Diet-related Non-communicable Diseases Research Articles

Situation analysis of sugar‑sweetened beverages taxation in Eastern Mediterranean Region

Background: Significant attention is being given to the role of sugar-sweetened beverages (SSBs) in the increasing rates of obesity and diet-related noncommunicable diseases in the Eastern Mediterranean Region (EMR). Aim: To document the different approaches being used by EMR countries in implementing the sugar-sweetened beverages taxation. Methods: This study used data on indirect taxes levied on SSBs by the 22 EMR countries and territories collected by WHO between July 2022 and June 2023. For comparison between countries, all applicable taxes were converted to a percentage of the tax-inclusive retail prices and standardized. Results: Eleven EMR countries imposed the national excise tax on carbonated SSBs and 10 imposed excise tax on at least one type of beverage other than carbonated SSBs. Ad valorem excise taxes were the most-used type for carbonated SSBs, with 10 of the 11 countries applying them. Morocco applied volume-based specific excise taxes with different rates depending on the sugar content. Excise tax represented the highest tax proportion (31.7%) in Oman and United Arab Emirates, while total tax represented the highest proportion (42.0%) of the retail price in Saudi Arabia and 36.5% in Oman and United Arab Emirates. Conclusion: Only half of the EMR countries are currently implementing SSBs taxation, and the imposed tax is less than 20% in half of these countries. All EMR countries should start implementing SSBs taxation as part of their national disease control policy frameworks to help reverse the increasing trend of obesity and other diet-related noncommunicable diseases in the region.

A review of sugar-sweetened beverages taxation in Saudi Arabia and United Arab Emirates

Background: The World Health Organization recommends taxes on sugar-sweetened beverages (SSBs) as part of costeffective interventions to prevent diet-related noncommunicable diseases. Aim: To analyse the adoption and implementation of SSBs taxation in Saudi Arabia and United Arab Emirates and its impact on obesity rates. Methods: Using a semi-structured questionnaire, we collected information on progress with implementation of SSBs taxes in Saudi Arabia and United Arab Emirates between January 2015 and December 2023. We searched literature published in Arabic and English on the subject and used the WHO acceleration scenario modelling tool to forecast the potential impact of SSBs on overweight and obesity in the 2 countries over the same period. Results: Both countries implemented SSBs taxation consistently between 2015 and 2023, generating additional revenue and reducing obesity rates. The acceleration scenario estimates showed that SBB taxation could reduce overweight prevalence among children and adolescents (aged 5–19 years) from 38.2% in 2020 to 34.4% in 2030 in Saudi Arabia and from 37.0% to 34.6% in United Arab Emirates, and could reduce obesity rate by approximately 12.7% in Saudi Arabia and 9.5% in United Arab Emirates in the same period. Conclusion: This review provides further evidence that SSBs taxes can be effective in reducing sugar consumption, thereby reducing overweight and obesity rates. However, to effectively combat obesity and overweight among children and adolescents, taxation policies must be implemented alongside other strategies, including public health campaigns to increase awareness about the health risks associated with excessive sugar consumption.

Fundamentals of a healthy and sustainable diet

BackgroundA healthy and sustainable diet is a prerequisite for population and planetary health. The evidence of associations between dietary patterns and health outcomes has now been synthesised to inform more than 100 national dietary guidelines. Yet, people select foods, not whole dietary patterns, even in the context of following specific diets such as a Mediterranean diet, presenting challenges to researchers, policymakers and practitioners wanting to translate dietary guideline recommendations into food-level selection guidance for citizens. Understanding the fundamentals that underpin healthy and sustainable diets provides a scientific basis for helping navigate these challenges. This paper’s aim is to describe the fundamentals of a healthy and sustainable diet.ResultsThe scientific rationale underpinning what is a healthy and sustainable diet is universal. Everyone shares a physiological need for energy and adequate amounts, types and combinations of nutrients. People source their energy and nutrient needs from foods that are themselves sourced from food systems. The physiological need and food systems’ sustainability have been shaped through evolutionary and ecological processes, respectively. This physiological need can be met, and food systems’ sustainability protected, by following three interlinked dietary principles: (i) Variety – to help achieve a nutritionally adequate diet and help protect the biodiversity of food systems. (ii) Balance – to help reduce risk of diet-related non-communicable diseases and excessive use of finite environmental resources and production of greenhouse gas emissions. (iii) Moderation – to help achieve a healthy body weight and avoid wasting finite environmental resources used in providing food surplus to nutritional requirements.ConclusionThe fundamentals of a healthy and sustainable diet are grounded in evolutionary and ecological processes. They are represented by the dietary principles of variety, balance and moderation and can be applied to inform food-level selection guidance for citizens.

