObjectivesThis study intended to find out the association between dietary patterns and perceived stress level among adults in Bangladesh as well as their dietary patterns and perceived stress level during COVID-19 pandemic.MethodsA Cross-sectional study was conducted among 300 adults (aged ≥18 years) of three urban communities in Dhaka city of Bangladesh from February 2021 to June 2021. A semi-structured questionnaire using purposive convenience sampling based on the Perceived Stress Scale (PSS) and minimum dietary diversity for individual adult, 24 hours recall by face to face interviews ensuring proper protective precautions. Measures included baseline and personal characteristics, perceived stress levels, dietary patterns. Data were analyzed by using latest SPSS software.ResultsThe results showed moderate level of perceived stress among majority of the population with approximate one-in ten (12.0%) and one-fourths (22.0%) of the respondents with a low and high level of stress, respectively. It also revealed the association of perceived stress level with several socio-demographic factors such as age group (p Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.18 Issue No:Vol. 5, No. Suppl_2 (2022)
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Oksuz, M; Inan-Eroglu, E. Abstract: BackgroundNowadays, dietitians widely use social media tools such as Instagram in order to build their clientele as well as share healthy eating tips and recipes.ObjectivesThis study aimed to evaluate the nutritional content of recipes shared by dietitians on Instagram.MethodsInstagram accounts of Turkish dietitians who had a blue tick (known as the Instagram verified sticker) in their account and more than 100,000 followers were included. We determined the last 10 Instagram recipe posts of each dietitian and divided them into 7 categories according to their content: main dish, soup, healthy bakery products, breakfast, salads, drink including smoothies and sweets. Nutritional composition (macro and micronutrients) of the recipes was analyzed based on one serving size. Post demographics including number of likes, hashtags and comments were also recorded.ResultsWe identified a total of 98 recipes. The majority of the posts were shared as photo (80.6%) whereas the rest of the posts (19.4%) were shared as video. The mean (SD) number of likes was 6108.9 (17971.2). The most shared recipe category was sweets category (36.1%), followed by salads category (17.0%). Salads category had the highest energy (381.4±126.8 kcal), protein (15.1 ± 14.5 g) and fat content (24.0 ± 10.0 g) per one serving. Sweets category had the lowest energy (139.9 ± 63.2 kcal) per one serving. Soup category had the highest carbohydrate content (44.1 ± 24.0 g).ConclusionOur research provides important information about the nutrient content of the recipes shared by dietitians on Instagram, which is an increasingly popular avenue for the general public, especially for those who do not have an opportunity to see a dietitian. Healthy recipe posts of dietitians on Instagram may be potentially misleading for public who may believe these foods are healthier than the regular alternatives. As such, following healthy recipes may be unlikely to confer any additional health benefits to the individual. There is a need for social media guidelines on how dietitians can effectively communicate via social media with the potential clients as trusted source of information. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.19 Issue No:Vol. 5, No. Suppl_2 (2022)
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Minh Do, T; Chen, H.-J. Abstract: BackgroundRelation between peer network and adolescent’s weight status has been investigated in Western, and high-income countries, yet little was known in low- and middle-income countries, especially in Vietnam.ObjectivesThe study investigated how peer network structure indicators were associated with adolescent’s weight status in Vietnam.MethodsThe study obtained data of 1049 children who participated in two different surveys in the Young Lives Study in Vietnam. Sociometric indicators (in-degree, out-degree, reciprocity, reciprocal in-degree, reciprocal out-degree) were generated from class-based networks in the school survey conducted from 2011–12 using UCINET program. Anthropometric measurements and other demographic characteristics were collected in another survey from 2013–14. Nutritional status was categorized into Thinness, Normal weight, and Overweight using International Obesity Task Force BMI cut-off points. Multinomial logistic regression was employed to estimate the relative risks ratio (RRR) of being thin or overweight compared with normal weight adjusted for gender, wealth index, birthweight, class-level network density, friends’ gender homophily, and BMI z-scores in round 3. Gender-network attributes interaction was also evaluated.ResultsReciprocity was associated with overweight in adolescents: model 1 (adjusted gender, wealth, birthweight, network density, gender homophily): RRRov=1.82, 95% CI: 1.10, 3.02, p-value Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.20 Issue No:Vol. 5, No. Suppl_2 (2022)
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Chrysostomou, S; Andreou, S, Giannakou, K. Abstract: BackgroundFood stress can be defined as the product of the cost of healthy food relative to the income of the household and occurs when households spend 30% or more of their income on food costs.ObjectivesTo examine the effect of chronic disease on food stress among low-income population in Cyprus.MethodsThree Food Baskets were developed for two different types of households (men and women). Healthy Food Baskets (HFB) were constructed based on the National Guidelines for Nutrition and Exercise. The Gluten Free Healthy Food Baskets (GFHFB) were based on the HFB and all products containing gluten were replaced with gluten free products. The Diabetic Healthy Food Baskets (DHFB) were based on the HFB and the guidelines of the American Diabetes Association (ADA). Affordability was defined as the cost of each basket as a percentage of the Guaranteed Minimum Income (GMI). The value of the GMI is set to be equal to 480 for a single individual and increases with the size of the recipient unit accordance to the Organization for Economic Co-operation and Development equivalence scales.ResultsThe monthly cost of the HFB for a man is 258.8 euros and for a woman is 187.1 euros. Also, a healthy man on GMI would need to spend 53.9% of his income on the HFB whereas the relative percentage for a healthy woman is to equal to 39%. The monthly cost of the GFHFB is about 16% (47 euros) and about 17% (33.6 euros) more expensive compared to the HFB for man and woman, respectively. Adults with celiac disease receiving GMI would need to spend 59.5% and 41.9% of their income on the GFHFB (man and woman, respectively). Moreover, the total monthly budget for a diabetic man is 16% (37.6 euros less) lower compared to the HFB and the relative percentage for the diabetic woman is about 15% (25.7 euros less). Moreover, for low-income adults with diabetes the proportion of income that would need to be spent on the DHFB is 50.1% and 35% for man and woman, respectively.ConclusionThe HFB, the GFHFB and the DHFB are characterized by low affordability causing food stress among the low-income population in Cyprus. Notably, healthy and non-healthy men seem to experience higher level of food stress compared to women. Moreover, results of the current study indicate that the occurrence of a chronic disease has a different impact on food stress. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.21 Issue No:Vol. 5, No. Suppl_2 (2022)
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Raquel Mejia, S; Chen, H.-J. Abstract: BackgroundAs the prevalence of obesity keeps rising world-wide, new approaches to decrease risk of metabolic disease have been studied, since traditional methods of calorie restriction and physical activity might be insufficient against the vast variety of dietary and lifestyle factors affecting metabolic status. Timing of meals has shown to influence multiple metabolic parameters and has therefore gained popularity among researches as a new strategy for managing bodyweight and improving health status.ObjectivesThe aim of this study was to test the association between the of the timing of the three main meals and blood lipid profile parameters in a sample of United States adults.MethodsCross sectional study of the NHANES (2017–2018) survey. Time of intake categories were created for the three main meals (breakfast, lunch, dinner) according quartiles from population values. Multivariable linear regression was performed to test the association between meal timing categories and lipid profile parameters (Total cholesterol, low-density lipoprotein (LDL), triglycerides and high-density lipoprotein (HDL), controlling for potential confoundersResultsA final sample of n=3700 adults were included in the analysis. Energy intake increased across meals during the day possibly due to less satiating effect, but also within meals as time of intake was delayed. Those who sleep less had both earlier breakfast and later dinner times (p>0.00), higher WC (p>0.00) but not BMI. Delaying breakfast and lunch was associated with both a higher BMI (p0.00), however dinner was only associated with higher WC (p0.00).ConclusionThis study suggests that maintaining earlier periods of intake has a favorable effect on lipid profile parameters such as HDL and triglycerides, as well as other metabolic indicators like BMI and WC. However further research is needed to further study possible long-term effects on HDL and total cholesterol, as well as the most appropriate intake periods for optimal metabolic function. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.22 Issue No:Vol. 5, No. Suppl_2 (2022)
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King, R; Palermo, C, Wilson, A. Abstract: BackgroundGlobally, one in five deaths are attributable to suboptimal diet. Doctors are well-positioned to address nutrition issues, however, often lack the knowledge and skills to do so. Nutrition in medical curricula is widely insufficient, resulting in an evidence-practice gap between nutrition knowledge and competency to provide effective nutrition care. In Australia and New Zealand, medical curricula are accredited by the Australian Medical Council (AMC). Throughout the AMC Standards there is no single competency related to nutrition, rather the onus is on individual medical schools to include nutrition education and teaching in their curricula.ObjectivesWe aimed to systematically map nutrition education in medical curricula across all 23 medical schools accredited by the AMC in Australia and New ZealandMethodsWe reviewed available learning objectives for 20 of the 23 AMC accredited medical schools in Australia and New Zealand between February to June 2021. Current learning objectives for each course were extracted. We reviewed all objectives and identified Nutrition Relevant Learning Objectives (NRLOs), or equivalent Learning Outcomes/Graduate Attributes. An adaption of Deakin University’s Extended Nutrition Competency Framework was used to determine keywords in classifying a learning objective as nutrition relevant. NRLOs were analyzed according to Bloom’s revised taxonomy to determine which level objectives met within Cognitive (Knowledge), Psychomotor (Action), or Affective (Emotive) domains.Results11 (55%) of 20 medical schools contained NRLOs in their curricula. One curriculum comprised 129 (69.4%) of all NRLOs, while nine curricula contained none. Learning objectives were unavailable for three medical schools. The majority of NRLOs (181, 97.3%) were in the Cognitive domain of Bloom’s revised taxonomy, predominantly at level three ‘applying’ (90, 49.7%). When comparing clinical and pre-clinical years across curricula, the proportion of NRLOs in the Psychomotor domain was 3.5-fold higher in clinical years (4, 4.1%) versus pre-clinical years (1, 1.2%). No curricula contained any NRLOs in the Affective domain.ConclusionThere is wide variation across medical curricula regarding the amount of NRLOs. New Zealand medical curricula were more likely to include NRLOs than Australian curricula, although only two medical schools were New Zealand based. This may lead to varying competency of medical graduates to provide nutrition care in Australia and New Zealand. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.23 Issue No:Vol. 5, No. Suppl_2 (2022)
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Bardhar, P; Wason, N. Abstract: IntroductionHealth care worker’s job accountability may influence their ability to maintain healthy lifestyle and dietary habits. Therefore, there is a need to address health issues among health care workers (HCW).MaterialBased on quota system, from the urban hospitals of Bangalore city (Karnataka) India, 205 subjects were selected. Professional classification was followed as suggested by WHO (2020). Self-reported height and weight was noted. Calculated BMI was classified as per WHO, (2020) further compared with macro and micronutrient intake (calculated using 2 day 24 hour dietary recall method), Mean Adequacy Ratio (MAR), Nutritional Adequacy Ratio (NAR), physical activity, stress and sleep pattern.ResultsCurrent study included, 74(36.07%) doctors, 97(47.32%) nurses and 34 (16.5%) paramedical staff. BMI classification indicated more male doctors 15(39.5%) and 5(13.9%) less overweight females. Only 4(11.1%) obese females, consumed (179.19±44.91gm/day) carbohydrates but 2(5.3%) obese male doctors, consumed more carbohydrates (213.02±38.9gm/day) and less physically active (P < 0.001). Among female nurses, 23(25.8%) were overweight, consumed 45.05±10.08gm protein per day. Only 10 (11.24%) female nurses were obese but more obese males consumed 49.56±11.41gm/day fat and energy intake as 178 kcal/per day. Increase in number of working hours among nurses (8 to 10 hours/day), significantly raised stress level (r = 5.996, P =0.05). NAR micronutrient intake showed (70%) were ‘inadequate’ to ‘fairly adequate’ for calcium, iron and vitamin B12. The Mean Adequacy Ratio (MAR) 82.18% and 44.62% respectively (P < 0.001 for doctors and nurses) and (P = 0.003 for nurses and paramedical staff). Pittsburg Sleep Quality Index (PSQI) scale showed (36%) ‘poor sleep’ quality and (20%) ‘need help’ category. Perceived Stress Scale (PSS) showed (72.68%) were moderately stressed with compromised sleep quality.ConclusionWhen BMI was compared with macronutrients and micronutrient, sleep and stress patterns results showed a positive correlation (r = 0.312; t=4.679; p< 0.001). Indicating stress can influence body composition, nutrition intake and sleep quality. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.24 Issue No:Vol. 5, No. Suppl_2 (2022)
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Milhench, N; Heitmar, R, Mellor, D. Abstract: BackgroundThe link between nutrition, systemic disease and ocular conditions is well established. Additionally, in England government initiatives are in place to make every contact count between health professionals and patients, which can require discussing nutrition to improve long-term health.1 Optometrists discuss general health with patients which often will include nutrition, and many sell nutritional supplements in their practice. However, the role of nutrition in systemic disease and ocular health does not form part of the core competencies of optometry training,2 therefore a patient’s overall diet could be overlooked. The self-perceived confidence, competence, and relevance of dietary advice within optometry care in the UK are unknown.ObjectivesTo investigate the self-perceived confidence, competence, and relevance of providing nutritional advice by the UK optometric workforce, within routine eye care. This survey will be used to identify if any knowledge gaps and if there is a need for further nutrition related education.MethodsThe UK optometric workforce was invited to anonymously complete the standardised NUTrition COMPetence (NUTCOMP)3 questionnaire via professional networks and organisations, social media, and personal optometric contacts of the research team, during winter 2020/21. The NUTCOMP questionnaire was modified for the UK dietary guidelines with additional domains relating to optical health. Ethical approval was granted by the College of Health and Life Science Research and Ethics Committee.ResultsA total of 259 participants, including 200 who identified as optometrists completed the survey. The modal age was 35–44 years with 20 ± 12 years (mean±S.D.) experience of working in optical care. Although 95.37% (n=247) somewhat or completely agree it is important to encourage patients to eat healthily, 33.2% (n=86) somewhat or completely disagree that providing specific nutritional recommendations falls within their current scope of practice. Over two-thirds (68.73% (n=178)) of respondents agreed there is a need for further education, with only 36.68% (n=95) having previously completed CET or CPD on nutrition and 56.37% (n=146) being unaware of national or professional guidelines relating to nutritional management.ConclusionThis is the first survey of a UK optometric workforce regarding nutrition and health. It found that nutritional advice is regarded as an important part of eye health, although identified a clear gap in current practice, with an expressed need for further training Further work is needed to assess the scope and type of post-registration training and education required to help eye professionals holistically support the health of their patients.References Harling M, Stephens K. London: Public Health England; Making Every Contact Count (MECC): Consensus statement; 2016 [cited 2020 Dec 6]. 18p. Available from: https://www.england.nhs.uk/publication/making-every-contact-count-mecc-consensus-statement/ General Optical Council. Core competencies. [internet]. N.d. [cited 2021 June 6]; Available fromL https://www.optical.org/en/Education/core-competencies--core-curricula/index.cfm Ball LE, Leveritt MD. Development of a validated questionnaire to measure the self-perceived competence of primary health professionals in providing nutrition care to patients with chronic disease. Fam Pract. 2015;32(6):706–710. doi:10.1093/fampra/cmv073. Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.25 Issue No:Vol. 5, No. Suppl_2 (2022)
