Association of Dietary Approaches to Stop Hypertension diet and Mediterranean diet with blood pressure in less-developed ethnic minority regions

Objective: We aimed to investigate the association of Dietary Approaches to Stop Hypertension (DASH)-style diet and Mediterranean-style diet with blood pressure in less-developed ethnic minority regions (LMERs). Design: Cross-sectional study. Setting: Dietary intakes were assessed by a validated food frequency questionnaire. Dietary quality was assessed by the DASH-style diet score and the alternative Mediterranean-style diet (aMED) score. The association between dietary quality and blood pressure was evaluated using multivariate linear regression model. We further examined those associations in subgroups of blood pressure level. Participants: A total of 81433 adults from the China Multi-Ethnic Cohort (CMEC) study were included in this study. Results: In the overall population, compared with the lowest quintile, the highest quintile of DASH-style diet score was negatively associated with systolic BP (coefficient: −2.78, 95% CI: −3.15 to −2.41; P-trend<0.001), while the highest quintile of aMED score had a weaker negative association with systolic BP (coefficient: −1.43, 95% CI: −1.81 to −1.05; P-trend<0.001). Both dietary indices also showed a weaker effect on diastolic BP (coefficient for DASH-style diet: −1.06, 95% CI: −1.30 to −0.82; coefficient for aMED: −0.43, 95% CI: −0.68 to −0.19). In the subgroup analysis, both dietary indices showed a stronger beneficial effect on systolic BP in the hypertension group than in either of the other subgroups. Conclusion: Our results indicated that the healthy diet originating from Western developed countries can also have beneficial effects on blood pressure in LEMRs. DASH-style diet may be a more appropriate recommendation than aMED as part of a dietary strategy to control blood pressure, especially in hypertensive patients.

Systematic review of metrics used to characterize dietary nutrient supply from household consumption and expenditure surveys

Objective: To review existing publications using Household Consumption & Expenditure Survey (HCES) data to estimate household dietary nutrient supply to (1) describe scope of available literature, (2) identify the metrics reported and parameters used to construct these metrics, (3) summarize comparisons between estimates derived from HCES and individual dietary assessment data, and (4) explore the demographic and socioeconomic sub-groups used to characterize risks of nutrient inadequacy. Design: This study is a systematic review of publications identified from online databases published between 2000 to 2019 that used HCES food consumption data to estimate household dietary nutrient supply. Further publications were identified by “snowballing” the references of included database-identified publications. Setting: Publications using data from low- and lower middle income countries Results: In total, 58 publications were included. Three metrics were reported that characterized household dietary nutrient supply: apparent nutrient intake per adult-male equivalent per day (n=35), apparent nutrient intake per capita per day (n=24), and nutrient density (n=5). Nutrient intakes were generally overestimated using HCES food consumption data, with several studies finding sizeable discrepancies compared to intake estimates based on individual dietary assessment methods. Sub-group analyses predominantly focused on measuring variation in household dietary nutrient supply according to socioeconomic position and geography. Conclusion: HCES data are increasingly being used to assess diets across populations. More research is needed to inform the development of a framework to guide the use of and qualified interpretation of dietary assessments based on these data.

Beyond food swamps and food deserts: Exploring urban Australian food retail environment typologies

Objective: ‘Food deserts’ and ‘food swamps’ are food retail environment typologies associated with unhealthy diet and obesity. This study aimed to identify more complex food retail environment typologies and examine temporal trends. Design: Measures of food retail environment accessibility and relative healthy food availability were defined for small areas (SA2s) of Melbourne, Australia from a census of food outlets operating in 2008, 2012, 2014 and 2016. SA2s were classified into typologies using a two-stage approach: 1) SA2s were sorted into 20 clusters according to accessibility and availability; 2) clusters were grouped using evidence-based thresholds. Setting: This study was set in Melbourne, the capital city of the state of Victoria, Australia. Subjects: Food retail environments in 301 small areas (Statistical Area 2) located in Melbourne in 2008, 2012, 2014 and 2016. Results: Six typologies were identified based on access (low, moderate and high) and healthy food availability including one where zero food outlets were present. Over the study period SA2s experienced an overall increase in accessibility and healthiness. Distribution of typologies varied by geographic location and area-level socioeconomic position. Conclusion: Multiple typologies with contrasting access and healthiness measures exist within Melbourne and these continue to change over time, the majority of SA2s were dominated by the presence of unhealthy relative to healthy outlets; with SA2s experiencing growth and disadvantage having the lowest access and to a greater proportion of unhealthy outlets.