Nutrient profile models for front-of-pack nutrition labelling: a systematic review

BackgroundFront-of-pack nutrition labelling (FOPNL) is a key policy to tackle diet-related non-communicable diseases. All types of FOPNL require an underlying nutrient profile model (NPM). Nutrient profiling is a scientific method for classifying foods according to their nutritional composition. This review aimed to identify all NPMs developed and/or used for FOPNL, to assist with the selection of appropriate NPMs to underpin nutrition policies, namely supporting the WHO Regional Office for Europe developing template NPMs for FOPNL. MethodsWe searched peer-reviewed databases (MEDLINE, CAB Abstracts, OvidSP, and Scopus) and grey literature (Overton and Google). Searches were limited to articles published in English, Spanish or Portuguese, and published between Jan 1, 2016, and May 4, 2023, building on a comparable review conducted by Labonté et al. in 2016. To be eligible for inclusion, NPMs developed for FOPNL had to allow for the classification or ranking of individual foods, be developed or endorsed by governmental or inter- governmental organisations and have a publicly available algorithm. FindingsFrom the 957 publications retrieved in the searches, 39 NPMs were included: 13 for warning labels, 12 for nutrient-specific systems (including ‘traffic-light’ labelling), 10 for health endorsements and four for graded summary indicators. Of these, 26 NPMs have been developed and four models updated since 2016. The WHO Region with highest number of models was the Americas (n=13, 33%), followed by the European Region (n=9, 23%) and the Western-Pacific Region (n=7, 18%). InterpretationThere has been a proliferation of new NPMs for FOPNL posing a potential challenge for policymakers in the selection of appropriate models for FOPNL policies. This systematic review facilitates the comparison of these models, demonstrating considerable heterogeneity in the NPMs underlying FOPNL, indicating there is little consensus in what constitutes the most appropriate model and reinforcing the need for more guidance and regional alignment. FundingMSB's DPhil is supported by the Nuffield Department of Population Health and St Cross College Joint Scholarship, as well as by the Saven European Scholarship. JAR is funded by the ESRC (SALIENT: Food System Trials for Healthier People and Planet project, Award ID/ref: ES/Y00311X/1). AK is funded by the Nuffield Department of Primary Care Health Sciences, University of Oxford, the Wellcome Trust (SHIFT (Sustainable Healthy Interventions for Food Transition, Award ID: 227132/Z/23/Z), and the NIHR PHR (COPPER: CO-designing for healthy People and Planet: food Economic policy Research. Award ID: NIHR133887). MJR is funded by the Nuffield Department of Population Health, University of Oxford.

Obesogenicity perception of food environments in adults: A cross-sectional study in urban areas of Santiago, Chile.

In Chile, there is a high prevalence of obesity, and most people have an inadequate quality of food. Food environments can constitute barriers that prevent healthy food choices and lead to overweight and obesity, as well as diet-related non-communicable diseases. There are international instruments that allow the characterization of food environments. In Chile, there are no studies on the perception of food environments. This study aimed to characterize the perception of obesogenicity of food environments in the urban Chilean population using an instrument previously validated in Chile. This is a cross-sectional study with probabilistic sampling. The "Perceived Nutrition Environment Measures Survey", based on the Chilean model of food environments, was applied to 256 participants from two urban communities of the Metropolitan Region. Scores were calculated for the instrument items, which allowed calculating scores by environments included in the Chilean model of Food Environments. Negative scores were related to a higher obesogenic level. The results show that the domestic food environment is perceived as less obesogenic (median of 15.8 points), with more than 90% of households having fruits, vegetables, and legumes, even though the supply food environment was negative (median -0.19 points). However, about 50% of households had ultra-processed foods. The street food environment was perceived as the most obesogenic (median -1.91 points), with more than 60% of the participants indicating difficulty finding healthy options. According to the level of obesogenicity of the environments studied, it is necessary to have public policies that improve them and ensure the availability and physical and economic access to healthy food, particularly in the food supply and public road environments.