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Chen; H.-J. Abstract: BackgroundMeal regularity is an elusive construct of eating patterns. There were various methods to assess meal regularity/irregularity, but no validation has been done so far.ObjectivesTo evaluate the validity of a clock hour-based meal regularity questionnaire.MethodsThe study recruited 125 healthy young adults. Participants were interviewed on three separate days within 2–3 months. The participants provided three days of 24-hour dietary recall, recalling time of eating occasions on the previous day of interview. The three non-consecutive days of dietary recalls were used as reference method assessing meal regularity. At the third visit, the participants also administered the clock hour-based meal regularity questionnaire about meals (breakfast, lunch, dinner) and snacks (morning snack, afternoon snack, and nighttime snack). Participants recalled the number of days per week eating the indicated meal/snack in the past three months, and recalled all the hours they had consumed the indicated meal/snack. The dietary recall data and meal regularity questionnaire data were respectively converted into Chaotic Eating Index (CEI) by Annie Zimmerman et al. The algorithm of Meal Regularity (mReg) Score by Barbara Lohse et al. was also used to summarize the meal regularity based on 3-day recalls. Pearson correlation coefficient was used to evaluate the consistency between meal regularity measured by questionnaire and 3-day recalls.ResultsThe participants were on average 22.5 years-old, and 58% of them were women. The mean (SD) of meal CEI assessed by questionnaire was 3.6(1.1), and the mean(SD) of meal CEI assessed by 3-day dietary recall was 2.2(0.4). Correlation coefficient between meal CEI by questionnaire and meal CEI by 3-day dietary recalls was 0.20 (95% CI: 0.03, 0.36; p=0.024). Correlation coefficient between CEI assessed by questionnaire and mReg assessed by 3-day recalls was -0.35 (95% CI: -0.50, -0.19; p Keywords: Open access PubDate: 2022-10-18T01:50:52-07:00 DOI: 10.1136/bmjnph-2022-summit2022.26 Issue No:Vol. 5, No. Suppl_2 (2022)
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Bell, J; Fallows, E, Dael, P. V, McAuliffe, S, Kohlmeier, M, Hernandez, A. M, Adamski, M, Ray, S, Crocombe, D, Vale, M. L. d. Abstract: The transfer of research evidence into practice has been historically slow, and requires an integration of many elements, including quality evidence, supportive physical and intellectual environments, and facilitation, as discussed at the NNEdPro Sixth International Summit on Nutrition and Health. Examples of applying clinical research into practice focused on the use of group consultations (also known as group clinics or shared medical appointments) to support behaviour change, the role of dietary micronutrients during the COVID-19 pandemic and the potential of Precision Nutrition. An emerging area from early implementation evidence includes group consultations, also known as shared medical appointments, as discussed by Dr Fallows. Group consultations have been shown to improve clinical outcomes for some patient groups (e.g., HbA1c, lipids, BMI), as well as improve self-care and health education, and patient and clinician satisfaction. These groups have been piloted throughout the UK both face-to-face and virtually, with initial findings suggesting they are feasible and acceptable to patients and clinicians. Further work is needed to assess whether these could be cost-effective when scaled-up in National Health Service UK primary care. During the COVID-19 pandemic, there has been increasing emphasis on the central role of nutrition in health, including the role of dietary micronutrients, as discussed by Dr Van Dael and Shane McAuliffe. Nutrition plays an important role in immunity, yet the nutritional status of the most vulnerable population groups is likely to deteriorate further due to the health and socio-economic impacts of the novel coronavirus. Thus, implementation of this evidence into health care practice is key. Precision Nutrition, defined as an ‘approach that uses information on individual characteristics to develop targeted nutrition advice, products or services’, offers an exciting opportunity to further individualise dietary advice for behaviour change, as discussed by Dr Kohlmeier and Dr Hernandez. Precision nutrition is underpinned by the recognition that individuals differ in many important ways due to identifiable molecular traits and can be utilised to determine personalised weight loss interventions based on genetic variants. Use of implementation science is in line with one of the six cross-cutting pillars of the Nutrition Decade: Aligned health systems for universal coverage of nutrition actions. Dr Bell, an Advanced Accredited Practising Dietitian in Australia, provided an overview of key implementation science models and frameworks. Implementation frameworks such as the Action Research Framework, the Knowledge to Action Cycle, and the Spread and Sustain Framework, are underpinned by knowledge creation, effective education, and culture change. Dr Bell then highlighted how theoretical frameworks have provided guidance for the implementation of real world, complex nutrition interventions, including the Systematised Interdisciplinary Program for Implementation and Evaluation (SIMPLE) in Australia, and the More-2-Eat program in Canada. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.1 Issue No:Vol. 5, No. Suppl_1 (2022)
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Kohlmeier, M; Vale, M. L. d. Abstract: Knowledge networks, such as the NNEdPro Nutrition and COVID-19 Taskforce, are central to the rapid creation and dissemination of evidence, as highlighted at the NNEdPro Sixth International Summit on Nutrition and Health. During the COVID-19 pandemic, the Taskforce rapidly collated evidence and widely shared clear and accessible resources globally, via NNEdPro Regional Networks. The impact of the Taskforce on disseminating evidence and encouraging collaboration was made evident, and thus demonstrates the importance of this approach for addressing regional and global nutrition challenges. Scientific journals, such as BMJ Nutrition, Prevention & Health, as discussed by Editor-in-Chief, Professor Kohlmeier, also play a significant role in the dissemination of evidence. Once published, research is open access, disseminated widely online, and is encouraged to be used to inform practice. During the COVID-19 pandemic, any article with research findings relevant to the Coronavirus outbreak, were also shared widely with policymakers to increase global uptake. Knowledge networks, and scientific journals such as BMJ Nutrition Prevention and Health, are critical to the generation and dissemination of evidence, which is key to its uptake and implementation in policy and practice. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.2 Issue No:Vol. 5, No. Suppl_1 (2022)
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Tramojntt, C; Tejeda, M. Z, Guzanic, J, Martini, D, Korre, M, Sokolovic, M, Trigueiro, H. Abstract: The WHO describes knowledge networks as a mechanism to strengthen collaboration among countries and facilitate and enhance local nutrition action in the Nutrition Decade. In line with this recommendation, the NNEdPro Global Centre convened 12 Regional Networks across six continents to foster collaboration and implement nutrition actions for sustained impact. Each network has a lead who connects the broader NNEdPro group to the local network to share evidence and encourage collaboration within and between Networks. Each Network is encouraged to understand the needs of their region, locally tailor relevant interventions, and share learnings with other networks. The focus of these networks is on knowledge exchange, capacity building among members, and wider public health impact. An example of these networks in action is the use of the Mobile Teaching Kitchen (MTK) model, which empowers marginalised community members to become culinary health educators. The intervention was originally developed by the Regional Network in India, and adaptations of the MTK intervention are planned across the Swiss, Mexico, Italy & The Mediterranean, and the Brazil Regional Networks. Networks will learn from each other while making adaptation relevant to their local need, resources, and capacity. Knowledge networks underpinned by strong leadership and clear communication strategies are essential to take collaborative action on nutrition and end malnutrition in all its forms. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.3 Issue No:Vol. 5, No. Suppl_1 (2022)
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Yeo, G; Kirsty Pourshahidi, L, Laur, C, Ray, S, Douglas, P. Abstract: Effective communication and leadership are needed when developing knowledge networks for nutrition research and education. The need for clear and approachable communication was highlighted by Dr Giles Yeo, who advocated for consensus, which takes time. As a result, nutrition has become a competitive space, contributing to a pseudoscience vacuum for people who want readily available and easy-to-understand information. Evidence-informed knowledge networks, and the individual participants who make up such networks, are key in cutting through the pseudoscience. During the Nutrition Decade, knowledge networks need skilled leaders, as mentioned in Action Area 4, regarding effective leadership to address these challenges and inspire future generations. Dr Kirsty Pourshahidi discussed the many different definitions and styles of leadership, underpinned by concepts of motivation and positive influence. To train these leaders, the European Nutrition Leadership Platform (ENLP) was introduced as a dynamic network of around 850 global leaders in food and nutrition with a mission to train, inspire and connect leaders in this space. The ENLP is a prime example of how to train leaders to drive progress in voluntary networks during the Nutrition Decade. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.4 Issue No:Vol. 5, No. Suppl_1 (2022)
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Laperriere, A; Bohn, J, Vale, M. L. d. Abstract: Data that is accurate and accessible helps to drive innovation and progress, which was a key theme of discussion at the NNEdPro Sixth International Summit on Nutrition and Health. Data-driven policies and programmes have the potential to reorient food systems and end malnutrition by 2030, according to Andre Laperriere of Global Open Data for Agriculture and Nutrition (GODAN). The COVID-19 pandemic has exacerbated the existing food crisis, affecting production, processing, and distribution within the food system, and highlights the critical need for timely and reliable data to drive decision-making. The pandemic has affected food on the levels of production, transformation, and distribution, which presents an unprecedented opportunity for change. Using data, we can identify and learn from countries who have had the most success in reducing hunger (E.g., Armenia, Brazil, Ghana) and those which have achieved zero hunger while keeping adult overweight and obesity to a minimum (E.g., Republic of Korea, Japan). However, making practice and policy decisions involves a complicated process influenced by logic, current evidence, existing models and authorities, previous experiences, emotions, and cognitive biases, as discussed by Dr Jeffrey Bohn. Causal inference approaches could be one way to address some of these complications by merging nutrition data and scientific evidence to promote better decision-making in the context of nutrition-related communicable diseases targeted by the Nutrition Decade and the Sustainable Development Goals. Although challenges exist in all data science, there are particular challenges in applying mathematical precision in nutrition. Nutrition research considers dynamic processes that evolve and are often influenced by the process of studying them. Additionally, nutrition research occurs against the backdrop of traditional biomedical research where the randomised control trial (RCT) is considered the gold standard in proving causation. While pre-registration of data, protocol and analyses can address some of these primary challenges with research behaviour, to truly understand causation we must consider counterfactuals, which consider the context of the research (models, interventions, characteristics, and cognitive bias) for a more complete understanding. Causal inference tools can be applied to relevant, curated data to identify confounders and subsequent causal linkages. There is a necessity for the quality use of data to identify and strengthen high-impact policies and programmes for action on nutrition. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.5 Issue No:Vol. 5, No. Suppl_1 (2022)
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Ball, L; Elahi, S, Lepre, B. Abstract: Research is a cumulative process, and the open flow of information is key to the uptake of evidence into policy and practice. There is growing interest in online knowledge hubs that provide open access to information for public good, and in particular, platforms that have the capability to foster collaboration between different stakeholders, such as content providers and users (e.g., health care professionals, researchers and policy makers). At the NNEdPro Sixth International Summit on Nutrition and Health, Professor Ball and Selvarani Elahi MBE presented on the development of the International Knowledge Application Network Hub in Nutrition 2025 (iKANN). iKANN is an open access, online portal that provides opportunities to interact with a collation of evidence accompanied by commentary and guidance for workforce capacity building. A key aim of the iKANN initiative is to synthesise and promote global evidence in food, nutrition, and health, and to drive the implementation of evidence into policy and practice. iKANN aims to enhance collaborative efforts with a range of stakeholders from different backgrounds, to support the monitoring of progress and drive improvements in the quality of research and co-ordination of efforts. iKANN was developed in line with the UN Decade of Action on Nutrition, and the encouragement from the World Health Organization to develop networks to support the nutrition and agriculture community to achieve food systems transformation and end malnutrition in all its forms. The initiative is led by the NNEdPro Global Centre, in conjunction with supporter, Swiss Re Institute, and implementation partners, which at the time of writing include GODAN, DSM, LGC, the BMJ, Nutrition in Medicine (NIM), Swiss Association for Co-operation on Food Education, and Konnexions. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.6 Issue No:Vol. 5, No. Suppl_1 (2022)
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Hachem, F; Mahy, L, Ray, S, Kumar, V, Johnsen, J, Raman, K. Abstract: Can diets be healthy and sustainable' This was the question posed by Dr Hachem from the Food and Agriculture Organization (FAO) at the NNEdPro Sixth International Summit on Nutrition and Health. The market value of the global food system is an estimated $10 trillion, while the hidden costs of global food and land use systems sum up to an astounding $12 trillion, according to the Food and Land Use Coalition 2019 report and highlighted by Lina Mahy, from the World Health Organization (WHO). Of those hidden costs, more than half is attributed to unhealthy diets and harmful farming practices. Food systems must enhance food security and nutrition for all, be inclusive, and have a positive impact on the health of people and planet, as well as be economically viable, in line with Nutrition Decade Action Area 1, Sustainable, resilient food systems for healthy diets. There are 16 guiding principles to achieve healthy diets sustainably produced, with eight related to nutrition, including promotion of exclusive breastfeeding, variety and balance across food groups, consumption of whole grains, legumes, nuts and fruits and vegetables and moderate to small amounts of animal source foods. Governments can signal commitment to a more sustainable and healthy future through the development and dissemination of food-based dietary guidelines that embed health and sustainability objectives.Professor Ray of the NNEdPro Global Centre, spoke on the role of global knowledge networks in response to global nutrition challenges, using the example of the Mobile Teaching Kitchens (MTK) model. The MTK project uses a scalable, micro-level innovation model for health and social innovation in partnership with marginalised populations. The model aims to improve the nutrition knowledge and capacity of the population through demonstration by Teaching Kitchen champions, who are trained nutrition educators. Qualified dietitians and nutritionists share knowledge and skills with community-based volunteers, to support the development of Teaching Kitchen champions in a ‘See One, Do One, Teach One’ model. Promotion of nutritious, affordable, culturally appropriate, and environmentally sustainable food is central to the MTK model. Investing in some of the most marginalised in society can have an upward social and health impact including localised supply chains and microenterprise and aligns with the Sustainable Development Goals and the UN Decade of Action on Nutrition (2016-2025).Professor Kumar, of the Zero Budget Natural Farming Programme of Rythu Sadhikara Samstha, continued the discussion on diet sustainability, focusing on the role of climate resilient, community managed natural farming related to nutrition and food security. To set the scene, it was discussed that the food system is facing multiple crises which pose serious threats to food security, nutrition, and the livelihood of farmers. The environmental crisis places additional strain on the food system, including soil degradation and continuous loss of soil organic matter, water stress, global warming, water and air pollution, and decreased biodiversity, thus increasing the number of people at risk of food insecurity and poor nutrition, and worsening farmer distress. While some agricultural practices are historical, namely, deforestation, forest fires, ploughing and keeping lands fallow, recent use of chemical fertilizers and pesticides (biocides) have accelerated environmental decline. Regenerative agriculture, such as zero budget natural farming, was posed an alternative. It is defined as a holistic land management practice that leverages the power of photosynthesis in plants to close the carbon cycle, and build soil health, crop resilience and nutrient density. Professor Kumar reiterated the value of local knowledge networks, namely, organised women in natural farming and champion farmers, as a strength in scaling up nutrition interventions such as this. Collective action and peer learning can support behaviour change and address inequities. Collective efforts are key to sustained impact and in the words of Professor Kumar, ‘If you want to change a farmer, you have to change an entire village’. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.7 Issue No:Vol. 5, No. Suppl_1 (2022)
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Soares Vaz de Castro, P. A; Vries, T. P. d, Soares Chagas, A. L, Vieira, D. A, Bering, T, Rocha, G. A, Silva, L. D. Abstract: BackgroundDespite the negative impact of low muscle mass (MM) on the survival of cirrhotic patients, the mechanisms linked to MM loss are not completely understood in patients with chronic hepatitis C (CHC).ObjectivesTo evaluate whether the IL-10 haplotype (-1082G>A, -819C>T, and -592C>A) and serum levels of tumour necrosis factor-alpha (TNF-α) were associated with low MM in CHC patients.Methods94 consecutive CHC outpatients (mean age, 50.3±11.5 yrs.; 74.5% males; 68.1% without cirrhosis and 31.9% with compensated cirrhosis) and 164 healthy controls were prospectively enrolled. SNPs were genotyped by RT-PCR. Serum levels of TNF-α were measured by ELISA. CHC patients, prospectively, underwent scanning of the lean tissue, appendicular skeletal muscle mass (ASM), and fat mass by dual-energy X-ray absorptiometry. The data analysed included appendicular skeletal mass (ASM) standardized for height (ASMI=ASM/height2). The cut-off points for low ASMI were 5.45 kg/m2 and 7.26 kg/m2 for women and men, respectively, according to Baumgartner et al. (1998). The International Physical Activity Questionnaire was used to determine the physical activity level.Results IL-10 SNPs were in Hardy Weinberg equilibrium. Patients and healthy subjects showed the same distribution of genotypes. Low ASMI was found in 12/94 (12.8%) of the patients with CHC. The IL-10 haplotype ATA (low-producer genotype) was observed in 11/12 (91.7%) of the patients with low ASMI (P=0.03) and in only one of the patients without low ASMI 1/82 (1.2%) (Figure 1). In the multivariate analysis, low ASMI was significantly and independently associated with moderate-to-high physical activity (OR=0.31; 95%CI=0.09-0.98; P=0.05), TNF-α levels (OR=1.06; 95%CI=1.01-1.11; P=0.02) and ATA haplotype (OR=9.87; 95%CI=1.13-94.85; P=0.05). 1 Figure 1Association between the prevalence of the IL-10 haplotype ATA and the low appendicular skeletal mass standardized for height (ASMI) in patients with chronic hepatitis C (CHC)ConclusionThis is the first study to demonstrate that the IL10 haplotype is associated with low ASMI in CHC patients. We also demonstrated that TNF-α is associated with low ASMI in CHC patients. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.8 Issue No:Vol. 5, No. Suppl_1 (2022)
