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  Subjects -> NUTRITION AND DIETETICS (Total: 201 journals)
Showing 1 - 64 of 64 Journals sorted alphabetically
Acta Portuguesa de Nutrição     Open Access   (Followers: 1)
Advances in Digestive Medicine     Open Access   (Followers: 11)
Advances in Eating Disorders : Theory, Research and Practice     Hybrid Journal   (Followers: 20)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 59)
Advances in Nutrition     Hybrid Journal   (Followers: 55)
African Journal of Biomedical Research     Open Access  
African Journal of Food, Agriculture, Nutrition and Development     Open Access   (Followers: 15)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
American Journal of Botany     Full-text available via subscription   (Followers: 17)
American Journal of Clinical Nutrition     Hybrid Journal   (Followers: 157)
American Journal of Food and Nutrition     Open Access   (Followers: 46)
American Journal of Food Technology     Open Access   (Followers: 9)
Amerta Nutrition     Open Access   (Followers: 1)
Amino Acids     Hybrid Journal   (Followers: 8)
Annals of Nutrition and Metabolism     Full-text available via subscription   (Followers: 52)
Annual Review of Food Science and Technology     Full-text available via subscription   (Followers: 13)
Annual Review of Nutrition     Full-text available via subscription   (Followers: 39)
Appetite     Hybrid Journal   (Followers: 24)
Arab Journal of Nutrition and Exercise     Open Access  
Archive of Food and Nutritional Science     Open Access   (Followers: 1)
Archivos Latinoamericanos de Nutrición     Open Access  
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 10)
Asian Journal of Clinical Nutrition     Open Access   (Followers: 12)
Bangladesh Journal of Nutrition     Open Access   (Followers: 5)
Bioactive Carbohydrates and Dietary Fibre     Hybrid Journal   (Followers: 2)
BMC Nutrition     Open Access   (Followers: 12)
BMJ Nutrition, Prevention & Health     Open Access   (Followers: 8)
British Journal Of Nutrition     Hybrid Journal   (Followers: 91)
Cahiers de Nutrition et de Diététique     Full-text available via subscription   (Followers: 1)
Canadian Food Studies / La Revue canadienne des études sur l'alimentation     Open Access   (Followers: 1)
Canadian Journal of Dietetic Practice and Research     Full-text available via subscription   (Followers: 17)
Case Reports in Clinical Nutrition     Open Access  
Childhood Obesity     Hybrid Journal   (Followers: 21)
Clinical Nutrition     Hybrid Journal   (Followers: 89)
Clinical Nutrition ESPEN     Hybrid Journal   (Followers: 22)
Clinical Nutrition Experimental     Open Access   (Followers: 1)
Clinical Nutrition Insight     Full-text available via subscription   (Followers: 13)
Clinical Nutrition Open Science     Open Access  
Clinical Obesity     Hybrid Journal   (Followers: 17)
Comparative Exercise Physiology     Hybrid Journal   (Followers: 21)
Current Developments in Nutrition     Open Access   (Followers: 6)
Current Nutrition & Food Science     Hybrid Journal   (Followers: 25)
Current Nutrition Reports     Hybrid Journal   (Followers: 8)
Current Opinion in Clinical Nutrition & Metabolic Care     Hybrid Journal   (Followers: 25)
Current Research in Nutrition and Food Science     Open Access   (Followers: 6)
DEMETRA : Alimentação, Nutrição & Saúde     Open Access  
Diabetes, Metabolic Syndrome and Obesity     Open Access   (Followers: 46)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 23)
Ecology of Food and Nutrition     Hybrid Journal   (Followers: 9)
Egyptian Journal of Obesity, Diabetes and Endocrinology     Open Access   (Followers: 1)
Endocrinología, Diabetes y Nutrición     Full-text available via subscription   (Followers: 1)
Endocrinología, Diabetes y Nutrición (English Edition)     Hybrid Journal   (Followers: 2)
Ernährung & Medizin     Hybrid Journal   (Followers: 3)
European Journal of Clinical Nutrition     Hybrid Journal   (Followers: 74)
European Journal of Nutrition     Hybrid Journal   (Followers: 35)
European Journal of Nutrition & Food Safety     Open Access   (Followers: 1)
Food & Nutrition Research     Open Access   (Followers: 34)
Food and Environmental Virology     Hybrid Journal   (Followers: 1)
Food and Foodways: Explorations in the History and Culture of     Hybrid Journal   (Followers: 12)
Food and Health     Open Access   (Followers: 1)
Food and Nutrition Bulletin     Hybrid Journal   (Followers: 6)
Food and Waterborne Parasitology     Open Access  
Food Digestion     Hybrid Journal   (Followers: 5)
Food Frontiers     Open Access   (Followers: 1)
Food Hydrocolloids for Health     Open Access  
Food Quality and Safety     Open Access   (Followers: 2)
Food Science & Nutrition     Open Access   (Followers: 59)
Food, Culture and Society: An International Journal of Multidisciplinary Research     Full-text available via subscription   (Followers: 13)
Frontiers in Nutrition     Open Access   (Followers: 11)
Frontiers in Sustainable Food Systems     Open Access   (Followers: 2)
Functional Foods in Health and Disease     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Genes & Nutrition     Open Access   (Followers: 5)
Hacettepe University Faculty of Health Sciences Journal     Open Access  
Human Nutrition & Metabolism     Open Access   (Followers: 1)
Indian Journal of Nutrition and Dietetics     Hybrid Journal   (Followers: 1)
Indonesian Food and Nutrition Progress     Open Access  
International Journal for Vitamin and Nutrition Research     Hybrid Journal   (Followers: 10)
International Journal of Behavioral Nutrition and Physical Activity     Open Access   (Followers: 30)
International Journal of Child Health and Nutrition     Hybrid Journal   (Followers: 6)
International Journal of Eating Disorders     Hybrid Journal   (Followers: 22)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 20)
International Journal of Food Science and Nutrition Engineering     Open Access   (Followers: 6)
International Journal of Food Sciences and Nutrition     Hybrid Journal   (Followers: 11)
International Journal of Gastroenterology, Hepatology, Transplant and Nutrition     Open Access   (Followers: 4)
International Journal of Nutrition and Metabolism     Open Access   (Followers: 23)
International Journal of Nutrition, Pharmacology, Neurological Diseases     Open Access   (Followers: 4)
International Journal of Obesity     Hybrid Journal   (Followers: 90)
International Journal of Sport Nutrition & Exercise Metabolism     Hybrid Journal   (Followers: 82)
Journal of Advanced Nutrition and Human Metabolism     Open Access   (Followers: 16)
Journal of Agriculture, Food Systems, and Community Development     Open Access   (Followers: 3)
Journal of Dietary Supplements     Hybrid Journal   (Followers: 10)
Journal of Eating Disorders     Open Access   (Followers: 13)
Journal of Ethnic Foods     Open Access   (Followers: 1)
Journal of Food & Nutritional Disorders     Hybrid Journal   (Followers: 1)
Journal of Food and Nutrition Research     Open Access   (Followers: 9)
Journal of Food Chemistry and Nutrition     Open Access   (Followers: 6)
Journal of Food Science and Nutrition Therapy     Open Access   (Followers: 1)
Journal of Health, Population and Nutrition     Open Access   (Followers: 12)
Journal of Human Nutrition and Dietetics     Hybrid Journal   (Followers: 50)
Journal of Hunger & Environmental Nutrition     Hybrid Journal   (Followers: 7)
Journal of Medical Nutrition and Nutraceuticals     Open Access   (Followers: 4)
Journal of Medicinal Herbs and Ethnomedicine     Open Access  
Journal of Muscle Foods     Hybrid Journal  
Journal of Nutraceuticals and Herbal Medicine     Open Access  
Journal of Nutrition     Hybrid Journal   (Followers: 38)
Journal of Nutrition & Intermediary Metabolism     Open Access  
Journal of Nutrition and Metabolism     Open Access   (Followers: 16)
Journal of Nutrition Education and Behavior     Hybrid Journal   (Followers: 19)
Journal of Nutrition in Gerontology and Geriatrics     Hybrid Journal   (Followers: 15)
Journal of Nutrition, Health and Aging     Hybrid Journal   (Followers: 30)
Journal of Nutritional & Environmental Medicine     Full-text available via subscription   (Followers: 2)
Journal of Nutritional Biochemistry     Hybrid Journal   (Followers: 8)
Journal of Nutritional Disorders & Therapy     Open Access  
Journal of Nutritional Ecology and Food Research     Full-text available via subscription  
Journal of Nutritional Science     Open Access   (Followers: 2)
Journal of Obesity     Open Access   (Followers: 24)
Journal of Parenteral and Enteral Nutrition     Hybrid Journal   (Followers: 35)
Journal of Pediatric Gastroenterology and Nutrition (JPGN)     Hybrid Journal   (Followers: 52)
Journal of Pharmacy and Nutrition Sciences     Open Access   (Followers: 5)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 28)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 2)
Journal of Sensory Studies     Hybrid Journal  
Journal of Spices and Aromatic Crops     Open Access   (Followers: 1)
Journal of the Academy of Nutrition and Dietetics     Full-text available via subscription   (Followers: 60)
Journal of the American College of Nutrition     Hybrid Journal   (Followers: 7)
Journal of the Australasian College of Nutritional and Environmental Medicine     Full-text available via subscription  
Jurnal Gizi dan Dietetik Indonesia : Indonesian Journal of Nutrition and Dietetics     Open Access   (Followers: 1)
Jurnal Gizi Indonesia / The Indonesian Journal of Nutrition     Open Access  
Jurnal Gizi Klinik Indonesia     Open Access  
Jurnal Penelitian Gizi dan Makanan     Open Access   (Followers: 1)
Jurnal Riset Kesehatan     Open Access  
La Ciencia al Servicio de la Salud y Nutrición     Open Access  
Lifestyle Genomics     Open Access   (Followers: 2)
Lifestyle Journal     Open Access  
Maternal & Child Nutrition     Hybrid Journal   (Followers: 14)
Médecine & Nutrition     Full-text available via subscription  
Media Gizi Indonesia     Open Access  
Metabolism and Nutrition in Oncology     Open Access   (Followers: 4)
Molecular Nutrition & Food Research     Hybrid Journal   (Followers: 6)
NFS Journal     Open Access  
Nigerian Food Journal     Full-text available via subscription   (Followers: 2)
Nigerian Journal of Nutritional Sciences     Full-text available via subscription  
npj Science of Food     Open Access  
Nutrición Hospitalaria     Open Access   (Followers: 3)
Nutrients     Open Access   (Followers: 12)
Nutrire     Hybrid Journal  
Nutrition     Hybrid Journal   (Followers: 21)
Nutrition & Dietetics     Hybrid Journal   (Followers: 30)
Nutrition & Food Science     Hybrid Journal   (Followers: 8)
Nutrition & Diabetes     Open Access   (Followers: 20)
Nutrition & Metabolism     Open Access   (Followers: 15)
Nutrition - Science en évolution     Full-text available via subscription   (Followers: 5)
Nutrition and Cancer     Hybrid Journal   (Followers: 13)
Nutrition and Dietary Supplements     Open Access   (Followers: 14)
Nutrition and Health     Hybrid Journal   (Followers: 6)
Nutrition and Metabolic Insights     Open Access   (Followers: 3)
Nutrition Bulletin     Hybrid Journal   (Followers: 10)
Nutrition Bytes     Open Access   (Followers: 5)
Nutrition in Clinical Practice     Hybrid Journal   (Followers: 43)
Nutrition Journal     Open Access   (Followers: 11)
Nutrition Research     Hybrid Journal   (Followers: 22)
Nutrition Research Reviews     Hybrid Journal   (Followers: 13)
Nutrition Reviews     Hybrid Journal   (Followers: 36)
Nutrition Today     Hybrid Journal   (Followers: 14)
Nutrition, Metabolism and Cardiovascular Diseases     Hybrid Journal   (Followers: 13)
Nutritional Neuroscience : An International Journal on Nutrition, Diet and Nervous System     Hybrid Journal   (Followers: 9)
Obesity     Hybrid Journal   (Followers: 56)
Obesity Facts     Open Access   (Followers: 8)
Obesity Reviews     Hybrid Journal   (Followers: 24)
Oil Crop Science     Open Access  
Open Food Science Journal     Open Access  
Open Nutrition Journal     Open Access   (Followers: 2)
Open Obesity Journal     Open Access   (Followers: 1)
Pakistan Journal of Nutrition     Open Access   (Followers: 2)
Pediatric Obesity     Hybrid Journal   (Followers: 9)
Perspectivas en Nutrición Humana     Open Access   (Followers: 2)
PharmaNutrition     Hybrid Journal   (Followers: 3)
Plant Foods for Human Nutrition     Hybrid Journal   (Followers: 5)
Plant Production Science     Open Access   (Followers: 1)
Proceedings of the Nutrition Society     Hybrid Journal   (Followers: 8)
Progress in Nutrition     Open Access   (Followers: 2)
Public Health Nutrition     Hybrid Journal   (Followers: 29)
RBNE - Revista Brasileira de Nutrição Esportiva     Open Access   (Followers: 1)
RBONE - Revista Brasileira de Obesidade, Nutrição e Emagrecimento     Open Access   (Followers: 1)
Revista Chilena de Nutricion     Open Access   (Followers: 2)
Revista Española de Nutrición Humana y Dietética     Open Access   (Followers: 3)
Revista Mexicana de Trastornos Alimentarios     Open Access   (Followers: 1)
Revista Salud Pública y Nutrición     Open Access  
Segurança Alimentar e Nutricional     Open Access  
South African Journal of Clinical Nutrition     Open Access   (Followers: 5)
The Australian Coeliac     Full-text available via subscription   (Followers: 1)
Topics in Clinical Nutrition     Hybrid Journal   (Followers: 18)
UNICIÊNCIAS     Open Access  
Universal Journal of Food and Nutrition Science     Open Access   (Followers: 4)
World Food Policy     Hybrid Journal   (Followers: 3)

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BMJ Nutrition, Prevention & Health
Number of Followers: 8  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2516-5542
Published by BMJ Publishing Group Homepage  [62 journals]
  • Assessments of risk of bias in systematic reviews of observational
           nutritional epidemiologic studies are often not appropriate or
           comprehensive: a methodological study

    • Authors: Zeraatkar, D; Kohut, A, Bhasin, A, Morassut, R. E, Churchill, I, Gupta, A, Lawson, D, Miroshnychenko, A, Sirotich, E, Aryal, K, Azab, M, Beyene, J, de Souza, R. J.
      Abstract: BackgroundAn essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called ‘nutritional epidemiologic studies’) assess risk of bias.ObjectiveTo describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies.MethodsWe searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018–Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies.ResultsMost reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%).ConclusionReviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
      Keywords: Open access
      PubDate: 2022-04-24T04:45:32-07:00
      DOI: 10.1136/bmjnph-2021-000248
      Issue No: Vol. 4, No. 2 (2022)
  • Plant-based dietary quality and depressive symptoms in Australian vegans
           and vegetarians: a cross-sectional study

    • Authors: Lee, M. F; Eather, R, Best, T.
      Abstract: Plant-based dietary patterns (vegan and vegetarian) are often considered ‘healthy’ and have been associated with broad health benefits, including decreased risk of obesity and ill health (cardiovascular disease, blood glucose and type II diabetes). However, the association between plant-based diets and mood disorders such as depression remains largely equivocal. This cross-sectional study of 219 adults aged 18–44 (M=31.22, SD=7.40) explored the associations between an estimate of overall plant-based diet quality and depression in vegans (n=165) and vegetarians (n=54). Overall plant-based diet quality was associated with depressive symptoms in vegans and vegetarians F(1, 215)=13.71, p
      Keywords: Open access
      PubDate: 2022-04-24T04:45:32-07:00
      DOI: 10.1136/bmjnph-2021-000332
      Issue No: Vol. 4, No. 2 (2022)
  • From observation to intervention: time to put 'food and mood to the test

    • Authors: Bradfield, J; Buckner, L, Amati, F, Burridge, J, Ray, S.
      Pages: 359 - 361
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000301
      Issue No: Vol. 4, No. 2 (2021)
  • Call for emergency action to limit global temperature increases, restore
           biodiversity and protect health

    • Authors: Atwoli, L; H Baqui, A, Benfield, T, Bosurgi, R, Godlee, F, Hancocks, S, Horton, R, Laybourn-Langton, L, Monteiro, C. A, Norman, I, Patrick, K, Praities, N, Rikkert, M. G. O, Rubin, E. J, Sahni, P, Smith, R, Talley, N. J, Turale, S, Vazquez, D.
      Pages: 362 - 364
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000356
      Issue No: Vol. 4, No. 2 (2021)
  • Effects of SARS-CoV-2 pandemic on follow-up and pharmacological treatment
           of chronic diseases in undocumented migrants

    • Authors: Fiorini, G; Franchi, M, Corrao, G, Tritto, R, Fadelli, S, Rigamonti, A. E, Sartorio, A, Cella, S. G.
      Pages: 365 - 373
      Abstract: BackgroundAll over the world, the COVID-19 pandemic, not unlikely other epidemics, has hit harder people in low socioeconomic conditions.In Western countries, undocumented migrants are a growing component of this disadvantaged segment of the population.Their health conditions are frequently burdened by a number of chronic conditions, and they experience many difficulties in accessing public health services. Frequently, the only medical assistance they can get is provided by non-governmental organisations.MethodsWe studied the medical records (including pharmacological treatments) of all patients attending the outpatient clinics of Opera San Francesco (OSF; a big charity in Milano, Italy), in the first 5 months of 2020. These comprise the outbreak of the pandemic and the lockdown period. The 1914 patients (1814 undocumented migrants and 100 Italians) seen during the lockdown were compared with those seen in the same period of 2019 and with those seen in the preceding months of 2020. We especially focused on three chronic conditions: cardiovascular diseases, diabetes and psychiatric disorders.ResultsThe number of consultations during the first 5 months of 2020 was much smaller than that of the same period of 2019. During the lockdown, we found 4048 consultations for 1914 patients, while they were 8051 in the same period of 2019 and 5681 in the first 2 months of 2020.The quantity of medicines dispensed by OSF showed a marked decrease in the period of the study and mainly during the lockdown.The decrease in consultations and dispensation of medicines was most evident for psychiatric patients and almost not existent for patients with diabetes. Female patients suffered a more pronounced reduction.ConclusionsWestern countries need strategies to better assist the very poor during epidemics.Differences among different groups of disadvantaged persons should be taken into account when designing recovery plans.
      Keywords: Open access, COVID-19
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000274
      Issue No: Vol. 4, No. 2 (2021)
  • Evaluation of different stool extraction methods for metabolomics
           measurements in human faecal samples

    • Authors: Erben, V; Poschet, G, Schrotz-King, P, Brenner, H.
      Pages: 374 - 384
      Abstract: BackgroundMetabolomics analysis of human stool samples is of great interest for a broad range of applications in biomedical research including early detection of colorectal neoplasms. However, due to the complexity of metabolites there is no consensus on how to process samples for stool metabolomics measurements to obtain a broad coverage of hydrophilic and hydrophobic substances.MethodsWe used frozen stool samples (50 mg) from healthy study participants. Stool samples were processed after thawing using eight different processing protocols and different solvents (solvents such as phosphate-buffered saline, isopropanol, methanol, ethanol, acetonitrile and solvent mixtures with or without following evaporation and concentration steps). Metabolites were measured afterwards using the MxP Quant 500 kit (Biocrates). The best performing protocol was subsequently applied to compare stool samples of participants with different dietary habits.ResultsIn this study, we were able to determine up to 340 metabolites of various chemical classes extracted from stool samples of healthy study participants with eight different protocols. Polar metabolites such as amino acids could be measured with each method while other metabolite classes, particular lipid species (better with isopropanol and ethanol or methanol following a drying step), are more dependent on the solvent or combination of solvents used. Only a small number of triglycerides or acylcarnitines were detected in human faeces. Extraction efficiency was higher for protocols using isopropanol (131 metabolites>limit of detection (LOD)) or those using ethanol or methanol and methyl tert-butyl ether (MTBE) including an evaporation and concentration step (303 and 342 metabolites>LOD, respectively) than for other protocols. We detected significant faecal metabolite differences between vegetarians, semivegetarians and non-vegetarians.ConclusionFor the evaluation of metabolites in faecal samples, we found protocols using solvents like isopropanol and those using ethanol or methanol, and MTBE including an evaporation and concentration step to be superior regarding the number of detected metabolites of different chemical classes over others tested in this study.
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2020-000202
      Issue No: Vol. 4, No. 2 (2021)
  • Tradition, taste and taboo: the gastroecology of maternal perinatal diet