Impact of added enzyme-treated bran on the techno-functional properties of puffed-extruded sorghum snack

Dietary fibre intake is crucial for improving human health and reducing the prevalence of diet-related non-communicable diseases. This study determines the effect of the enzyme (Viscozyme®L: a cocktail of cell wall degrading enzymes including arabanase, cellulase, β-glucanase, hemicellulase and xylanase) hydrolyzed fibre on the techno-functional properties of puffed-extruded sorghum snacks made from sorghum flour. Sorghum flour and sorghum flour mixed with untreated bran, water-incubated bran, and enzyme-treated bran were extruded using a twin-screw extruder. The puffed-extruded snacks from sorghum flour with 2-h enzyme-treated bran showed similar expansion ratios to snacks from sorghum flour without bran. The expansion ratios of the without-bran snacks (2.80) and enzyme-treated bran-added snacks (2.77) were significantly (P < 0.05) higher than those made with untreated sorghum bran (1.87). A higher expansion ratio usually results in a lighter, crispier texture and a more attractive appearance of puffed-extruded snacks, which consumers often prefer. The enzyme treatment also increased the water solubility index and decreased the water absorption index compared to snacks with untreated bran. This study explores the potential of using an enzyme-treated sorghum bran to manufacture puffed-extruded snacks comparable to those made with sorghum flour.

Emerging perspectives: the interplay of taste perception and oral microbiota composition in dietary preferences and obesity.

Recent advancements in sensory research have brought to light the intricate relationship between taste perception and the oral microbiota, prompting investigations into their influence on human health, particularly in the context of dietary preferences and obesity. This review aims to update the current understanding of how oral microbiota influence taste perception and dietary choices, elucidating shared metabolic pathways between food processing and oral bacteria. Further, this review outlines the mechanisms underlying taste perception, emphasising the role of taste receptors and taste buds in shaping sensory experiences influenced by genetic and environmental factors. Notably, we explore the bidirectional relationship between oral microbiota and taste sensitivity, highlighting the potential impact of microbial composition on taste perception thresholds and implications for dietary habits and health outcomes, such as obesity and dental caries. However, significant research gaps remain, particularly in the understanding of the molecular mechanisms linking oral microbiota with taste sensitivity, as well as the long-term effects of microbiota-targeted interventions. Future research should focus on longitudinal studies and experimental interventions to explore these connections more deeply, offering insights into potential strategies for promoting healthier dietary behaviours and managing diet-related non-communicable diseases.

A cross-sectional study of the relative availability and prominence of shelf space allocated to healthy and unhealthy foods in supermarkets in urban Ireland, by area-level deprivation