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Soares Vaz de Castro, P. A; Brito, M. D, Viana, N. L, Bering, T, Rocha, G. A, Silva, L. D. Abstract: BackgroundAlthough the use of electrical bioimpedance (BIA) is impaired when patients with hepatic cirrhosis have ascites, oedema and electrolyte disturbances, the measurement of phase angle (PhA) in this population has been shown to be superior to anthropometric and biochemical methods for early detection of malnutrition. The PhA reflects the cellular integrity and normal values (according to sex and age) indicate preserved cellular activity. In patients with chronic hepatitis C (CHC), the role played by PhA has not been completely clarified.ObjectivesTo evaluate the prevalence of low PhA and its association with demographic, clinical and nutritional variables in CHC.MethodsWe prospectively included 222 patients [mean age, 53.7 ± 11.7 years; males, 116 (52.3%); diabetes mellitus, 40 (18.0%); hypertension, 91 (41.0%); cirrhosis, 87 (39.2%); underweight (BMI, Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.9 Issue No:Vol. 5, No. Suppl_1 (2022)
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Kaliyeva, A; Chan, M. Y, Turgambayeva, A. Abstract: IntroductionMaintaining optimal nutritional status is important for children with cancer because it can affect clinical outcomes. This study aimed to prospectively study clinical practices in children’s cancer departments to improve the nutritional health of children and adolescents receiving cancer treatment. Currently, there are no unified and harmonized protocols for assessing the nutritional status and nutritional support of children in pediatric wards in Kazakhstan.Method200 children with cancer aged 6 months to 17 years (n=200) were recruited. Dietary data and other relevant anthropometric and biochemical data were collected using a data collection form validated and developed by the researchers. Data processing is still in progress. They were randomly allocated either to a treatment group or a control group (age-matched and gender matched). The treatment group received nutritional advice and support and the control group received the standard treatment.ResultsA significant decrease in the intake of protein and energy with the consumed diets, which are prescribed by doctors in daily practice, was revealed, which is a risk factor for the development of severe nutritional disorders (p>0.5).Patients who were assigned nutritional support in addition to the General diets during the study had higher nutrient intake. Comparing week zero with subsequent weeks of nutritional support, children in the main group showed significant improvements in the thickness of the triceps skin fold (P Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.10 Issue No:Vol. 5, No. Suppl_1 (2022)
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Yoon, W. Y; Ragavan, S, Stokes, A, Tay, T, Christian, N, Gilani, S, Macaninch, E. Abstract: BackgroundNutrition plays a significant role in decreasing the burden of disease in the population. Quality nutritional teaching is essential to allow clinicians to effectively counsel patients on their diet and nutrition. However, nutrition education at UK medical schools is not rigorously standardised.ObjectivesThis study aims to quantify the nutritional teaching at UK medical schools and measure variation in teaching methods and duration.MethodsA Freedom of Information request was emailed to all public medical schools in the UK with programmes resulting in a primary medical qualification. Data were requested on how much time was allocated to lectures, practical skills, e-learning and independent study on nutrition. The lognormal and normal distributions were tested with Anderson-Darling, D’Agostino-Pearson and Shapiro-Wilk tests.ResultsOf thirty-seven universities contacted, twenty-six universities responded (70.2%), four declined to respond, and seven did not provide data (figure 1a). The mean number of teaching hours is 26.9 hours (CI 95%, 14.8–38.8). Universities spend an average of 2.7 hours on group learning (CI 95%, 0.6–4.8) and 12 hours on lectures (CI 95%, 8.5–15.4) (figure 1c). The mean teaching hours were greatest in Year 1 of medical schools at 8.7 hours (CI 95%, 5.9–11.5) (figure 1d). Teaching hours follow a lognormal distribution (LR Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.11 Issue No:Vol. 5, No. Suppl_1 (2022)
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Reyhani, H; Macaninch, E, Martyn, K, Copeland, E. Abstract: IntroductionMalnutrition prior to Elective Lower Gastrointestinal Surgery (ELGIS) impacts on post-operative recovery. Prolonged post-operative ileus (PPOI) is a prevalent complication post-surgery that may require Total Parenteral Nutrition (TPN) with severe intestinal arrest.The Malnutrition Universal Screening Tool (MUST) is validated for malnutrition screening. There has historically been poor uptake of nutrition screening and assessment in surgical patients.ObjectivesTo gauge severity of PPOI via proportion of patients requiring TPN, and association of PPOI with MUST scores.MethodsA retrospective audit of patients undergoing ELGIS at a 58-bedded tertiary Digestive Diseases Unit on the South Coast of England over 3 months was performed.Primary outcomes: Incidence of PPOI; Proportion of patients requiring TPN for PPOI.Secondary outcomes: Incidence of Preoperative MUST scoring; Post-operative time to MUST scoring and MUST scores documented.Results39 eligible patients were included. 11/39 (28%) developed PPOI; 0 (0%) progressed to TPN.MUST scoring preoperatively was documented for 11 (28%) patients. 2/11 (18%) scored ≥1 [i.e. were at some risk of malnutrition]. Scores documented for these patients were: 1 and 2. Of these, 2/2 (100%) developed PPOI in their postoperative course.MUST scoring postoperatively was documented for 36/39 (92%). 12/36 (33%) scored ≥1. Of these, 6/12 (50%) developed PPOI. Average days to postop MUST scoring: 3.7 ± 2. Of those with PPOI, 6/11 (55%) scored ≥1 on MUST postoperative.ConclusionsPPOI is prevalent among ELGIS patients, but not associated with high TPN use in this sample. Nutrition screening (MUST) is not routinely done preoperatively, reflecting a missed opportunity in nutrition optimisation for surgery. Larger studies are required to assess outcomes of improved nutrition screening. High rate but low accuracy and timeliness of MUST scoring postoperatively was suggested by this study. Barriers to MUST utilisation and accurate scoring by surgical teams should be explored in future studies. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.12 Issue No:Vol. 5, No. Suppl_1 (2022)
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Silva, M; Rodrigues, S, Correia, D, Torres, D, Lopes, C, Severo, M. Abstract: BackgroundEating out of home (OH) has been increasing due to social and contextual changes. This phenomenon varies according to age, region and eating location and can contribute to a poor diet quality. Overall, there is insufficient information on the nutrient intake and types of food groups consumed OH by the Portuguese population.ObjectivesDescribe and compare energy and nutrient intake and food groups (FG) consumption according to eating out patterns (EOP), by age groups.MethodsThis analysis used data from the National Food, Nutrition and Physical Activity Survey (IAN-AF;2015–2016) and includes 5005 individuals (3-84 years). Dietary intake was estimated by two non-consecutive days of food dairies in children ( Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.13 Issue No:Vol. 5, No. Suppl_1 (2022)
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Ravula, P; Kasala, K. Abstract: BackgroundTribal population – especially pregnant and lactating women are susceptible to undernutrition because of low socio-economic, cultural norms and practices regarding dietary habits and practices, market access and availability. Nutrition knowledge, attitudes and practices (KAP) studies offer an opportunity to better understand the socio-cultural-psychological-behavioural determinants of nutrition, providing an evidence for planning knowledge interventions.ObjectivesThis paper aims to assess nutrition KAP during pregnancy and lactation in selected locations of Adilabad and Komaram Bheem-Asifabad districts of Telangana, India.MethodsA cross sectional KAP baseline survey was conducted on 358 individuals in the selected locations during February-March 2020. Tablet based data collection was implemented for pregnant and lactating mothers, and frontline workers (Anganwadi workers, School teachers and Accredited Social Health Activist - ASHA workers). Data was validated, coded and analyzed using STATA. Alongside descriptive statistics, differential weightage method was adopted to generate the knowledge, attitudes and practices scores for the respondents.ResultsThe nutrition knowledge of pregnant and lactating mothers was inadequate less than 50 percent across all the respondents (table 1). Pregnant women scored low on attitudes regarding healthy diets compared to lactating mothers and frontline workers. Attitudes translate into practices, however the baseline data revealed that all categories of respondents were not adopting appropriate dietary and nutrition practices. 7 Table 1Scoring percentages on KAP during pregnancy and lactation periods Pregnant Women Lactating Mothers Anganwadi Workers School Teachers ASHA workers Knowledge 27.74 32.90 41.63 47.81 40.99 Attitudes 44.52 92.03 92.36 92.71 94.71 Practices 48.57 42.27 46.42 47.57 45.53 ConclusionThe inadequate knowledge by all categories of respondents indicates a gap in nutrition literacy and education. It is planned to co-design, co-create innovative approaches to improve nutrition knowledge through nutrition messaging for a transformative behavior change about nutrition, healthy diets, dietary behaviors and practices. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.14 Issue No:Vol. 5, No. Suppl_1 (2022)
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Alexander, A; Sureshkumar, A, Jones, M, Marais, D. Abstract: Background/ObjectiveNutrition education plays a key role in the management of chronic diseases. This review aimed to assess whether nutritional educational programmes (NEPs) utilising whole-diet approaches improved health outcomes in patients with chronic diseases.MethodsSearches were conducted on 5 databases (Medline, Pubmed, EMBASE, CINAHL and Web of Science) independently by three reviewers. Search terms and MESH headings included: Nutrition OR diet OR eating habits AND education OR teaching OR training OR counselling AND health OR morbidity OR mortality OR well-being OR quality of life. Studies of NEPs involving educational interventions on whole diet modification (i.e. improving total nutritional intake) vs. usual diet or no intervention were included. Studies lacking a comparison group, case-control studies and those involving single dietary or nutrient modifications were excluded. Papers were independently assessed for eligibility; quality (Agency for Healthcare Research and Quality assessment tool); risk of bias (Cochrane Risk of bias 2 tool) and data extracted. Outcomes of interest were nutritional status, biochemical markers and quality of life. Data heterogeneity meant meta-analyses could not be performed so a descriptive approach was used.ResultsFrom a total of 8453 papers, 18 studies were identified as relevant and grouped by disease: cancer (n=8); Type 2 diabetes (n=6) and CKD (n=4). NEPs in 12 studies were dietician-led, with the remainder delivered via telehealth (n=2), group therapy (n=2), nutritionist (n=1) or nurse specialist (n=1). Results showed that NEPs had statistically significant improvements in quality of life and prevention of malnutrition in cancer patients, but did not prevent deterioration in weight. Diabetic patients showed improvements in weight loss, reduced waist circumference and HbA1c; however changes in BMI, blood pressure and cholesterol were not significant. NEPs did not improve clinical markers in CKD (e.g. cholesterol, phosphate and eGFR), but following the intervention patients reported better knowledge of their illness. ConclusionsThis review suggests that nutrition education programmes are an important tool in improving health outcomes of patients with cancer, Type 2 diabetes and CKD. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.15 Issue No:Vol. 5, No. Suppl_1 (2022)
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Ball, L; Somerville, M, Crowley, J, Calleja, Z, Barnes, K. Abstract: BackgroundThe World Health Organization recommends all countries to facilitate healthy eating through primary care settings; recognised as one of the ‘best buys’ for improving the health of societies. However, health professionals face barriers to discussing nutrition and weight management in consultations, warranting alternative models of support to be explored. Providing food directly to patients in primary care is an underexplored yet promising approach to healthy eating and weight management.ObjectivesThis systematic review aimed to determine whether providing food to patients in primary care facilitates weight loss and improves other health outcomes.MethodA systematic literature review was conducted using four electronic databases. Interventions that directly and exclusively provided foodstuffs and/or supplements to patients in primary care settings were included. Interventions that involved other components such as exercise classes or education sessions were excluded.ResultsFour studies fulfilled the inclusion criteria; two from the United Kingdom, one from the USA and one from Israel. Two studies utilised meal replacement products but differed in length and intensity of the intervention, another study provided green tea and vitamin E supplementation to patients and the final study incorporated a voucher for use at a farmers’ market hosted at a primary care clinic. Three of the four studies observed some weight loss among participants and all studies observed at least one other improvement such as reduced waist circumference, blood pressure or glycosylated haemoglobin (HbA1c). However, the methodological quality of the studies ranged from weak to moderate, reducing confidence in results.Discussion/ConclusionA small but promising body of literature exists on providing food directly to patients in primary care. There is clear opportunity for further research on the efficacy and cost-effectiveness of directly providing food to patients to support weight loss, improve health outcomes and ultimately inform policy initiatives for primary care. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.16 Issue No:Vol. 5, No. Suppl_1 (2022)
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Crowley, J; Ball, L, Wall, C. Abstract: BackgroundMedical nutrition education aims to equip doctors with adequate nutrition knowledge, skills, attitudes and confidence to counsel patients about how to improve their diet and health. Incorporating sufficient nutrition education into medical curricula remains an ongoing challenge for medical schools.ObjectiveThis study aimed to describe changes in medical students’ self-perceived nutrition competence at three time points during medical training.MethodA prospective longitudinal observational study was conducted among one year-group of students at the University of Auckland, School of Medicine. In May 2016, Year 2 medical students (phase 1, preclinical) were surveyed for self-perceived nutrition competence using the validated NUTCOMP tool. The survey was repeated with the same students in February 2018 as Year 4 students and July 2019 (phase 2, clinical) as Year 5 students.ResultsIn 2016, 102 of 279 eligible Year 2 medical students completed the survey [response rate (RR 36.7%)]. In 2018, 89 Year 4 students repeated the survey (RR 87.3%) and 26 students as Year 5 students in 2019 (RR 25.5%). There was a significant increase in total NUTCOMP scores (knowledge, skills, confidence to counsel and attitude towards nutrition) between Year 2 and Year 4 (p=0.012). There was a significant increase in the confidence to counsel construct (mean difference 7.615, 95% CI 2.291-12.939, p=0.003) between Year 2 and Year 4. Constructs with lowest scores at all time points were nutrition knowledge and nutrition skills. There was clear desire for more nutrition education from all students: Year 2 [mean=3.8 out of 5, (1.1)], Year 4 [mean=3.9 out of 5 (0.9)], Year 5 [mean=3.8 out of 5 (0.8)].ConclusionMedical students’ self-perceived nutrition competence in providing nutrition care increased modestly at three points throughout medical training. Opportunity exists for further supporting medical students to increase their competence nutrition care, which could be achieved through mandatory and greater medical nutrition education. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.17 Issue No:Vol. 5, No. Suppl_1 (2022)
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Bhat, S; Molony, D. Abstract: BackgroundHypertension is the leading cause of cardiovascular-related mortality in Ireland. Due to the lack of diagnosis, awareness and early treatment, the prevalence of hypertension in the community is increasing at an alarming rate. Latest guidelines suggest the use of ambulatory blood pressure measurement (ABPM) as the gold standard to diagnose hypertension.ObjectivesTo investigate the current prevalence of hypertension in a rural primary care practice by assessment of current anthropometric measures and the uptake of 24hr ABPM. This study also explores the development of a practice-based algorithm to better identify and manage patients with hypertension.MethodsThis study included (1) a retrospective cross-sectional chart audit assessing the anthropometric measurements and uptake of 24hr ABPM in patients aged ≥25 years with the last clinic BP systolic ≥150mmHg or had a coded diagnosis of hypertension and (2) the development of a hypertension management protocol based on clinical guidelines.ResultsA total of 890 patients were included. Out of those with a coded diagnosis of hypertension (78%, n=691), the mean BMI was 29.9 with a mean weight of 84.4kg, 13% were current smokers and 64% had an ABPM. With 22% (n=199) of the patients without a coded diagnosis of hypertension, the mean BMI was 28.8 with a mean weight of 85.2kg and 26% had an ABPM. Overall, 18% of the patients had diabetes and 62% of the patients had a lipid disorder. 11 Figure 1Prototype of the hypertension protocol developed to streamline diagnosis and management of hypertension in the practiceDiscussionWith most of the patients currently being overweight and have a history of lipid disorder along with almost half of the patients without an ABPM, this audit exposes a significant gap in diagnosis and management of hypertension. To meet guideline targets, an evidence-based hypertension protocol (figure 1) was designed and implemented where the practice nurses were empowered to measure, identify and refer patients with elevated blood pressure for ABPM and nutritional counselling. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.18 Issue No:Vol. 5, No. Suppl_1 (2022)