    • Authors: Lunkenheimer, H. G; Burger, O, Akhauri, S, Chaudhuri, I, Dibbell, L, Hashmi, F. A, Johnson, T, Little, E. E, Mondal, S, Mor, N, Saldanha, N, Schooley, J, Legare, C. H.
      Pages: 385 - 396
      Abstract: BackgroundMaternal malnutrition is a major source of regional health inequity and contributes to maternal and infant morbidity and mortality. Bihar, a state in eastern India adjacent to Jharkhand and West Bengal, has relatively high neonatal mortality rates because a large portion of infants are born to young mothers. Bihar has the second-highest proportion of underweight children under 3 in India, with infant mortality rates of 48 per 1000 live births. Maternal malnutrition remains a major threat to perinatal health in Bihar, where 58.3% of pregnant women are anaemic.MethodsWe examined dietary beliefs and practices among mothers, mothers-in-law and community members, including Accredited Social Health Activists (ASHAs), using focus group discussions (n=40 groups, 213 participants), key informant interviews (n=50 participants) and quantitative surveys (n=1200 recent mothers and 400 community health workers). We report foods that are added/avoided during the perinatal period, along with stated reasons underlying food choice. We summarise the content of the diet based on responses to the quantitative survey and identify influencers of food choice and stated explanations for adding and avoiding foods.Key findingsAnalyses for all methodologies included gathering frequency counts and running descriptive statistics by food item, recommendation to eat or avoid, pregnancy or post partum, food group and health promoting or risk avoiding. During pregnancy, commonly added foods were generally nutritious (milk, pulses) with explanations for consuming these foods related to promoting health. Commonly avoided foods during pregnancy were also nutritious (wood apples, eggplant) with explanations for avoiding these foods related to miscarriage, newborn appearance and issues with digestion. Post partum, commonly added foods included sweets because they ease digestion whereas commonly avoided foods included eggplants and oily or spicy foods. Family, friends, relatives or neighbours influenced food choice for both mothers and ASHAs more than ASHAs and other health workers.Perinatal dietary beliefs and behaviours are shaped by local gastroecologies or systems of knowledge and practice that surround and inform dietary choices, as well as how those choices are explained and influenced. Our data provide novel insight into how health influencers operating within traditional and biomedical health systems shape the perinatal dietary beliefs of both mothers and community health workers.
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000252
      Issue No: Vol. 4, No. 2 (2021)
  • Effect of reducing ultraprocessed food consumption on obesity among US
           children and adolescents aged 7-18 years: evidence from a simulation model

    • Authors: Livingston, A. S; Cudhea, F, Wang, L, Steele, E. M, Du, M, Wang, Y. C, Pomeranz, J, Mozaffarian, D, Zhang, F. F, on behalf of the Food-PRICE project
      Pages: 397 - 404
      Abstract: BackgroundChildren and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity rate in the USA.MethodsWe developed a microsimulation model to project the effect of reducing UPF consumption in children’s diet on reducing the prevalence of overweight or obesity among US youth. The model incorporated nationally representative data on body mass index (BMI) percentile and dietary intake of 5804 children and adolescents aged 7–18 years from the National Health and Nutrition Examination Survey 2011–2016, and the effect of reducing UPF consumption on calorie intake from a recent randomised controlled trial. Uncertainties of model inputs were incorporated using probabilistic sensitivity analysis with 1000 simulations.ResultsReducing UPFs in children’s diet was estimated to result in a median of –2.09 kg/m2 (95% uncertainty interval –3.21 to –0.80) reduction in BMI among children and adolescents aged 7–18 years. The median prevalence of overweight (BMI percentile ≥85th) and obesity (BMI percentile ≥95th percentile) was reduced from 37.0% (35.9%, 38.1%) to 20.9% (15.1%, 29.9%) and from 20.1% (19.2%, 21.0%) to 11.0% (7.86%, 15.8%), respectively. Larger BMI and weight reductions were seen among boys than girls, adolescents than children, non-Hispanic black and Hispanic youth than non-Hispanic white youth, and those with lower levels of parental education and family income.ConclusionsReducing UPF consumption in children’s diet has the potential to substantially reduce childhood obesity rate among children and adolescents in the USA.
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000303
      Issue No: Vol. 4, No. 2 (2021)
  • 'Bhavishya Shakti: Empowering the Future: establishing and evaluating a
           pilot community mobile teaching kitchen as an innovative model, training
           marginalised women to become nutrition champions and culinary health
           educators in Kolkata, India

    • Authors: Buckner, L; Carter, H, Crocombe, D, Kargbo, S, Korre, M, Bhar, S, Bhat, S, Chakraborty, D, Douglas, P, Gupta, M, Maitra-Nag, S, Muhkerjee, S, Saha, A, Rajput-Ray, M, Tsimpli, I, Ray, S.
      Pages: 405 - 415
      Abstract: BackgroundMalnutrition is a global emergency, creating an overlapping burden on individual, public and economic health. The double burden of malnutrition affects approximately 2.3 billion adults worldwide. Following 3 years of capacity building work in Kolkata, with assistance of local volunteers and organisations, we established an empowering nutrition education model in the form of a ‘mobile teaching kitchen (MTK)’ with the aim of creating culinary health educators from lay slum-dwelling women.AimsTo evaluate the piloting of a novel MTK nutrition education platform and its effects on the participants, alongside data collection feasibility.MethodsOver 6 months, marginalised (RG Kar and Chetla slums) women underwent nutrition training using the MTK supported by dietitians, doctors and volunteers. Preintervention and postintervention assessments of knowledge, attitudes and practices (KAP), as well as anthropometric and clinical nutritional status of both the women and their children were recorded. The education was delivered by a ‘See One, Do One, Teach One’ approach with a final assessment of teaching delivery performed in the final session.ResultsTwelve women were trained in total, six from each slum. Statistically significant improvements were noted in sections of KAP, with improvements in nutrition knowledge (+4.8) and practices (+0.8). In addition, statistically significant positive changes were seen in ‘understanding of healthy nutrition for their children’ (p=0.02), ‘sources of protein rich food’ (p=0.02) and ‘not skipping meals if a child is ill’ (p≤0.001).ConclusionThe MTK as a public health intervention managed to educate, empower and upskill two groups of lay marginalised women into MTK Champions from the urban slums of Kolkata, India. Improvements in their nutrition KAP demonstrate just some of the effects of this programme. By the provision of healthy meals and nutritional messages, the MTK Champions are key drivers nudging improvements in nutrition and health related awareness with a ripple effect across the communities that they serve. There is potential to upscale and adapt this programme to other settings, or developing into a microenterprise model, that can help future MTK Champions earn a stable income.
      Keywords: Open access, Global Food Security
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2020-000181
      Issue No: Vol. 4, No. 2 (2021)
  • Nutritional parameters and outcomes in patients admitted to intensive care
           with COVID-19: a retrospective single-centre service evaluation

    • Authors: Eden, T; McAuliffe, S, Crocombe, D, Neville, J, Ray, S.
      Pages: 416 - 424
      Abstract: BackgroundCOVID-19 is an inflammatory syndrome caused by novel coronavirus SARS-CoV-2. Symptoms range from mild infection to severe acute respiratory distress syndrome (ARDS) requiring ventilation and intensive care. At the time of data collection, UK cases were around 300 000 with a fatality rate of 13% necessitating over 10 000 critical care admissions; now there have been over 4 million cases. Nutrition is important to immune function and influences metabolic risk factors such as obesity and glycaemic control, as well as recovery from acute illnesses. 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.ObjectivesInvestigate the effect of body mass index (BMI), glycaemic control and vitamin D status on outcomes in adult patients with COVID-19 admitted to an intensive care unit (ICU).MethodsRetrospective review of all patients admitted to a central London ICU between March and May 2020 with confirmed COVID-19. Electronic patient records data were analysed for patient demographics; comorbidities; admission BMI; and serum vitamin D, zinc, selenium and haemoglobin A1c (HbA1c) concentrations. Serum vitamin D and HbA1c were measured on admission, or within 1 month of admission to ICU. Primary outcome of interest was mortality. Secondary outcomes included time intubated, ICU stay duration and ICU-related morbidity.ResultsSeventy-two patients; 54 (75%) men, mean age 57.1 (±9.8) years, were included. Overall, mortality was 24 (33%). No significant association with mortality was observed across BMI categories. In the survival arm admission, HbA1c (mmol/mol) was lower, 50.2 vs 60.8, but this was not statistically significant. Vitamin D status did not significantly associate with mortality (p=0.131). However, 32% of patients with low vitamin D (26 IU/L. Serum zinc and selenium, and vitamin B12 and folate levels were measured in 46% and 26% of patients, respectively.Discussion/conclusionIncreased adiposity and deranged glucose homeostasis may potentially increase risk of COVID-19 infection and severity, possibly relating to impaired lung and metabolic function, increased proinflammatory and prothrombotic mechanisms. Vitamin D deficiency may also associate with poorer outcomes and mortality, supporting a possible role of vitamin D in immune function specific to pulmonary inflammation and COVID-19 pathophysiology. There are plausible associations between raised BMI, glycaemic control, vitamin D status and poor prognosis, as seen in wider studies; however, in this service evaluation audit during the first wave of the pandemic in the UK, with a limited data set available for this analysis, the associations did not reach statistical significance. Further research is needed into specific nutritional markers influencing critical care admissions with COVID-19.
      Keywords: Open access, COVID-19, Nutrition Interactions with COVID-19
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000270
      Issue No: Vol. 4, No. 2 (2021)
  • Impact evaluation of the efficacy of different doses of vitamin D
           supplementation during pregnancy on pregnancy and birth outcomes: a
           randomised, controlled, dose comparison trial in Pakistan

    • Authors: Nausheen, S; Habib, A, Bhura, M, Rizvi, A, Shaheen, F, Begum, K, Iqbal, J, Ariff, S, Shaikh, L, Raza, S. S, Soofi, S. B.
      Pages: 425 - 434
      Abstract: BackgroundVitamin D deficiency during pregnancy is a public health problem in Pakistan and is prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and vitamin D deficiency in both the mother and her newborn.MethodsWe conducted a double-blinded, randomised controlled trial in Karachi, Pakistan to evaluate the effect of different doses of vitamin D supplementation during pregnancy on biochemical markers (serum 25(OH)D, calcium, phosphorus and alkaline phosphatase) in women and neonates, and on pregnancy and birth outcomes (gestational diabetes, pre-eclampsia, low birth weight, preterm births and stillbirths).ResultsPregnant women (N=350) in their first trimester were recruited and randomised to three treatment groups of vitamin D supplementation: 4000 IU/day (group A, n=120), 2000 IU/day (group B, n=115) or 400 IU/day (group C, n=115). Women and their newborn in group A had the lowest vitamin D deficiency at endline (endline: 75.9%; neonatal: 64.9%), followed by group B (endline: 84.9%; neonatal: 73.7%) and then the control group (endline: 90.2%; neonatal: 91.8%). Vitamin D deficiency was significantly lower in group A than in group C (p=0.006) among women at endline and lower in both groups A and B than in the control group (p=0.001) in neonates. Within groups, serum 25(OH)D was significantly higher between baseline and endline in group A and between maternal baseline and neonatal levels in groups A and B. Participant serum 25(OH)D levels at the end of the trial were positively correlated with those in intervention group A (4000 IU/day) (β=4.16, 95% CI 1.6 to 6.7, p=0.002), with food group consumption (β=0.95, 95% CI 0.01 to 1.89, p=0.047) and with baseline levels of serum 25(OH)D (β=0.43, 95% CI 0.29 to 0.58, p
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000304
      Issue No: Vol. 4, No. 2 (2021)
  • The role of trained champions in sustaining and spreading nutrition care
           improvements in hospital: qualitative interviews following an
           implementation study

    • Authors: Laur, C; Bell, J, Valaitis, R, Ray, S, Keller, H.
      Pages: 435 - 446
      Abstract: BackgroundMany patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1.MethodsSemistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups.ResultsTen interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Concepts of change management, implementation, adaptation, sustainability and spread in order to embed changes into routine practice. Champions also needed the Competence, including the skills to identify, support and empower new champions, thus sharing the responsibility. Capacity, including time, resources and leadership support, was the most important facilitator for staying engaged, and the most challenging. All themes identified in qualitative interviews in phase 1 were applicable 4 years later and were mentioned by new phase 2 hospitals. There was increased emphasis on audit and feedback, and the need for standardisation to support embedding into current practice.ConclusionTrained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements.Trial registration number NCT02800304, NCT03391752.
      Keywords: Open access, Implementing Effective Interventions in Healthcare
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000281
      Issue No: Vol. 4, No. 2 (2021)
  • Cross-sectional associations of schoolchildrens fruit and vegetable
           consumption, and meal choices, with their mental well-being: a
           cross-sectional study

    • Authors: Hayhoe, R; Rechel, B, Clark, A. B, Gummerson, C, Smith, S. J. L, Welch, A. A.
      Pages: 447 - 462
      Abstract: BackgroundPoor mental well-being is a major issue for young people and is likely to have long-term negative consequences. The contribution of nutrition is underexplored. We, therefore, investigated the association between dietary choices and mental well-being among schoolchildren.MethodsData from 7570 secondary school and 1253 primary school children in the Norfolk Children and Young People Health and Well-being Survey, open to all Norfolk schools during October 2017, were analysed. Multivariable linear regression was used to measure the association between nutritional factors and mental well-being assessed by the Warwick-Edinburgh Mental Well-being Scale for secondary school pupils, or the Stirling Children’s Well-being Scale for primary school pupils. We adjusted all analyses for important covariates including demographic, health variables, living/home situation and adverse experience variables.ResultsIn secondary school analyses, a strong association between nutritional variables and well-being scores was apparent. Higher combined fruit and vegetable consumption was significantly associated with higher well-being: well-being scores were 3.73 (95% CI 2.94 to 4.53) units higher in those consuming five or more fruits and vegetables (p
      Keywords: Open access, Press releases
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2020-000205
      Issue No: Vol. 4, No. 2 (2021)
  • Effect of milk supplementation on the status of micronutrients among rural
           school children aged 5-19 years in a tribal predominating district of

    • Authors: Kumar, C; Rana, R. K, Kumar, M, Kujur, A, Kashyap, V, Singh, S. B, Sagar, V, Kumari, N, Kumar, D.
      Pages: 463 - 468
      Abstract: BackgroundIn the tribal state of Jharkhand, there have been very few studies on micronutrient deficiency and how it is addressed among school children. This study was conceived and undertaken to assess the effect of milk supplementation on the micronutrient status of school children.DesignA comparative observational study was conducted among school children of a tribal district in India during 2017–2018. Two groups of schools/clusters were randomly selected, one with milk supplementation and the other without supplementation. A total of 318 children from the two groups of schools were recruited for biochemical analysis of certain micronutrients, such as calcium, vitamin D, vitamin B12 and iron (haemoglobin level), using cluster random sampling. Data were analysed using SPSS V.20.0 software, and multiple logistic regression analysis was done to determine the predictors of serum calcium and vitamin B12 level among school children.ResultsAlmost all children from both groups had vitamin D deficiency. A higher risk of lower serum vitamin B12 level (OR 2.59, 95% CI 1.61 to 4.16) and calcium level (OR 3.36, 95% CI 1.74 to 6.49) was observed in children of the control group. The difference in the proportion of anaemia in the two study groups was found to be statistically insignificant. Milk consumption was found to be the only significant predictor of normal vitamin B12 and calcium level in the present study.ConclusionsIn this study, it was concluded that milk consumption may help in improving the calcium and vitamin B12 status of school children of a tribal state, whereas it does not have any significant effect on vitamin D level.
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2020-000223
      Issue No: Vol. 4, No. 2 (2021)
  • Association between severity of COVID-19 symptoms and habitual food intake
           in adult outpatients

    • Authors: Salazar-Robles, E; Kalantar-Zadeh, K, Badillo, H, Calderon-Juarez, M, Garcia-Barcenas, C. A, Ledesma-Perez, P. D, Lerma, A, Lerma, C.
      Pages: 469 - 478
      Abstract: ObjectiveTo evaluate the association between habitual frequency of food intake of certain food groups during the COVID-19 pandemic and manifestations of COVID-19 symptoms in adult outpatients with suspected SARS-CoV-2 infection.DesignWe included 236 patients who attended an outpatient clinic for suspected COVID-19 evaluation. Severity of symptoms, habitual food intake frequency, demographics and Bristol chart scores were obtained before diagnostic confirmation with real-time reverse transcriptase PCR using nasopharyngeal swab.ResultsThe results of the COVID-19 diagnostic tests were positive for 103 patients (44%) and negative for 133 patients (56%). In the SARS-CoV-2-positive group, symptom severity scores had significant negative correlations with habitual intake frequency of specific food groups. Multivariate binary logistic regression analysis adjusted for age, sex and occupation confirmed that SARS-CoV-2-positive patients showed a significant negative association between having higher symptom severity and the habitual intake frequency of ‘legumes’ and ‘grains, bread and cereals’.ConclusionsIncrease in habitual frequency of intake of ‘legumes’, and ‘grains, bread and cereals’ food groups decreased overall symptom severity in patients with COVID-19. This study provides a framework for designing a protective diet during the COVID-19 pandemic and also establishes a hypothesis of using a diet-based intervention in the management of SARS-CoV-2 infection, which may be explored in future studies.
      Keywords: Open access, COVID-19, Nutrition Interactions with COVID-19
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000348
      Issue No: Vol. 4, No. 2 (2021)
  • Child nutritional status as screening tool for identifying undernourished
           mothers: an observational study of mother-child dyads in Mogadishu,
           Somalia, from November 2019 to March 2020

    • Authors: Zacks, R; Ververs, M, Hwang, C, Mahdi, A, Leidman, E.
      Pages: 501 - 509
      Abstract: BackgroundActive screening of only pregnant and lactating mothers (PLMs) excludes other mothers of reproductive age susceptible to undernutrition. Our analysis evaluated if mothers presenting with wasted children were more likely to be undernourished themselves.MethodsThe observational study enrolled mother and child dyads presenting to an outpatient facility in Mogadishu, Somalia, between November 2019 and March 2020. Trained nurses recorded lower extremity oedema for children aged 6–59 months, parity and gestational status for women aged 19–50 years and age, access to care, height/length, mid-upper arm circumference (MUAC) and weight for both. Weight-for-height z-score (WHZ) for children and body mass index (BMI) for mothers were calculated using standard procedures. Wasting was defined as WHZ
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000302
      Issue No: Vol. 4, No. 2 (2021)
  • Comparing McDonalds food marketing practices on official Instagram
           accounts across 15 countries

    • Authors: Cassidy, O; Shin, H. W, Song, E, Jiang, E, Harri, R, Cano, C, Vedanthan, R, Ogedegbe, G, Bragg, M.
      Pages: 510 - 518
      Abstract: BackgroundSocial media advertising by fast food companies continues to increase globally, and exposure to food advertising contributes to poor diet and negative health outcomes (eg, cardiovascular disease). McDonald’s—the largest fast food company in the world—operates in 101 countries, but little is known about their marketing techniques in various regions. The objective of this study was to compare the social media advertising practices of McDonald’s—the largest fast food company in the world—in 15 high-income, upper-middle-income and lower-middle-income countries.MethodsWe randomly selected official McDonald’s Instagram accounts for 15 high-income, upper-middle-income and lower-middle-income countries. We captured all the screenshots that McDonald’s posted on those Instagram accounts from September to December 2019. We quantified the number of followers, ‘likes’, ‘comments’ and video views associated with each account in April 2020. We used content analysis to examine differences in the marketing techniques.ResultsThe 15 accounts collectively maintained 10 million followers and generated 3.9 million ‘likes’, 164 816 comments and 38.2 million video views. We identified 849 posts. The three lower-middle-income countries had more posts (n=324; M, SD=108.0, 38.2 posts) than the five upper-middle-income countries (n=227; M, SD=45.4, 37.5 posts) and seven high-income countries (n=298; M, SD=42.6, 28.2 posts). Approximately 12% of the posts in high-income countries included child-targeted themes compared with 22% in lower-middle-income countries. Fourteen per cent of the posts in high-income countries included price promotions and free giveaways compared with 40% in lower-middle-income countries.ConclusionsSocial media advertising has enabled McDonald’s to reach millions of consumers in lower-middle-income and upper-middle-income countries with disproportionately greater child-targeted ads and price promotions in lower-middle-income countries. Such reach is concerning because of the increased risk of diet-related illnesses, including cardiovascular disease, in these regions.
      Keywords: Open access, Press releases
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2021-000229
      Issue No: Vol. 4, No. 2 (2021)
  • Fruit and vegetable consumption and the risk of type 2 diabetes: a
           systematic review and dose-response meta-analysis of prospective studies