BackgroundDiet-related noncommunicable diseases (NCDs) are a leading cause of ill-health and death across Europe. In Ireland, dietary intakes of saturated fat, free sugar and salt exceed World Health Organization recommendations, and excess consumption follows a social gradient increasing population risk of diet-related NCDs. The retail food environment can influence consumer food choice and subsequent dietary intakes. In high income countries, supermarkets are an increasingly influential actor in consumer food availability, choice, purchase, and subsequent food intake. This study aims to assess the relative availability and prominence of healthy and unhealthy foods in Irish supermarkets, by area-level deprivation.MethodsThis study used a cross-sectional study design, and applied a validated measure, as described in the INFORMAS Protocol: Food Retail – Food availability in supermarkets. Between October 2021 and February 2022, shelf space (m2) (height or depth (cm) × length (cm)) and prominence (visibility), of foods, classified as healthy and unhealthy and represented by a proxy indicator, were collected in supermarkets (n = 36) in County Dublin, Ireland. Overall the proportion of mean relative shelf space (m2), allocated to healthy and unhealthy foods, and its prominence, by area-level deprivation, and retailer, were determined. We used t-tests and one-way ANOVA to analyse possible differences between the proportion of relative shelf space available to healthy and unhealthy foods, and its prominence, by area-level deprivation and retailer.ResultsThe study found the proportion of shelf space measured allocated to unhealthy food was 68.0% (SD 10.6). Unhealthy foods were more likely to be in areas of high prominence. Overall, there was no statistically significant difference between the proportion of relative shelf space available to unhealthy foods in areas of high and low deprivation. A statistically significant difference in the proportion of relative shelf space allocated to healthy and unhealthy food by area level deprivation was found in one retailer.ConclusionUnhealthy foods had a higher proportion of shelf space and were more prominent than healthy foods in supermarkets in County Dublin, Ireland. The current availability and prominence of foods in supermarkets does not align with Food Based Dietary Guideline recommendations and does not support consumers to make healthier food choices. There is a need for supermarkets in Ireland to improve the availability and prominence of healthy foods to support consumers to make healthier food choices.

Impact of low-carbohydrate diet on health status: an umbrella review.

The prevalence of diet-related non-communicable diseases has increased. A low-carbohydrate diet (LCDs) is one of the most popular interventions. Several systematic reviews and meta-analyses of randomised clinical trials (RCTs) and non-RCTs have linked LCDs to the management of obesity, diabetes, cardiovascular disease, epilepsy, and cancer. However, there has been limited appraisal of the strength and quality of this evidence. To systematically appraise existing meta-analyses and systematic reviews of RCTs and non-RCTs on the effects of LCDs on different health conditions. To understand their potential efficacy, we summarised the studies' findings and assessed the strength of the evidence. A search was conducted using the PubMed database from inception to October 2021 for systematic reviews and meta-analyses of RCTs and non-RCTs investigating the association between LCDs and multiple health outcomes in humans. The Academy of Nutrition and Dietetics Quality Criteria was used for the quality assessment. In addition, the evolution of heterogeneity, strength of the included studies, and effect sizes were extracted from each systematic review and meta-analysis. Ten systematic reviews and meta-analyses were included. Of the included reviews, 70% were of positive quality, 30% were neutral, and none were negative. The majority of the studies included strength in each systematic review, and the meta-analyses were of low to medium strength. The existing literature indicates that LCDs may help promote weight reduction in adults who are obese or overweight. This conclusion is supported by the findings of studies included in the analysis, which were of low to moderate strength. Furthermore, compelling data indicates a significant association between low-carbohydrate diets (LCDs) and a reduction in haemoglobin A1c levels among those diagnosed with type 2 diabetes mellitus. In contrast, there was a lack of evidence of this correlation in type 1 diabetes mellitus patients or those with cardiovascular diseases. Additionally, there was limited evidence regarding the effectiveness of LCDs in epilepsy and adult cancer patients. This review thoroughly examines the current body of information on how LCDs affect various health outcomes. Studies have presented evidence to support the idea that incorporating LCDs can positively influence weight management and HbA1c levels. However, there is a lack of information regarding the association between LCDs and individuals with Type 1 diabetes mellitus and cardiovascular diseases. Additionally, there is limited empirical evidence to substantiate the effectiveness of LCDs in the treatment of epilepsy and adult cancer patients. The long-term effects of LCDs on mortality and other chronic diseases that account for different carbohydrate subtypes is unclear. Further longitudinal cohort studies are required to reach definitive conclusions.

Design Optimization of a Novel Catalytic Approach for Transglucosylated Isomaltooligosaccharides into Dietary Polyols Structures by Leuconostoc mesenteroides Dextransucrase.