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Buckner, L; Gnanananthan, P, Howie, C, Lobo-Horth, G, Vora, C, Perrin, R. Abstract: BackgroundCommunity kitchens comprise of small groups of people who meet regularly to prepare meals, and are a means to develop kitchen skills, improve nutrition and diet diversity, and to reduce social isolation. FirstBite Café is a community kitchen based in Winchester, Hampshire founded in 2016 that has aimed to re-use food that would otherwise be destroyed, to produce high quality and affordable meals for its local communityObjectivesWe sought to evaluate the impact FirstBite has had on its customers, volunteers, and wider community. Concurrently we hoped to produce local data on the role of community kitchens and possible recommendations on the continued development of the Café.MethodsA questionnaire was developed to capture demographics, attitudes, and perceptions of customers towards the café, and the impact the café has had on them. Two volunteer focus groups were run, asking what values attracted them to the café, what prompted re-attendance, who benefits from the café, and where they see the café going forward.ResultsOf the 67 respondents, the largest proportion of customers were aged between 55 and 75, and 41.7% lived alone; with the majority attending for over 12 months. The factors most appreciated were the food (87%), company (78%), affordability (75%) and core values of the kitchen (48%). The focus groups corroborated the greatest benefit came from developing social skills and confidence, giving a sense of purpose and community, and reduced social isolation in the elderly, those with mental health issues, and background of substance misuse.ConclusionsThe results of this evaluation were overwhelmingly positive, with the impact of the café on reducing social isolation and providing nutritious and affordable food echoed throughout. The barriers that FirstBite is now facing revolve around infrastructure and accessibility, and a permanent location with greater space would continue to extend its effectiveness. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.19 Issue No:Vol. 5, No. Suppl_1 (2022)
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Buckner, L; Korre, M, Rajput-Ray, M, Kargbo, S, Banerjee, S, Chakraborty, D, Ray, S. Abstract: BackgroundIndia suffers from significant undernourishment, alongside obesity at concerning levels. Both poor diet and health education contribute to this, we developed a pilot local capacity building research project to apply a novel intervention in line with the United Nations ‘Sustainable Development Goals’.MethodsFollowing NNEdPro’s key contributions to the ‘14th World Congress of Public Health’ in Kolkata (2015), a capacity building exercise was launched for healthcare professionals and students. 10 selected attendees became ‘NELICO (Nutrition Education and Leadership for Improved Clinical/Public Health Outcomes) Champions’ leading action research projects. Project 1: Utilising ‘See one, Do one, Teach one’ education models, dietitians and volunteers transformed 12 slum-dwelling women into educators, teaching to prepare and cook nutritionally balanced, affordable and tasty template menus using local ingredients. The research team measured baseline and post-intervention nutritional status and knowledge, attitude and practice (KAP) of participants. Project 2: Performed an interactive nutrition workshop at 2 Kolkata medical colleges, measuring KAP of students before and after.Results Project 1: Increased nutritional KAP’s (p Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.20 Issue No:Vol. 5, No. Suppl_1 (2022)
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McAuliffe, S; Vale, M. L. d, Macaninch, E, Bradfield, J, Crocombe, D, Kargbo, S, Rio, D. D, Fallon, E, Martyn, K, Kohlmeier, M, Beck, E, Almoosawi, S, Ray, S. Abstract: BackgroundFollowing considerable interest in the relationship between obesity and COVID-19, the UK Government have released a policy paper: ‘Tackling obesity: empowering adults and children to live healthier lives’.1 This response may be focused on a limited and potentially historical view of overweight and obesity. We consider the complexity of the condition, its determinants, and co-existing conditions.2 ObjectivesWe sought to gain consensus iteratively, using implementation framework thinking, to advocate for the appreciation of a wider, more complete understanding of the existing science behind obesity and the appropriate strategies needed to address it.ResultsWe identified four strategic points and provided recommendations for more comprehensive coverage and greater impact: 1. Improving focus and messaging 2. Understanding drivers of food choice and nutritional status 3. Promoting healthy eating from early years 4. Addressing the complexity of obesityDiscussion 1. Effective messaging should be inclusive, collaborative and non-judgemental, promoting co-participation in the development of messages used in public national campaigns.3 2. Higher rates of obesity are observed in socioeconomically deprived groups who rely on food assistance programmes, in which nutritional quality could be improved through involvement of nutrition professionals.4 In order to influence behaviour, basic food literacy and financial management skills could be developed, while subsidies for healthier alternatives may complement taxes on less healthy foods.5 3. Advocating for better education on food science and nutrition from early learning sectors will promote increased awareness early in life.6 This could be augmented by reinstatement of initiatives like the healthy start programme. 4. Human health is multi-dimensional, therefore focussing on a single-metric risks oversimplifying this complexity and undervaluing the importance of healthy behaviours, even those not directly associated with weight.7 Instead, we should consider positive lifestyle habits, rather than a narrow focus on weight or BMI alone for the individual, informed by existing and accepted scientific findings.ConclusionAn integrated systems approach ought to be developed with a multipronged intervention strategy, targeting food production, supply and environments as well as marketing to improve availability of as well as accessibility to more nutrient-rich but less energy-dense foods. These combined with appropriate food education for consumers would enable more consistently healthy food choices.AcknowledgementsNNEdPro Virtual Core and Global Innovation Panel; Nutrition and COVID19 TaskforceReferences UK Government - Tackling obesity: empowering adults and children to live healthier lives. July 2020. Foresight, Obesity Systems Map. 2007. Language Matters: Language and diabetes. 2018. Fallaize R, Newlove J, White A, Lovegrove JA. Nutritional adequacy and content of food bank parcels in Oxfordshire, UK: a comparative analysis of independent and organisational provision. J Hum Nutr Diet 2020;33:477–486. https://doi.org/10.1111/jhn.12740 Garcia A, Reardon R, Hammond E, Parrett A, Gebbie-Diben A. Evaluation of the ‘eat better feel better’ cooking programme to tackle barriers to healthy eating. International Journal of Environmental Research and Public Health 2017;14(4):380. doi:10.3390/ijerph14040380 Oostindjer M, Aschemann-Witzel J, Wang Q, Skuland S, Egelandsdal B, Amdam G, et al. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of childrens diet and food consumption' A cross-national comparative perspective. Critical Reviews In Food 2016. Salas-Salvado J, Bullo M, Babio N, Martinez-Gonzalez M, Ibarrola-Jurado N, Basora J, et al. Reduction in the incidence of type 2 diabetes with the mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care 2010;34(1):14–19. doi:10.2337/dc10-1288 Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.21 Issue No:Vol. 5, No. Suppl_1 (2022)
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Laur, C; Corrado, A. M, Grimshaw, J. M, Ivers, N. Abstract: BackgroundQuality Improvement (QI) evaluations rarely consider how a successful intervention can be sustained, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained.ObjectiveTo explore why and how the effective diabetes QI interventions were sustained, spread or scaled.MethodsA qualitative approach was used, focusing on case examples. Diabetes QI program trial authors were purposefully sampled and recruited for interviews. Authors were eligible if they had completed the survey, agreed to follow-up, and had a completed a diabetes QI trial they deemed ‘effective’ by improving care for people living with diabetes. Snowball sampling was used if the participant indicated someone could provide a different perspective on the same trial. Interviews were transcribed verbatim. Inductive thematic analysis was conducted to identify factors associated with spread, and/or scale of the QI program. Case examples were used to show trajectories across projects and people.ResultsEleven of 44 eligible trialist participated. Four reported that the diabetes intervention was ‘sustained’ and nine were ‘spread,’ however interviews highlighted that these terms were interpreted differently over time. Participant stories highlighted the trajectories of how projects evolved and how research careers adapted to increase impact. Three interacting themes were identified: i) understanding the concepts of implementation, sustainability, spread and scale; ii) having the appropriate competencies; and iii) the need for individual, organisational and system capacity.ConclusionsTrialists need to think beyond local effectiveness to achieve population-level impact, particularly in nutrition. Early consideration of whether an intervention is feasible and sustainable once research funding ends is necessary to plan for sustainability, spread and/or scale of effective QI programs. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.22 Issue No:Vol. 5, No. Suppl_1 (2022)
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Naseer, F; Baird, J, Price, R, Douglas, P, Livingstone, B. Abstract: Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, UKIntroductionWeight bias leads to the stigmatisation of individuals with obesity and has been associated with exacerbating psychological and physiological stress as well as further weight gain.1 2 As such, there is a need for interventions to effectively address weight bias and stigma-reduction.3 AimThe aim of this observational study was to evaluate the understanding of obesity-related weight bias and stigma amongst university students and staff.MethodA health promotion stand was set up in Ulster University on World Obesity Day 2020. Students and staff who engaged were presented with definitions of weight bias and stigma, associated consequences and the importance of person-first-language. Subsequently they were asked to translate the new knowledge into practical suggestions or advice to help combat weight bias/stigma. They were also given the option to sign a pledge to ameliorate weight bias/stigma. All suggestions were categorised into common sub-groups as shown in table 1.Results101 students and staff pledged their support and 83 gave a suggestion to minimise weight bias/stigma. In the latter group, the majority (71%) had a sound understanding of weight bias and stigma. However, 24 participants (29%) appeared to have confused the body acceptance initiative with reducing weight bias and stigma (table 1). This was further verified through their interaction and comments with the volunteers at the stall. 16 Table 1Suggestions to minimise weight bias and stigma (n=83) Comments relevant to minimising weight bias & stigma n=59 (71%) Treat individuals with obesity with respect & kindness. Show empathy 38 (64%) Use ‘Person-first Language’ 11 (19%) Promote education regarding consequences of weight bias/stigma 2 (3%) Judge less & understand obesity is a complex disease that requires various forms of treatment 7 (12%) Find a balance between ‘body confidence & glorifying a disease’ 1 (2%) Comments related to body acceptance initiative n=24 (29%) ‘Love your body’ 14 (58%) ‘Accept that everyone comes in different sizes’ 10 (42%) ConclusionThis pilot evaluation provides empirical evidence that ‘minimising weight bias/stigma’ and the ‘body acceptance initiative’ may be easily confused and even addressed interchangeably. Education initiatives to distinguish between these concepts is warranted to reduce weight-related stigma and improve access to care for individuals with obesity.References Pearl R. Weight bias and stigma: public health implications and structural solutions. Social Issues and Policy Review 2018;12(1):146–182. doi https://doi.org/10.1111/sipr.12043 Stewart S, Ogden J. The role of BMI group on the impact of weight bias versus body positivity terminology on behavioral intentions and beliefs: an experimental study. Frontiers in Psychology 2019;10. doi: https://doi.org/10.3389/fpsyg.2019.00634 World Health Organisation, 2017, Weight bias and obesity stigma: considerations for the WHO European Region, World Health Organisation (2017), viewed on 12 March 2020, http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/publications/2017/weight-bias-and-obesity-stigma-considerations-for-the-who-european-region-2017 Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.23 Issue No:Vol. 5, No. Suppl_1 (2022)
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Fernandez, M. A; Caretero, A, Jacob, E, Karatha, J, Raine, K. D. Abstract: BackgroundNutrition influencers can reach large segments of the public, regardless of formal training or credentials. Though social media is a popular source of nutrition information, it may not be credible. Furthermore, the perceived credibility of nutrition information may be enhanced through social validation (i.e., popularity of the public figure), yet this phenomenon has not been examined.ObjectiveTo examine the credibility of nutrition influencers’ websites in relation to their social media reach.MethodsNutrition influencers identified through a key word search on popular search engines: Yahoo! Google, and Bing who had active public websites and Instagram accounts were included. ‘Tips to Spot Misinformation’ developed for the public by the Dietitians of Canada and PEN: Practice Evidence-Based Nutrition were used to create a credibility score for each website. Based on scores, websites were categorized as having low, moderate, or high credibility. The reach of each influencer was ascertained by combining the total number of followers/subscribers from five popular social media platforms (Instagram, Facebook, Twitter, YouTube, and Pinterest).ResultsOf the 39 websites, there were 12 (31%) high, 13 (33%) moderate, and 14 (36%) low credibility sites, and the average number of followers for each group were 186 775, 547 088 and 2 153 515, respectively. There was a significant difference in followers between the three groups (p = 0.017) and a significantly lower number of followers for influencers with high credibility websites compared to low credibility websites (p = 0.022), with more than 10 times fewer followers.DiscussionPopular influencers with low credibility websites have enormous reach whereas influencers with highly credible websites lack the ability to reach large segments of the population. Further research is needed to understand how social validation influences the public’s eating behaviors and to identify strategies that will increase the visibility of highly credible information. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.24 Issue No:Vol. 5, No. Suppl_1 (2022)
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Crocombe, D; Buckner, L, Vale, M. L. d, Macaninch, E, Almoosawi, S, Ray, S. Abstract: BackgroundThe COVID-19 pandemic has impacted the nutrition and health of individuals, households, and populations globally. Through exposing fragilities in food, health, and social welfare systems, the negative influence of COVID-19 continues to affect the global burden of malnutrition. The nature and scale of these impacts are not yet well understood thus the body of evidence for informing policy is limited. Collating and monitoring relevant data in real-time from multiple levels, sectors and sources is essential in preparing and responding to the ongoing COVID-19 pandemic.ObjectivesTo identify key data sources related to food, nutrition, and health indicators in the context of the COVID-19 pandemic.MethodsA COVID-19, food, nutrition and health framework was developed through multiple iterative rounds of online multidisciplinary discussions including the NNEdPro COVID-19 taskforce and the Swiss Re Institute’s Republic of Science, which comprised researchers and clinicians with expertise in data science, food, nutrition, and health.ResultsThe proposed framework encompasses five socio-ecological levels which were further sub-divided by six categories of the food and nutrition ecosystem, including food production & supply, food environment & access, food choices & dietary patterns, nutritional status & comorbidities, health & disease outcomes, health & nutrition services. A limited number of exemplar variables for the assessment of global status of food, nutrition and health are identified under each category. 18 Table 1Proposed data framework in relation to health, food, nutrition, and the COVID-19 pandemic Food Production & Supply Food Access Food Choices & Dietary patterns Nutritional status & comorbidities Health/disease outcomes Health & Nutrition Services Individual/Household Allotment use/gardening metrics; Policies and incentives Proportion of expenditure on food; Food bank use; Food insecurity; Coping strategy index; Social mobility (across generations and in the shorter term); Numbers moving into (and out of) poverty Food preferences; Food purchasing; Food preparation; Food consumption; Food waste; Breastfeeding Primary/secondary health care records Physical activity; Mental health; Wearable device data; Chronic disease management; Health insurance data Access to sanitation & potable water; Use of universal healthcare services; Use of nutrition/dietitian services; Use of mental health services Regional/National Production indices of specific food groups; Production values; Export/import quantities & values; Dietary energy supply adequacy; Share of dietary energy supply derived from cereals, roots and tubers; Protein supply; Protein supply of animal origin; Local food production; Organic agriculture; Policies and incentives for farmers; Local or Community initiatives Cereal import dependency; Population living in poverty; Un/Employment rates; Proportion of expenditure on food; Food prices (food basket & food groups); Food bank use; Financial aid for families; Food emergency services; Disruption food provision services (schools, community kitchens, etc.); Food delivery services Purchasing patterns (supermarkets, grocery stores, take away, restaurants); Food waste; Food advertisement; Supplement sales; Policies & incentives promoting specific foods Low birthweight; Stunting/wasting; Overweight & obesity; Micronutrient deficiencies Hospital admissions; Prescribed/OTC drugs purchasing; Mortality rates (disease-specific & all cause) Provision of sanitation services & potable water; Universal healthcare services; Nutrition/dietitian part of universal healthcare; Mental health part of universal healthcare; Healthcare services disruption; Hospital admission patterns Global UN Food and Agriculture Organisation (FAO) surveillance data Global Hunger Index; Global Food Security Index Global Dietary Database WHO, UNICEF and Global Nutrition Report surveillance data WHO and Global Burden of Disease and CDC (with regional equivalents) surveillance data Commonwealth Association of Dietitians and Nutritionists, European Federation of Associations of Dietitians (with regional equivalents) Discussion/ConclusionThis collaborative framework is the first step towards the development of a better understanding of the impact of COVID-19 on food, nutrition, and health systems. Limited data availability and disruption in routine data collection as well as other nutrition assessments during the pandemic are challenges that might limit the potential of the proposed framework. Next steps will include formal research and data gap analysis and the identification, as well as utilisation, of other indicators that could b... Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.25 Issue No:Vol. 5, No. Suppl_1 (2022)