    • Authors: Halvorsen, R. E; Elvestad, M, Molin, M, Aune, D.
      Pages: 519 - 531
      Abstract: BackgroundThe association between intake of fruit and vegetables and their subtypes, and the risk of type 2 diabetes has been investigated in several studies, but the results have been inconsistent.ObjectiveWe conducted an updated systematic review and dose–response meta-analysis of prospective studies on intakes of fruit and vegetables and fruit and vegetable subtypes and the risk of type 2 diabetes.DesignPubMed and Embase databases were searched up to 20 October 2020. Prospective cohort studies of fruit and vegetable consumption and type 2 diabetes mellitus were included. Summary relative risks (RRs) and 95% CIs were estimated using a random effects model.ResultsWe included 23 cohort studies. The summary RR for high versus low intake and per 200 g/day were 0.93 (95% CI: 0.89 to 0.98, I2=0%, n=10 studies) and 0.98 (95% CI: 0.95 to 1.01, I2=37.8%, n=7) for fruit and vegetables combined, 0.93 (95% CI: 0.90 to 0.97, I2=9.3%, n=20) and 0.96 (95% CI: 0.92 to 1.00, I2=68.4%, n=19) for fruits and 0.95 (95% CI: 0.88 to 1.02, I2=60.4%, n=17) and 0.97 (95% CI: 0.94 to 1.01, I2=39.2%, n=16) for vegetables, respectively. Inverse associations were observed for apples, apples and pears, blueberries, grapefruit and grapes and raisins, while positive associations were observed for intakes of cantaloupe, fruit drinks, fruit juice, brussels sprouts, cauliflower and potatoes, however, most of these associations were based on few studies and need further investigation in additional studies.ConclusionsThis meta-analysis found a weak inverse association between fruit and vegetable intake and type 2 diabetes risk. There is indication of both inverse and positive associations between intake of several fruit and vegetables subtypes and type 2 diabetes risk, however, further studies are needed before firm conclusions can be made.
      Keywords: Open access
      PubDate: 2021-12-29T22:21:24-08:00
      DOI: 10.1136/bmjnph-2020-000218
      Issue No: Vol. 4, No. 2 (2021)
  • When Mendelian randomisation fails

    • Authors: Kohlmeier, M; Baah, E.
      Pages: 1 - 3
      Keywords: Open access, Nutrition Interactions with COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000265
      Issue No: Vol. 4, No. 1 (2021)
  • Impact of supervised beego, a traditional Chinese water-only fasting, on
           thrombosis and haemostasis

    • Authors: Fang, Y; Gu, Y, Zhao, C, Lv, Y, Qian, J, Zhu, L, Yuan, N, Zhang, S, Wang, L, Li, M, Zhang, Q, Xu, L, Wei, W, Li, L, Ji, L, Gao, X, Zhang, J, Shen, Y, Chen, Z, Wang, G, Dai, K, Wang, J.
      Pages: 4 - 17
      Abstract: Beego is a traditional Chinese complete water-only fasting practice initially developed for spiritual purposes, later extending to physical fitness purposes. Beego notably includes a psychological induction component that includes meditation and abdominal breathing, light body exercise and ends with a specific gradual refeeding program before returning to a normal diet. Beego has regained its popularity in recent decades in China as a strategy for helping people in subhealthy conditions or with metabolic syndrome, but we are unaware of any studies examining the biological effects of this practice. To address this, we here performed a longitudinal study of beego comprising fasting (7 and 14 day cohorts) and a 7-day programmed refeeding phase. In addition to detecting improvements in cardiovascular physiology and selective reduction of blood pressure in hypertensive subjects, we observed that beego decreased blood triacylglycerol (TG) selectively in TG-high subjects and increased cholesterol in all subjects during fasting; however, the cholesterol levels were normalised after completion of the refeeding program. Strikingly, beego reduced platelet formation, activation, aggregation and degranulation, resulting in an alleviated thrombosis risk, yet maintained haemostasis by sustaining levels of coagulation factors and other haemostatic proteins. Mechanistically, we speculate that downregulation of G6B and MYL9 may influence the observed beego-mediated reduction in platelets. Fundamentally, our study supports that supervised beego reduces thrombosis risk without compromising haemostasis capacity. Moreover, our results support that beego under medical supervision can be implemented as non-invasive intervention for reducing thrombosis risk, and suggest several lines of intriguing inquiry for future studies about this fasting practice (http://www.chictr.org.cn/index.aspx, number, ChiCTR1900027451).
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000183
      Issue No: Vol. 4, No. 1 (2021)
  • Possible causalities between malnutrition and academic performances among
           primary schoolchildren: a cross-sectional study in rural Madagascar

    • Authors: Aiga, H; Abe, K, Randriamampionona, E, Razafinombana, A. R.
      Pages: 18 - 29
      Abstract: BackgroundThe importance of addressing malnutrition is increasing in the context of children’s health and their academic performances. Childhood malnutrition further could reduce a country’s economic productivity. No earlier study adequately estimated the causalities between schoolchildren’s malnutrition and their academic performances. How nutritional status contributes to children’s academic performances has never been reported from Madagascar. This study aims to estimate the possible causalities between their nutritional status and academic performances in rural Madagascar.MethodsA cross-sectional household survey was conducted in Antananarivo-Avaradrano district, Madagascar, from November to December 2017, by targeting 404 first and second graders 5–14 years of age enrolled in 10 public primary schools. Children’s anthropometric measurements and structured interviews with their mothers/caregivers were conducted. Children’s academic performances data (mathematical and national language proficiencies) were collected at each school. To estimate associations between their malnutrition and academic performances, bivariate and multivariate analyses were conducted. To estimate their possible causalities between them, three conditions were examined (crude covariational relationship, covariational relationship through controlling for a third variable and temporal precedence).ResultsFour independent variables produced significantly positive coefficients with mathematical proficiency in multivariate analysis. Of the four, ‘not being stunted’ and ‘attendance rate’ were estimated to be possible causes of higher mathematical proficiency because they satisfied all the three conditions for a causality. On the other hand, three independent variables produced significantly positive coefficients with national language proficiency in multivariate analysis. Yet, none of them were estimated to be possible causes of higher national language proficiency.ConclusionsA hypothetical causal path indicates that ‘not being stunted’ is likely to have caused higher ‘attendance rate’ and thereby higher ‘mathematical proficiency’ in a two-step manner. This study is the first attempt to estimate the possible causalities between schoolchildren’s nutritional status and their academic performances in Madagascar.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000192
      Issue No: Vol. 4, No. 1 (2021)
  • Assessment of vitamin B12 deficiency and B12 screening trends for patients
           on metformin: a retrospective cohort case review

    • Authors: Martin, D; Thaker, J, Shreve, M, Lamerato, L, Budzynska, K.
      Pages: 30 - 35
      Abstract: ObjectivesOur study investigated the use of vitamin B12 testing in a large cohort of patients on metformin and assesses appropriateness and benefits of screening recommendations for vitamin B12 deficiency.DesignThis retrospective cohort study included insured adult patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin to establish compliance. The comparison group was not exposed to metformin. Primary outcome was incidence of B12 deficiency diagnosed in patients on metformin. Secondary outcome was occurrence of B12 testing in the patient population on metformin. Records dated through 31 December 2018 were analysed.SettingLarge hospital system consisting of inpatient and outpatient data base.ParticipantsA diverse, adult, insured population of patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin.ResultsOf 13 489 patients on metformin, 6051 (44.9%) were tested for vitamin B12 deficiency, of which 202 (3.3%) tested positive (vs 2.2% of comparisons). Average time to test was 990 days. Average time to test positive for deficiency was 1926 days. Factors associated with testing were linked to sex (female, 47.8%), older age (62.79% in patients over 80 years old), race (48.98% white) and causes of malabsorption (7.11%). Multivariable logistic regression showed older age as the only factor associated with vitamin B12 deficiency, whereas African-American ethnicity approached significance as a protective factor.ConclusionsBased on our study’s findings of vitamin B12 deficiency in patients on metformin who are greater than 65 years old and have been using it for over 5 years, we recommend that physicians consider screening in these populations.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000193
      Issue No: Vol. 4, No. 1 (2021)
  • Body mass index, prudent diet score and social class across three
           generations: evidence from the Hertfordshire Intergenerational Study

    • Authors: Carter, S; Parsons, C, Ward, K, Clynes, M, Dennison, E. M, Cooper, C.
      Pages: 36 - 41
      Abstract: BackgroundStudies describing body mass index (BMI) and prudent diet score have reported that they are associated between parents and children. The Hertfordshire Intergenerational Study, which contains BMI, diet and social class information across three generations, provides an opportunity to consider the influence of grandparental and parental BMI and prudent diet score across multiple generations, and the influence of grandparental and parental social class on child BMI.MethodsLinear regressions examining the tracking of adult BMI and prudent diet score across three generations (grandparent (F0), parent (F1) and child (F2)) were run from parent to child and from grandparent to grandchild. Linear mixed models investigated the influence of F0 and F1 BMI or prudent diet score on F2 BMI and prudent diet score. Linear regressions were run to determine whether social class and prudent diet score of parents and grandparents influenced the BMI of children and grandchildren.ResultsBMI was significantly associated across each generational pair and from F0 to F1 in multilevel models. Prudent diet score was significantly positively associated between grandparents and grandchildren. Lower grandparental and parental social class had a significantly positive association with F2 BMI (F0 low social class: b=1.188 kg/m2, 95% CI 0.060 to 2.315, p=0.039; F1 middle social class: b=2.477 kg/m2, 95% CI 0.726 to 4.227, p=0.006).ConclusionAdult BMI tracks across generations of the Hertfordshire Intergenerational Study, and child BMI is associated with parental and grandparental social class. The results presented here add to literature supporting behavioural and social factors in the transmission of BMI across generations.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000178
      Issue No: Vol. 4, No. 1 (2021)
  • No evidence that vitamin D is able to prevent or affect the severity of
           COVID-19 in individuals with European ancestry: a Mendelian randomisation
           study of open data

    • Authors: Amin, H. A; Drenos, F.
      Pages: 42 - 48
      Abstract: BackgroundUpper respiratory tract infections are reportedly more frequent and more severe in individuals with lower vitamin D levels. Based on these findings, it has been suggested that vitamin D can prevent or reduce the severity of COVID-19.MethodsWe used two-sample Mendelian randomisation (MR) to assess the causal effect of vitamin D levels on SARS-CoV-2 infection risk and COVID-19 severity using publicly available data. We also carried out a genome-wide association analysis (GWA) of vitamin D deficiency in the UK Biobank (UKB) and used these results and two-sample MR to assess the causal effect of vitamin D deficiency on SARS-CoV-2 infection risk and COVID-19 severity.ResultsWe found no evidence that vitamin D levels causally affect the risk of SARS-CoV-2 infection (ln(OR)=0.17 (95% CI –0.22 to 0.57, p=0.39)) nor did we find evidence that vitamin D levels causally affect COVID-19 severity (ln(OR)=0.36 (95% CI –0.89 to 1.61, p=0.57)). Based on our GWA analysis, we found that 17 independent variants are associated with vitamin D deficiency in the UKB. Using these variants as instruments for our two-sample MR analyses, we found no evidence that vitamin D deficiency causally affects the risk of SARS-CoV-2 infection (ln(OR)=–0.04 (95% CI –0.1 to 0.03, p=0.25)) nor did we find evidence that vitamin D deficiency causally affects COVID-19 severity (ln(OR)=–0.24 (95% CI –0.55 to 0.08, p=0.14)).ConclusionsIn conclusion, we found no evidence that vitamin D is protective against SARS-CoV-2 infection or COVID-19 severity. Our data support the recent statement by the National Institute for Health and Care Excellence that the use of vitamin D supplementation to mitigate COVID-19 is not supported by the available data.
      Keywords: Open access, Nutrition Interactions with COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000151
      Issue No: Vol. 4, No. 1 (2021)
  • Estimating the potential impact of Australias reformulation programme on
           households sodium purchases

    • Authors: Coyle, D; Shahid, M, Dunford, E, Ni Mhurchu, C, Mckee, S, Santos, M, Popkin, B, Trieu, K, Marklund, M, Neal, B, Wu, J.
      Pages: 49 - 58
      Abstract: BackgroundOn average, Australian adults consume 3500 mg sodium per day, almost twice the recommended maximum level of intake. The Australian government through the Healthy Food Partnership initiative has developed a voluntary reformulation programme with sodium targets for 27 food categories. We estimated the potential impact of this programme on household sodium purchases (mg/day per capita) and examined potential differences by income level. We also modelled and compared the effects of applying the existing UK reformulation programme targets in Australia.MethodsThis study used 1 year of grocery purchase data (2018) from a nationally representative consumer panel of Australian households (Nielsen Homescan) that was linked with a packaged food and beverage database (FoodSwitch) that contains product-specific sodium information. Potential reductions in per capita sodium purchases were calculated and differences across income level were assessed by analysis of variance. All analyses were modelled to the Australian population in 2018.ResultsA total of 7188 households were included in the analyses. The Healthy Food Partnership targets covered 4307/26 728 (16.1%) unique products, which represented 22.3% of all packaged foods purchased by Australian households in 2018. Under the scenario that food manufacturers complied completely with the targets, sodium purchases will be reduced by 50 mg/day per capita, equivalent to 3.5% of sodium currently purchased from packaged foods. Reductions will be greater in low-income households compared with high-income households (mean difference –7 mg/day, 95% CI –4 to –11 mg/day, p
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000173
      Issue No: Vol. 4, No. 1 (2021)
  • Three-year review of a capacity building pilot for a sustainable regional
           network on food, nutrition and health systems education in India

    • Authors: Buckner, L; Carter, H, Ahankari, A, Banerjee, R, Bhar, S, Bhat, S, Bhattacharya, Y, Chakraborty, D, Douglas, P, Fitzpatrick, L, Maitra-Nag, S, Muhkerjee, S, Ray, S, Roy, A, Saha, A, Sayegh, M, Rajput-Ray, M, Tsimpli, I, Ray, S.
      Pages: 59 - 68
      Abstract: BackgroundIn Kolkata (India), there are high rates of malnourished children (45.9%) under the age of three, impacting growth, organ development, function, and cognition. Mothers have a major role to play during this crucial development stage, with research showing nutrition knowledge, attitudes and practices (KAP) of mothers are important determinants of childhood malnutrition.AimsTo document 3 years of capacity building towards a sustainable nutrition education network in Kolkata, India, while assessing the ability to perform data collection in the form of needs assessments, impact assessments and capacity reviews.MethodsDescriptive review and analysis of engagement and impact from 3 years of work by the NNEdPro Global Centre for Nutrition and Health, initiating locally led nutrition education interventions. Mapping to the Indian National Nutrition Strategy was also performed to review adherence to nationwide priorities surrounding nutrition and determine the wider application potential of the network.ResultsTwo simultaneous projects were taken forward by a team of local healthcare professionals and student champions. Project 1—medical college workshops for medical student nutrition education with added focus on underserved populations, Project 2—preparation for a ‘Mobile Teaching Kitchen’ (MTK) in marginalised communities to empower local women as nutrition educators.Data collection methods used for analysing markers of impact and sustainability were semi-structured interviews of the community members, and KAP questionnaires to assess response to educational sessions.ConclusionWith local support it is possible to create and sustain fieldwork for an extended period with meaningful outputs and impact. This initiative demonstrates that it is possible to use healthcare professionals, students and volunteers with low-intensity training and a low-cost approach to produce action research with considerable impact and results in rapid, reliable and robust manner.
      Keywords: Open access, Global Food Security
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000180
      Issue No: Vol. 4, No. 1 (2021)
  • Prevalence and predictors of gestational diabetes mellitus among pregnant
           women attending antenatal clinic in Dodoma region, Tanzania: an analytical
           cross-sectional study

    • Authors: Mdoe, M. B; Kibusi, S. M, Munyogwa, M. J, Ernest, A. I.
      Pages: 69 - 79
      Abstract: IntroductionGestational diabetes mellitus (GDM) is rapidly increasing worldwide. Globally, 18.4 million pregnancies are complicated by GDM. Despite its known effect, GDM screening is not part of routine antenatal services in Tanzania. There is paucity of data on the magnitude and risk factors for GDM. Therefore, this study sought to determine prevalence and predictors of GDM among pregnant women in Dodoma region, Tanzania from March to August 2018.Research design and methodsA cross-sectional study was carried out in Dodoma region, Tanzania between April and August of 2018. A total of 582 pregnant women were recruited from four local health facilities, where purposive sampling procedure was used to select the region, districts and health facilities. Simple random sampling was used to select study participants. Screening and diagnosis of GDM were performed using the 2013 WHO criteria. Descriptive and inferential analyses were performed using SPSS V.23 to determine prevalence and independent predictors of GDM.ResultsAmong 582 participants, 160 (27.5%) participants were diagnosed with GDM. GDM was more prevalent in urban areas than rural areas, among overweight participants, among participants with a history of a large for gestational age baby, among participants with a history of caesarean section, and among participants with college or university education. Multiple logistic regression analysis showed that maternal age above 35 years (adjusted OR (AOR) 3.115 (95% CI: 1.165 to 8.359)), pre-eclampsia (AOR 3.684 (95% CI: 1.202 to 5.293)), low physical activity level (AOR 4.758 (95% CI: 2.232 to 10.143)), lack of awareness of GDM (AOR 6.371 (95% CI: 1.944 to 13.919)), alcohol use (AOR 4.477 (95% CI: 1.642 to 12.202)) and family history of diabetes (AOR 2.344 (95% CI: 1.239 to 4.434)) were significantly associated with GDM.ConclusionsPrevalence of GDM is relatively high in Dodoma region. Most pregnant women are unaware of the condition such that it leads to a high-risk lifestyle. Besides, GDM significantly contributes to the number of high-risk pregnancies that go undetected and suboptimally managed. The antenatal care centres offer an optimum platform for screening, preventing and treating GDM by prioritising high-risk women.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000149
      Issue No: Vol. 4, No. 1 (2021)
  • Gender-specific association between carbohydrate consumption and blood
           pressure in Chinese adults

    • Authors: Liu, R; Mi, B, Zhao, Y, Li, Q, Dang, S, Yan, H.
      Pages: 80 - 89
      Abstract: BackgroundThe association between dietary carbohydrate consumption and blood pressure (BP) is controversial. The present study aimed to evaluate the possible gender-specific association of carbohydrate across the whole BP distribution.MethodCross-sectional survey including 2241 rural adults was conducted in northwestern China in 2010. BP was measured by trained medical personnel. Dietary information was collected by semiquantitative Food-Frequency Questionnaire. Multivariate quantile regression model was used to estimate the association between total carbohydrates consumption and systolic BP (SBP) and diastolic BP (DBP) at different quantiles. Gender-specific β coefficient and its 95% CI was calculated.ResultsThe average carbohydrate intake was 267.4 (SD 112.0) g/day in males and 204.9 (SD 90.7) g/day in females, with only 10.6% of males and 6.5% females consumed at least 65% of total energy from carbohydrates. And more than 80% carbohydrates were derived from refined grains. In females, increased total carbohydrates intake was associated with adverse SBP and DBP. An additional 50 g carbohydrates per day was positively associated with SBP at low and high quantiles (10th–20th and 60th–80th) and with DBP almost across whole distribution (30th–90th), after adjusting for age, fortune index, family history of hypertension, body mass index, physical activity level, alcohol intake and smoke, energy, two nutrient principal components, protein and sodium intake. Both relatively low and high carbohydrate intake were associated with increased SBP, with minimum level observed at 130–150 g carbohydrate intake per day from restricted cubic splines. However, no significant associations were observed in males.ConclusionsHigher total carbohydrates consumption might have an adverse impact on both SBP and DBP in Chinese females but not males. Additionally, the positive association varies across distribution of BP quantiles. Further research is warranted to validate these findings and clarify the causality.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000165
      Issue No: Vol. 4, No. 1 (2021)
  • Genetic factors associated with obesity risks in a Kazakhstani population

