Can Public Health Interventions Change Immediate and Long-Term Dietary Behaviours? Encouraging Evidence from a Pilot Study of the U.K. Change4Life Sugar Swaps Campaign

The aim of this pilot study was to evaluate the effectiveness of the U.K. Change4Life Sugar Swaps campaign for improving nutritional intake in a small sample of families prior to the 2015 nationwide launch. A total of 49 participants from 14 families received information and materials during a two-week intervention period in November 2014 encouraging them to swap high sugar foods and drinks for low sugar alternatives. Daily dietary intake was reported with online food diaries over four stages, each two weeks in length: (i) baseline (no information provided), (ii) intervention when Sugar Swaps materials were accessible, (iii) immediate follow-up, and (iv) one year on from baseline. Data were analysed for sugar, glucose, fructose, sucrose, lactose, fat, saturated fat, carbohydrate, protein, salt, fibre, vitamin C, and energy. During the intervention, significant daily reductions of 32 g sugar, 11 g fat, and 236 kcal for each family member were observed, among others, and 61% of benefits achieved during the intervention period were maintained at immediate follow-up. Encouragingly, for children, reductions in sugar, sucrose, fat, saturated fat, carbohydrate, and energy were observed one year on. The Sugar Swaps Campaign is potentially an effective public health intervention for improving short- and long-term dietary behaviour for the whole family.

Association between nutrition knowledge, lifestyle, dietary practices and nutritional status among civil servants in western Nigeria

Nutrition knowledge plays a crucial role in promoting healthier eating practices, leading to the maintenance of healthy body weight. This is because knowledge of dietary guidelines and healthy eating habits among adults has been positively correlated. However, in terms of dietary habits, presumptions that the supposed civil servants in some parts of Western Nigeria are knowledgeable about basic dietary practices are yet to be explored. Therefore, this study was designed to assess the nutrition knowledge, lifestyle, dietary practices, and nutritional status among men and women civil servants in Ado, Ekiti State, Nigeria. A structured interviewer questionnaire was administered to civil servants (180 male and 220 female elderly respondents, <60years old) to collect data on economic and socio-demographic characteristics, nutrition knowledge, lifestyle, and dietary habits. Anthropometric measurements were also taken. The quantitative were coded, collated, and analyzed using SPSS. Descriptive statistics were used to summarize data from categorical variables. Chi-square test, at a 5% confidence level, was used to establish any significant relationship between food intake parameters and nutrition knowledge. Most of the respondents (66.7%) were affected by the delayed payment of their monthly salaries. The total knowledge scores revealed that 13.25%, 41.25% and 45.50% of the respondents had poor, fair and good nutrition knowledge, respectively. Unfortunately, this higher nutrition knowledge does not translate into good dietary habits. Data obtained revealed bad eating habits, as a more significant percentage of the respondents regularly ate high-fat foods (99.5%), ate outside the home (85.3%) and did not take vegetables (83.3%) nor fruits (60%) daily. There exists, however, a significant and positive relationship between nutrition knowledge and physical activity (P=0.043), high-fat foods consumption (P<0.001), daily fruits consumption (P<0.001) and vegetable consumption (P<0.001). In conclusion, the discrepancy between the respondents' high nutrition knowledge and their seemingly poor lifestyle and dietary behaviour show that nutrition knowledge alone does not translate into good dietary behaviour.

Relating aspects of adolescents’ critical nutrition literacy at the personal level

Efforts targeting adolescents’ dietary behaviour have often focused on improving their access to nutrition information; however, adolescents report finding nutrition information difficult to understand. Exploring adolescents’ critical nutrition literacy might provide insight into how best to improve their use of available nutrition information. Purpose The purpose of this article is to explore how the two aspects of the critical nutrition literacy - critical evaluation of nutrition information’ and ‘engagement in dietary behaviour’ are linked at personal level. Additionally, the study sought to establish the association between critical nutrition literacy and self-efficacy in nutrition related subjects. Methods Applying a cross-sectional study design, the study sampled 1622 adolescents aged 15-16years, enrolled in 58 secondary schools in Norway. The adolescents responded to scales measuring self-efficacy and CNL. Using Lisrel 9.30, the study evaluated a structural equation model linking CNL and SEBH. Results The study yielded a simple yet theoretically sound model depicting the link between CNL and self-efficacy. Conclusion Efforts promoting adolescents’ nutrition literacy might benefit from increasing their self-efficacy in nutrition-related subjects.