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Crocombe, D; Mcauliffe, S, Kohlmeier, M, Ray, S. Abstract: Acknowledgements: NNEdPro Nutrition and COVID-19 Taskforce (Named authors plus James Bradfield, Luke Buckner, Harrison Carter, Elaine Macaninch, Suzana Almoosawi, Timothy Eden, Emily Fallon, Claudia Mitrofan, Niky Raja, Sucheta Mitra, Matheus Abrantes, Lynn Haynes) and BMJ Nutrition, Prevention and Health. BackgroundNutritional issues relating to the COVID-19 pandemic span clinical nutrition in acute patients to impacts on global dietary patterns and food security. In March 2020, the NNEdPro Global Centre for Nutrition and Health established a rapid-response Nutrition and COVID-19 Taskforce to help the organisation navigate the initial phases of the pandemic and make a constructive contribution to the scientific landscape.1–3 ObjectivesTo highlight lessons learned over 6 months (March-September 2020) of the COVID-19 pandemic in understanding the role(s) of nutrition.MethodsCritical and constructive reflections from Taskforce co-chairs and lead scientific members based on a 6-month summative webinar and journal club examining the strength of evidence and key gaps.ResultsSuccesses in Taskforce operations include pooling a broad range of expertise including clinical medicine, nutrition and dietetics, research, public health, and communications. Pre-existing NNEdPro operations were predominantly online and dedicated virtual meetings supported the proactive collation of key resources relating to nutrition and COVID-19 with production of public-facing information summaries. Academic collaboration with partner organisations, including BMJ Nutrition, Prevention & Health, has focused research priorities and produced contributions to the scientific landscape.4 Challenges included managing the sense of urgency, particularly earlier in the pandemic and driven by an unease of the unknown, both at organisational level and in the need to translate nutrition knowledge to COVID-19 sensitive practice. A collaborative, scientific and politically neutral approach was intended to ensure the quality of outputs and the avoidance of hasty conclusions. Other challenges have been maintaining relevance to all geographic regions given the global variation of COVID-19 and maximising the reach of outputs to stakeholders who would benefit most from them. More recently the Taskforce has provided key inputs to consensus in a national guideline agency and global advisory bodies. Further progress will require involvement of researchers and innovators, policymakers, practitioners, patients and the public.Discussion/ConclusionThis Taskforce has already made a significant contribution to the scientific conversation about food and nutrition in the prevention and management of COVID-19. Future work should focus on multiple-stakeholder collaboration to transform research into positive action at all levels (from patient to policy) for the benefit of public health.References NNEdPro Global Centre for Nutrition and Health. COVID19: Useful resources. nnedpro.org.uk. [Online] [Cited: September 7, 2020.] https://www.nnedpro.org.uk/coronavirus. NNEdPro Global Centre for Nutrition and Health. COVID19: Nutrition Resources. nnedpro.org.uk. [Online] [Cited: September 7, 2020.] https://www.nnedpro.org.uk/covid-19nutrition-resources. NNEdPro Global Centre for Nutrition and Health. Combatting COVID-19: A 10-point summary on diet, nutrition and the role of micronutrients. nnedpro.org.uk. [Online] [Cited: September 7, 2020.] https://www.nnedpro.org.uk/post/combatting-covid-19. Dietary micronutrients in the wake of COVID-19: an appraisal of evidence with a focus on high-risk groups and preventative healthcare. McAuliffe, Shane, et al. s.l. : BMJ Nutrition, Prevention & Health, 2020, Vols. bmjnph-2020-000100. doi: 10.1136/bmjnph-2020-000100. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.26 Issue No:Vol. 5, No. Suppl_1 (2022)
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Eden, T; Neville, J, McAuliffe, S, Crocombe, D, Ray, S. Abstract: BackgroundCoronavirus disease 2019 (COVID-19) is an inflammatory syndrome caused by a novel coronavirus (SARS-CoV-2). Symptoms range from mild infection to severe acute respiratory distress syndrome (ARDS) requiring ventilation and intensive care (ICU).1 UK cases have exceeded 300,000 with a fatality rate of 13% necessitating>10,000 critical care admissions.2 Nutrition is important to immune function and influences metabolic risk factors such as obesity and glycaemic control. Poor nutritional status is associated with worse outcomes in ARDS and viral infections yet limited research has assessed pre-morbid nutritional status and outcomes in patients critically unwell with COVID-19.3 ObjectivesInvestigate the effect of body mass index, glycemic control and vitamin D status on outcomes in adult patients admitted to a ICU with COVID-19.MethodsRetrospective review of all patients admitted to a central London ICU between March-May 2020 with confirmed COVID-19. Electronic patient records data was analysed for patient demographics; co-morbidities; admission BMI; serum vitamin D concentration and plasma HbA1c. Serum vitamin D and HbA1c were measured on admission, or within one month of admission to ICU. Primary outcome was mortality. Secondary outcomes included time intubated, ICU stay duration, and ICU-related morbidity.ResultsN = 72 patients; 54 (75%) male, mean age 57.1 (± 9.8) years. Overall mortality was 24 (33%). The highest rate was observed in the overweight BMI range (25-29.9kg/m2) p-value Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.27 Issue No:Vol. 5, No. Suppl_1 (2022)
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Bradfield, J; Butler, T, Skinner, R, Ray, S. Abstract: BackgroundLow carbohydrate diets (LCDs) have gained popularity among those seeking to lose weight and improve glycaemic control. They feature heavily in online discussions such as on social media. Evidence exists to support their use,1 but at present no universal definition of ‘low carbohydrate’ exists. Though the practices of dietitians around LCDs have been examined,2 3 none have assessed this in relation to use of social media.ObjectivesThe objective was to establish what a representative sample of dietitians in England believe, think and do with LCDs in their clinical practice.MethodsRecruitment of 10 dietitians working in weight management and/or diabetes in England took place online. They completed a short survey and a one-to-one, semi-structured interview using online teleconferencing. Interviews lasted 30 minutes and explored their knowledge, attitudes and practices towards LCDs, and how they are discussed online. Interviews were transcribed for content and thematic analysis.ResultsA number of themes became apparent, namely: (1) patient-centred care, (2) LCD community, (3) considered use of LCDs, (4) social media and (5) terminology. Each also had a number of sub-themes, such as individualisation, lack of dialogue and labelling of diets for the themes above. 23 Figure 1ThemesDiscussionOverall, the dietitians in this study were happy to use LCDs with their patients, in a safe and individualised manner. They expressed concerns about how the diets are sometimes represented online as a panacea and the inability to engage in respectful discussion with some of its proponents. These findings add to existing work completed in the area.2 3 ConclusionsThe dietitians in this study were happy to support patients to follow an LCD, in a safe and individualised manner such as under dietetic supervision. They considered them more useful for improving GC and medication reductions. A standard definition of LCDs would help patients and practitioners to communicate effectively. Additionally, education in online engagement could help improve dietitians overall confidence and practice in operating effectively in this environment.References Hallberg S, McKenzie A, Williams P, et al. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Diabetes Therapy 2018;9(2):613–621. Huntriss R, Boocock R, McArdle P. Dietary carbohydrate restriction as a management strategy for adults with type 2 diabetes: exploring the opinions of dietitians. Journal of Diabetes Nursing 2019;23:JDN104. McArdle P, Greenfield S, Avery, et al. Dietitians’ practice in giving carbohydrate advice in the management of type 2 diabetes: a mixed methods study. Journal of Human Nutrition and Dietetics 2016;30(3):385–393. Keywords: Open access PubDate: 2022-04-12T05:37:01-07:00 DOI: 10.1136/bmjnph-2022-nnedprosummit.28 Issue No:Vol. 5, No. Suppl_1 (2022)
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Summers, C; Lima Do Vale, M, Haines, L, Armes, S, Bradfield, J, Crocombe, D, Ray, S. Pages: 137 - 144 Abstract: BackgroundThe COVID-19 pandemic may have contributed to poorer self-management (ie, diet, physical activity and sleep) of diabetes mellitus (DM), which might predispose individuals to more severe COVID-19 outcomes.ObjectiveThe first objective was to capture perceived changes in diet, physical activity and sleeping during the COVID-19 pandemic in adults with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in the UK. A second objective was to explore differences between individuals with DM compared with ‘no’ or ‘other’ health conditions.MethodsParticipants aged>18 years were selected by convenience. Individuals subscribed to the Diabetes.co.uk community were sent a web-based survey including questions about demographics and health, followed by 5-point Likert-type scale questions relating to lifestyle-related behaviours during the COVID-19 pandemic. Individuals were grouped by diagnosis of DM, ‘other’ or ‘no’ health condition and responses were compared.Results4764 individuals responded, with 2434 (51.3%) being female and 1550 (32.6%) aged 55–64 years. T2DM (2974; 62.7%), hypertension (2147; 45.2%) and T1DM (1299; 27.4%) were most frequently reported. Compared with T1DM, ‘no’ or ‘other’ health conditions, respondents with T2DM reported making a less conscious effort to get outside and exercise daily (p Keywords: Open access, COVID-19 PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000391 Issue No:Vol. 5, No. 2 (2022)
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Horne, B. D; May, H. T, Muhlestein, J. B, Le, V. T, Bair, T. L, Knowlton, K. U, Anderson, J. L. Pages: 145 - 153 Abstract: ObjectivesIntermittent fasting boosts some host defence mechanisms while modulating the inflammatory response. Lower-frequency fasting is associated with greater survival and lower risk from COVID-19-related comorbidities. This study evaluated associations of periodic fasting with COVID-19 severity and, secondarily, initial infection by SARS-CoV-2.DesignProspective longitudinal observational cohort study.SettingSingle-centre secondary care facility in Salt Lake City, Utah, USA with follow-up across a 24-hospital integrated healthcare system.ParticipantsPatients enrolled in the INSPIRE registry in 2013–2020 were studied for the primary outcome if they tested positive for SARS-CoV-2 during March 2020 to February 2021 (n=205) or, for the secondary outcome, if they had any SARS-CoV-2 test result (n=1524).InterventionsNo treatment assignments were made; individuals reported their personal history of routine periodic fasting across their life span.Main outcome measuresA composite of mortality or hospitalisation was the primary outcome and evaluated by Cox regression through February 2021 with multivariable analyses considering 36 covariables. The secondary outcome was whether a patient tested positive for SARS-CoV-2.ResultsSubjects engaging in periodic fasting (n=73, 35.6%) did so for 40.4±20.6 years (max: 81.9 years) prior to COVID-19 diagnosis. The composite outcome occurred in 11.0% of periodic fasters and 28.8% of non-fasters (p=0.013), with HR=0.61 (95% CI 0.42 to 0.90) favouring fasting. Multivariable analyses confirmed this association. Other predictors of hospitalisation/mortality were age, Hispanic ethnicity, prior MI, prior TIA and renal failure, with trends for race, smoking, hyperlipidaemia, coronary disease, diabetes, heart failure and anxiety, but not alcohol use. In secondary analysis, COVID-19 was diagnosed in 14.3% of fasters and 13.0% of non-fasters (p=0.51).ConclusionsRoutine periodic fasting was associated with a lower risk of hospitalisation or mortality in patients with COVID-19. Fasting may be a complementary therapy to vaccination that could provide immune support and hyperinflammation control during and beyond the pandemic.Trial registrationClinicaltrials.gov, NCT02450006 (the INSPIRE registry). Keywords: Open access, COVID-19 PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000462 Issue No:Vol. 5, No. 2 (2022)
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Volk, B. M; Roberts, C. G. P, VanTieghem, M, George, M. P, Adams, R. N, Athinarayanan, S. J, McKenzie, A. L. Pages: 154 - 158 Abstract: ObjectiveTo investigate factors associated with COVID-19 severity in ambulatory individuals with type 2 diabetes mellitus (T2DM) and obesity treated with a medically supervised ketogenic diet (MSKD).Research design and methodsIn this real-world, retrospective, exploratory analysis, multivariate modelling was used to assess clinical factors associated with hospitalisation for COVID-19 in a geographically diverse outpatient population with T2DM treated virtually.ResultsLeading up to COVID-19 onset, non-hospitalised patients had higher average ketones (0.64 vs 0.52 mmol/L; p=0.016) and greater weight loss (6.8% vs 4.2%; p=0.009) compared with those hospitalised. Greater weight loss was significantly associated with lower likelihood of hospitalisation (adjusted OR=0.91, p=0.005), controlling for enrolment demographics and medical characteristics.ConclusionsTherapies such as MSKD, which elicit rapid, significant weight loss, may favourably impact COVID-19 hospitalisation rate and severity in individuals with T2DM and obesity. Keywords: Open access, COVID-19 PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000444 Issue No:Vol. 5, No. 2 (2022)
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Murphy, R; Al Rasheed, A, Keaver, L. Pages: 159 - 163 Abstract: Introduction15% of all presentations to our emergency department last year were chest pain related. This presented an opportunity to evaluate the impact of a brief physician counselling intervention on patient-reported changes in cardio-protective foodstuff intake.MethodsThis is a prospective non-randomised before and after comparison study without controls, conducted between an emergency department presentation and a scheduled follow-up visit at a cardiac diagnostics department. Participants were recruited between February and March 2021. The selected dietary components for inclusion after review of the literature were green leafy vegetables, other coloured vegetables, wholegrains, legumes and fruits. A food frequency questionnaire was completed by patients before and after a physician counselling intervention aided by a dietary infographic. Additionally, using the transtheoretical model for health behaviour change, we assessed each patient’s evolution during the study.Results38 patients were recruited. For patients with total baseline consumptions of five or fewer per day, there was an increase in cardioprotective foodstuff intakes (z=–2.784 p Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000385 Issue No:Vol. 5, No. 2 (2022)
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Tan, M; He, F, Morris, J. K, MacGregor, G. Pages: 164 - 170 Abstract: IntroductionIn China, salt intake is among the highest in the world (~11 g/day) and cardiovascular disease (CVD) accounts for 40% of deaths. We estimated the potential impact of reducing salt intake on CVD events in China, via systolic blood pressure (SBP).MethodsTo develop our model, we extracted the effect of salt reduction on SBP from a meta-regression of randomised trials and a population study, and that of SBP on CVD risk from pooled cohort studies.ResultsReducing population salt intake in China by 1 g/day could lower the risk for ischaemic heart disease by about 4% (95% uncertainty interval 1.8%–7.7%) and the risk for stroke by about 6% (2.4%–9.3%). Should this reduced salt level be sustained until 2030,~9 million (M) (7M–10.8M) CVD events could be prevented, of which ~4M (3.1M–4.9M) would have been fatal. Greater and gradual salt intake reductions, to achieve WHO’s target of 30% reduction by 2025 or the Chinese government’s target of ≤5 g/day by 2030, could prevent ~1.5 or 2 times more CVD events and deaths, respectively. Should the prolonged effect of salt reduction over several years be accounted for, all estimates of CVD events and deaths prevented would be 25% greater on average.ConclusionBringing down the high salt intake levels in China could result in large reductions in CVD. An easily achievable reduction of 1 g/day could prevent ~9M CVD events by 2030. Urgent action must be taken to reduce salt intake in China. Keywords: Open access, Press releases PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000408 Issue No:Vol. 5, No. 2 (2022)