Polyols, or sugar alcohols, are widely used in the industry as sweeteners and food formulation ingredients, aiming to combat the incidence of diet-related Non-Communicable Diseases. Given the attractive use of Generally Regarded As Safe (GRAS) enzymes in both academia and industry, this study reports on an optimized process to achieve polyols transglucosylation using a dextransucrase enzyme derived from Leuconostoc mesenteroides. These enzyme modifications could lead to the creation of a new generation of glucosylated polyols with isomalto-oligosaccharides (IMOS) structures, potentially offering added functionalities such as prebiotic effects. These reactions were guided by a design of experiment framework, aimed at maximizing the yields of potential new sweeteners. Under the optimized conditions, dextransucrase first cleared the glycosidic bond of sucrose, releasing fructose with the formation of an enzyme-glucosyl covalent intermediate complex. Then, the acceptor substrate (i.e., polyols) is bound to the enzyme-glucosyl intermediate, resulting in the transfer of glucosyl unit to the tested polyols. Structural insights into the reaction products were obtained through nuclear maneic resonance (NMR) and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) analyses, which revealed the presence of linear α(1 → 6) glycosidic linkages attached to the polyols, yielding oligosaccharide structures containing from 4 to 10 glucose residues. These new polyols-based oligosaccharides hold promise as innovative prebiotic sweeteners, potentially offering valuable health benefits.

The change in food service costs associated with increasing the healthiness of ready-to-eat food provision: A systematic scoping review.

Increasing the healthiness of food retail environments is an identified mechanism to help halt rising rates of diet-related non-communicable diseases. Previous studies on healthy food environment adoption report that retailers' perceptions of loss of profitability and higher food costs are often barriers to change. Despite this, actual changes to profitability and food costs have not been fully explored. This study aimed to systematically scope the evidence relating to changes to food costs or profitability when changes are made to increase the healthiness of food and drinks sold by food service retailers. Nine databases were searched, with studies included from settings that sold ready-to-consume items, with interventions to increase the healthiness of menus, and reporting food environment/nutrition outcomes, and cost/profit outcomes. Of the 12 studies included, the majority were conducted in the United States and in school settings. Most studies indicated that increasing the healthiness of food service retail environments resulted in neutral or favorable financial outcomes. Food costs and/or profit changes were most often monitored via simple accounting measures. While further research is needed to strengthen the evidence on financial outcomes of healthier food provision, this review indicates that some perceived barriers to change may not be warranted.

Sugar taxation policy and sugar consumption in Malaysia

Malaysia has been taking initiatives to combat obesity as well as non-communicable diseases. A sugar-sweetened beverage (SSBs) tax was proposed in 2014 and implemented in 2019 with an excise duty of RM0.40 per litre for ready-to-drink sugar content. This article aimed to spark a discussion about Malaysia's current sugar tax policies to reduce excessive sugar consumption among Malaysians. However, the alarming rise in the number of obesity and diet-related noncommunicable diseases indicates that the sugar tax control measures are less effective in combating health issues. This study compares Malaysia's neighbours' sugar tax policies and other sugar consumption-related measures. To combat the emerging sugar-related health issues in Malaysia, the government should collaborate with food manufacturers to reduce the amount of sugar in their food production, abate sugar-containing products’ promotion, educate the consequences of excess sugar consumption at all levels of education, apply sugar taxes with lower tax base rate and specific tax rate depends on sugar addition, and form a regional policy between neighbours.

The Development and Effectiveness of Interactive Multimedia-Based Nutrition Education Module (IMNEM): A Concept Paper