    • Authors: Razbekova, M; Issanov, A, Chan, M.-Y, Chan, R, Yerezhepov, D, Kozhamkulov, U, Akilzhanova, A, Chan, C.-K.
      Pages: 90 - 101
      Abstract: ObjectivesThere is limited published literature on the genetic risks of chronic inflammatory related disease (eg, obesity and cardiovascular disease) among the Central Asia population. The aim is to determine potential genetic loci as risk factors for obesity for the Kazakhstani population.SettingKazakhstan.ParticipantsOne hundred and sixty-three Kazakhstani nationals (ethnic groups: both Russians and Kazakhs) were recruited for the cross-sectional study. Linear regression models, adjusted for confounding factors, were used to examine the genetic associations of single nucleotide polymorphisms (SNPs) in 19 genetic loci with obesity (73 obese/overweight individuals and 90 controls).ResultsOverall, logistic regression analyses revealed genotypes C/T in CRP (rs1205), A/C in AGTR1 (rs5186), A/G in CBS (rs234706), G/G in FUT2 (rs602662), A/G in PAI-1 (rs1799889), G/T (rs1801131) and A/G (rs1801133) in MTHFR genes significantly decrease risk of overweight/obesity. After stratification for ethnicity, rs234706 was significantly associated with overweight/obesity in both Russians and Kazakhs, while rs1800871 was significant in Kazakhs only.ConclusionsThis study revealed that variations in SNPs known to be associated with cardiovascular health can also contribute to the risks of developing obesity in the population of Kazakhstan.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000139
      Issue No: Vol. 4, No. 1 (2021)
  • Weight loss, hypertension and mental well-being improvements during
           COVID-19 with a multicomponent health promotion programme on Zoom: a
           service evaluation in primary care

    • Authors: Walker, L; Smith, N, Delon, C.
      Pages: 102 - 110
      Abstract: BackgroundObesity is a risk factor for complications from SARS-CoV-2 infection, increasing the need for effective weight management measures in primary care. However, in the UK, COVID-19 restrictions have hampered primary care weight management referral and delivery, and COVID-19 related weight gain has been reported. The present study evaluated outcomes from a multicomponent weight loss and health promotion programme in UK primary care, delivered remotely due to COVID-19 restrictions.MethodPatients with obesity, type 2 diabetes or pre-diabetes attended six 90 min sessions over 10 weeks on Zoom. The dietary component comprised a low-carbohydrate ‘real food’ approach, augmented with education on physical activity, intermittent fasting, gut health, stress management, sleep and behaviour change. Anthropometric and cardiometabolic data were self-reported. Mental well-being was assessed with the Warwick Edinburgh Mental Wellbeing Scale. Subjective outcomes and participant feedback about the programme were collected with an anonymous online survey.ResultsTwenty participants completed the programme. Weight loss and improvements in body mass index, waist circumference, systolic and diastolic blood pressure and mental well-being achieved statistical and clinical significance. Mean weight loss (5.8 kg) represented a 6.5% weight loss. Participants’ subjective outcomes included weight loss without hunger (67%) and increased confidence in their ability to improve health (83%). All participants reported the usage of Zoom to access the programme as acceptable with 83% reporting it worked well.ConclusionA multicomponent weight loss and health promotion programme with a low-carbohydrate dietary component, clinically and statistically significantly improved health outcomes including weight status, blood pressure and mental well-being in a group of primary care patients when delivered remotely. Further research is warranted.
      Keywords: Open access, COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000219
      Issue No: Vol. 4, No. 1 (2021)
  • Effect of overweight/obesity on caesarean section occurrence among
           reproductive-aged women in Ethiopia: a secondary data analysis

    • Authors: Endalifer, M. L; Diress, G, Almaw, H, Endalifer, B. L.
      Pages: 111 - 114
      Abstract: BackgroundThe burden of overweight/obesity increased worldwide and it has unpredictable effect on maternal morbidity and mortality. Different adverse perinatal outcomes observed in overweight/obese women, of those caesarean section occurred frequently. In Ethiopia, the national caesarean section and overweight/obesity rate among reproductive-aged women increased tremendously. Therefore, we intend to assess the association between overweight/obesity with caesarean section in Ethiopia.MethodThe data were extracted from the 2016 Ethiopia Demographic and Health Survey in nine regions and two city administrations. A stratified two-stage random sampling design was used to collect data. The exposure variable was overweight/obesity, and the outcome variable was a caesarean section. The final analytical sample consisted of 6928 participants. SPSS V.23 was used to analyse the data. Descriptive statistics and cross-tabulation were performed to describe the study variables. Univariable and multivariable logistic regression models were regressed.ResultsThe prevalence of caesarean section among women aged between 15–49 years old who gave birth in the last 5 years was 245 (3.54%). The occurrence of caesarean section among overweight/obese women was 2.05 higher as compared with normal-weight women (AOR: 2.05, 95% CI: 1.09 - 3.83).Conclusion and recommendationPromoting weight reduction programmes throughout the country would have a greater contribution to reduce caesarean section rate and health cost, and to improve the health of the mother.
      Keywords: Open access, Implementing Effective Interventions in Healthcare
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000121
      Issue No: Vol. 4, No. 1 (2021)
  • How fragile are Mediterranean diet interventions' A
           research-on-research study of randomised controlled trials

    • Authors: Grammatikopoulou, M. G; Nigdelis, M. P, Theodoridis, X, Gkiouras, K, Tranidou, A, Papamitsou, T, Bogdanos, D. P, Goulis, D. G.
      Pages: 115 - 131
      Abstract: IntroductionThe Mediterranean diet (MD) is a traditional regional dietary pattern and a healthy diet recommended for the primary and secondary prevention of various diseases and health conditions. Results from the higher level of primary evidence, namely randomised controlled trials (RCTs), are often used to produce dietary recommendations; however, the robustness of RCTs with MD interventions is unknown.MethodsA systematic search was conducted and all MD RCTs with dichotomous primary outcomes were extracted from PubMed. The fragility (FI) and the reverse fragility index (RFI) were calculated for the trials with significant and non-significant comparisons, respectively.ResultsOut of 27 RCTs of parallel design, the majority failed to present a significant primary outcome, exhibiting an FI equal to 0. The median FI of the significant comparisons was 5, ranging between 1 and 39. More than half of the comparisons had an FI
      Keywords: Open access, Implementing Effective Interventions in Healthcare
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000188
      Issue No: Vol. 4, No. 1 (2021)
  • COVID-19 illness in relation to sleep and burnout

    • Authors: Kim, H; Hegde, S, LaFiura, C, Raghavan, M, Luong, E, Cheng, S, Rebholz, C. M, Seidelmann, S. B.
      Pages: 132 - 139
      Abstract: BackgroundSleep habits and burnout have been shown to be associated with increase in infectious diseases, but it is unknown if these factors are associated with risk of COVID-19. We assessed whether sleep and self-reported burnout may be risk factors for COVID-19 among high-risk healthcare workers (HCWs).MethodsFrom 17 July to 25 September 2020, a web-based survey was administered to HCWs in six countries (France, Germany, Italy, Spain, UK, USA) with a high frequency of workplace exposure. Participants provided information on demographics, sleep (number of sleep hours at night, daytime napping hours, sleep problems), burnout from work and COVID-19 exposures. We used multivariable linear and logistic regression models to evaluate the associations between sleep, burnout and COVID-19.ResultsAmong 2884 exposed HCWs, there were 568 COVID-19 cases and 2316 controls. After adjusting for confounders, 1-hour longer sleep duration at night was associated with 12% lower odds of COVID-19 (p=0.003). Daytime napping hours was associated with 6% higher odds, but the association varied by countries, with a non-significant inverse association in Spain. Compared with having no sleep problems, having three sleep problems was associated with 88% greater odds of COVID-19. Reporting burnout ‘every day’ was associated with greater odds of COVID-19 (OR: 2.60, 95% CI 1.57 to 4.31, p trend across categories=0.001), longer duration (OR: 2.98, 95% CI 1.10 to 8.05, p trend=0.02) and severity (OR: 3.26, 95% CI 1.25 to 8.48, p trend=0.02) compared with reporting no burnout. These associations remained significant after adjusting for frequency of COVID-19 exposures.ConclusionsIn six countries, longer sleep duration was associated with lower odds of COVID-19, but the association with daytime nap may not be consistent across countries. Greater sleep problems and high level of burnout were robustly associated with greater odds of COVID-19. Sleep and burnout may be risk factors for COVID-19 in high-risk HCWs.
      Keywords: Open access, Press releases, COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000228
      Issue No: Vol. 4, No. 1 (2021)
  • Random forest approach for determining risk prediction and predictive
           factors of type 2 diabetes: large-scale health check-up data in Japan

    • Authors: Ooka, T; Johno, H, Nakamoto, K, Yoda, Y, Yokomichi, H, Yamagata, Z.
      Pages: 140 - 148
      Abstract: IntroductionEarly intervention in type 2 diabetes can prevent exacerbation of insulin resistance. More effective interventions can be implemented by early and precise prediction of the change in glycated haemoglobin A1c (HbA1c). Artificial intelligence (AI), which has been introduced into various medical fields, may be useful in predicting changes in HbA1c. However, the inability to explain the predictive factors has been a problem in the use of deep learning, the leading AI technology. Therefore, we applied a highly interpretable AI method, random forest (RF), to large-scale health check-up data and examined whether there was an advantage over a conventional prediction model.Research design and methodsThis study included a cumulative total of 42 908 subjects not receiving treatment for diabetes with an HbA1c
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000200
      Issue No: Vol. 4, No. 1 (2021)
  • Modest effects of dietary supplements during the COVID-19 pandemic:
           insights from 445 850 users of the COVID-19 Symptom Study app

    • Authors: Louca, P; Murray, B, Klaser, K, Graham, M. S, Mazidi, M, Leeming, E. R, Thompson, E, Bowyer, R, Drew, D. A, Nguyen, L. H, Merino, J, Gomez, M, Mompeo, O, Costeira, R, Sudre, C. H, Gibson, R, Steves, C. J, Wolf, J, Franks, P. W, Ourselin, S, Chan, A. T, Berry, S. E, Valdes, A. M, Calder, P. C, Spector, T. D, Menni, C.
      Pages: 149 - 157
      Abstract: ObjectivesDietary supplements may ameliorate SARS-CoV-2 infection, although scientific evidence to support such a role is lacking. We investigated whether users of the COVID-19 Symptom Study app who regularly took dietary supplements were less likely to test positive for SARS-CoV-2 infection.DesignApp-based community survey.Setting445 850 subscribers of an app that was launched to enable self-reported information related to SARS-CoV-2 infection for use in the general population in the UK (n=372 720), the USA (n=45 757) and Sweden (n=27 373).Main exposureSelf-reported regular dietary supplement usage (constant use during previous 3 months) in the first waves of the pandemic up to 31 July 2020.Main outcome measuresSARS-CoV-2 infection confirmed by viral RNA reverse transcriptase PCR test or serology test before 31 July 2020.ResultsIn 372 720 UK participants (175 652 supplement users and 197 068 non-users), those taking probiotics, omega-3 fatty acids, multivitamins or vitamin D had a lower risk of SARS-CoV-2 infection by 14% (95% CI (8% to 19%)), 12% (95% CI (8% to 16%)), 13% (95% CI (10% to 16%)) and 9% (95% CI (6% to 12%)), respectively, after adjusting for potential confounders. No effect was observed for those taking vitamin C, zinc or garlic supplements. On stratification by sex, age and body mass index (BMI), the protective associations in individuals taking probiotics, omega-3 fatty acids, multivitamins and vitamin D were observed in females across all ages and BMI groups, but were not seen in men. The same overall pattern of association was observed in both the US and Swedish cohorts.ConclusionIn women, we observed a modest but significant association between use of probiotics, omega-3 fatty acid, multivitamin or vitamin D supplements and lower risk of testing positive for SARS-CoV-2. We found no clear benefits for men nor any effect of vitamin C, garlic or zinc. Randomised controlled trials are required to confirm these observational findings before any therapeutic recommendations can be made.
      Keywords: Open access, Press releases, COVID-19, Nutrition Interactions with COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000250
      Issue No: Vol. 4, No. 1 (2021)
  • Empirical study of the 30-s chair-stand test as an indicator for
           musculoskeletal disorder risk of sedentary behaviour in Japanese office
           workers: a cross-sectional empirical study

    • Authors: Arimoto, A; Ishikawa, S, Tadaka, E.
      Pages: 158 - 165
      Abstract: ObjectivesSedentary behaviour among office workers and the risk of adverse health outcomes are public health problems. However, risk indicators for these outcomes require invasive biochemical examination. A proactive screening tool using a non-invasive, easy-to-use method is required to assess the risk focused on musculoskeletal health for primary prevention. However, middle-aged adults have insufficient awareness of musculoskeletal disorders. This study examined to determine whether the 30-s chair-stand test (CS-30) can be used as a proactive screening index for musculoskeletal disorder risk of sedentary behaviour in office workers.DesignCross-sectional study using self-administered questionnaires and physical measurements.SettingFour workplaces located in a metropolitan area of Japan.Participants431 Japanese office workers aged 20–64 years. 406 valid sets of results remained (valid response rate: 94.2%).Primary and secondary outcome measuresMusculoskeletal function was measured using the CS-30, quadriceps muscle strength. Receiver operating characteristic curve analysis was used to determine the sensitivity, specificity and optimal cut-off value for the CS-30. The risk of future incidence of musculoskeletal disorders was calculated using current quadriceps muscle strength.ResultsIn total participants, 47.0% were male and the mean sitting time in work duration was 455.6 min/day (SD=111.2 min). The mean lower limb quadriceps muscle strength was 444.8 N (SD=131.3 N). For the optimum cut-off value of 23 on the CS-30 for all participants, sensitivity was 0.809 and specificity was 0.231. For men, the optimum cut-off was 25, with a sensitivity of 0.855 and a specificity 0.172. For women, the optimum cut-off was 21, with a sensitivity of 0.854 and a specificity 0.275.ConclusionsSensitivity was high, but specificity was insufficient. The CS-30 may be a potential proactive screening index for musculoskeletal disorder risk of sedentary behaviour, in combination with other indicators.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000211
      Issue No: Vol. 4, No. 1 (2021)
  • Temporal variations in the severity of COVID-19 illness by race and

    • Authors: Ebinger, J. E; Driver, M, Ji, H, Claggett, B, Wu, M, Luong, E, Sun, N, Botting, P, Kim, E. H, Hoang, A, Nguyen, T. T, Diaz, J, Park, E, Davis, T, Hussain, S, Cheng, S, Figueiredo, J. C.
      Pages: 166 - 173
      Abstract: IntroductionEarly reports highlighted racial/ethnic disparities in the severity of COVID-19 seen across the USA; the extent to which these disparities have persisted over time remains unclear. Our research objective was to understand temporal trends in racial/ethnic variation in severity of COVID-19 illness presenting over time.MethodsWe conducted a retrospective cohort analysis using longitudinal data from Cedars-Sinai Medical Center, a high-volume health system in Southern California. We studied patients admitted to the hospital with COVID-19 illness from 4 March 2020 through 5 December 2020. Our primary outcome was COVID-19 severity of illness among hospitalised patients, assessed by racial/ethnic group status. We defined overall illness severity as an ordinal outcome: hospitalisation but no intensive care unit (ICU) admission; admission to the ICU but no intubation; and intubation or death.ResultsA total of 1584 patients with COVID-19 with available demographic and clinical data were included. Hispanic/Latinx compared with non-Hispanic white patients had higher odds of experiencing more severe illness among hospitalised patients (OR 2.28, 95% CI 1.62 to 3.22) and this disparity persisted over time. During the initial 2 months of the pandemic, non-Hispanic blacks were more likely to suffer severe illness than non-Hispanic whites (OR 2.02, 95% CI 1.07 to 3.78); this disparity improved by May, only to return later in the pandemic.ConclusionIn our patient sample, the severity of observed COVID-19 illness declined steadily over time, but these clinical improvements were not seen evenly across racial/ethnic groups; greater illness severity continues to be experienced among Hispanic/Latinx patients.
      Keywords: Open access, COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000253
      Issue No: Vol. 4, No. 1 (2021)
  • Effect of ultraprocessed food intake on cardiometabolic risk is mediated
           by diet quality: a cross-sectional study

    • Authors: Griffin, J; Albaloul, A, Kopytek, A, Elliott, P, Frost, G.
      Pages: 174 - 180
      Abstract: ObjectiveTo examine the effect of the consumption of ultraprocessed food on diet quality, and cardiometabolic risk (CMR) in an occupational cohort.DesignCross-sectional.SettingOccupational cohort.Participants53 163 British police force employees enrolled (2004–2012) into the Airwave Health Monitoring Study. A total of 28 forces across the UK agreed to participate. 9009 participants with available 7-day diet record data and complete co-variate data are reported in this study.Main outcome measuresA CMR and Dietary Approaches to Stop Hypertension score were treated as continuous variables and used to generate measures of cardiometabolic health and diet quality. Secondary outcome measures include percentage of energy from fat, saturated fat, carbohydrate, protein and non-milk extrinsic sugars (NMES) and fibre grams per 1000 kcal of energy intake.ResultsIn this cohort, 58.3%±11.6 of total energy intake was derived from ultraprocessed (NOVA 4) foods. Ultraprocessed food intake was negatively correlated with diet quality (r=–0.32, p
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000225
      Issue No: Vol. 4, No. 1 (2021)
  • Effect of nutrition education by health professionals on
           pregnancy-specific nutrition knowledge and healthy dietary practice among
           pregnant women in Asmara, Eritrea: a quasi-experimental study

    • Authors: Teweldemedhin, L. G; Amanuel, H. G, Berhe, S. A, Gebreyohans, G, Tsige, Z, Habte, E.
      Pages: 181 - 194
      Abstract: BackgroundHealthy pregnancy and birth outcomes are greatly influenced by the intake of adequate and balanced nutrition. Pregnant women’s nutritional knowledge and practice have been identified as an important prerequisites for their proper nutritional intake. The antenatal period with the opportunities for regular contact with health professionals appears to be the ideal time and setting to institute the intervention which could maximise pregnant women’s outcome and that of their baby by motivating them to make nutritional changes.ObjectiveTo assess the effect of nutrition education on the appropriate nutritional knowledge and practice of pregnant women.MethodologyA facility-based single-group pre–post quasi-experimental study design was employed in five health facilities providing antenatal care (ANC) service in Asmara on 226 pregnant women. A predesigned and pretested questionnaire was used to collect data regarding nutritional knowledge via interview by trained data collectors during the pretest, immediate post-test and 6 weeks later. The practice was assessed at pre-intervention and 6 weeks later only. Repeated measures analysis of variance and paired t-test were used to make comparisons in knowledge and practice scores, respectively, using SPSS (V.22).ResultsTraining provided to pregnant women resulted in a significant increase on the mean scores of their knowledge from 29.01/47 (SE=0.35) pre-intervention to 42.73/47 (SE=0.24) immediate post-intervention. However, the score declined significantly from immediate after intervention to 6-week follow-up by 1.79 (SE=0.22). Although the score declined, knowledge at 6-week follow-up was still significantly greater than that of pre-intervention (p
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000159
      Issue No: Vol. 4, No. 1 (2021)
  • Pasta meal intake in relation to risks of type 2 diabetes and
           atherosclerotic cardiovascular disease in postmenopausal women : findings
           from the Womens Health Initiative

    • Authors: Huang, M; Lo, K, Li, J, Allison, M, Wu, W.-C, Liu, S.
      Pages: 195 - 205
      Abstract: ObjectiveTo evaluate the association between pasta meal intake and long-term risk of developing diabetes or atherosclerotic cardiovascular disease (ASCVD, including coronary heart disease (CHD) and stroke) in postmenopausal women.DesignProspective cohort study.SettingWomen’s Health Initiative (WHI) in the USA.Participants84 555 postmenopausal women aged 50–79 in 1994, who were free of diabetes, ASCVD and cancer at baseline who were not in the dietary modification trial of the WHI, completed a validated food frequency questionnaire, and were evaluated for incident diabetes and ASCVD outcomes during the follow-up until 2010.Main outcome measureDiabetes and ASCVD.ResultsCox proportional hazards models were used to estimate the association (HR) between quartiles of pasta meal consumption (residuals after adjusting for total energy) and the risk of incidence diabetes, CHD, stroke or ASCVD, accounting for potential confounding factors, with testing for linear trend. We then statistically evaluated the effect of substituting white bread or fried potato for pasta meal on disease risk. When comparing the highest to the lowest quartiles of residual pasta meal intake, we observed significantly reduced risk of ASCVD (HR=0.89, 95% CI 0.83 to 0.96, p trend=0.002), stroke (HR=0.84, 95% CI 0.75 to 0.93, p trend=0.001), CHD (HR=0.91, 95% CI 0.83 to 1.00, p trend=0.058) and no significant alteration in diabetes risk (HR=1.02, 95% CI 0.96 to 1.07, p trend=0.328). Replacing white bread or fried potato with pasta meal was statistically associated with decreased risk of stroke and ASCVD.ConclusionsPasta meal intake did not have adverse effects on long-term diabetes risk and may be associated with significant reduced risk of stroke and ASCVD. The potential benefit of substituting pasta meal for other commonly consumed starchy foods on cardiometabolic outcomes warrants further investigation in additional high-quality and large prospective studies of diverse populations.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000198
      Issue No: Vol. 4, No. 1 (2021)
  • Breast health screening: a UK-wide questionnaire