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Blake, M. R; Romaniuk, H, Riesenberg, D, Boelsen-Robinson, T, Cameron, A. J, Orellana, L, Peeters, A. Pages: 171 - 181 Abstract: BackgroundFew studies have explored behavioural and financial impacts of retail initiatives after 2 years to address the unhealthy food environments common in local government sporting settings.AimsTo evaluate the impact of a 2-year local government capacity building intervention in sporting facility food outlets on (1) the healthiness of refrigerated drink choices available and visible to customers, (2) healthiness of refrigerated drinks sold and (3) refrigerated drink revenue.Methods52 sporting facilities within 8 local governments from Victoria, Australia, participated in an intervention between March 2018 and February 2020 by limiting ‘red’ (least healthy) drinks to ≤20% of refrigerator display and increasing ‘green’ (healthiest) drinks to ≥50% of display. Mixed models assessed changes in mean percentage of ‘red’, ‘amber’ and ‘green’ drinks displayed over time, compared with baseline.Facilities provided electronic weekly itemised sales data (December 2015 to February 2020). Weekly volume of ‘red’ or ‘green’ drinks sold as a proportion of total drinks sold, and total refrigerated drinks revenue were compared preimplementation and postimplementation using mixed models (seasonal facilities), and mixed-effect interrupted time series models (non-seasonal facilities).ResultsDisplay of ‘red’ drinks decreased by mean –17.1 percentage points (pp) (95% CI –23.9 to –10.3) and ‘green’ drinks increased 16.1 pp (95% CI 9.30, 22.9) between baseline and 18-month audits.At nine seasonal facilities, compared with the summer preimplementation, the mean volume of ‘red’ drinks sold decreased by –19.0 pp (95% CI –28.6, to –9.51) and refrigerated drink revenue decreased by–AU$81.8 (95% CI –AU$123 to –AU$40.8) per week. At 15 non-seasonal facilities, by February 2020, the volume of ‘red’ drinks sold decreased on average by –11.0 pp (95% CI –21.6 to –0.41) with no change in drink revenue.ConclusionReducing the display of unhealthy drinks can be an effective public health policy to improve the healthiness of customer purchases, provided there is consideration of potential impacts on revenue. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000445 Issue No:Vol. 5, No. 2 (2022)
Authors:
Lundberg, H. E; Glaso, M, Chhura, R, Shukla, A. A, Austlid, T, Sarwar, Z, Hovland, K, Iqbal, S, Fagertun, H. E, Holo, H, Larsen, S. E. Pages: 182 - 190 Abstract: BackgroundDaily intake of 57 g Jarlsberg cheese has been shown to increase the total serum osteocalcin (tOC). Is this a general cheese effect or specific for Jarlsberg containing vitamin K2 and 1,4-dihydroxy-2naphtoic acid (DHNA)'Methods66 healthy female volunteers (HV) were recruited. By skewed randomisation (3:2), 41 HV were allocated to daily intake of 57 g Jarlsberg (J-group) and 25–50 g Camembert (C-group) in 6 weeks. After 6 weeks the C-group was switched to Jarlsberg. The study duration was 12 weeks with clinical investigations every 6 weeks. The main variables were procollagen type 1 N-terminal propeptide (PINP), tOC, carboxylated osteocalcin (cOC) and the osteocalcin ratio (RO) defined as the ratio between cOC and undercarboxylated osteocalcin (ucOC). Serum cross-linked C-telopeptide type I collagen (CTX), vitamin K2, lipids and clinical chemistry were used as secondary variables.ResultsPINP, tOC, cOC, RO and vitamin K2 increased significantly (p Keywords: Open access, Press releases PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000424 Issue No:Vol. 5, No. 2 (2022)
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Chopp-Hurley, J. N; Wiebenga, E. G, Keller, H. H, Maly, M. R. Pages: 191 - 200 Abstract: ObjectiveSarcopenic obesity is a key feature in osteoarthritis (OA). While ideal OA treatment involves physical activity and diet, how diet influences OA pathophysiology is unclear. We explored the associations between diet, nutrition risk and physical activity with body composition in older adults with OA.MethodsBaseline data from the Canadian Longitudinal Study on Aging data set were analysed. Participants with hip, knee, hand or multiple forms of OA were included in this cross-sectional analysis. Body composition measures (lean, fat and total masses (kg) and body fat percentage) were separate dependent variables. Regression analyses were conducted to explore associations between body composition with dietary intake (high calorie snack, fibre), nutrition risk (SCREEN II) and physical activity (Physical Activity Scale for the Elderly).Results1596 participants were 66.5 (9.0) years old with a body mass index of 28.2 (5.3) kg/m2. Higher fibre cereal intake was associated with higher lean mass (unstandardised beta coefficient 0.5 (0.1, 0.9), p=0.02) and lower body fat percentage (–0.3 (–0.6, 0.0), p=0.046). Lower nutrition risk was associated with higher lean mass (0.1 (0.0, 0.1), p=0.03), lower fat mass (–0.05 (–0.1, 0.0), p=0.009) and lower body fat percentage (–0.1 (–0.1, 0.0), p Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000319 Issue No:Vol. 5, No. 2 (2022)
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Ebitu, A. K. S; Fegran, L, Haraldstad, K, Johannessen, B, Chiduo, M. G, Hovland, O. J. Pages: 201 - 207 Abstract: IntroductionGood nutrition is the foundation of sustainable growth and development among children. The United Nations aims to achieve food security and improve nutrition through its Sustainable Development Goal 2 - Zero Hunger. In close collaboration with local communities and authorities, the Tanga International Competence Centre, Tanzania, supports projects aimed at achieving the United Nations Sustainable Development Goals. One of their initiatives, The Banana Project, which is a free school fruit scheme, started in 2011 based on a recognised need for nutritional support among preschool children at a rural school in Tanga District. In the interest of improving nutrition, the free school fruit scheme provides one banana 5 school days a week to each child in the class. This study aimed to explore caregivers’ (parents and/or guardians) and teachers’ experiences with preschool children’s participation in the project, with a specific focus on nutrition and health.MethodsThis qualitative study was performed in 2017. A total of 16 semistructured indepth interviews with 14 caregivers and 2 teachers of the preschool children participating in the project were conducted. Data were analysed using a hermeneutic perspective.ResultsCaregivers and teachers of the preschool children participating in the intervention experienced that bananas (1) reduced children’s hunger and nutritional deficiency, (2) increased fruit intake and improved their appetite for other foods, (3) improved their physical health and provided energy, and (4) supported cognitive and socioemotional development.ConclusionThese findings indicate that the banana intervention has several benefits to preschool children and has an impact on their families. To improve health and reduce the risk of malnutrition of children in rural Tanzania, The Banana Project can be an recommended as a simple, cost-effective and sustainable health and nutrition promotion initiatives. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000403 Issue No:Vol. 5, No. 2 (2022)
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Jones, G; Macaninch, E, Mellor, D, Spiro, A, Martyn, K, Butler, T, Johnson, A, Moore, J. B. Pages: 208 - 216 Abstract: COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training. With this imperative, the Association for Nutrition established the Inter-Professional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service, royal colleges, medical schools and universities, government public health departments, learned societies, medical students and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors. Through an iterative and transparent consultative process, 13 key nutritional competencies, to be achieved through mastery of 11 graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skills acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students’ achievement of the General Medical Council Outcomes for Graduates. As nutrition is an integrative science, the AfN IPG recommends the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden to teaching staff. The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip front-line staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered nutritionist (RNutr)/registered associate nutritionist (ANutr) or a registered dietitian (RD) where this is likely to be beneficial. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000510 Issue No:Vol. 5, No. 2 (2022)
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Jefferson, A; Borges, C. Pages: 217 - 226 Abstract: BackgroundVitamin D delivered transdermally may suppress hyperactivity in nociceptor pain receptors and alter pain intensity, offering a useful addition to localised pain management in varying clinical settings. Currently, little is known about long-term usage of continuous-release vitamin D patches.MethodWe conducted a randomised parallel pilot trial to evaluate safety and tolerability of daily application of patented (US8821921B2) transdermal vitamin D patches over 8 weeks and assess time-level profile of serum vitamin D. Compliance, tolerance and sun exposure were monitored daily, serum 25(OH)D measured 2-weekly and dietary intake and safety markers 4-weekly.ResultsThirty healthy adults were randomised to two treatment groups: big patch and small patch. mean age was 36 years (20–68 years) with a 63% female to 37% male split. Patches differed in size but contained identical ingredients including 30 000 IU cholecalciferol. Physical and blood safety markers remained stable, within normal clinical parameters, and with no clinically meaningful changes throughout. Five big patch participants experienced skin irritation, which was mild and occasional for three, but continuous for two leading to patch withdrawal. There were no skin reactions in small patch group. average, serum 25(OH)D levels increased by +14 nmol/L (SD 11.63, range, –4 to 40 nmol/L) between baseline and week 8, with no significant differences between patch sizes. There was a shift in overall vitamin D status between baseline and week 8 (23% deficient (50 nmol/L) increasing from 37% to 70% at week 8).ConclusionBased on these results, long-term (8 weeks) application of patented transdermal vitamin D patches was found to be safe. There may be minor skin tolerance issues with big patches for some, which appears to relate to patch size. Larger trials are warranted to explore the increase in vitamin D levels beyond 8 weeks.Trial registration number NCT04851990. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000471 Issue No:Vol. 5, No. 2 (2022)
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Bablani, L; Ni Mhurchu, C, Neal, B, Skeels, C. L, Staub, K. E, Blakely, T. Pages: 227 - 234 Abstract: Front-of-pack labelling (FoPL) aims to promote healthier diets by altering consumer food purchasing behaviour. We quantify the impact of the voluntary Health Star Rating (HSR) FoPL adopted by New Zealand (NZ) in 2014, on (i) the quantity of foods purchased by HSR scores and food groups and (ii) the quantities of different nutrients purchased.We used Nielsen HomeScan household purchasing panel data over 2013–2019, linked to Nutritrack packaged food composition data. Fixed effects analyses were used to estimate the association of HSR with product and nutrient purchasing. We controlled for NZ-wide purchasing trends and potential confounding at the household and product level.In 2019, HSR-labelled products accounted for 24% (2890) of 12 040 products in the dataset and 32% of purchasing volume. Of HSR-labelled products, 1339 (46%) displayed a rating of 4.0–5.0 stars and 556 (19%) displayed a rating of 0.5–2.0 stars.We found little or no association between HSR labelling and the quantities of different foods purchased. Introduction of HSR was, however, associated with lower sodium (–9%, 95% CI –13% to –5%), lower protein (–3%, 95% CI –5% to 0%) and higher fibre (5%, 95% CI 2% to 7%) purchases when purchased products carrying an HSR were compared with the same products prior to introduction of the programme.Robust evidence of HSR labelling changing consumer purchasing behaviour was not observed. The positive effect on nutrient purchasing of HSR-labelled foods likely arises from reformulation of products to achieve a better HSR label. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000459 Issue No:Vol. 5, No. 2 (2022)
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Narciso, J; Croome, N. Pages: 235 - 242 Abstract: BackgroundObesity remains a major global public health issue, despite numerous attempts to address it. Health behaviour theories suggest that a misconception of how excess weight affects general health may be preventing individuals from taking action towards addressing it. The present study explores this relationship in European countries.MethodsThis study analysed cross-sectional secondary data collected as part of the European Health Interview Survey Wave 2 (2013–2015), with a total sample of 299 846 participants. The association between body mass index and self-perceived health was analysed using logistic regression models. Age, sex, country, degree of urbanisation and level of education were included in the model to determine excess weight’s independent contribution to self-perceived health over and above these variables.ResultsThe majority of the sample was in the excess weight category (52.92%; n=155 812), with only Austria and Luxembourg reporting a higher proportion of normal weight than excess weight. An analysis of self-perceived health revealed that most individuals perceived themselves to be in good health (42.88%; n=128 579). Logistic regression results show that overweight individuals were more likely to report being in poorer self-perceived health (OR=1.27, 95% CI 1.25 to 1.29) compared with normal weight individuals. The same effect was observed for individuals in the obese class I (OR=2.00, 95% CI 1.96 to 2.05), obese class II (OR=3.00, 95% CI 2.88 to 3.13) and obese class III (OR=4.38, 95% CI 4.07 to 4.71) categories. However, this study did not find a rigid pattern of association between excess weight and self-perceived health across European countries.ConclusionIn general, a higher body mass index category is associated with poorer self-perceived health, suggesting that the majority of the study population have a correct perception of how their weight affects their health. However, in some key countries this relationship is not observed and should be further explored. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000439 Issue No:Vol. 5, No. 2 (2022)
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Haynes, E; Augustus, E, Brown, C. R, Guell, C, Iese, V, Jia, L, Morrissey, K, Unwin, N. Pages: 243 - 253 Abstract: IntroductionFood security in Small Island Developing States (SIDS) is an international policy priority. SIDS have high rates of nutrition-related non-communicable diseases, including obesity and type 2 diabetes, micronutrient deficiencies and, in many, persistent childhood stunting. This is associated with an increasing reliance on imported processed food of poor nutritional quality. Calls have been made for strengthening local food systems, resilient to climate change, to increase the consumption of nutritious locally produced food. We aimed to systematically review interventions intended to improve diet in SIDS, and specifically explore whether these interventions applied a local food approach.MethodsThe search strategy was applied to 11 databases, including in health, social science and agriculture. Screening of titles, abstracts and data extraction was undertaken in duplicate. Risk of bias was assessed using Cochrane tools. Narrative synthesis of the results was undertaken. The study protocol was registered (PROSPERO registration number: 2020CRD42020201274).ResultsFrom 26 062 records, 154 full texts were reviewed and 24 were eligible. Included studies were from the Caribbean, Pacific, Mauritius and Singapore. Five were a randomised study design, one an interrupted time series analysis, eight controlled and ten uncontrolled pre-test and post-test. Nine studies included some aspect of a local food approach. Most interventions (n=15) included nutrition education, with evidence of effectiveness largely limited to those that also included practical skills training, such as vegetable gardening or food preparation. Three studies were considered low risk of bias, with the majority (n=13) of moderate risk.ConclusionThere is a lack of robust evidence on interventions to improve diet in SIDS. The evidence suggests that multifaceted approaches are likely to be the most effective, and local food approaches may promote effectiveness, through mechanisms of cultural and contextual relevance. Further development and evaluation of interventions is urgently required to increase the comparability of these studies, to help guide policy on improving nutrition in SIDS. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000410 Issue No:Vol. 5, No. 2 (2022)
Authors:
Potter, A. W; Nindl, L. J, Soto, L. D, Pazmino, A, Looney, D. P, Tharion, W. J, Robinson-Espinosa, J. A, Friedl, K. E. Pages: 254 - 262 Abstract: Bioelectrical impedance analysis (BIA) provides a practical method of body composition estimation for field research and weight management programmes, with devices and algorithms that have improved in recent years. We compared suitability of a commercial BIA system that uses multi-frequency-based proprietary algorithms (InBody 770, Cerritos, California, USA) and a laboratory-based validated single-frequency system (Quantum IV, RJL Systems, Clinton Township, Michigan, USA) with dual-energy X-ray absorptiometry (DXA) (iDXA, GE Lunar, Madison, Wisconsin, USA). Volunteers included fit non-obese active duty US Marines (480 men; 315 women), assessed by DXA and the two BIA systems. Both RJL and InBody BIA devices predicted DXA-based fat-free mass (FFM) (mean absolute error (MAE) 2.8 and 3.1 kg, respectively) and per cent body fat (%BF) (MAE 3.4% and 3.9%, respectively), with higher correlations from the InBody device (r2=0.96 (%BF) and 0.84 (FFM)) versus the RJL (r2=0.92 (%BF) and 0.72 (FFM)). InBody overpredicted FFM (bias +2.7, MAE 3.1 kg) and underpredicted %BF (bias –3.4 and MAE 3.9%) versus the RJL. A 3% correction factor applied to the InBody device results provided values very close to the DXA measurements. These findings support the application of modern BIA systems to body composition goals of maximum %BF and minimum lean body mass for both men and women. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000512 Issue No:Vol. 5, No. 2 (2022)
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Otten, H. S; Seferidi, P. Pages: 263 - 270 Abstract: BackgroundThe double burden of malnutrition (DBM), which refers to the coexistence of overnutrition and undernutrition among populations, households or individuals, is a growing problem in low/middle-income countries. The Latin America and the Caribbean (LAC) region has been particularly affected by the DBM, following a nutrition transition and a rapid increase in overweight, obesity and diet-related disease, while high levels of undernutrition persist. This study aims to describe the prevalence of four different DBM definitions in mother–child pairs across nine LAC countries and investigate the socioeconomic determinants of overweight mothers with at least one stunted child (SCOM).MethodsWe used cross-sectional data from the Demographic and Health Surveys for all analyses. We used descriptive statistics to obtain prevalence rates and conducted multiple logistic regression analyses to investigate the association between SCOM households and socioeconomic determinants, including wealth index, maternal education, place of residency and whether the mother was working, adjusted for a range of variables.ResultsOverweight/obese mothers with at least one anaemic child were the most common type of DBM, with a prevalence of 19.39%, followed by SCOM with a prevalence of 10.44%. Statistically significant socioeconomic predictors of SCOM were households with a lower wealth index, lower maternal education and living in rural areas.ConclusionThis study showed that the overall prevalence of most DBM definitions examined was high, which points to the need for urgent interventions in the LAC region. The unique set of socioeconomic predictors of SCOM identified in this study calls for future double-duty policies that simultaneously target food affordability, nutrition education and access to healthy food. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000489 Issue No:Vol. 5, No. 2 (2022)