Globally, malnutrition is an issue that has never been overcome, even after a series of efforts by experts, which have never been impressive. The world’s malnutrition burden remains unsatisfactory since malnutrition is solely responsible for more illnesses than other reasons. Malnutrition continues to be a significant problem in Malaysia. The most common manifestation of chronic malnutrition in children is stunting, a lifetime problem for a child in Malaysia. Stunting is an irreversible condition in which a child cannot regain their height in the same way that they can regain weight. Notably, various factors have been identified associated with the risk of stunting among Malaysian children. This includes socio-demographic background, gestational characteristics, maternal and infant diet, feeding practice, illness, and infection. As discovered through the literature review, stunted children face many disabilities, such as learning deficiencies, which affect their productivity for economic prosperity, mostly falling sick more often, losing opportunities to learn, performing poorly in school and growing up to be backward, and more likely to suffer from diet-related Non-Communicable Diseases (NCDs). Therefore, this study will develop and evaluate the effectiveness of interactive multimedia-based nutrition education on Knowledge, Attitude, and Practice (KAP) about nutrition, growth monitoring, breastfeeding, and child-feeding practices among mothers with stunted children using the ADDIE model. This study will employ a quasi-experimental research method consisting of control and treatment groups. The study will be conducted in maternal child health clinics in the Seberang Perai district in Pulau Pinang. The population of this study consists of mothers with stunted children under five years old. In this study, convenience sampling will be used to recruit the target population, and the sample size was determined using G*power.

Mapping ultra-processed foods (UPFs) in India: a formative research study

BackgroundIncreased consumption of ultra-processed foods (UPFs) which have additives such as artificial colours, flavours and are usually high in salt, sugar, fats and specific preservatives, are associated with diet-related non-communicable diseases (NCDs). In India, there are no standard criteria for identifying UPFs using a classification system based on extent and purpose of industrial processing. Scientific literature on dietary intake of foods among Indian consumers classifies foods as unhealthy based on presence of excessive amounts of specific nutrients which makes it difficult to distinguish UPFs from other commercially available processed foods.MethodsA literature review followed by an online grocery retailer scan for food label reading was conducted to map the types of UPFs in Indian food market and scrutinize their ingredient list for the presence of ultra-processed ingredients. All UPFs identified were randomly listed and then grouped into categories, followed by saliency analysis to understand preferred UPFs by consumers. Indian UPF categories were then finalized to inform a UPF screener.ResultsA lack of application of a uniform definition for UPFs in India was observed; hence descriptors such as junk-foods, fast-foods, ready-to-eat foods, instant-foods, processed-foods, packaged-foods, high-fat-sugar-and-salt foods were used for denoting UPFs. After initial scanning of such foods reported in literature based on standard definition of UPFs, an online grocery retailer scan of food labels for 375 brands (atleast 3 brands for each food item) confirmed 81 food items as UPFs. A range of packaged traditional recipes were also found to have UPF ingredients. Twenty three categories of UPFs were then developed and subjected to saliency analysis. Breads, chips and sugar-sweetened beverages (e.g. sodas and cold-drinks) were the most preferred UPFs while frozen ready-to-eat/cook foods (e.g. chicken nuggets and frozen kebabs) were least preferred.ConclusionIndia needs to systematically apply a food classification system and define Indian food categories based on the level of industrial processing. Mapping of UPFs is the first step towards development of a quick screener that would generate UPF consumption data to inform clear policy guidelines and regulations around UPFs and address their impact on NCDs.

Sugar-Sweetened Beverages and Diet Related Chronic Non-Communicable Diseases in Sub-Saharan Africa

abstract In Sub-Saharan Africa (SSA), diet-related chronic non-communicable diseases (DR-CNCDs) pose a growing public health threat, jeopardising progress towards achieving Sustainable Development Goal 3.4. One contributing factor to this rising threat is the recent surge in consumption of sugar-sweetened beverages (SSBs), across SSA in recent years. Using the socio-ecological model, this commentary explores the nexus between DR-NCDs and SSBs and offers interventions to address this public health challenge at the individual, interpersonal, community, organisational and policy levels. At the individual level, health education campaigns should target individuals and ensure an increase in awareness creation. The life-course approach underscores the importance of promoting healthier dietary choices from childhood to prevent diet-related non-communicable diseases in later life. Schools and workplaces enforcing local policies that discourage SSB consumption patterns will make a huge difference at the community and organisational levels. At the societal/policy level, comprehensive strategies such as sugar taxes, front-of-pack labelling, advertising restrictions and health education programmes are crucial.