    • Authors: Jiwa, N; Takats, Z, Leff, D. R, Sutton, C.
      Pages: 206 - 212
      Abstract: BackgroundCurrently, there is an unmet clinical need in identifying and screening women at high risk of breast cancer, where tumours are often aggressive and treatment intervention is too late to prevent metastasis, recurrence and mortality. This has been brought into sharp focus by the SARS-CoV-2 global pandemic, constantly changing hospital policies and surgical guidelines in reducing access to established screening and treatment regimens. Nipple aspirate fluid (NAF), is thought to provide a unique window into the biological processes occurring within the breast, particularly in the context of a developing neoplasm. Evaluation of NAF in asymptomatic women, for novel chemical biomarkers of either early disease and/or cancer risk offers tremendous promise as a tool to facilitate early detection and to supplement screening. However, it is acceptability as a method of collection and screening by women is critical and yet unknown. A breast health questionnaire was disseminated to women through breast cancer charities, patient support groups and social media platforms, with the aim of collecting opinions on the acceptability of use of NAF as a potential screening tool.MethodFollowing ethical approval a questionnaire was prepared using online surveys consisting of four parts: (a) introduction on breast health screening in the UK, (b) core demographic data, (c) questions regarding screening and the acceptability of using NAF and (d) opinions about the process of collecting and using nipple fluid for screening. The voluntary and anonymous questionnaire was disseminated through social media, professional networks, charity websites and by individuals between October 2019 and December 2020. Survey responses were collected electronically, and the data analysed using online surveys statistical tools.ResultsA total of 3178 women completed the questionnaire (65.9% Caucasian, 27.7% Asian/British Asian, 0.6% black and 5.0% other). Of these, 2650 women (83.4%) had no prior knowledge of NAF and 89.4% were unaware that NAF can be expressed in up to 90% of all women. Concerning their risk of breast cancer, 89.8% of women were keen to know their future risk of breast cancer, 8.5% were unsure whether they wanted to know their risk and a further, 1.6% did not want to know. Regarding screening, 944 women (29.8%) were unaware of the lack of routine National Health Service Breast Screening for those under the age of 47 years. Furthermore, 53.0% of women were unaware that mammographic screening is affected by breast density. In terms of the acceptability of home testing for breast health, 92.0% were keen to undergo a home test. Both 79.7% and 70.9% stated they would consider hand massage and a breast pump to acquire nipple fluid samples, respectively. A further 48.6% of women would consider the use of a hormonal nasal spray for the same purpose. However, with regards to acquiring results from NAF testing, 42.6% of women would prefer to receive results at home and 34.2% in a medical facility. Finally, 91.6% of women believed that breast health should be incorporated as part of school education curriculum.ConclusionPublic awareness regarding breast screening protocols and limitations of mammography could be improved. Many women were unaware that NAF might be a useful biofluid for future risk prediction, and yet the concept of self-testing of nipple fluid, with either hand massage or a breast pump was well received. Efforts should be made to increase awareness of the benefits of alternative and supplementary tests, especially in the context of high-risk individuals and younger patients.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000266
      Issue No: Vol. 4, No. 1 (2021)
  • Genetically predicted serum vitamin D and COVID-19: a Mendelian
           randomisation study

    • Authors: Patchen, B. K; Clark, A. G, Gaddis, N, Hancock, D. B, Cassano, P. A.
      Pages: 213 - 225
      Abstract: ObjectivesTo investigate causality of the association of serum vitamin D with the risk and severity of COVID-19 infection.DesignTwo-sample Mendelian randomisation study.SettingSummary data from genome-wide analyses in the population-based UK Biobank and SUNLIGHT Consortium, applied to meta-analysed results of genome-wide analyses in the COVID-19 Host Genetics Initiative.Participants17 965 COVID-19 cases including 11 085 laboratory or physician-confirmed cases, 7885 hospitalised cases and 4336 severe respiratory cases, and 1 370 547 controls, primarily of European ancestry.ExposuresGenetically predicted variation in serum vitamin D status, instrumented by genome-wide significant single nucleotide polymorphisms (SNPs) associated with serum vitamin D or risk of vitamin D deficiency/insufficiency.Main outcome measuresSusceptibility to and severity of COVID-19 infection, including severe respiratory infection and hospitalisation.ResultsMendelian randomisation analysis, sufficiently powered to detect effects comparable to those seen in observational studies, provided little to no evidence for an effect of genetically predicted serum vitamin D on susceptibility to or severity of COVID-19 infection. Using SNPs in loci related to vitamin D metabolism as genetic instruments for serum vitamin D concentrations, the OR per SD higher serum vitamin D was 1.04 (95% CI 0.92 to 1.18) for any COVID-19 infection versus population controls, 1.05 (0.84 to 1.31) for hospitalised COVID-19 versus population controls, 0.96 (0.64 to 1.43) for severe respiratory COVID-19 versus population controls, 1.15 (0.99 to 1.35) for COVID-19 positive versus COVID-19 negative and 1.44 (0.75 to 2.78) for hospitalised COVID-19 versus non-hospitalised COVID-19. Results were similar in analyses using SNPs with genome-wide significant associations with serum vitamin D (ie, including SNPs in loci with no known relationship to vitamin D metabolism) and in analyses using SNPs with genome-wide significant associations with risk of vitamin D deficiency or insufficiency.ConclusionsThese findings suggest that genetically predicted differences in long-term vitamin D nutritional status do not causally affect susceptibility to and severity of COVID-19 infection, and that associations observed in previous studies may have been driven by confounding. These results do not exclude the possibility of low-magnitude causal effects or causal effects of acute responses to therapeutic doses of vitamin D.
      Keywords: Open access, COVID-19, Nutrition Interactions with COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000255
      Issue No: Vol. 4, No. 1 (2021)
  • Supporting people to implement a reduced carbohydrate diet: a qualitative
           study in family practice

    • Authors: Cupit, C; Redman, E.
      Pages: 226 - 234
      Abstract: IntroductionMuch of the science behind dietary guidelines for risk reduction and chronic disease management is equivocal, and there are well-accepted uncertainties and complexities relating to diet in everyday life, as well as physiological processes. Guidelines have therefore stopped short of aligning with one particular approach, instead highlighting several evidence-based options. However, reduced carbohydrate, or ‘low-carb’, diets have increasing traction in the media and with patients, practitioners and the general public. This qualitative study examines healthcare practitioner (HCP) experiences of implementing a reduced carbohydrate diet.MethodsSemistructured, qualitative interviews were conducted with 19 HCPs in the UK family practice (including general practitioners, practice nurses and non-medical practitioners), recruited through a special interest forum, and social media. Data analysis employed social science theory and methods to produce key themes.ResultsAll participants self-identified as ‘low-carb practitioners’ who, over time, had introduced a specific focus around carbohydrate reduction into their work. They reported transformations in patients’ metabolic markers, patient enthusiasm for the approach and renewed job satisfaction. Key themes highlight experiences of: (1) discovering low-carb as a new ‘tool-in-the-box’; (2) promoting and supporting incremental low-carb experimentation; and (3) diverging from established dietary guidelines.ConclusionsThis study provides important experience-based evidence on a topical dietary intervention. Participants strongly advocated for the use of low-carb diets. The successes described draw attention to the need for pragmatic, formative evaluation of low-carb advice and support as a ‘complex intervention’ (alongside physiological research), to justify, challenge and/or shape low-carb intervention in clinical practice. The findings raise important questions about the contribution of particular care practices to the apparent success of low-carb. Social science analyses can elucidate how dietary intervention is carried out across different healthcare settings (eg, dietetics, endocrinology) and patient groups, how healthcare practices intersect with people’s everyday self-management and how different forms of evidence are invoked and prioritised.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000240
      Issue No: Vol. 4, No. 1 (2021)
  • Effects on child growth of a reduction in the general food distribution
           ration and provision of small-quantity lipid-based nutrient supplements in
           refugee camps in eastern Chad

    • Authors: Fenn, B; Myatt, M, Mates, E, Black, R. E, Wilkinson, C, Khara, T.
      Pages: 235 - 242
      Abstract: BackgroundWe used the United Nations High Commissioner for Refugees Standardised Expanded Nutrition Survey data to evaluate the effect of a change in food ration on child growth in refugee camps in eastern Chad.MethodsWe compared trends of wasting and stunting prevalence over time and the association between the coexistence of being both stunted and wasted using Pearson’s 2 test. We analysed the effect of an approximate 50% reduction in the general food distribution, with the introduction of a 20 g daily ration of small quantity lipid-based nutrient supplements given to all children aged 6–23 months, on child growth. This was done using interrupted time-series analysis to observe differences in levels and trends in mean height-for-age z-score (HAZ) and weight-for-height z-score (WHZ) over time and by age group (6–24 months and 24–59 months).ResultsOverall the prevalence of stunting and wasting decreased significantly over time. The odds of being both stunted and wasted was 1.38 higher than having one or the other condition separately (p
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000292
      Issue No: Vol. 4, No. 1 (2021)
  • Iodine status in women attending Mnazi Mmoja Hospital in Zanzibar: a
           matched case-control study

    • Authors: Bysheim, O; Vogt, E. M. C, Engebretsen, I. M. S, Kassim Mohammed, N, Storaas, T, Rosendahl-Riise, H.
      Pages: 243 - 250
      Abstract: BackgroundIodine deficiency can have adverse health effects in all age groups affecting growth, development and cognitive functions as well as the incidence of goitre. Worldwide, the most important dietary source of iodine is iodised salt. In Tanzania, iodine intake has varied due to multiple salt suppliers producing iodised salt with varying quality. Zanzibar has faced challenges with the packing, storing and monitoring of salt iodisation, and universal salt iodisation has not been achieved. Furthermore, the number of available studies on the iodine status in Zanzibar are sparse.ObjectiveThe main objective of this study is to describe the iodine status of euthyroid female adult patients with and without goitre in Zanzibar.Design and methodsA single-centre matched case-control study was conducted among 48 female patients at the ear, nose and throat clinic of Mnazi Mmoja Hospital, Zanzibar. Blood samples were drawn for serum-analysis of the thyroid hormone profile to confirm that all patients were euthyroid prior to inclusion. Urinary iodine concentrations and the iodine concentration in household salt samples were analysed. A semiquantitative food frequency questionnaire (FFQ) was used to describe trends in the dietary intake of iodine-rich and goitrogenic foods. Clinical examinations were conducted, and the patients were categorised into goitre (cases) and non-goitre (controls) groups.ResultsA moderate iodine deficiency (median urinary iodine concentration between 20 and 49 µg/L) was found in patients both with and without goitre. In total, only 35 % of the salt samples were adequately iodised. The salt samples from the cases had a lower average concentration of iodine compared with the controls. The FFQ revealed that the daily consumption of marine fish and the weekly consumption of raw cassava were more frequent in the cases than the controls.ConclusionThese findings suggest that iodine deficiency may be a problem in both patients with and without goitre in Zanzibar. The salt iodisation programme may require monitoring and implementation of satisfactory quality control practices as universal salt iodisation is yet to be achieved in Zanzibar.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000259
      Issue No: Vol. 4, No. 1 (2021)
  • Nutrition content of summative examinations within an Australian 4-year
           graduate entry medical course: 2013-2016

    • Authors: Perlstein, R; McLeod, J, Bell, C, Nowson, C.
      Pages: 251 - 256
      Abstract: BackgroundPoor nutrition is a major contributor to chronic disease, but the level of nutrition education in medical training is limited. Deakin University Medical School has been working to embed more nutrition into the curriculum since 2009.AimTo assess the nutrition content of all summative examinations in the Bachelor of Medicine, Bachelor of Surgery over a 4-year period.MethodsThe type, amount and scope of nutrition-related questions were assessed in all summative examinations delivered to all 4-year levels from 2013 to 2016. These were assessed independently and analysed for nutrition content. The amount of nutrition was quantified, and the nutrition topic areas and nutrition competencies addressed were documented.ResultsLess than 10% of summative examination questions contained any nutrition content. For first-year and second-year students, these examinations included an average yearly total of 433 multiple choice questions (MCQs) (range 337–530) and 47 short answer questions (SAQs) (range 33–62). Third-year and fourth-year students had 150 MCQs on average per year and no SAQs. The percentage of nutrition-related questions across all 4 years ranged from 6% in 2013 to 10% in 2016. The proportion of SAQs with nutrition content ranged from 12% in 2013 to 19% in 2016. Basic nutritional sciences, accounted for 60% of nutrition content and, 25% addressed dietary strategies for prevention and treatment of disease, and skills-based nutrition competencies represented approximately 10% of all questions.Summary and conclusionsMinimal nutrition was included in the summative examinations. There did not appear to be any consistent increase in the nutrition content of MCQs over the 4-year period but there was some indication of an increase in nutrition content in SAQs. Longer term evaluation is required to confirm this trend. Only a small number of nutrition questions were skills based, most focused on basic nutritional science. Examinations included few skills-based nutrition questions, and consideration of setting a minimum level of nutrition in examinations could assist in ensuring the development of appropriate nutrition competencies in medical graduates.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000280
      Issue No: Vol. 4, No. 1 (2021)
  • Plant-based diets, pescatarian diets and COVID-19 severity: a
           population-based case-control study in six countries

    • Authors: Kim, H; Rebholz, C. M, Hegde, S, LaFiura, C, Raghavan, M, Lloyd, J. F, Cheng, S, Seidelmann, S. B.
      Pages: 257 - 266
      Abstract: BackgroundSeveral studies have hypothesised that dietary habits may play an important role in COVID-19 infection, severity of symptoms, and duration of illness. However, no previous studies have investigated the association between dietary patterns and COVID-19.MethodsHealthcare workers (HCWs) from six countries (France, Germany, Italy, Spain, UK, USA) with substantial exposure to COVID-19 patients completed a web-based survey from 17 July to 25 September 2020. Participants provided information on demographic characteristics, dietary information, and COVID-19 outcomes. We used multivariable logistic regression models to evaluate the association between self-reported diets and COVID-19 infection, severity, and duration.ResultsThere were 568 COVID-19 cases and 2316 controls. Among the 568 cases, 138 individuals had moderate-to-severe COVID-19 severity whereas 430 individuals had very mild to mild COVID-19 severity. After adjusting for important confounders, participants who reported following ‘plant-based diets’ and ‘plant-based diets or pescatarian diets’ had 73% (OR 0.27, 95% CI 0.10 to 0.81) and 59% (OR 0.41, 95% CI 0.17 to 0.99) lower odds of moderate-to-severe COVID-19 severity, respectively, compared with participants who did not follow these diets. Compared with participants who reported following ‘plant-based diets’, those who reported following ‘low carbohydrate, high protein diets’ had greater odds of moderate-to-severe COVID-19 (OR 3.86, 95% CI 1.13 to 13.24). No association was observed between self-reported diets and COVID-19 infection or duration.ConclusionIn six countries, plant-based diets or pescatarian diets were associated with lower odds of moderate-to-severe COVID-19. These dietary patterns may be considered for protection against severe COVID-19.
      Keywords: Open access, Press releases, COVID-19, Nutrition Interactions with COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000272
      Issue No: Vol. 4, No. 1 (2021)
  • Assessment, outcomes and implications of multiple anthropometric deficits
           in children

    • Authors: Kundan, I; Nair, R, Kulkarni, S, Deshpande, A, Jotkar, R, Phadke, M.
      Pages: 267 - 274
      Abstract: BackgroundMalnutrition in children is widely prevalent around the world. It has been observed that malnourished children with multiple anthropometric deficits have higher mortality. However, adequate studies are not available on the outcome and recovery of these children.Nandurbar, a tribal district from Maharashtra, India, shows high prevalence of all three forms of malnutrition, often occurring simultaneously. A project previously undertaken in Nandurbar from July 2014 to June 2016 studied the effect of various therapeutic feeds in treatment of children with uncomplicated severe acute malnutrition (SAM). In this study, we analyse secondary data from it to correlate effects of stunting, wasting and underweight on treatment recovery.MethodsAnalysis was done on 5979 children with SAM using linear and logistic regression on R software for recovery rates and weight gain in children with SAM with single versus multiple anthropometric deficits, their relation to age, sex, and recovery from severe stunting by gain in height.ResultsThe mean age of children was 35 months and 53.1% of the children were males. 2346 (39.2%) children recovered at the end of the 8-week treatment. 454 (7.6%) had single anthropometric deficit (SAM only), 3164 (52.9%) had two anthropometric deficits (SAM and severe underweight (SUW)) and 2355 (39.4%) children had three anthropometric deficits (SAM, SUW and severe stunting). Out of the 5979 children with SAM, only 52 (0.9%) of children were not underweight (severe or moderate).44.94% of children with SAM who were severely stunted recovered, compared with 35.52% of children who were not (p
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000233
      Issue No: Vol. 4, No. 1 (2021)
  • Cost and greenhouse gas emissions of current, healthy, flexitarian and
           vegan diets in Aotearoa (New Zealand)

    • Authors: Kidd, B; Mackay, S, Vandevijvere, S, Swinburn, B.
      Pages: 275 - 284
      Abstract: ObjectiveTo compare the costs and climate impact (greenhouse gas emissions) associated with current and healthy diets and two healthy and environmentally friendly dietary patterns: flexitarian and vegan.DesignModelling studySettingAotearoa (New Zealand).Main outcome measuresThe distribution of the cost and climate impact (kgCO2e/kg of food per fortnight) of 2 weekly current, healthy, vegan and flexitarian household diets was modelled using a list of commonly consumed foods, a set of quantity/serves constraints for each, and constraints for food group and nutrient intakes based on dietary guidelines (Eating and Activity Guidelines for healthy diets and EAT-Lancet reference diet for vegan and flexitarian diets) or nutrition survey data (current diets).ResultsThe iterative creation of 210–237 household dietary intakes for each dietary scenario was achieved using computer software adapted for the purpose (DIETCOST). There were stepwise differences between diet scenarios (p
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000262
      Issue No: Vol. 4, No. 1 (2021)
  • Impact of smoking on COVID-19 outcomes: a HOPE Registry subanalysis

    • Authors: Espejo-Paeres, C; Nunez-Gil, I. J, Estrada, V, Fernandez-Perez, C, Uribe-Heredia, G, Cabre-Verdiell, C, Uribarri, A, Romero, R, Garcia-Aguado, M, Fernandez-Rozas, I, Becerra-Munoz, V, Pepe, M, Cerrato, E, Raposeiras-Roubin, S, Barrionuevo-Ramos, M, Aveiga-Ligua, F, Aguilar-Andrea, C, Alfonso-Rodriguez, E, Ugo, F, Garcia-Prieto, J. F, Feltes, G, Akin, I, Huang, J, Jativa, J, Fernandez-Ortiz, A, Macaya, C, Carrero-Fernandez, A, Signes-Costa, J.
      Pages: 285 - 292
      Abstract: BackgroundSmoking has been associated with poorer outcomes in relation to COVID-19. Smokers have higher risk of mortality and have a more severe clinical course. There is paucity of data available on this issue, and a definitive link between smoking and COVID-19 prognosis has yet to be established.MethodsWe included 5224 patients with COVID-19 with an available smoking history in a multicentre international registry Health Outcome Predictive Evaluation for COVID-19 (NCT04334291). Patients were included following an in-hospital admission with a COVID-19 diagnosis. We analysed the outcomes of patients with a current or prior history of smoking compared with the non-smoking group. The primary endpoint was all-cause in-hospital death.ResultsFinally, 5224 patients with COVID-19 with available smoking status were analysed. A total of 3983 (67.9%) patients were non-smokers, 934 (15.9%) were former smokers and 307 (5.2%) were active smokers. The median age was 66 years (IQR 52.0–77.0) and 58.6% were male. The most frequent comorbidities were hypertension (48.5%) and dyslipidaemia (33.0%). A relevant lung disease was present in 19.4%. In-hospital complications such sepsis (23.6%) and embolic events (4.3%) occurred more frequently in the smoker group (p
      Keywords: Open access, COVID-19, Implementing Effective Interventions in Healthcare
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000269
      Issue No: Vol. 4, No. 1 (2021)
  • Potential for elimination of folate and vitamin B12 deficiency in India
           using vitamin-fortified tea: a preliminary study