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Wilmsen, N; Pijl, H, Geerlings, W, Navis, G. Pages: 271 - 276 Abstract: ObjectiveType 2 diabetes is one of the main causes of kidney damage. Recent intervention studies suggest that the progression of type 2 diabetes can be halted, or even brought into remission by lifestyle interventions. In a pragmatic trial, the Reverse Diabetes2 Now programme (RD2N, NL: Keer Diabetes2 Om), a multicomponent lifestyle intervention, reduced the need for bloodglucose lowering medications up to 24 months.Research design and methodsHere, we retrospectively investigate the effect of RD2N on markers of kidney function in patients selected for impaired kidney function at baseline (eGFR Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000397 Issue No:Vol. 5, No. 2 (2022)
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Borresen, K. O; Rosendahl-Riise, H, Brantsaeter, A. L, Egeland, G. M. Pages: 277 - 285 Abstract: ObjectiveTo investigate the association between intake of sucrose-sweetened beverages (SSBs) and risk of developing pharmacologically treated hypertension in a population of Norwegian mothers followed up to 10 years after delivery.DesignWomen without hypertension at baseline in the Norwegian Mother, Father and Child Cohort Study (n=60 027) who delivered between 2004 and 2009 were linked to the Norwegian Prescription Database to ascertain antihypertensive medication use after the first 90 days following delivery. Diet was assessed by a validated semiquantitative Food Frequency Questionnaire in mid pregnancy. Cox proportional hazard analyses evaluated HRs for the development of hypertension associated with SSB consumption as percent energy by quintiles in multivariable models. Supplemental analyses were stratified by gestational hypertension and by a low versus high sodium-to-potassium intake ratio ( Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000426 Issue No:Vol. 5, No. 2 (2022)
Authors:
Rothkopf, M; Pant, M, Brown, R, Haselhorst, J, Gagliardotto, F, Tallman, A, Stevenson, D, DePalma, A, Saracco, M, Rosenberg, D, Proudan, V, Shareef, K, Ayub, N. Pages: 286 - 296 Abstract: IntroductionHome parenteral nutrition (HPN) is essential for patients with intestinal failure requiring long-term nutritional support. The Amerita Quality Improvement Project for HPN Patients (QIP-PN) explored the effect of a physician nutrition expert (PNE)-led multidisciplinary nutritional support team (MNST) on HPN care for patients under its service.ObjectiveTo determine an MNST effect on adherence to protocols, outcomes and quality of life (QOL) in HPN.MethodsThe study was divided into three phases: data review (phases 1a and 1b), observation (phase 2) and intervention (phase 3). Seven Amerita locations were selected as ‘study branches’ (population), from which all study patients and controls were drawn. The quality improvement project employed a quasi-experimental case-matched control group (control) design. Data were collected on demographics, treating physicians PNE status, HPN care variables, recommended interventions, quality-of-life assessment, adverse outcomes and hospitalisations. Paired t-test compared continuous data between phases 2 and 3. Comparisons between study and control groups used a negative binomial regression model.ResultsThirty-four patients were reviewed in phase 1a and 197 in phase 1b. Forty study patients completed phase 2 and progressed into phase 3, of whom 30 completed ≥60 therapy days. Patients were lost to follow-up if they discontinued HPN for any reason. Improvements in weight, body mass index and QOL were seen in the study patients during intervention. Recommendations made and accepted by treating physicians differed based on PNE status. Study patients had fewer adverse outcomes and related hospitalisations than controls.ConclusionMNST recommendations improved clinical, biochemical parameters and patients’ self-reported overall health. MNST input reduced adverse outcomes, hospitalisation and the length of stay at the hospital. This study highlights the potential for MNST to have a significant impact on the quality and overall cost of HPN management. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000484 Issue No:Vol. 5, No. 2 (2022)
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Earley, T; Young, A, Pringle, S, Clarkson, Y, Williams, A, Howell, R, Ineson, M. Pages: 306 - 312 Abstract: The clinical objectives of this prospective, random, convenience series were:1. Compare a novel fibre-optic pH test device (NGPOD) to gastric aspirate and pH testing for nasogastric tube (NGT) confirmation.2. Determine if the new device reduces the need for chest radiography (chest X-ray, CXR).MethodsRecruitment of patients over the age of 18, requiring NGT feeding.Exclusion criteria: oesophageal gastrointestinal surgery within 3 months; all those with partial or total gastrectomy; bleeding gastric and duodenal ulcers; gastric cancer; those with oesophageal varices; those considered to be inappropriate.The index test, NGPOD, comprises a fine, flexible fibre-optic sensor passed down the NGT, then connected to an electronic device. A green light indicates pH ≤5.5, and a red light if pH is>5.5.The reference test is withdrawal of gastric aspirate and testing with universal pH indicator strips then comparison to a colour chart. Second-line testing is establishing NGT position by CXR or subjective clinical assessment (SCA) in intensive care unit (ICU).ResultsThe analysed data set contained 174 subjects who had undergone 496 tests, 96 initial and 400 repeat NGT checks.For all patients, NGPOD can reduce the need for CXR or SCA by 21.2%.In ICU, NGPOD can reduce the need for CXR or SCA by 24.5%.When performing initial tests, immediately after tube placement, NGPOD can reduce the need for CXR or SCA in 61% of patients.With repeat testing, NGPOD can reduce the need to progress to CXR or SCA in 16% of tests.ConclusionsThe objective, yes—no result delivered by NGPOD, eliminates the subjective reading of a pH strip colour change, reducing the subjective element. The index test has the opportunity to reduce risk, improve safety and decrease the numbers of patients requiring X-ray. It, therefore, has the potential to reduce never events associated with NGT misplacement. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000506 Issue No:Vol. 5, No. 2 (2022)
Authors:
Vejrup, K; Brantsaeter, A.-L, Meltzer, H. M, Mohebbi, M, Knutsen, H. K, Alexander, J, Haugen, M, Jacka, F. Pages: 313 - 320 Abstract: ObjectiveWhile maternal fish consumption in pregnancy has consistently been linked to better cognitive and emotional outcomes in children, fish is also a primary source of exposure to methyl mercury (MeHg), which has been linked to poorer child cognitive outcomes. The aim of this study was to evaluate the associations between MeHg exposure, using calculated MeHg exposure from maternal diet and total mercury (Hg) concentration in maternal blood during pregnancy, and child internalising and externalising behaviours at 3 and 5 years of age.Design and participantsThe study sample comprised 51 238 mother–child pairs in the Norwegian Mother, Father and Child Cohort Study. Data on maternal blood Hg concentration in gestational week 18 were available for a sub-sample of 2936 women. Maternal MeHg exposure from diet was calculated from a validated Food Frequency Questionnaire answered in mid-pregnancy. Mothers reported children’s emotional behaviour at age 3 and 5 years by questionnaires including twenty items from the Child Behaviour Checklist. Longitudinal associations were examined using generalised estimating equations, adjusted for potential confounders and stratified by maternal fish intake.ResultsMaternal blood Hg concentration (median=1.02 µg/L, 90th percentile=2.22, range=0–13.8) was not associated with emotional behaviour in children. Increasing dietary MeHg intake (median 0.15 µg/kg body weight/week, 90th percentiles=0.31, range=0–1.86) was significantly associated with lower internalising β=–0.03 (95% CI –0.05 to –0.00) and externalising child behaviours β=–0.04 (95% CI –0.07 to –0.02) in adjusted models. The inverse associations were also apparent when stratifying by low/high maternal fish intake ( Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000412 Issue No:Vol. 5, No. 2 (2022)
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van Rens, T; Hanson, P, Oyebode, O, Walasek, L, Barber, T. M, Al-Khudairy, L. Pages: 321 - 331 Abstract: Background‘Lockdowns’ to control the spread of COVID-19 in the UK affected many aspects of life and may have adversely affected diets. We aimed to examine (1) the effect of lockdowns on fruit and vegetable consumption, as a proxy for healthy diets more generally, and on weight and well-being, (2) whether any subgroup was particularly affected and (3) the barriers and facilitators to a healthy diet in lockdown.MethodsWe conducted a mixed-method longitudinal study, involving an online survey of 1003 adults in the West Midlands, UK, 494 of whom were surveyed at two different points in time. Our first time point was during stringent COVID-19 lockdown and the second during a period of more relaxed restrictions. We asked quantitative questions about fruit and vegetable consumption; physical activity, sociodemographic characteristics, body mass index and well-being and qualitative questions about the reasons behind reported changes.ResultsWe find no evidence for decreased fruit and vegetable consumption during lockdown compared with afterwards. If anything, consumption increased by half a portion daily among women, particularly among those who normally have a long commute. This finding, combined with a significant increase in physical activity, suggests that behaviours were healthier during lockdown, consistent with higher self-reported health. However, well-being deteriorated markedly, and participants reported being heavier during the lockdown as well. Our qualitative data suggest that an abundance of resources (more time) supported higher fruit and vegetable consumption during lockdown, despite increased access issues.ConclusionsOur results may assuage concerns that lockdowns adversely affected diets. They may point to the impact of commuting on diet, particularly for women. We add longitudinal evidence to a growing body of literature on the adverse effect of lockdown on mental health. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000562 Issue No:Vol. 5, No. 2 (2022)
Authors:
Koyratty, N; Ntozini, R, Mbuya, M. N, Jones, A. D, Schuster, R. C, Kordas, K, Li, C.-S, Tavengwa, N. V, Majo, F. D, Humphrey, J, Smith, L. E. Pages: 332 - 343 Abstract: IntroductionStunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied.MethodsWe used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1–M18).ResultsA total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=–0.09; 95% –0.19 to –0.13). From M6 to M18, poor food access was associated with lower LAZ (β=–0.11; 95% –0.20 to –0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time.ConclusionFI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000470 Issue No:Vol. 5, No. 2 (2022)
Authors:
Bawazeer, N. M; Alshehri, L. H, Alharbi, N. M, Alhazmi, N. A, Alrubaysh, A. F, Alkasser, A. R, Aburisheh, K. H. Pages: 344 - 351 Abstract: IntroductionCarbohydrate counting (CC) is an important nutritional strategy to improve glycaemic outcomes among patients with diabetes. Few studies have investigated CC knowledge among individuals with type 1 diabetes mellitus (T1DM) in Saudi Arabia. Therefore, we aimed to evaluate CC knowledge in Saudi adults with T1DM.Study design and methodsA cross-sectional study was conducted between December 2021 and February 2022, including 224 patients with T1DM from the University Diabetes Center, Riyadh. Adults aged ≥18 years, diagnosed with T1DM for>1 year, and residing in Saudi Arabia were included. CC knowledge was assessed using a previously well-studied tool (AdultCarbQuiz), which was translated into Arabic and tested for validity by a group of dieticians. Descriptive statistics were used for data analysis, and bivariate and regression analyses were conducted.ResultsThe AdultCarbQuiz questionnaire-Arabic version had good validity and reliability (Cronbach’s α: 0.87). The CC method was used by 54% of the participants. The mean CC knowledge score was 23.01±7.31. A significant negative linear relationship between the participants’ CC knowledge scores, and age and glycated haemoglobin (HbA1c) levels, was revealed by simple regression analysis. Furthermore, significant independent variables related to CC knowledge scores were CC use, HbA1c levels, being taught about CC (>5 times), insulin pump usage and DM duration (≤15 years).ConclusionsApproximately half of the patients used the CC method. The mean CC knowledge scores were better in patients who used the CC method, were more frequently taught about CC, were treated using an insulin pump, and had a shorter DM duration than their counterparts. Therefore, designing and implementing a well-structured nutrition education programme tailored to individuals with diabetes is crucial to provide them with up-to-date dietary information, as well as the necessary knowledge and skills, to improve their outcomes and manage their condition. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2022-000553 Issue No:Vol. 5, No. 2 (2022)
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Jones, P; Wirnitzer, K. Pages: 358 - 363 Abstract: Background to issueFuture sustainable healthcare delivery and systems need reflective practitioners and critical thinkers to engage the public to achieve health policy aims and objectives. Therefore, this descriptive review introduces a generic conceptual framework, adopting a specific theme to illustrate and demonstrate a model of care or any other context. Whatever the purpose, context or philosophical stance in healthcare and health literacy, there is no standardised generic conceptual framework to structure reflection and critical thinking. This work presents a pragmatic solution focused on the one-to-one relationship of learner–mentor, patient–clinician, public health professional–public and groups.MethodsThe method is constructivist, an educational exercise, practical and the target group can be defined/viewed as student, teacher, patient, carer or member of the public in a health promotion campaign, for example. The building blocks are health and care concepts that arise clinically in practice, or for a student writing an assignment. As will be explained, concepts (including the Sustainable Development Goals) are assigned by the subject(s)—in this instance the authors—to a domain of knowledge.ResultsAs two-by-two tables, the results represent the structure of the conceptual framework, framing the content in a series of four knowledge (care) domains. The contents, ultimately the Sustainable Development Goals, may then be linked and relationships discussed. Results are produced gradually, building a cognitive or mind-map. The results, it must be stressed, are therefore qualitative.ConclusionDrawing on educational theory and practice, the results are explored and justified using the theme of nutrition, and the often stated desirability in education of reflective practice and critical thinking abilities. Providing a series of cross-disciplinary, the reader will gain insight into the potential of Hodges’ model to facilitate integrated, person-centred and care that improves parity of esteem, supporting students and qualified personnel in their learning careers. Keywords: Open access PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000254 Issue No:Vol. 5, No. 2 (2022)
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Thankachan, P; Selvam, S, Narendra, A. R, Mishra, H. N, Sachdev, H. S, Thomas, T, Kurpad, A. V. Pages: 364 - 366 Abstract: BackgroundThe COVID-19 pandemic lockdown in 2020 resulted in school closures with eventual suspension of the mid-day meal programme, biannual deworming and iron–folic acid supplements. One year into the lockdown, we evaluated the impact of the withdrawal of these programmes on the nutritional status of rural primary-school children, aged 6–12 years, in Karnataka, India.MethodsAnthropometry, haemoglobin, serum ferritin and C reactive protein were measured in 290 children at two time points, 1 year apart, starting from just before the lockdown (February 2020 to February 2021).ResultsThe prevalence of anaemia doubled from 21% to 40% (p Keywords: Open access, COVID-19 PubDate: 2022-12-30T02:00:31-08:00 DOI: 10.1136/bmjnph-2021-000358 Issue No:Vol. 5, No. 2 (2022)
Authors:
Romieu, I; Khandpur, N, Katsikari, A, Biessy, C, Torres-Mejia, G, Angeles-Llerenas, A, Alvarado-Cabrero, I, Sanchez, G. I, Maldonado, M. E, Porras, C, Rodriguez, A. C, Garmendia, M. L, Chajes, V, Aglago, E. K, Porter, P. L, Lin, M, His, M, Gunter, M. J, Huybrechts, I, Rinaldi, S, PRECAMA team Pages: 1 - 9 Abstract: Ultra-processed food intake has been linked to an increased risk of breast cancer in Western populations. No data are available in the Latin American population although the consumption of ultra-processed foods is increasing rapidly in this region.We evaluated the association of ultra-processed food intake to breast cancer risk in a case–control study including 525 cases (women aged 20–45 years) and 525 matched population-based controls from Chile, Colombia, Costa Rica and Mexico. The degree of processing of foods was classified according to the NOVA classification.Overall, the major contributors to ultra-processed food intake were ready-to-eat/heat foods (18.2%), cakes and desserts (16.7%), carbonated and industrial fruit juice beverages (16.7%), breakfast cereals (12.9%), sausages and reconstituted meat products (12.1%), industrial bread (6.1%), dairy products and derivatives (7.6%) and package savoury snacks (6.1%). Ultra-processed food intake was positively associated with the risk of breast cancer in adjusted models (OR T3-T1=1.93; 95% CI=1.11 to 3.35). Specifically, a higher risk was observed with oestrogen receptor positive breast cancer (ORT3-T1=2.44, (95% CI=1.01 to 5.90, P-trend=0.049), while no significant association was observed with oestrogen receptor negative breast cancer (ORT3-T1=1.87, 95% CI=0.43 to 8.13, P-trend=0.36).Our findings suggest that the consumption of ultra-processed foods might increase the risk of breast cancer in young women in Latin America. Further studies should confirm these findings and disentangle specific mechanisms relating ultra-processed food intake and carcinogenic processes in the breast. Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000335 Issue No:Vol. 5, No. 1 (2022)