Double-duty actions addressing the double burden of malnutrition among adolescents aged 10-19: protocol for a scoping review.

The global adolescent population faces the challenge of the double burden of malnutrition (DBM), characterized by the coexistence of undernutrition and overweight/obesity, including diet-related non-communicable diseases (NCDs). This dual challenge, prevalent across various socio-economic backgrounds, necessitates double-duty actions, i.e., integrated interventions designed to concurrently address both sets of conditions. These actions are critical for fostering the overall health and well-being of adolescents. The objective of this review is to describe the content, setting, and delivery mechanisms of double-duty actions, synthesize their impacts on adolescents' nutritional status, and offer policy and program implications for future interventions. As part of this scoping review, we will conduct a comprehensive search across multiple databases, including MEDLINE, Embase, CENTRAL, CINAHL, and Google Scholar, to identify relevant interventions, programs, policies, guidelines, evaluation studies, and strategies targeting DBM among adolescents aged 10-19 years. Inclusion criteria encompass a range of evidence sources with methodologically sound and well-described study designs. All full-text articles and abstracts will be independently screened by two reviewers to ensure a comprehensive inclusion of papers that align with the established criteria. The final protocol is available on Open Science Forum (https://osf.io/kxapb). Addressing DBM through integrated double-duty actions is crucial for achieving global nutrition and public health goals. However, challenges persist in the form of uncoordinated efforts, lack of comprehensive evidence for what interventions work among adolescents, and the need for context-specific strategies to effectively address the heterogeneity of DBM. The results of this scoping review may provide evidence for future policies and interventions, emphasizing integrated, multi-sectoral strategies tailored to the unique needs of the adolescent population.

Evaluation of micronutrient and nutritional status among preschool children in Jordan: results from a Nationwide survey.

Jordan faces various malnutrition challenges, including undernutrition, micronutrient deficiencies, overweight, obesity, and diet-related non-communicable diseases. The country has shifted from issues of undernutrition to rising rates of overweight and obesity, while still dealing with micronutrient deficiencies. The 2010 national survey revealed high rates of iron and vitamin D deficiencies among preschool children, with about 20% experiencing vitamin A deficiencies. The goals of the 2019 Jordan National Micronutrient & Nutrition Survey (JNMNS) include assessing feeding practices of infants and young children, determining the frequency of consuming micronutrient-rich foods, evaluating causes of anemia, assessing the health status of specific subgroups, and comparing findings to the 2010 survey. JNMNS 2019 was a comprehensive national cross-sectional survey structured across four strata. Within each stratum, 40 primary sampling units were chosen in proportion to their size based on the 2015 Jordan census. Subsequently, the Department of Statistics conducted household listings in each PSU. Separate response rates were assumed for households and target groups, encompassing interviews, anthropometric measurements, and specimen collection. The survey aimed to collect data from 2,210 households, including interviews and anthropometry for 1,232 preschool children, with blood samples obtained from 992 of them. The findings revealed no severe anemia cases, but 11% of preschoolers aged 12-59 months were anemic. Iron deficiency affected 22.4%, with 5% having iron deficiency anemia. Vitamin D deficiency increased to 22.9% in 2019. Stunting and wasting rates improved slightly to 6.3 and 0.1%, respectively. Overweight and obesity rates remained stable at 6.2 and 2.1%. Anemia decreased by 5-6%, but iron deficiency rose by 7%. Vitamin A deficiency decreased, but iron deficiency anemia remained largely unchanged. Undernutrition was rare, but vitamin D deficiency affected 27.7% of preschoolers, impacting growth and immunity. Iron deficiency, affecting 25% of children, poses a risk to cognitive development. Overweight or obesity affected 9% of children, a medium public health issue according to the WHO. While malnutrition rates are low, the persistent issues of vitamin D deficiency, iron deficiency, and childhood obesity require focused attention. The study highlights ongoing nutritional challenges among Jordanian preschoolers. Although severe anemia was rare, 11% were anemic, and 22.4% had iron deficiency, including 5% with iron deficiency anemia. Vitamin D deficiency affected 22.9%, impacting growth and immunity. While stunting and wasting improved, childhood overweight and obesity rates remained steady. Anemia decreased, but iron deficiency rose by 7%. Despite reduced vitamin A deficiency, stable iron deficiency anemia rates indicate ongoing concerns. Overall, undernutrition is uncommon, but vitamin D and iron deficiencies, along with childhood obesity, need sustained attention and targeted interventions to improve children's health in Jordan.