Implications of updated protocol for classification of childhood malnutrition and service delivery in world’s largest refugee camp amid this COVID-19 pandemic

Objectives: During the COVID-19 pandemic, the authorities made a change in the classification of malnutrition and concomitant service delivery protocol among the Rohingya children, residing in world’s largest refugee camp, located in Bangladesh. In this paper, we discussed the potential implications of this updated protocol on the malnutrition status among children from the Rohingya camp. Design: This paper reviewed relevant literature and authors’ own experience to provide a perspective of the updated protocol for the classification of malnutrition among the children in the Rohingya camps and its implication from a broader perspective. Setting: Rohingya refugee camps, Bangladesh Participants: Children aged less than five years residing in the Rohingya camps. Results: Major adaptation during this COVID-19 was discontinuation of using weight-for-height z-score (WHZ) and use of only MUAC and presence of edema for admission, follow up and discharge of malnourished children in camps. However, evidence suggest that use of MUAC only can underestimate the prevalence of malnutrition among the children in Rohingya camps. These apparently non-malnourished children are devoid of the rations that they would otherwise receive if classified as malnourished, making them susceptible to more severe malnutrition. Conclusions: Our analysis suggests that policymakers should consider using the original protocol of using both MUAC and WHZ to classify malnutrition and retain the guided ration size. We also believe that it would not take an extra effort to adopt the original guideline as even with MUAC only guideline, certain health measures needed to adopt during this pandemic.

Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices

Objective: To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices. Setting: Pudong District, Shanghai, China. Participants: A convenience sample of 1164 mothers who were primary caregivers of preschool children. Results: Sixty percent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0.212, P < 0.001). Structural equation modeling (SEM) indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0.035, P < 0.001), restriction (β = 0.022, P < 0.001), and food as a reward (β = -0.017, P < 0.05). Conclusion: Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.

Serum antioxidant status and mortality from influenza and pneumonia in US adults

Objective: We examined the association between serum antioxidant status and mortality from influenza and pneumonia in US adults. Design: Serum concentrations of antioxidants included vitamin C, vitamin A, vitamin E, sum of α- and β-carotene, β-cryptoxanthin, lutein+zeaxanthin, and lycopene. We computed total antioxidant capacity (TAC) as a measure of composite antioxidant status in serum. Survey-weighted Cox proportional hazard models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) comparing quartiles of each antioxidant and TAC. Setting: Data from the US National Health and Nutrition Examination Survey (NHANES)-III. Participants: A total of 7428 NHANES-III participants ≥45 years of age. Results: With a weighted-median follow-up of 16.8 years, 154 participants died from influenza/pneumonia. After adjustment for covariates, serum vitamin C, the sum of α- and β-carotene, and TAC were non-linearly associated with influenza/pneumonia mortality, with the statistically significant smallest HRs at the third quartile vs the first quartile [HRs=0.38 (95% CI: 0.19–0.77), 0.29 (0.16–0.51), and 0.30 (0.15–0.59), respectively]. HRs comparing the fourth vs the first quartiles were weaker and non-significant: 0.57 (95% CI: 0.27–1.17), 0.70 (0.41–1.19), and 0.65 (0.31–1.35), respectively. Serum lycopene had a monotonic association with influenza/pneumonia mortality [HR=0.43 (95% CI: 0.23–0.83) comparing the fourth vs the first quartile, P-for-trend=0.01]. Conclusions: The present study suggests that antioxidant intake as reflected by serum concentrations may reduce mortality risk from influenza or pneumonia in the US general population. These findings warrant further confirmation in other populations with different settings (e.g., a shorter-term association with influenza infection).

Limited implementation of California’s Healthy Default Beverage law for children’s meals sold online