Impact of the Front-of-Pack Label Nutri-Score on the Nutritional Quality of Food Choices in a Quasi-Experimental Trial in Catering

The front-of-pack labelling Nutri-Score has recently been implemented as a policy measure to improve the healthiness of food choices. The aim of this study was to investigate the impact of the Nutri-Score label in catering. A quasi-experimental trial was conducted in France between 16 December 2019 and 13 March 2020 in two staff restaurants (one intervention and one control site) from the same company. After a control period of seven weeks, the Nutri-Score label was affixed on all proposed products in the intervention site. Overall effects of the intervention were investigated using a difference in difference approach with generalised linear models. Over the 13 weeks of the study, 2063 participants who frequented the restaurant cafeteria at least once were included (1268 and 795 in the intervention and control site, respectively), representing 36,114 meals. Overall, the intervention led to a significant improvement in the nutritional quality of meals (p = 0.008) and a significant reduction in the intake of calories, sugars and saturated fat (p < 0.0001). Mixed effects models showed a qualitative improvement of food choices initially, and an adaptation of the quantities consumed over time, suggesting for the first time longer-term effects of the label on dietary behaviour.

Association between stress and eating behaviour among nurses in Hospital Universiti Sains Malaysia

Introduction: Stress is a factor that may affect dietary behaviour among nurses, which can contribute to a risk of overweight or obesity in the future. The aim of this study was to determine the association between stress and eating behaviour among nurses at Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Methods: A cross-sectional analysis was performed among 105 nurses (30-50 years of age; 84.8% females and 15.2% males) and participants were assessed using a selfadministered questionnaire consisting of socio-demographic data, body mass index (BMI), Perceived Stress Scale-10 (PSS-10), and the Dutch Eating Behaviour Questionnaire (DEBQ). Data were analysed using descriptive statistics and the associations were determined by Kruskal-Wallis Test. Results: Based on descriptive data, 73.3% of nurses (n=77) were moderately stressed and 49.5% had normal BMI (n=52). Furthermore, according to three eating domains, the emotional eating score was the highest (30.0±16.0). An association was found between emotional eating [χ2(2)=10.305, p=0.006], while external eating [χ2(2)=5.103, p=0.078], and restrained eating [χ2(2)=2.335, p=0.311] did not display a significant difference. The Bonferroni test was further used and there was a significant difference between low and moderate stress levels only (p<0.01), while others were not significantly different (low-high and moderate-high) (p>0.05). The results showed that nurses in the low stress group had lower scores of emotional eating behaviour than nurses with moderate stress levels. Conclusion: Stress has an impact on emotional eating behaviour and more research is needed to fully understand this link.

Dietary Behaviour and Nutrition in Patients with COPD Treated with Long-Term Oxygen Therapy

Background: It is the first study in Poland and one of the first in the world to assess the nutrition of patients with chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy (LTOT). Methods: The study group consisted of 110 COPD patients treated with LTOT. Anthropometric measurements and spirometry were performed. The diet of patients was assessed using a 3-day nutrition diary. Results: When assessing the degree of airflow obstruction (FEV1% N) depending on the BMI in patients treated with LTOT, a statistically significant correlation was demonstrated between the BMI and the value of the FEV% N parameter (p = 0.0093). Patients with COPD with a BMI >30 had statistically significantly higher values of FEV1% N than patients with a BMI in the range of 20–24.9 (p = 0.0278). Intake of calcium, vitamins A, C, D, E and folates was lower than the recommended daily intake in more than 95% of COPD patients. Conclusions: The diet of COPD patients treated with long-term oxygen therapy was improperly balanced, with deficiencies of important nutrients. Airflow obstruction in the respiratory tract was significantly smaller in obese patients, and greater in patients with diagnosed malnutrition.

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Background This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. Trial registration ClinicalTrials.gov, NCT03136211. Registered 2 May 2017, “retrospectively registered”.

The effect of eraser sampling for proteomic analysis on Palaeolithic bone surface microtopography

Bone surface modifications are crucial for understanding human subsistence and dietary behaviour, and can inform about the techniques employed in the production and use of bone tools. Permission to destructively sample such unique artefacts is not always granted. The recent development of non-destructive proteomic extraction techniques has provided some alternatives for the analysis of rare and culturally significant artefacts, including bone tools and personal ornaments. The Eraser Extraction Method (EEM), first developed for ZooMS analysis of parchment, has recently been applied to bone and ivory specimens. To test the potential impact of the EEM on ancient bone surfaces, we analyse six anthropogenically modified Palaeolithic bone specimens from Bacho Kiro Cave (Bulgaria) through a controlled sampling experiment using qualitative and 3D quantitative microscopy. Although the overall bone topography is generally preserved, our findings demonstrate a slight flattening of the microtopography alongside the formation of micro-striations associated with the use of the eraser for all bone specimens. Such modifications are similar to ancient use-wear traces. We therefore consider the EEM a destructive sampling approach for Palaeolithic bone surfaces. Together with low ZooMS success rates in some of the reported studies, the EEM might not be a suitable approach to taxonomically identify Pleistocene bone specimens.