    • Authors: Vora, R. M; Alappattu, M. J, Zarkar, A. D, Soni, M. S, Karmarkar, S. J, Antony, A. C.
      Pages: 293 - 306
      Abstract: IntroductionThe majority of Indian women have a poor dietary folate and vitamin B12 intake resulting in their chronically low vitamin status, which contributes to anaemia and the high incidence of folate-responsive neural-tube defects (NTDs) in India. Although many countries have successfully deployed centrally-processed folate-fortified flour for prevention of NTDs, inherent logistical problems preclude widespread implementation of this strategy in India. Because tea—the second most common beverage worldwide (after water)—is consumed by most Indians every day, and appeared an ideal vehicle for fortification with folate and vitamin B12, we determined if daily consumption of vitamin-fortified tea for 2 months could benefit young women of childbearing-age in Sangli, India.MethodsWomen (average age=20±2 SD) used teabags spiked with therapeutic doses of 1 mg folate plus either 0.1 mg vitamin B12 (Group-1, n=19) or 0.5 mg vitamin B12 (Group-2, n=19), or mock-fortified teabags (Group-0, n=5) to prepare a cup of tea every day for 2 months, following which their pre-intervention and post-intervention serum vitamin and haemoglobin concentrations were compared.ResultsMost women had baseline anaemia with low-normal serum folate and below-normal serum vitamin B12 levels. After 2 months, women in both Group-1 and Group-2 exhibited significant increases in mean differences in pre-intervention versus post-intervention serum folate levels of 8.37 ng/mL (95% CIs 5.69 to 11.04, p
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000209
      Issue No: Vol. 4, No. 1 (2021)
  • Reference to nutrition in medical accreditation and curriculum guidance: a
           comparative analysis

    • Authors: Lepre, B; Mansfield, K. J, Ray, S, Beck, E.
      Pages: 307 - 318
      Abstract: ObjectivePoor diet is a leading cause of death worldwide. Doctors are well placed to provide dietary advice, yet nutrition remains insufficiently integrated into medical education. Enforcement of curriculum or accreditation requirements such as nutrition requires relevant regulatory frameworks. The aim of this review was to identify nutrition content or requirements for nutrition education in accreditation standards or formal curriculum guidance for medical education internationally.DesignNon-systematic comparative analysis.Data sourcesAn internet search using the Google Search engine, the WHO Directory of Medical Schools and Foundation for Advancement of International Medical Education and Research Directory of Organizations that Recognise/Accredit Medical Schools was conducted through September 2020 to identify government and organisational reports as well as publications from regulatory and professional bodies relevant to medical education.Eligibility criteriaEligible publications included (A) accreditation standards, (B) competency standards or a framework, (C) curricula, and (D) assessment content.Data extraction and synthesisWe stratified findings by country or region and both preregistration and postregistration education. Findings were synthesised based on the existence of nutrition content or requirements for nutrition education within systems used to guide medical education internationally.ResultsThis review found that despite an emphasis on meeting the needs of the community and the demands of the labour market, only 44% of accreditation and curriculum guidance included nutrition. Nutrition remains inadequately represented in accreditation and curriculum guidance for medical education at all levels internationally. Accreditation standards provide a mandated framework for curricula and inclusion of nutrition in accreditation frameworks provides an incentive for the integration of nutrition into medical education.ConclusionsThis review is a call to action for the medical profession including government, health agencies and educational and accreditation entities. The inclusion of nutrition in medical education has appeared throughout medical education literature for more than five decades, yet without consensus standards there is little likelihood of uniform adoption.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000234
      Issue No: Vol. 4, No. 1 (2021)
  • Low-energy sweeteners and body weight: a citation network analysis

    • Authors: Normand, M; Ritz, C, Mela, D, Raben, A.
      Pages: 319 - 332
      Abstract: ObjectiveReviews on the relationship of low-energy sweeteners (LES) with body weight (BW) have reached widely differing conclusions. To assess possible citation bias, citation analysis was used to quantify the relevant characteristics of cited articles, and explore citation patterns in relation to review conclusions.DesignA systematic search identified reviews published from January 2010 to March 2020. Different characteristics (for example, type of review or research, journal impact factor, conclusions) were extracted from the reviews and cited articles. Logistic regression was used to estimate likelihood of articles with particular characteristics being cited in reviews. A qualitative network analysis linked reviews sub-grouped by conclusions with the types of articles they cited.Main outcome measures(OR; 95% CI) for likelihood that articles with particular characteristics were cited as evidence in reviews.ResultsFrom 33 reviews identified, 183 different articles were cited (including other reviews). Narrative reviews were 62% less likely to be cited than systematic reviews with meta-analysis (OR 0.38; 0.16 to 0.86; p=0.03). Likelihood of being cited was higher for evidence on children than adults (OR 2.27; 1.59 to 3.25; p
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000210
      Issue No: Vol. 4, No. 1 (2021)
  • Providing food to patients in primary care to induce weight loss: a
           systematic literature review

    • Authors: Ball, L; Somerville, M, Crowley, J, Calleja, Z, Barnes, K.
      Pages: 333 - 341
      Abstract: PurposePrimary care is the ideal setting to promote weight management, warranting innovative ways to support patients. This systematic review aimed to determine whether providing food to patients in primary care can help to reduce body weight.MethodsFour databases were searched for studies that aimed to elicit weight loss by directly providing foodstuffs and/or supplements to patients in primary care settings. Interventions with adults of any gender or race were included. Interventions that involved other components such as exercise classes or education sessions were excluded. The methodological quality of each study was appraised using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.ResultsFour heterogeneous studies met the eligibility criteria, representing 476 adults. Two studies used meal-replacement products but differed in length and intensity, another study provided green tea and vitamin E supplementation, and the final study provided vouchers for use at a farmers’ market hosted at a primary care clinic. Interventions ranged in length from 4 to 13 weeks. Three of the four studies observed weight loss in some form and all studies observed at least one other improvement in a health outcome such as waist circumference, blood pressure or fasting insulin levels.ConclusionsA small yet notable body of literature supports the concept of providing food to patients in primary care settings to support weight loss. Further, high-quality research is needed on the efficacy and cost-effectiveness of this approach to ultimately inform policy initiatives for primary care.
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000195
      Issue No: Vol. 4, No. 1 (2021)
  • Critical care nutrition and COVID-19: a cause of malnutrition not to be

    • Authors: Eden, T; McAuliffe, S.
      Pages: 342 - 347
      Abstract: Malnutrition in critical care is highly prevalent and well documented to have adverse implications on morbidity and mortality. During the current COVID-19 pandemic, the evolving literature has been able to identify high risk groups in whom unfavourable outcomes are more common, for example, obesity, premorbid status, male sex, members from the Black, Asian and Minority Ethnic (BAME) community and others. Nutritional status and provision precritical and pericritical phase of COVID-19 illness is gaining traction in the literature assessing how this can influence the clinical course. It is therefore of importance to understand and address the challenges present in critical care nutrition and to identify and mitigate factors contributing to malnutrition specific to this patient group. We report a case of significant disease burden and the associated cachexia and evidence of malnutrition in a young 36-year-old male with Somalian heritage with no pre-existing medical conditions but presenting with severe COVID-19 during the first wave of the pandemic (March 2020). We highlight some key nutritional challenges during the critical phase of illness signposting to some of the management instigated to counter this. These considerations are hoped to provide further insight to help continue to evolve nutritional management when treating patients with COVID-19.
      Keywords: Open access, COVID-19, Nutrition Interactions with COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000271
      Issue No: Vol. 4, No. 1 (2021)
  • Making a difference in healthcare: community food provision during the
           COVID-19 pandemic

    • Authors: Buckner, L; Bradfield, J, Ray, S.
      Pages: 348 - 349
      Keywords: Open access, COVID-19, Global Food Security
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000106
      Issue No: Vol. 4, No. 1 (2021)
  • Bridging the gap between science-led research and evaluation of clinical
           practice: the role of service innovation audits and case studies

    • Authors: McAuliffe, S; Unwin, D, Bradfield, J, Ray, S, Martyn, K.
      Pages: 350 - 351
      Keywords: Open access, Implementing Effective Interventions in Healthcare
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2020-000226
      Issue No: Vol. 4, No. 1 (2021)
  • No evidence that vitamin D is able to prevent or affect the severity of
           COVID-19 in individuals with European ancestry: a Mendelian randomisation
           study of open data, by Amin et al

    • Authors: Boucher; B. J.
      Pages: 352 - 353
      Keywords: Open access, COVID-19
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000263
      Issue No: Vol. 4, No. 1 (2021)
  • Genetic variants for personalised management of very low carbohydrate
           ketogenic diets

    • Authors: OHearn; L. A.
      Pages: 354 - 354
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000282
      Issue No: Vol. 4, No. 1 (2021)
  • Personalised, population and planetary nutrition for precision health

    • Authors: Martinez-Gonzalez, M. A; Kim, H.-S, Prakash, V, Ramos-Lopez, O, Zotor, F, Martinez, J. A.
      Pages: 355 - 358
      Keywords: Open access
      PubDate: 2021-06-30T21:50:16-07:00
      DOI: 10.1136/bmjnph-2021-000235
      Issue No: Vol. 4, No. 1 (2021)
  • Is global dietary change an effective strategy to curb climate change'

    • Authors: Bradfield, J; Trigueiro, H, Ray, S.
      Pages: 121 - 122
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000101
      Issue No: Vol. 3, No. 2 (2021)
  • Building on what we know: moving beyond effectiveness to consider how to
           implement, sustain and spread successful health interventions

    • Authors: Laur, C; Ball, L, Keller, H, Ivers, N.
      Pages: 123 - 125
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000115
      Issue No: Vol. 3, No. 2 (2021)
  • Opportunities for innovation in nutrition education for health

    • Authors: Nowson; C.
      Pages: 126 - 128
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000135
      Issue No: Vol. 3, No. 2 (2021)
  • Nutrition is key to global pandemic resilience

    • Authors: Birgisdottir; B. E.
      Pages: 129 - 132
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000160
      Issue No: Vol. 3, No. 2 (2021)
  • Association between plant-based diets and blood pressure in the INTERMAP

    • Authors: Aljuraiban, G; Chan, Q, Gibson, R, Stamler, J, Daviglus, M. L, Dyer, A. R, Miura, K, Wu, Y, Ueshima, H, Zhao, L, Van Horn, L, Elliott, P, Oude Griep, L. M, for the INTERMAP Research Group
      Pages: 133 - 142
      Abstract: BackgroundPlant-based diets are associated with a lower risk of cardiovascular diseases; however, little is known how the healthiness of the diet may be associated with blood pressure (BP). We aimed to modify three plant -based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) according to country-specific dietary guidelines to enable use across populations with diverse dietary patterns – and assessed their associations with BP.DesignWe used cross-sectional data including 4,680 men and women ages 40–59y in Japan, China, the United Kingdom, and the United States from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). During four visits, eight BP measurements, and four 24-h dietary recalls were collected. Multivariable regression coefficients were estimated, pooled, weighted, and adjusted extensively for lifestyle/dietary confounders.ResultsModified PDI was not associated with BP. Consumption of hPDI higher by 1SD was inversely associated with systolic (-0.82 mm Hg;95% CI:-1.32,-0.49) and diastolic BP (-0.49 mm Hg; 95% CI:-0.91, -0.28). In contrast, consumption of an uPDI was directly associated with systolic (0.77 mm Hg;95% CI:0.30,1.20). Significant associations between hPDI with BP were attenuated with separate adjustment for vegetables and whole grains; associations between uPDI and BP were attenuated after adjustment for refined grains, sugar-sweetened beverages, and meat.ConclusionAn hPDI is associated with lower BP while a uPDI is adversely related to BP. Plant-based diets rich in vegetables and whole grains and limited in refined grains, sugar-sweetened beverages, and total meat may contribute to these associations. In addition to current guidelines, the nutritional quality of consumed plant foods is as important as limiting animal-based components.Trial registration numberThe observational INTERMAP study was registered at www.clinicaltrials.gov as NCT00005271.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000077
      Issue No: Vol. 3, No. 2 (2021)
  • Empowering local communities to make lifestyle changes: is the Health Mela
           a potential solution'

    • Authors: Watson, J; Satyan, R, Gupta, R, Myers, M, Campbell, R, Macphie, E.
      Pages: 143 - 150
      Abstract: BackgroundHealth Melas are community-led public health events held in the North West of England that provide health information and free health checks. This descriptive observational study evaluates whether Health Melas are able to identify undiagnosed cardiovascular disease (CVD) risk factors in hard-to-reach communities and encourage individuals to make lifestyle changes.MethodsAttendees ≥18 years at three separate Health Melas in 2016–2017 were invited to participate in screening and counselling for CVD risk factors as part of a Health MOT. Information was collected about demographics, CVD risk factors, blood pressure, total cholesterol, blood sugar and attendees’ feedback. QRISK2 scoring system was used to estimate CVD risk.Results375 attendees completed a questionnaire. The highest proportion (36.9%) of attendees were from areas of the lowest Index of Health Deprivation and Disability quintile; 38.8% were of South Asian ethnicity. Of the attendees who were eligible for a free National Health Service Health Check, 9.1% had received one. Overall, 57.5% of all attendees had a QRISK2 score ≥10% (of whom 56.9% were not on statins), 92.2% of attendees believed the Health Mela will help them to make lifestyle changes, 98.2% said they had improved their understanding of their health, and 99.6% thought the Health Mela was useful. 73.6% of those who had received a previous Health MOT reported making lifestyle changes. There was a positive correlation between South Asian ethnicity and QRISK2 score.ConclusionThis study suggests the Health Melas successfully involve South Asian populations and people from a lower Index of Health Deprivation and Disability. Attendees felt the events were useful, improved understanding of their health needs and encouraged them to make lifestyle changes. High rates of modifiable CVD risk factors were newly identified and a high proportion of attendees were found to be at intermediate to high risk of CVD.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000067
      Issue No: Vol. 3, No. 2 (2021)
  • Relationship between maternal body composition during pregnancy and
           infants birth weight in Nairobi informal settlements, Kenya

    • Authors: Wanjohi, M. N; Ogada, I, Wekesah, F. M, Khayeka-Wandabwa, C, Kimani-Murage, E. W.
      Pages: 151 - 161
      Abstract: BackgroundMaternal nutrition depletion during pregnancy compromises fetal programming, and is a cause of adverse birth outcomes. Maternal body composition measurement using direct body composition assessment methods such as the deuterium dilution technique provides better prediction of birth outcomes as compared with commonly used techniques like anthropometry. This study assessed body composition of pregnant mothers in urban informal settlements in Nairobi, Kenya, and established the relationship between maternal body composition and infant birth weight.MethodsDeuterium dilution technique was used to determine body composition, including total body water (TBW), fat-free mass (FFM) and fat mass (FM), among 129 pregnant women who were enrolled into the study in their first or second trimester. Descriptive statistics and regression analysis were applied using Stata V.13.ResultsThe mean TBW, FFM and FM were 33.3 L (±4.7), 45.7 kg (±6.5) and 17.01 kg (±7.4), respectively. Both TBW and FFM were significantly related to maternal age and gestation/pregnancy stage during body composition assessment while FM was significantly associated with gestation stage during body composition assessment. TBW and FFM were significantly lower in younger mothers (
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2019-000060
      Issue No: Vol. 3, No. 2 (2021)
  • Contrasting prenatal nutrition and environmental exposures in association
           with birth weight and cognitive function in children at 7 years

    • Authors: Gennings, C; Wolk, A, Hakansson, N, Lindh, C, Bornehag, C.-G.
      Pages: 162 - 171
      Abstract: BackgroundGood nutrition is essential for individual health, a notion that is particularly true during pregnancy. We have used a nutrition index that measures the adequacy of one’s diet relative to the unique nutritional needs of individuals due to, for example, their activity level, dietary restrictions, lifestyle and body size. The use of this personalised metric of dietary nutritiousness in the analysis of prenatal environmental exposures and developmental outcomes permits testing for potential mitigating effects of good nutrition. We also provide an analysis strategy for investigating the balance in beneficial food sources which are also the source of environmental toxicants.MethodsA holistic measure of nutrition, My Nutrition Index (MNI), measures the nutrient quality (ie, ‘nutritiousness’) of a specified daily diet. MNI is calculated based on quantification of dozens of macronutrients and micronutrients that are specific to an individual’s nutritional needs by incorporating dietary restrictions, subject characteristics, activity level and health behaviours. The Swedish Environmental, Longitudinal, Mother and child, Asthma and allergy Study is a Swedish pregnancy cohort, with prenatal endocrine disrupting chemicals (EDCs) exposure and dietary data available. This makes it possible to test for the potential mitigating effects of good nutrition on health and development effects in offspring from EDCs.ResultsUsing prenatal Food Frequency Questionnaire data to construct an individual’s MNI, the index was significantly and positively associated with important metabolic outcome (as measured by birth weight) and cognitive function at age 7 years (as measured by WISC IQ) in children when adjusted for covariates and prenatal concentrations of an EDC. In a stratified analysis of ‘low’ and ‘high’ fish consumption, a potential source of perfluoro-octanesulfonic acid (PFOS), the association between PFOS and birth weight was diminished in the high consumption group compared with the low consumption group.ConclusionsThus, MNI is evidently a metric of the general nutritiousness of daily diets and is useful in environmental health studies in representing the impact of good nutrition, even during pregnancy.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000099
      Issue No: Vol. 3, No. 2 (2021)
  • Preventable causes of cancer in Texas by race/ethnicity: insufficient
           physical activity

    • Authors: Gudenkauf, F. J; Thrift, A. P.
      Pages: 172 - 179
      Abstract: BackgroundAccording to the 2018 Third Expert Report from the World Cancer Research Fund/American Institute for Cancer Research, there is strong evidence that physical activity of all types and intensities protects against colon, endometrial and breast cancers. We aimed to estimate the percentage and number of incident cancer cases diagnosed in Texas in 2015 that were attributable to insufficient physical activity, and we examined for differences across racial/ethnic subgroups to reveal important causes of and potential avenues for reductions to cancer health disparities.MethodsWe calculated population attributable fractions for cancers attributable to insufficient physical activity using prevalence data from the Texas Behavioral Risk Factor Surveillance System and relative risk estimates associated with insufficient physical activity from prior studies. Cancer incidence data were gathered from the Texas Cancer Registry.ResultsOverall, approximately 2.0% of all new cancers or 2094 excess cancer cases diagnosed in 2015 in Texans aged ≥25 years were attributable to insufficient physical activity, with more cancers in women (3.2%) than in men (0.8%). Of all cancer sites, the highest population attributable fraction for insufficient physical activity was observed for endometrial cancers (21.7% compared with 12.7% for colon cancers, 10.9% for premenopausal breast cancers and 2.0% for postmenopausal breast cancers). Hispanics (2.6%) and non-Hispanic blacks (2.5%) had higher proportions of cancers attributable to insufficient physical activity than non-Hispanic whites (1.8%).ConclusionsPublic health programmes should stress physical activity as a means of cancer prevention, especially among minority groups, who may have disproportionately higher percentages of cancers attributable to insufficient physical activity.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000087
      Issue No: Vol. 3, No. 2 (2021)
  • Modification of vitamin B6 on the associations of blood lead levels and
           cardiovascular diseases in the US adults

    • Authors: Wei, J; Ji, J. S.
      Pages: 180 - 187
      Abstract: BackgroundCardiovascular disease (CVD) is a leading cause of death in the US population. Lead exposure is an important risk factor of CVDs, as is associated with elevated homocysteine level and oxidative stress. We aim to examine whether vitamin B6, which has been shown to reduce homocysteine level, can modify the relationship between blood lead and the risk of CVDs.MethodsCross-sectional data on ever-report CVDs (congestive heart failure, coronary heart disease, angina pectoris, heart attack and stroke), blood lead level (BLL) and vitamin B6 in the form of plasma pyridoxal 5'-phosphate were obtained from US National Health and Nutrition Examination Survey 2005–2006 for adults≥20 years old. The association between CVDs and quartiles of BLL was estimated using multivariate logistic regression models adjusted for demographics factors, lifestyle variables, stress variables, comorbidities and CVD biomarkers (C reactive protein, homocysteine, cholesterol) and was stratified by vitamin B6 deficiency level (
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000088
      Issue No: Vol. 3, No. 2 (2021)
  • Lifestyle medicine for type 2 diabetes: practice-based evidence for
           long-term efficacy of a multicomponent lifestyle intervention (Reverse
           Diabetes2 Now)