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Sawadogo, W; Tsegaye, M, Gizaw, A, Adera, T. Pages: 10 - 18 Abstract: ObjectiveTo quantify the current weight of evidence of the association between overweight and obesity as risk factors for COVID-19-related hospitalisations (including hospital admission, intensive care unit admission, invasive mechanical ventilation) and death, and to assess the magnitude of the association and the potential dose–response relationships.DesignPubMed, Embase, Cochrane, Web of Sciences, WHO COVID-19 database and Google Scholar were used to identify articles published up to 20 July 2021. Peer-reviewed studies reporting adjusted estimates of the association between overweight or obesity and COVID-19 outcomes were included. Three authors reviewed the articles and agreed. The quality of eligible studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analysis was used to estimate the combined effects.ResultsA total of 208 studies with 3 550 997 participants from over 32 countries were included in this meta-analysis. Being overweight was associated with an increased risk of COVID-19-related hospitalisations (OR 1.19, 95% CI 1.12 to 1.28, n=21 studies), but not death (OR 1.02, 95% CI 0.92 to 1.13, n=21). However, patients with obesity were at increased risk of both COVID-19-related hospitalisations (OR 1.72, 95% CI 1.62 to 1.84, n=58) and death (OR 1.25, 95% CI 1.19 to 1.32, n=77). Similarly, patients with extreme obesity were at increased risk of COVID-19-related hospitalisations (OR 2.53, 95% CI 1.67 to 3.84, n=12) and death (OR 2.06, 95% CI 1.76 to 3.00, n=19). There was a linear dose–response relationship between these obesity categories and COVID-19 outcomes, but the strength of the association has decreased over time.ConclusionBeing overweight increases the risk of COVID-19-related hospitalisations but not death, while obesity and extreme obesity increase the risk of both COVID-19-related hospitalisations and death. These findings suggest that prompt access to COVID-19 care, prioritisation for COVID-19 vaccination and other preventive measures are warranted for this vulnerable group. Keywords: Open access, COVID-19 PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000375 Issue No:Vol. 5, No. 1 (2022)
Authors:
Grout, L; Mizdrak, A, Nghiem, N, Jones, A. C, Blakely, T, Ni Mhurchu, C, Cleghorn, C. Pages: 19 - 35 Abstract: Poor diet is a major risk factor for excess weight gain and obesity-related diseases, including cardiovascular diseases, type 2 diabetes mellitus, osteoarthritis and several cancers. This paper aims to assess the potential impacts of real-world food and beverage taxes on change in dietary risk factors, health gains (in quality-adjusted life years (QALYs)), health system costs and greenhouse gas (GHG) emissions as if they had all been implemented in New Zealand (NZ). Ten taxes or tax packages were modelled. A proportional multistate life table model was used to predict resultant QALYs and costs over the remaining lifespan of the NZ population alive in 2011, as well as GHG emissions. QALYs ranged from 12.5 (95% uncertainty interval (UI) 10.2 to 15.0; 3% discount rate) per 1000 population for the import tax on sugar-sweetened beverages (SSB) in Palau to 143 (95% UI 118 to 171) per 1000 population for the excise duties on saturated fat, chocolate and sweets in Denmark, while health expenditure savings ranged from 2011 NZ$245 (95% UI 188 to 310; 2020 US$185) per capita to NZ$2770 (95% UI 2140 to 3480; US$2100) per capita, respectively. The modelled taxes resulted in decreases in GHG emissions from baseline diets, ranging from –0.2% for the tax on SSB in Barbados to –2.8% for Denmark’s tax package. There is strong evidence for the implementation of food and beverage tax packages in NZ or similar high-income settings. Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000376 Issue No:Vol. 5, No. 1 (2022)
Authors:
Hatcher, A. M; Neilands, T. B, Rebombo, D, Weiser, S. D, Christofides, N. J. Pages: 36 - 43 Abstract: BackgroundAlthough food insecurity has been associated with intimate partner violence (IPV), few studies examine it longitudinally or among male perpetrators.MethodsWe used secondary data from a trial that followed 2479 men in a peri-urban settlement in South Africa (February 2016–August 2018). Men self-completed questionnaires at baseline (T0), 12 months (T1) and 24 months (T2) on food security, household type, relationship status, childhood abuse exposure, alcohol use, and perpetration of physical and/or sexual IPV. Cross-lagged dynamic panel modelling examines the strength and direction of associations over time.ResultsAt baseline, rates of IPV perpetration (52.0%) and food insecurity (65.5%) were high. Food insecure men had significantly higher odds of IPV perpetration at T0, T1 and T2 (ORs of 1.9, 1.4 and 1.4, respectively). In longitudinal models, food insecurity predicted men’s IPV perpetration 1 year later. The model had excellent fit after controlling for housing, relationship status, age, childhood abuse and potential effect of IPV on later food insecurity (standardised coefficient=0.09, p=0.031. root mean squared error of approximation=0.016, comparative fit index=0.994). IPV perpetration did not predict later food security (p=0.276).ConclusionFood insecurity had an independent, longitudinal association with men’s IPV perpetration in a peri-urban South African settlement. These findings suggest food security could be a modifiable risk factor of partner violence.Trial registration number NCT02823288. Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000288 Issue No:Vol. 5, No. 1 (2022)
Authors:
Anand, C; Kranz, R.-M, Husain, S, Koeder, C, Schoch, N, Alzughayyar, D.-K, Gellner, R, Hengst, K, Englert, H. Pages: 44 - 54 Abstract: BackgroundThe potential of adopting a healthy lifestyle to fight non-communicable diseases (NCDs) is not fully used. We hypothesised that the Healthy Lifestyle Community Programme (HLCP, cohort 1) reduces weight and other risk markers compared with baseline and control.Methods24-month, non-randomised, controlled intervention trial. Intervention: intensive 8-week phase with seminars, workshops and coaching focusing on a healthy lifestyle (eg, plant-based diet, physical activity, stress management) and group support followed by a 22-month alumni phase. Weight reduction as the primary outcome and other NCD risk parameters were assessed at six time points. Participants were recruited from the general population. Multiple linear regression analyses were conducted.Results143 participants (58±12 years, 71% female) were enrolled (91 in the intervention (IG) and 52 in the control group (CG)). Groups’ baseline characteristics were comparable, except participants of IG were younger, more often females, overweight and reported lower energy intake (kcal/day). Weight significantly decreased in IG at all follow-ups by –1.5 ± 1.9 kg after 8 weeks to –1.9 ± 4.0 kg after 24 months and more than in CG (except after 24 months). Being male, in the IG or overweight at baseline and having a university degree predicted more weight loss. After the intervention, there were more participants in the IG with a ‘high’ adherence (+12%) to plant-based food patterns. The change of other risk parameters was most distinct after 8 weeks and in people at elevated risk. Diabetes-related risk parameters did not improve.ConclusionThe HLCP was able to reduce weight and to improve aspects of the NCD risk profile. Weight loss in the IG was moderate but maintained for 24 months. Participants of lower educational status might benefit from even more practical units. Future interventions should aim to include more participants at higher risk.Trial registration numberDRKS00018821. Keywords: Open access, Implementing Effective Interventions in Healthcare PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000340 Issue No:Vol. 5, No. 1 (2022)
Authors:
Paisey, R; Daniels, C, Howitt, W, Greatorex, D, Campbell, C, Paisey, C, Paisey, R, Frost, J, Bromige, R. Pages: 55 - 61 Abstract: ObjectiveTo assess weight loss maintenance, diabetes status, mortality and morbidity 15 years after a very low calorie diet programme (VLCD) in patients with obesity.DesignGeneral practice data bases were interrogated for subjects coded for group therapy with VLCD in the 1990s. Causes of death, occurrence of vascular disease and remission or development of diabetes were ascertained from patient records and national stroke and cardiovascular disease data bases.Results325 subjects engaged in the programme and had sufficient data for analysis. Baseline characteristics were: age 47.8±12. 8 years; body mass index (BMI) 36.1±6.8 kg/m2; 79.1% female/20.9% male; 13.5% had type 2 diabetes. After 15±4 years weight had changed from 97.9±19 kg at baseline to 100±20.8 kg. 10 with diabetes at baseline were in remission at 3 months, but only two remained in remission at 5 years. 50 new cases of type 2 diabetes and 11 of impaired fasting glucose developed during follow-up. Only 5.9% who remained healthy at follow-up had maintained>10% body weight reduction. Neither diabetes incidence nor diabetes free survival were related to percentage body weight lost during VLCD. Only baseline BMI was related to development of new impaired fasting glucose or diabetes by 15 years (p=0.007). 37 subjects had a cardiovascular event. Age (p=0.000002) and degree of weight loss after VLCD (p=0.03) were significantly associated with subsequent vascular events.ConclusionLong-term maintenance of weight loss after VLCD was rare in this single centre retrospective study 15 years later. Glucose intolerance developed in 21.4%. Lasting remission of type 2 diabetes or prevention of later glucose intolerance were not achieved. Vascular events were more frequent in those who lost most weight. Risk management during weight regain should be studied in future to assess potential for reduction in adverse cardiovascular outcomes. Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000363 Issue No:Vol. 5, No. 1 (2022)
Authors:
Kopasker, D; Ejebu, O.-Z, Norwood, P, Ludbrook, A. Pages: 62 - 71 Abstract: ObjectivesTaxes and restrictions on promotions have recently been proposed as policy instruments to reduce consumption of unhealthy foods. The objective of this study is to add to the limited evidence on the comparative effectiveness of price changes, price promotions and volume promotions in changing household purchasing of unhealthy foods, using biscuits, crisps and savoury snacks as examples.DesignLongitudinal regression analysis of consumer microdata.SettingSecondary data on itemised household purchases of biscuits, crisps and savoury snacks from 2006 to 2012.ParticipantsSample of 3024 households in Scotland.Main outcome measuresChanges in the number of calories (kcal) purchased in the product category by a household caused by changes in the price for the product category, any temporary in-store price promotions and any temporary in-store volume promotions. Changes are measured at the mean, median, 25th percentile and 75th percentile of the household purchasing distribution for the full sample. Subgroup analyses were conducted by household income band and for households with and without children.ResultsBetween product categories, the scale of purchasing response to incentives varies significantly. Within product categories, the mean calories (kcal) purchased by a household are more responsive to any volume promotion than to price or any price promotion for all product categories. As the volume of items purchased increases, households are less responsive to price, less responsive to any volume promotion and more responsive to any price promotion. Statistically significant differences are observed between household income groups in their response to price and promotion incentives within the biscuits category only. In cases where statistically significant differences are observed, households with children are more responsive to promotion and price incentives than households without children.ConclusionsFor all product categories analysed (biscuits, crisps and savoury snacks), household purchasing is most responsive to any volume promotion. Therefore, assuming the response of consumers to incentives remains constant following legislation, the most effective policy instrument to reduce the calorie intake from these products may be a ban on volume promotions. Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000323 Issue No:Vol. 5, No. 1 (2022)
Authors:
Jenkins, R. H; Vamos, E. P, Taylor-Robinson, D, Mason, K. E, Laverty, A. A. Pages: 72 - 86 Abstract: ObjectivesChanges in public sector service spending may influence food consumption. We make use of changing local authority (LA) expenditure in England to assess impacts on food purchasing. We examine total LA service spending and explore two potential pathways: highways and transport spending which may affect access to food; and housing service expenditure which may affect household resources available to purchase foods.DesignLongitudinal panel survey at the LA level (2008–2015) using fixed effects linear regression.Setting324 LAs in England.Main exposureExpenditure per capita on total LA services, highways and transport services, and housing services.Main outcome measuresLA area estimates of purchasing of fresh fruits and vegetables, high in fat, sugar and salt (HFSS) foods, and takeaways at home, expressed as a percentage of total food and drink expenditure.ResultsTotal LA service spending decreased by 17% on average between 2008 and 2015. A 10% decrease in total LA spending was associated with a 0.071 percentage point decrease in HFSS (95% CI –0.093 to –0.050) and a 0.015 percentage point increase in takeaways (95% CI 0.006 to 0.024). A 10% decrease in highways and transport expenditure was associated with a 0.006 percentage point decrease in fruit and vegetable purchasing (95% CI –0.009 to –0.002) and a 0.006 percentage point increase in takeaway purchasing (95% CI 0.001 to 0.010). These associations were seen in urban areas only when analyses were stratified by rural/urban area status. A 0.006 percentage point decrease in HFSS purchasing was also seen with a 10% decrease in housing expenditure (95% CI –0.010 to –0.002).ConclusionChanges in LA spending may have impacts on food purchasing which are evident at the area level. This suggests that in addition to more prominent impacts such as foodbank use, austerity measures may have mixed impacts on food purchasing behaviours among the wider population. Individual-level research is needed to further elucidate these relationships. Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000346 Issue No:Vol. 5, No. 1 (2022)
Authors:
Rojas Huayta, V. M; Galvez-Davila, R, Calvo-Torres, O, Cardozo Alarcon, V, Aparco, J. P, Silva Fhon, J. R, Estrada-Acero, B, Jaimes-Velasquez, C, Cespedes-Panduro, B, Espinoza-Bernardo, S, Dolores-Maldonado, G, Ramirez Ramirez, R, Gallo Ruelas, M, Arteaga-Romero, I, Higa, A. M. Pages: 87 - 97 Abstract: ObjectiveThe objective of this study is to assess changes in the dimensions of the food system and consumption associated with body weight variations during the first month’s lockdown in Peruvian adults in Metropolitan Lima.MethodsA cross-sectional study conducted during the first months of lockdowns in Peru. 694 adults completed a web-based survey about changes experienced in the process of acquiring food during lockdown, changes in their intake and self-perceived body weight. A multinomial logistic regression analysis was conducted to evaluate the factors associated with changes in body weight.ResultsWeight gain was perceived in 38% of the participants and 22.8% perceived weight loss. 39.2% did not perceive changes in their weight. Risk factors for body weight gain were increased alcohol consumption (OR=4.510, 95% CI 1.764 to 11.531) and decreased fruit consumption (OR=2.129, 95% CI 1.290 to 3.515), while decreasing cereal intake (OR=0.498, 95% CI 0.269 to 0.922) and choosing nutritious food as a driver for purchase (OR=0.512, 95% CI 0.320 to 0.821) were found to be protective against gaining weight. Decreasing food intake during the pandemic (OR=2.188, 95% CI 1.348 to 3.550) and having to miss important foods (OR=2.354, 95% CI 1.393 to 3.978), were associated with weight loss.ConclusionsDuring confinement, weight gain was mostly associated with food consumption and personal food system factors. Meanwhile, weight loss was associated with external food system factors. Keywords: Open access, COVID-19 PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000416 Issue No:Vol. 5, No. 1 (2022)
Authors:
Lacey, L. F; Armstrong, D. J, Royle, E, Magee, P, Pourshahidi, L. K, Ray, S, Strain, J. J, McSorley, E. Pages: 98 - 105 Abstract: BackgroundThis study investigated the cost-effectiveness of vitamin D3 supplementation in older adults in Ireland, with year-round vitamin D deficiency (serum 25-hydroxyvitamin D concentration Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000382 Issue No:Vol. 5, No. 1 (2022)
Authors:
Lepre, B; Trigueiro, H, Johnsen, J. T, Khalid, A. A, Ball, L, Ray, S. Pages: 106 - 117 Abstract: BackgroundThis paper provides an overview of capacity-building efforts in the context of nutrition education for medical and healthcare professionals.MethodsContent analysis of eighteen reports related to nutrition education and capacity building, and interviews with key personnel from the WHO and NNEdPro Global Centre for Nutrition and Health were synthesised. Recommendations to improve nutrition education and subsequent nutrition capacity of healthcare professionals were identified based on policy guidance and interviews.FindingsMost included documents noted the importance of nutrition education and capacity building for medical and healthcare professionals. Healthcare professionals and the ‘health sector’ were positioned as central to achieving improved public health, and the promotion of nutrition knowledge and awareness in the general population.ConclusionIncreased focus on nutrition education and capacity of the health workforce are key to improvements in population health and well-being. The WHO is well placed to support global nutrition education.RecommendationsKey recommendations from the literature review and interviews include improved global data collection mechanisms, a pledge from governments to prioritise nutrition education and capacity building, along with implementation of standardised nutrition curricula for all healthcare sectors. This would include the development and expansion of on-line resources. Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000354 Issue No:Vol. 5, No. 1 (2022)
Authors:
Perry, A; Stephanou, A, Rayman, M. P. Pages: 118 - 133 Abstract: Pre-eclampsia affects 3%–5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia. Several nutrients and dietary factors previously believed to be implicated in the risk of pre-eclampsia have now been shown to have no effect on risk; these include vitamins C and E, magnesium, salt, -3 long-chain polyunsaturated fatty acids (fish oils) and zinc. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain. The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25–30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk. Our recommendations are summarised in a table of guidance for women at particular risk of developing pre-eclampsia. Keywords: Open access PubDate: 2022-06-22T07:18:08-07:00 DOI: 10.1136/bmjnph-2021-000399 Issue No:Vol. 5, No. 1 (2022)
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