Extruded wholegrain sorghum porridges fortified with baobab fruit and moringa leaves display bioactive phenolics-related health-promoting properties

Background and objectivesFood-to-food fortification (FtFF) is gaining traction as a strategy to enhance nutritional value of cereal-based foods. Sorghum, a major food crop for millions in the semi-arid tropics lends itself to such FtFF efforts. Such food-to-food fortified (FtF fortified) foods also contain bioactive phenolics with health-promoting properties in relation to potential protection against diet-related non-communicable diseases (NCDs) whose prevalence is increasing in sub-Saharan Africa. In this study, the effects of extrusion cooking of sorghum-based porridges FtF fortified with baobab fruit powder and moringa leaf powder on antioxidant, anti-inflammatory, antidiabetic and anti-lipogenic properties were determined. FindingsFtFF porridges showed higher phenolic content (phenolic acids and their esters, flavonoids and their glycosides) and greater radical scavenging properties and reduction in advanced glycation end products (AGEs) compared to unfortified porridges. Extruded instant porridges had lower phenolic content, radical scavenging properties and showed less reduction in AGEs compared to conventionally wet-cooked porridges. All porridges exerted antioxidant effects in Caco-2 cells and FtFF inhibited nitric oxide (NO) formation in RAW 264.7 cells. Extracts from all porridge samples exhibited prevention and reduction of adipocyte formation in 3 T3-L1 cells, indicating anti-lipogenic effects. ConclusionFtFF (with moringa and baobab) and extrusion cooking can be used to produce instant porridges from wholegrain sorghums with targeted health-promoting properties to address rising non-communicable diseases in sub-Saharan Africa. Significance and noveltyThis study highlights the potential of FtFF with tropical plant foodstuffs to improve health-promoting properties of cereal wholegrain-based starchy staple foods.

An Evaluation of Healthy Hydration Recommendations for 93 Countries with Sugary Beverage Tax Legislation Globally, 2000-2023.

Adequate water intake is essential for human health. Sugary beverage taxes are a best buy policy to reduce obesity and diet-related non-communicable diseases. Food-based dietary guidelines (FBDGs) promote healthy dietary patterns. The study purpose was to evaluate national FBDGs for countries with sugary beverage tax legislation (2000-2023) to promote water and discourage sugary beverage consumption. We developed a coding framework to conduct a content analysis of FBDG documents, and used six indicators to identify messages and images to assign healthy hydration recommendation (HHR) scores from 0-12 to compare FBDGs across countries and six regions. Results showed 93 countries with sugary beverage tax legislation of which 58 countries (62%) had published FBDGs (1998-2023). Of 58 FBDGs reviewed, 48 (83%) had complementary recommendations that encouraged water and discouraged sugary beverages. Of 93 countries, 13 (14%) had the highest HHR scores (11-12); 22, (24%) had high HHR scores (9-10); 20 (21%) had medium HHR scores (4-8); 3 (3%) had low HHR scores (0-3); and 35 (38%) countries had no FBDGs. To reduce health risks for populations, governments must ensure policy coherence to optimize sugary beverage tax impacts by developing FBDGs that encourage water and discourage sugary beverages complementary to national policies.

Climate change-induced shifts in the food systems and diet-related non-communicable diseases in sub-Saharan Africa: a scoping review and a conceptual framework

ObjectivesTo determine the relationship between climate change, food systems and diet-related non-communicable diseases (DR-NCDs) in sub-Saharan Africa (SSA) and propose a conceptual framework for food systems in SSA.DesignA scoping review.Eligibility...