    • Authors: Pot, G. K; Battjes-Fries, M. C, Patijn, O. N, van der Zijl, N, Pijl, H, Voshol, P.
      Pages: 188 - 195
      Abstract: IntroductionA wealth of evidence supports short-term efficacy of lifestyle interventions in type 2 diabetes (T2D). However, little is known about long-term effects of lifestyle interventions in real-life settings.MethodsThis observational, single-arm study evaluated long-term impact of ‘Voeding Leeft: Reverse-Diabetes2-Now’, a 6-month multicomponent lifestyle programme, on glycaemic control and glucose-lowering medication (GLmed) use, other T2D parameters and quality of life in 438 T2D participants at 6, 12, 18 and 24 months using paired sample t-tests, 2 and generalised linear models.ResultsAt 24 months, 234 participants provided information on GLmed and HbA1c (‘responders’). 67% of the responders used less GLmed, and 28% ceased all GLmed. Notably, 71% of insulin users at baseline (n=47 of 66 insulin users) were off insulin at 24 months. Mean HbA1c levels were similar at 24 months compared with baseline (55.6±12.8 vs. 56.3±10.5 mmol/mol, p=0.43), but more responders had HbA1c levels ≤53 mmol/mol at 24 months (53% vs 45% at baseline). Furthermore, triglyceride levels (–0.34±1.02 mmol/L, p=0.004), body weight (–7.0±6.8 kg, p
      Keywords: Open access, Press releases
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000081
      Issue No: Vol. 3, No. 2 (2021)
  • Role of food aid and assistance in addressing the double burden of
           malnutrition in Ghana: a qualitative policy analysis

    • Authors: Torto, N. M; Brownell, K. D.
      Pages: 196 - 204
      Abstract: Background and aimsIn many low-income and middle-income countries, the double burden of malnutrition threatens public health and economic progress, urging a re-evaluation of the roles and responsibilities of nutrition actors, both traditional and non-traditional. This study examines the food aid and assistance activities of the United Nations World Food Programme (WFP)—one non-traditional actor in the double burden conversation—and the potential for these activities to reach beyond their traditional mandate on undernutrition to also address overweight and obesity in Ghana.MethodsInformation on WFP activities in Ghana from 2012 up through its planning into 2023 was extracted from 11 WFP planning, operations and evaluation documents. WFP activities were then judged against the WHO’s framework on the determinants of the double burden of malnutrition to determine their potential to address the double burden. Semistructured interviews were also conducted with 17 key informants in the global nutrition landscape to identify challenges that may complicate the role of WFP and other actors in addressing the double burden.ResultsThe analysis demonstrates that WFP activities in Ghana can serve as a platform on which to address the double burden, particularly by targeting the food access, food systems and socioeconomic disadvantage determinants of the double burden. Actors’ uncertainty with what role WFP should play in addressing the double burden, insufficient government attention to malnutrition and poor data on overweight and obesity were identified as potential challenges that complicate addressing the double burden.ConclusionThe findings suggest that integrating WFP as a partner in the effort to address the double burden in Ghana might help amplify progress. To better address the double burden, WFP might prioritise retrofitting existing activities rather than implementing new interventions.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000136
      Issue No: Vol. 3, No. 2 (2021)
  • Effect of the COVID-19-induced lockdown on nutrition, health and lifestyle
           patterns among adults in Zimbabwe

    • Authors: Matsungo, T. M; Chopera, P.
      Pages: 205 - 212
      Abstract: BackgroundThe COVID-19 is a global public health emergency resulting in lockdowns, associated diet and lifestyle changes and constrained public health delivery.ObjectiveTo investigate the impacts of the COVID-19-induced lockdown in Zimbabwe on nutrition, physical activity, alcohol consumption and smoking among Zimbabwean population aged ≥18 years.MethodsA cross-sectional online survey was conducted using a structured questionnaire to collect information on demographics (age, gender, place of residence, current employment), food system dimensions, diet and physical activity patterns, stress and anxiety, body image perceptions, lifestyle behaviours like smoking, alcohol intake, screen time and ease of access to health services. Results The participants (n=507) were mostly women (63.0%) between the ages of 31 and 40 years (48.1%) and had tertiary education (91.3%). The lockdown resulted in increase in food prices (94.8%) and decrease in availability of nutritious foods (64%). Most (62.5%) of the participants reported a reduction in their physical activity levels. The prevalence of generalised anxiety disorder (GAD) was 40.4% and mostly affecting woman (63.5%, p=0.909), 31–40 years age group (49.6%, p=0.886). Based on the Body Mass Index-based Silhouette Matching Test (BMI-SMT) 44.5% gained weight, 24.3% lost weight and 31.2% did not have weight change. The paired samples t-test showed that there was a significant increase in perceived body weight (p
      Keywords: Open access, COVID-19
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000124
      Issue No: Vol. 3, No. 2 (2021)
  • Rationale and description of a lifestyle intervention programme to achieve
           moderate weight loss in women with non-metastatic breast cancer: the
           lifestyle intervention part of the SUCCESS C Study

    • Authors: Hauner, D; Rack, B, Friedl, T, Hepp, P, Janni, W, Hauner, H.
      Pages: 213 - 219
      Abstract: ObjectiveThere is growing evidence from observational studies that lifestyle factors such as obesity, an unhealthy diet and lack of physical activity are associated with poor long-term outcome in women with breast cancer. The primary objective of the lifestyle modification part of the Simultaneous Study of Docetaxel Based Anthracycline Free Adjuvant Treatment Evaluation, as well as Life Style Intervention Strategies (SUCCESS C) Trial is to investigate the effect of an individualised lifestyle intervention programme aiming at moderate weight loss on disease-free survival in women with HER2/neu-negative breast cancer. Secondary objectives include the effect of the intervention on body weight, cardiovascular risk and quality of life.MethodsThe SUCCESS C Trial is an open-label, multicentre, randomised controlled phase III study using a 2x2 factorial design in women with newly diagnosed HER2/neu-negative intermediate-risk to high-risk breast cancer. The first randomisation served to compare disease-free survival in patients treated with two different chemotherapy regimens (3642 participants). The second randomisation served to compare disease-free survival in patients with a body mass index of 24–40 kg/m² (2292 participants) receiving either a telephone-based individualised lifestyle intervention programme for moderate weight loss or general recommendations for a healthy lifestyle for 2 years. Outcome analyses will be conducted after 5 years of follow-up.PerspectiveThis study will provide information on the efficacy and safety of a comprehensive lifestyle intervention programme on disease-free survival in a large cohort of women with breast cancer. EU Clinical Trials Identifier: 2008-005453-38.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000119
      Issue No: Vol. 3, No. 2 (2021)
  • Alcohol consumption and fruits and vegetable intake among older adults in
           Ghana: a cross-sectional survey based on WHO-SAGE Wave 2 data

    • Authors: Tachi, K; Tetteh, J, Yawson, A. E, Agyei-Nkansah, A, Archampong, T.
      Pages: 220 - 228
      Abstract: BackgroundAlcohol consumption and inadequate fruits and vegetable (FnV) intake are major reasons for the shift from communicable to non-communicable diseases (NCDs) over the years. The older Ghanaian adult is at high risk of NCD and data on alcohol and FnV consumption are required to guide policy to mitigate its effect. This analysis aimed to determine the factors associated with alcohol consumption and assess the relationship between alcohol consumption and FnV intake among Ghanaians aged 50 years and older.MethodsThis analysis used WHO Study on Global Ageing and Adult Health (SAGE) Wave 2, Ghana data set conducted between 2014 and 2015. Data on demographic characteristics, FnV intake, and alcohol consumption were collated and analysed. Multivariable Poisson, logistic and probit regression analyses were performed to assess the associations between alcohol consumption and inadequate FnV intake.ResultsA total of 3533 Ghanaians aged 50 years and older, 41.0% men and 59.0% women, were included in this study. The prevalence of lifetime alcohol consumption was 22.8% (95% CI 20.7% to 25.1%). Alcohol consumption was significantly associated with sex, age group, marital status, religion, place of residence and history of smoking. The prevalence of adequate FnV intake was 52.6% with a mean daily intake of 6.45 servings: 2.98 for fruits and 3.47 for vegetables. There was a significant positive correlation between inadequate FnV intake and alcohol consumption. Inadequate FnV consumption was significantly higher among lifetime alcohol consumers compared with non-alcohol consumers. (Poisson estimate; adjusted Prevalence Ratio (aPR) (95% CI)=1.35 (1.12 to 1.63), logistic estimate; adjusted Old Ratio (aOR) (95% CI)=1.13 (1.05 to 1.21) and probit estimate; adjusted normalized coefficient (aβ) (95% CI)=0.19 (0.07 to 0.31))ConclusionAbout a quarter and nearly half of older Ghanaian adults consume alcohol and inadequate FnV, respectively. Alcohol consumption is significantly associated with inadequate FnV intake. Interventions to address inadequate FnV intake among older adults in Ghana should also include policies that regulate the use of alcohol in this population.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000102
      Issue No: Vol. 3, No. 2 (2021)
  • Adherence to dietary and physical activity guidelines among shift workers:
           associations with individual and work-related factors

    • Authors: Kelly, C; Nea, F. M, Pourshahidi, L. K, Kearney, J. M, O'Brien, V, Livingstone, M. B. E, Corish, C. A.
      Pages: 229 - 238
      Abstract: ObjectivesShift work is associated with adverse effects on the health and lifestyle behaviours of employees. This study aimed to examine factors associated with adherence among shift workers to selected indicators of dietary and physical activity guidelines.MethodsA cross-sectional study was conducted on 1300 shift workers. Data were collected using a 15 minute telephone-administered questionnaire. Logistic regression methods were used for data analysis.ResultsMale shift workers (p
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000091
      Issue No: Vol. 3, No. 2 (2021)
  • Farming for life: impact of medical prescriptions for fresh vegetables on
           cardiometabolic health for adults with or at risk of type 2 diabetes in a
           predominantly Mexican-American population

    • Authors: Kerr, D; Barua, S, Glantz, N, Conneely, C, Kujan, M, Bevier, W, Larez, A, Sabharwal, A.
      Pages: 239 - 246
      Abstract: IntroductionPoor diet is the leading cause of poor health in USA, with fresh vegetable consumption below recommended levels. We aimed to assess the impact of medical prescriptions for fresh (defined as picked within 72 hours) vegetables, at no cost to participants on cardiometabolic outcomes among adults (predominantly Mexican-American women) with or at risk of type 2 diabetes (T2D).MethodsBetween February 2019 and March 2020, 159 participants (122 female, 75% of Mexican heritage, 31% with non-insulin treated T2D, age 52.5 (13.2) years) were recruited using community outreach materials in English and Spanish, and received prescriptions for 21 servings/week of fresh vegetable for 10 weeks. Pre-post comparisons were made of weight; waist circumference; blood pressure; Hemoglobin A1c (HbA1c, a measure of long-term blood glucose control); self-reported sleep, mood and pain; vegetable, tortilla and soda consumption. After obtaining devices for this study, 66 of 72 participants asked, agreed to wear blinded continuous glucose monitors (CGM).ResultsPaired data were available for 131 participants. Over 3 months, waist circumference fell (–0.77 (95% CI –1.42 to 0.12) cm, p=0.022), as did systolic blood pressure (SBP) (–2.42 (95% CI –4.56 to 0.28) mm Hg, p=0.037), which was greater among individuals with baseline SBP>130 mm Hg (–7.5 (95% CI –12.4 to 2.6) mm Hg, p=0.005). Weight reduced by –0.4 (–0.7 to –0.04) kg, p=0.029 among women. For participants with baseline HbA1c>7.0%, HbA1c fell by –0.35 (-0.8 to –0.1), p=0.009. For participants with paired CGM data (n=40), time in range 70–180 mg/dL improved (from 97.4% to 98.9%, p
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000133
      Issue No: Vol. 3, No. 2 (2021)
  • Genetic risk of obesity as a modifier of associations between
           neighbourhood environment and body mass index: an observational study of
           335 046 UK Biobank participants

    • Authors: Mason, K. E; Palla, L, Pearce, N, Phelan, J, Cummins, S.
      Pages: 247 - 255
      Abstract: BackgroundThere is growing recognition that recent global increases in obesity are the product of a complex interplay between genetic and environmental factors. However, in gene-environment studies of obesity, ‘environment’ usually refers to individual behavioural factors that influence energy balance, whereas more upstream environmental factors are overlooked. We examined gene-environment interactions between genetic risk of obesity and two neighbourhood characteristics likely to be associated with obesity (proximity to takeaway/fast-food outlets and availability of physical activity facilities).MethodsWe used data from 335 046 adults aged 40–70 in the UK Biobank cohort to conduct a population-based cross-sectional study of interactions between neighbourhood characteristics and genetic risk of obesity, in relation to body mass index (BMI). Proximity to a fast-food outlet was defined as distance from home address to nearest takeaway/fast-food outlet, and availability of physical activity facilities as the number of formal physical activity facilities within 1 km of home address. Genetic risk of obesity was operationalised by weighted Genetic Risk Scores of 91 or 69 single nucleotide polymorphisms (SNP), and by six individual SNPs considered separately. Multivariable, mixed-effects models with product terms for the gene-environment interactions were estimated.ResultsAfter accounting for likely confounding, the association between proximity to takeaway/fast-food outlets and BMI was stronger among those at increased genetic risk of obesity, with evidence of an interaction with polygenic risk scores (p=0.018 and p=0.028 for 69-SNP and 91-SNP scores, respectively) and in particular with a SNP linked to MC4R (p=0.009), a gene known to regulate food intake. We found very little evidence of gene-environment interaction for the availability of physical activity facilities.ConclusionsIndividuals at an increased genetic risk of obesity may be more sensitive to exposure to the local fast-food environment. Ensuring that neighbourhood residential environments are designed to promote a healthy weight may be particularly important for those with greater genetic susceptibility to obesity.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000107
      Issue No: Vol. 3, No. 2 (2021)
  • Responsibility for vitamin D supplementation of elderly care home
           residents in England: falling through the gap between medicine and food

    • Authors: Williams, J; Williams, C.
      Pages: 256 - 262
      Abstract: IntroductionDaily vitamin D supplements are recommended for elderly care home residents; however, they are rarely given and vitamin D deficiency in care homes is widespread. This study aimed to understand the determinants of current practice and perceived responsibility for the vitamin D status of residents.MethodsThirteen semi-structured interviews were conducted with key informants in two areas of Southern England including care home managers, general practitioners (GPs) and public health professionals. Interviews were audio recorded and transcribed verbatim.ResultsInductive thematic analysis identified four themes: framing of vitamin D supplements as medicines; professional and sector boundaries whereby GPs are perceived as responsible for the vitamin D status of residents and care home managers felt unable to administer over-the-counter vitamin tablets; low awareness of national guidance; and ethical and practical issues. This results in vitamin D supplements requiring prescription by medical professionals and few residents receiving them.ConclusionThe medical framing of vitamin D supplements in care homes is a practical barrier to implementation of longstanding nutrition guidelines. A paradigm shift is needed so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility. Vitamin D is important for musculoskeletal health. Possible links with COVID-19 are still being investigated. The pandemic has drawn attention to conditions in care homes and there is an opportunity to revise current guidance on vitamin D supplementation which will have lasting benefit for this vulnerable group.
      Keywords: Open access, Press releases
      PubDate: 2021-01-19T21:52:40-08:00
      DOI: 10.1136/bmjnph-2020-000129
      Issue No: Vol. 3, No. 2 (2021)
  • Relative validity and reliability of a diet risk score (DRS) for clinical

    • Authors: Johnston, E. A; Petersen, K. S, Beasley, J. M, Krussig, T, Mitchell, D. C, Van Horn, L. V, Weiss, R, Kris-Etherton, P. M.
      Pages: 263 - 269
      Abstract: IntroductionAdherence to cardioprotective dietary patterns can reduce risk for developing cardiometabolic disease. Rates of diet assessment and counselling by physicians are low. Use of a diet screener that rapidly identifies individuals at higher risk due to suboptimal dietary choices could increase diet assessment and brief counselling in clinical care.MethodsWe evaluated the relative validity and reliability of a 9-item diet risk score (DRS) based on the Healthy Eating Index (HEI)-2015, a comprehensive measure of diet quality calculated from a 160-item, validated food frequency questionnaire (FFQ). We hypothesised that DRS (0 (low risk) to 27 (high risk)) would inversely correlate with HEI-2015 score. Adults aged 35 to 75 years were recruited from a national research volunteer registry (ResearchMatch.org) and completed the DRS and FFQ in random order on one occasion. To measure reliability, participants repeated the DRS within 3 months.ResultsIn total, 126 adults (87% female) completed the study. Mean HEI-2015 score was 63.3 (95% CI: 61.1 to 65.4); mean DRS was 11.8 (95% CI: 10.8 to 12.8). DRS and HEI-2015 scores were inversely correlated (r=–0.6, p
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000134
      Issue No: Vol. 3, No. 2 (2021)
  • How does self-perceived nutrition competence change over time during
           medical training' A prospective longitudinal observational study of
           New Zealand medical students

    • Authors: Crowley, J; Ball, L, Wall, C.
      Pages: 270 - 276
      Abstract: ObjectivesMedical nutrition education aims to equip doctors with nutrition knowledge, skills, attitudes and confidence to counsel patients to improve their diet. This study aimed to describe changes in medical students’ self-perceived nutrition competence at three time points during medical training.DesignProspective longitudinal observational study.SettingThe University of Auckland, School of Medicine.ParticipantsYear 2 medical students (phase 1, preclinical) were surveyed in May 2016. Participants repeated the survey in February 2018 as Year 4 students and July 2019 (phase 2, clinical) as Year 5 students.Primary outcome measurePrimary outcome measure was self-perceived nutrition competence measured using the validated NUTrition Competence (NUTCOMP) survey.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 30 students as Year 5 students in 2019 (RR 29.41%). 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 to 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. There remains opportunity for further supporting medical students to increase their competence in nutrition care, which could be achieved through mandatory and greater medical nutrition education.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000080
      Issue No: Vol. 3, No. 2 (2021)
  • Perfluoroalkyl substances (PFASs) and mercury in never-pregnant women of
           fertile age: association with fish consumption and unfavorable lipid

    • Authors: Bjorke-Monsen, A.-L; Varsi, K, Averina, M, Brox, J, Huber, S.
      Pages: 277 - 284
      Abstract: ObjectivesTo examine concentrations of perfluoroalkyl substances (PFASs) and lifestyle factors that may contribute to higher levels of pollutants in never-pregnant women of fertile age.DesignObservational cross-sectional study.SettingParticipants were recruited among employees and students at Haukeland University Hospital and the University of Bergen, Norway.ParticipantsHealthy, never-pregnant Norwegian women (n=158) of fertile age (18–39 years).OutcomesConcentrations of 20 different PFASs, mercury (Hg), lead, cadmium, total, high-density lipoprotein and low-density lipoprotein (LDL) cholesterol, in addition to self-reported data on dietary intake.ResultsSeven PFASs were detected in more than 95% of the women. Women aged 30–39 years had higher concentrations of sum PFAS compared with younger women. Serum PFASs were significantly intercorrelated (rho: 0.34–0.98, p
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000131
      Issue No: Vol. 3, No. 2 (2021)
  • Insights from a general practice service evaluation supporting a lower
           carbohydrate diet in patients with type 2 diabetes mellitus and
           prediabetes: a secondary analysis of routine clinic data including HbA1c,
           weight and prescribing over 6 years

    • Authors: Unwin, D; Khalid, A. A, Unwin, J, Crocombe, D, Delon, C, Martyn, K, Golubic, R, Ray, S.
      Pages: 285 - 294
      Abstract: BackgroundIn a single general practice (GP) surgery in England, there was an eightfold increase in the prevalence of type 2 diabetes (T2D) in three decades with 57 cases and 472 cases recorded in 1987 and 2018, respectively. This mirrors the growing burden of T2D on the health of populations round the world along with healthcare funding and provision more broadly. Emerging evidence suggests beneficial effects of carbohydrate-restricted diets on glycaemic control in T2D, but its impact in a ‘real-world’ primary care setting has not been fully evaluated.MethodsAdvice on a lower carbohydrate diet was offered routinely to patients with newly diagnosed and pre-existing T2D or prediabetes between 2013 and 2019, in the Norwood GP practice with 9800 patients. Conventional ‘one-to-one’ GP consultations were used, supplemented by group consultations, to help patients better understand the glycaemic consequences of their dietary choices with a particular focus on sugar, carbohydrates and foods with a higher Glycaemic Index. Those interested were computer coded for ongoing audit to compare ‘baseline’ with ‘latest follow-up’ for relevant parameters.ResultsBy 2019, 128 (27%) of the practice population with T2D and 71 people with prediabetes had opted to follow a lower carbohydrate diet for a mean duration of 23 months. For patients with T2D, the median (IQR) weight dropped from of 99.7 (86.2, 109.3) kg to 91.4 (79, 101.1) kg, p
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000072
      Issue No: Vol. 3, No. 2 (2021)
  • Literacy is power: structural drivers of child malnutrition in rural

    • Authors: Kumeh, O. W; Fallah, M. P, Desai, I. K, Gilbert, H. N, Silverstein, J. B, Beste, S, Beste, J, Mukherjee, J. S, Richardson, E. T.
      Pages: 295 - 307
      Abstract: BackgroundIn Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country’s civil war and were further exacerbated by the 2014–2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations.MethodsBetween July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers’ experiences, as well as health workers’ understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data.ResultsMothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000140
      Issue No: Vol. 3, No. 2 (2021)
  • Nutrition education in medical school: the case of international medical
           students in China