Objective: To reduce children’s sugar-sweetened beverage intake, California’s Healthy-By-Default Beverage law (SB1192) mandates only unflavored dairy/non-dairy milk or water be the default drinks with restaurant children’s meals. The objective of this study is to examine consistency with this law for meals sold through online platforms from restaurants in low-income California neighborhoods. Design: This observational, cross-sectional study examines beverage availability, upcharges (additional cost), and presentation of beverage options consistent with SB1192 (using 4 increasingly restrictive criteria) within a random sample of quick service restaurants (QSRs) in SNAP-Ed eligible census tracts selling children’s meals online from November 2020-April 2021. Setting: Low-income California neighborhoods (n=226 census tracts). Participants: QSRs that sold children’s meals online via a restaurant-specific platform, DoorDash, GrubHub, and/or UberEats (n=631 observations from 254 QSRs). Results: Seventy percent of observations offered water; 63% offered unflavored milk. Among all beverages, water was most likely to have an upcharge; among observations offering water (n=445), 41% had an upcharge (average $0.51). Among observations offering unflavored milk (n=396), 11% had an upcharge (average $0.38). No observations upcharged for soda (regular or diet). Implementation consistency with SB1192 ranged from 40.5% (using the least restrictive criteria) to 5.6% (most restrictive) of observations. Conclusions: Based on observations from restaurant websites and three of the most popular online ordering platforms, most California QSRs located in low-income neighborhoods are not offering children’s meal beverages consistent with the state’s Healthy-By-Default Beverage law. As the popularity of online ordering increases, further work to ensure restaurants are offering healthy default beverages with children’s meals sold online is necessary.

Breastfeeding, rapid growth in the first year of life and excess weight at age 2 years: the 3D Cohort Study

Objective: To assess relationships between breastfeeding, rapid growth in the first year of life, and overweight/obesity status at age 2. Design: As part of an observational, longitudinal study beginning in early pregnancy, multivariable logistic regressions were used to assess associations between breastfeeding duration (total and exclusive) and rapid weight gain (RWG) between birth and age 1, and to determine predictors of overweight/obesity status at age 2. Setting: 9 hospitals located in the province of Quebec, Canada. Participants: 1599 term infants participating in the 3D Cohort Study Results: Children having RWG in the first year and those having excess weight at age 2 accounted for 28% and <10%, respectively. In multivariable models, children breastfed <6 months and from 6 months to <1 year were, respectively, 2.5 times (OR: 2.45; 95% CI: 1.76-3.41) and 1.8 times (OR: 1.78; 1.29-2.45) more likely to show RWG up to age 1 compared to children breastfed ≥ 1 year. Children exclusively breastfed < 3 months had significantly greater odds of RWG in the first year (OR: 1.94; 1.25-3.04) compared to children exclusively breastfed for ≥6 months. Associations between breastfeeding duration (total or exclusive) and excess weight at age 2 were not detected. RWG in the first year was found to be the main predictor of excess weight at age 2 (OR: 6.98; 4.35-11.47). Conclusions: The potential beneficial effects of breastfeeding on rate of growth in the first year of life suggest that interventions promoting breastfeeding are relevant for obesity prevention early in life.

An analysis of food and beverage advertising on bus shelters in a deprived area of Northern England

Objective: To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people. Design: Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation. Setting: Middlesbrough and Redcar and Cleveland in South Teesside. Participants: N/A Results: 832 advertisements were identified, almost half (48.9%) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35.1% were less healthy. Most food advertisements (98.9%) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years (71.9%). No differences in healthiness of advertised foods were found by level of deprivation. Conclusions: Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.

Electoral campaign contributions: an obstacle to health-related sugary drinks regulation in Brazil? The case of the Chamber of Deputies

Objective: To assess corporate electoral campaign contributions from industries related to sugary drinks production and the characteristics of the elected officials financed by the sector. Design: Cross-sectional analysis of electoral campaign contributions from corporations related to sugary drinks production (sugary drink industries and sugary drink input industries) to candidates to the Chamber of Deputies, Brazil. Setting: Elections to the 55th Congress (2015-2019), held in October 2014. Participants: Candidates to the Chamber of Deputies, Brazil. Results: Forty-nine companies or corporate groups that produce sugary drinks and 52 corporations that produce inputs for sugary drinks manufacturing contributed to electoral campaigns of candidates in the 2014 Election. Contributions from this industry sector represented 7.3% of all corporate contributions and helped finance 11.7% of the candidates and 46.2% of the elected officials. The transnationals Ambev and Coca-Cola were the first and second biggest donors, respectively. Revenues mediated by political parties, from sugary drink industries, and from corporate members of some industry associations (Abir, Unica and CitrusBR) were more prevalent. Among elected officials, a significant association was found between being financed by the sector and representing the Southeast region, having higher education level and referring themselves as being professional politicians. In the multivariate model, financed candidates were 27% more likely to be elected. Conclusions: Corporations related to sugary drinks production have contributed to the electoral campaigns of almost half of the Federal Deputies in Brazil in 2014. This possibly facilitates access to decision-makers and could help buy influence on legislative proposals, including health-related food policies.