    • Authors: Amakye, W. K; Bozovic, S, Faraque, A, Yao, M, Ren, J.
      Pages: 308 - 319
      Abstract: ObjectiveTo assess the knowledge on country-specific nutrition situation, perceptions of the nutrition curricula and factors influencing capacity to offer nutrition guidance among medical students studying internationally in China compared with their home-country counterparts.DesignCross-sectional study.SettingsChina, Ghana, India and Montenegro.ParticipantsInternational medical students in China and medical students studying in their home countries of Ghana, India and Montenegro.Main measureAn online semistructured questionnaire was administered using WeChat for international students and Microsoft Forms for home-country medical students to assess students’ perceived knowledge and significance of nutrition, knowledge of country-specific nutrition situation, perceptions of the nutrition curricula and perceived capacity to offer nutrition counselling.ResultIn all, 190 medical students responded to the survey: 110 international students studying in China and 80 home-country students from Ghana (40), India (20) and Montenegro (20). Home-country students rated the importance of nutrition in health and disease development higher than international students (p
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000117
      Issue No: Vol. 3, No. 2 (2021)
  • Spectrum of nutrition-specific and nutrition-sensitive determinants of
           child undernutrition: a multisectoral cross-sectional study in rural

    • Authors: Aiga, H; Nomura, M, Langa, J. P. M, Mahomed, M, Marlene, R, Alage, A, Trindade, N, Buene, D, Hiraoka, H, Nakada, S, Arinde, E, Varimelo, J, Chivale, A. J.
      Pages: 320 - 338
      Abstract: BackgroundDespite an increasing need for multisectoral interventions and coordinations for addressing malnutrition, evidence-based multisectoral nutrition interventions have been rarely developed and implemented in low-income and middle-income countries. To identify key determinants of undernutrition for effectively designing a multisectoral intervention package, a nutrition survey was conducted, by comprehensively covering a variety of variables across sectors, in Niassa province, Mozambique.MethodsA cross-sectional household survey was conducted in Niassa province, August–October 2019. Anthropometric measurements, anaemia tests of children under 5 years of age and structured interviews with their mothers were conducted. A total of 1498 children under 5 years of age participated in the survey. We employed 107 background variables related to possible underlying and immediate causes of undernutrition, to examine their associations with being malnourished. Both bivariate (2 test and Mann-Whitney’s U test) and multivariate analyses (logistic regression) were undertaken, to identify the determinants of being malnourished.ResultsPrevalence rates of stunting, underweight and wasting were estimated at 46.2%, 20.0% and 7.1%, respectively. Timely introduction of solid, semi-solid or soft foods to children of 6–8 months of age was detected as a determinant of being not stunted. Mother–child cosleeping and ownership of birth certificate were a protective factor from and a promoting factor for being underweight, respectively. Similarly, availability and consumption of eggs at the household level and cough during the last 2 weeks among children were likely to be a protective factor from and a promoting factor for being wasted, respectively.ConclusionTimely introduction of solid, semi-solid or soft foods could serve as an entry point for the three sectors to start making joint efforts, as it requires the interventions from all health, agriculture and water sectors. To enable us to make meaningful interprovincial, international and inter-seasonal comparisons, it is crucially important to develop a standard set of variables related to being malnourished.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000182
      Issue No: Vol. 3, No. 2 (2021)
  • Misalignment of global COVID-19 breastfeeding and newborn care guidelines
           with World Health Organization recommendations

    • Authors: Vu Hoang, D; Cashin, J, Gribble, K, Marinelli, K, Mathisen, R.
      Pages: 339 - 350
      Abstract: IntroductionRecommendations for the clinical management of new mothers with suspected or confirmed COVID-19 and their infants are required. Guidance must weigh the risk posed by transmission of SARS-CoV-2 against the protection that maternal proximity and breastfeeding provide infants. Our aim was to review international COVID-19 guidance for maternal and newborn care, assessing alignment with WHO recommendations and the extent to which policy supported or undermined breastfeeding.MethodsGuidance documents from 33 countries on the care of infants whose mothers were suspected or confirmed as having COVID-19 were assessed for alignment with WHO recommendations regarding: (1) skin-to-skin contact; (2) early initiation of breastfeeding; (3); rooming-in; (4) direct breastfeeding; (5) provision of expressed breastmilk; (6) provision of donor human milk; (7) wet nursing; (8) provision of breastmilk substitutes; (9) psychological support for separated mothers; and (10) psychological support for separated infants.ResultsConsiderable inconsistency in recommendations were found. Recommendations against practices supportive of breastfeeding were common, even in countries with high infant mortality rates. None of the guidance documents reviewed recommended all aspects of WHO guidance. The presence of influential guidance conflicting with WHO recommendations and an undervaluing of the importance of maternal proximity and breastfeeding to infant health appeared to contribute to this poor alignment.ConclusionThose developing guidance in the COVID-19 pandemic and other infectious disease outbreaks need to appropriately consider the importance of skin-to-skin contact, early initiation of breastfeeding, rooming-in and breastfeeding to maternal and infant physical and psychological health. In weighing the value of recommendations of others in future guidance development, countries should consider past reliability and value placed on breastfeeding. Recommendations against maternal proximity and breastfeeding should not be made without compelling evidence that they are necessary, and less harmful than maintaining dyad integrity.
      Keywords: Open access, Nutrition Interactions with COVID-19
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000184
      Issue No: Vol. 3, No. 2 (2021)
  • Food & mood: a review of supplementary prebiotic and probiotic
           interventions in the treatment of anxiety and depression in adults

    • Authors: Noonan, S; Zaveri, M, Macaninch, E, Martyn, K.
      Pages: 351 - 362
      Abstract: BackgroundA bidirectional relationship exists between the brain and the gastrointestinal tract. Foods containing bacteria that positively influence the gastrointestinal microbiome are termed, probiotics; compounds that promote the flourishing of these bacteria are termed, prebiotics. Whether microbiome influencing therapies could treat psychiatric conditions, including depression and anxiety, is an area of interest. Presently, no established consensus for such treatment exists.MethodsThis systematic review analyses databases and grey literature sites to investigate pre and/or probiotics as treatments for depression and/or anxiety disorders. Articles included are from within 15 years. Pre-determined inclusion exclusion criteria were applied, and articles were appraised for their quality using a modified-CASP checklist. This review focuses specifically on quantitative measures from patients with clinical diagnoses of depression and/or anxiety disorders.Results7 studies were identified. All demonstrated significant improvements in one or more of the outcomes measuring the of effect taking pre/probiotics compared with no treatment/placebo, or when compared to baseline measurements.DiscussionOur review suggests utilising pre/probiotic may be a potentially useful adjunctive treatment. Furthermore, patients with certain co-morbidities, such as IBS, might experience greater benefits from such treatments, given that pre/probiotic are useful treatments for other conditions that were not the primary focus of this discourse. Our results are limited by several factors: sample sizes (adequate, though not robust); short study durations, long-term effects and propensity for remission undetermined.ConclusionOur results affirm that pre/probiotic therapy warrants further investigation. Efforts should aim to elucidate whether the perceived efficacy of pre/probiotic therapy in depression and/or anxiety disorders can be replicated in larger test populations, and whether such effects are maintained through continued treatment, or post cessation. Interventions should also be investigated in isolation, not combination, to ascertain where the observed effects are attributable to. Efforts to produce mechanistic explanations for such effect should be a priority.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2019-000053
      Issue No: Vol. 3, No. 2 (2021)
  • Genetic variants for personalised management of very low carbohydrate
           ketogenic diets

    • Authors: Aronica, L; Volek, J, Poff, A, D'agostino, D. P.
      Pages: 363 - 373
      Abstract: The ketogenic diet (KD) is a low-carbohydrate, high-fat, adequate-protein diet proven to be effective for the reversal of obesity, metabolic syndrome and type 2 diabetes, and holding therapeutic potential for the prevention and treatment of other chronic diseases. Genetic and dynamic markers of KD response may help to identify individuals most likely to benefit from KD and point to individuals at higher risk for adverse health outcomes. Here, we provide a clinician-friendly review of state-of-the-art research on biomarkers of KD response for a variety of outcomes including weight loss, body composition and cognitive performance drawing data from both intervention trials and case reports of rare inborn errors of metabolism. We also present a selection of the most promising candidate genes to evaluate in future studies and discuss key aspects of study design and variant interpretation that may help accelerate the implementation of these biomarkers in clinical practice.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000167
      Issue No: Vol. 3, No. 2 (2021)
  • Exploring the implications of COVID-19 on widening health inequalities and
           the emergence of nutrition insecurity through the lens of organisations
           involved with the emergency food response

    • Authors: Macaninch, E; Martyn, K, Lima do Vale, M.
      Pages: 374 - 382
      Abstract: BackgroundThis paper describes the impact of COVID-19 during the first month of containment measures on organisations involved in the emergency food response in one region of the UK and the emerging nutrition insecurity. This is more than eradicating hunger but considers availability of support and health services and the availability of appropriate foods to meet individual requirements. In particular, this paper considers those in rural communities, from lower socioeconomic groups or underlying health conditions.MethodsSemistructured professional conversations informed the development of a questionnaire which gathered insights from five organisations involved with the emergency food response in the South East, England, UK. Descriptive themes were derived though inductive analysis and are further discussed in relation to UK government food support measures and early published data.ResultsFour themes emerged from conversations, including: (1) increasing demand, (2) meeting the needs of specific groups, (3) awareness of food supply and value of supporting local and (4) concerns over sustainability. All organisations mentioned changes in practice and increased demand for emergency food solutions. Positive, rapid and innovative changes helped organisations to adapt to containment restrictions and to meet the needs of vulnerable people. Although concern was raised with regards to meeting the specific needs of those with underlying health conditions and the sustainability of current efforts.ConclusionConsiderable gaps in food provision were identified, as well as concerns regarding increased long-term food and nutrition insecurity. The paper makes recommendations to improve nutrition security for the future and considers the lessons learnt from the COVID-19 pandemic. The generalisability of these early insights is unknown but these real-time snapshops can help to direct further research and evaluation.
      Keywords: Open access, COVID-19
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000120
      Issue No: Vol. 3, No. 2 (2021)
  • Qualitative research study on addressing barriers to healthy diet among
           low-income individuals at an urban, safety-net hospital

    • Authors: Cahill, E; Schmidt, S. R, Henry, T. L, Kumar, G, Berney, S, Bussey-Jones, J, Girard, A. W.
      Pages: 383 - 386
      Abstract: BackgroundSome American households experience food insecurity, where access to adequate food is limited by lack of money and other resources. As such, we implemented a free 6-month Fruit and Vegetable Prescription Program within a large urban safety-net hospital .Methods32 participants completed a baseline and postintervention qualitative evaluation about food-related behaviour 6 months after study completion. Deductive codes were developed based on the key topics addressed in the interviews; inductive codes were identified from analytically reading the transcripts. Transcripts were coded in MAXQDA V.12 (Release 12.3.2).ResultsThe information collected in the qualitative interviews highlights the many factors that affect dietary habits, including the environmental and individual influences that play a role in food choices people make. Participants expressed very positive sentiments overall about their programme participation.ConclusionsA multifaceted intervention that targets individual behaviour change, enhances nutritional knowledge and skills, and reduces socioeconomic barriers to accessing fresh produce may enhance participant knowledge and self-efficacy around healthy eating. However, socioeconomic factors remain as continual barriers to sustaining healthy eating over the long term. Ongoing efforts that address social determinants of health may be necessary to promote sustainability of behaviour change.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000064
      Issue No: Vol. 3, No. 2 (2021)
  • Sex and gender differences in childhood obesity: contributing to the
           research agenda

    • Authors: Shah, B; Tombeau Cost, K, Fuller, A, Birken, C. S, Anderson, L. N.
      Pages: 387 - 390
      Abstract: Childhood obesity is a major public health challenge and its prevalence continues to increase in many, but not all, countries worldwide. International data indicate that the prevalence of obesity is greater among boys than girls 5–19 years of age in the majority of high and upper middle-income countries worldwide. Despite this observed sex difference, relatively few studies have investigated sex-based and gender-based differences in childhood obesity. We propose several hypotheses that may shape the research agenda on childhood obesity. Differences in obesity prevalence may be driven by gender-related influences, such as societal ideals about body weight and parental feeding practices, as well as sex-related influences, such as body composition and hormones. There is an urgent need to understand the observed sex differences in the prevalence of childhood obesity; incorporation of sex-based and gender-based analysis in all childhood obesity studies may ultimately contribute to improved prevention and treatment.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000074
      Issue No: Vol. 3, No. 2 (2021)
  • Connecting nutrition as a hard science and international knowledge
           networks: Proceedings of the Fourth International Summit on Medical and
           Public Health Nutrition Education and Research

    • Authors: Barrett, E. M; Brown, M, Buckner, L, Bradfield, J, Khalid, A. A, Laur, C, Ray, S.
      Pages: 391 - 396
      Abstract: IntroductionNutrition is a ‘hard’ science in two ways; the scientific rigour required for quality nutrition research, and equally, the challenges faced in evidence translation. Ways in which quality nutrition research can be synthesised and evidence effectively translated into practice were the focus of the Fourth Annual International Summit on Medical and Public Health Nutrition Education and Research.SettingWolfson College, University of Cambridge, and Addenbrookes Hospital at the Cambridge Biomedical Campus, Cambridge, in July 2018.Key findingsOpen communication and collaboration across disciplines and systems, including transfer of knowledge, ideas and data through international knowledge application networks, was presented as a key tool in enhancing nutrition research and translation of evidence. Increasing basic nutrition competence and confidence in medical professionals is needed to encourage the implementation of nutrition therapy in prevention and treatment of health outcomes.ConclusionsA sustained focus on producing quality nutrition research must be coupled with increased efforts in collaboration and building of knowledge networks, including educating and training multidisciplinary health and medical professionals in nutrition. Such efforts are needed to ensure nutrition is both reliable in its messaging and effective in translation into healthcare.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000090
      Issue No: Vol. 3, No. 2 (2021)
  • Closing the gap: data-based decisions in food, nutrition and health
           systems: proceedings of the Fifth International Summit on Medical and
           Public Health Nutrition Education and Research

    • Authors: Laur, C; Johnsen, J. T, Bradfield, J, Eden, T, Mitra, S, Ray, S.
      Pages: 397 - 402
      Abstract: IntroductionLike many of the biological sciences, nutrition has rapidly become a science which relies heavily on data collection, analysis and presentation. Knowledge gaps exist where data does not, and so the fifth annual International Summit on Medical and Public Health Nutrition Education and Research was held to address the theme of ‘Closing the Gap: Data-based Decisions in Food, Nutrition and Health Systems’.SettingHomerton College, University of Cambridge, Cambridge in July 2019.Key findingsData-driven decision making is more likely to lead to positive change in areas such as malnutrition, food insecurity and food production. These decisions must be informed by multiple stakeholders from various backgrounds in multisectorial collaboration. Case examples presented at the Summit contribute to the International Knowledge Application Network in Nutrition 2025, which aims to help identify and close gaps in nutrition and healthcare.ConclusionsFormation of international networks are required to advance nutrition research, identify gaps and generate high-quality data. These data can be used to adequately train healthcare professionals resulting in positive impact on clinical and public health. Strengthening collaboration between existing networks will be essential in sharing data for better health outcomes.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000118
      Issue No: Vol. 3, No. 2 (2021)
  • Association between vitamin intake and respiratory complaints in adults
           from the UK National Diet and Nutrition Survey years 1-8

    • Authors: Almoosawi, S; Palla, L.
      Pages: 403 - 408
      Abstract: ObjectiveTo examine the cross-sectional association between vitamins A, E, C and D from diet and supplements and the prevalence of respiratory complaints in a nationally representative sample of UK adults.MethodsData from adult participants of the National Diet and Nutrition Survey Rolling Programme years 2008–2016 were used for the analysis. Logistic regression adapted for complex survey design was used to investigate the relationship between each vitamin intake in turn (exposure) and self-reported respiratory complaints (outcome), adjusting for relevant confounders.ResultsOverall, respiratory complaints were found in 33 of the 6115 adult patients aged 19 years and above. After adjustment for potential confounders, a negative association was observed between the intake of vitamin A and E intake from diet and supplements and respiratory complaints. For vitamin D, intake from supplements, but not diet, was inversely significantly associated with respiratory complaints. No association between vitamin C and respiratory complaints was observed.ConclusionIn conclusion, intake of vitamin A and E from diet and supplements, and vitamin D from supplements, show strong evidence of association with lower self-reported prevalence of respiratory complaints in a nationally representative sample of UK adults.
      Keywords: Open access, Press releases, COVID-19
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000150
      Issue No: Vol. 3, No. 2 (2021)
  • Mitigating the global health threat of violent conflict: a preventive

    • Authors: Shapiro, D; Hua, C.
      Pages: 409 - 412
      Abstract: Objective To examine the problem of large-scale violent conflict and the unique preventive role that the global health community can play. Methods We conducted a comprehensive literature review and extrapolated insights from practice-based research and consultation with leaders and grassroot organisations confronting emergent and ongoing large-scale conflict. Results The field of global health has thoroughly investigated the physical and mental health consequences of violent conflict, yet there is a dire need for preventive research and action. Conclusions Global health scholars and practitioners are well-positioned to track early warning signs of violence, construct predictive models of its outbreak, lobby for policy reform to address the structural roots of conflict, and provide mediation and educational support to mitigate emerging conflict.
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000114
      Issue No: Vol. 3, No. 2 (2021)
  • Does a ketogenic diet lower a very high Lp(a)' A striking experiment
           in a male physician

    • Authors: Scholl; J. G.
      Pages: 413 - 415
      Abstract: The level of lipoprotein(a) (Lp(a)), an important cardiovascular risk factor, is considered to be genetically determined. I am a 55-year-old male physician specialised in preventive medicine and a hobby triathlete with a body mass index of 24.9 kg/m2 and a maximum oxygen consumption (VO2max) of ~50 mL/(kgxmin), with an average of 7–10 hours of exercise per week.I discovered my own Lp(a) at 92–97 mg/dL in 2004 and measured a maximum Lp(a) of 108 mg/dL in 2013. Surprisingly, I observed a much lower Lp(a) of 65 mg/dL in 2018. This happened after I had adopted a very-low-carb ketogenic diet for long-term endurance exercise.My n=1 experiment in July 2020 demonstrated an increase in Lp(a) back to 101 mg/dL on a very high-carb diet within 2 weeks, and a drop back to 74 mg/dL after 3 weeks on the ketogenic diet afterwards. The observed large changes in my Lp(a) were thus reproducible by a change in carbohydrate consumption and might have clinical relevance for patients as well as researchers in the field of Lp(a).
      Keywords: Open access
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000189
      Issue No: Vol. 3, No. 2 (2021)
  • Using the 'shit of the current COVID-19 crisis as fertiliser for the soil
           to lay the foundations of a new and sustainable era: lessons from past
           crises to improve the future

    • Authors: Roseboom; T.
      Pages: 416 - 418
      Abstract: Studies of past crises have demonstrated that adverse experiences during critical periods of human development hamper the individual’s ability to reach its full potential and leaves lasting marks on health, behaviour, productivity and society as a whole. The COVID-19 crisis has severely worsened the environment in which we live and in which our future generations are being shaped, and will lead to loss of future human potential and capital. It is clear that the COVID-19 pandemic does not only harm the current world population, but also affects our future, as well as that of future generations. The science of transgenerational plasticity demonstrates that investments in early life hold the promise of having beneficial effects across multiple generations. As governments are reopening societies and prioritising policies, their overarching goal should be to improve the environment in which future generations grow and develop, learn and live. This will change the lifetime trajectories of children for the better and affect future health, school success, behaviour, productivity and well-being. This prioritisation will prove to be the most effective intervention to build sustainable futures but will also yield returns many times the original investment. It is a promising way to break the intergenerational cycle of adversity and accelerate progress on achieving the Sustainable Development Goals.
      Keywords: Open access, COVID-19
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000122
      Issue No: Vol. 3, No. 2 (2021)
  • Micronutrient deficiencies in patients with COVID-19: how metabolomics can
           contribute to their prevention and replenishment

    • Authors: Tsoukalas, D; Sarandi, E.
      Pages: 419 - 420
      Keywords: Open access, COVID-19, Nutrition Interactions with COVID-19
      PubDate: 2021-01-19T21:52:41-08:00
      DOI: 10.1136/bmjnph-2020-000169
      Issue No: Vol. 3, No. 2 (2021)
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