Diet-related Non-communicable Diseases Research Articles

Evaluating compliance with local and International Food Labelling Standards in urban Tanzania: a cross-sectional study of pre-packaged snacks in Dar Es Salaam

BackgroundUrbanization influences food culture, particularly in low- and middle-income countries where there is an increasing consumption of processed and pre-packaged foods. This shift is contributing to a rise in non-communicable diseases. Food labelling standards are crucial for regulating manufacturing practices and helping consumers make healthy food choices. We aimed to assess the compliance of local and imported pre-packaged snacks with Tanzanian and international labelling standards in Dar es Salaam, Tanzania.MethodologyA cross-sectional study was conducted on 180 snack products. A checklist based on Tanzanian and Codex labelling standards was used to evaluate adherence. We also examined factors influencing adherence, such as product origin, price, category, purchase location, and package size.ResultsThe majority of the snacks demonstrated partial adherence to Tanzania (n = 97; 54%) and International (Codex) (n = 120; 67%) labelling standards. Imported products showed significantly better adherence to both Tanzanian (n = 46; 53%) and international (n = 42; 48%) standards. Notably, more than half (n = 110; 66.7%) of the products used English for labelling, and infrequently (n = 74; 41.4%) used the recommended World Health Organization Front-of-Pack Nutrition Labelling. Product category, origin, and package size were significantly associated with higher levels of international standard adherence (p < 0.05).ConclusionThe inadequate adherence to mandatory labelling standards and the scarce use of Swahili and FoPL highlight the need to strengthen labelling practices and potential challenges faced by consumers in understanding nutritional information. Thus, strengthening and emphasizing good labelling practices are urgently needed as we seek to address diet-related noncommunicable diseases.

#junkfluenced: the marketing of unhealthy food and beverages by social media influencers popular with Canadian children on YouTube, Instagram and TikTok

BackgroundMarketing of unhealthy foods to children on digital media significantly impacts their dietary preferences and contributes to diet-related noncommunicable diseases. Canadian children spend a significant amount of time on digital devices and are frequently exposed to unhealthy food marketing on social media, including by influencers with celebrity status who endorse products. This study aimed to examine the frequency, healthfulness, and power of unhealthy food marketing in posts by influencers popular with Canadian children on YouTube, Instagram and TikTok.MethodsThe top 9 influencers popular amongst Canadian children aged 10–12 years were identified from the 2021 International Food Policy Study Youth Survey. A total of 2,232 Instagram, YouTube and TikTok posts made by these influencers between June 1st 2021 and May 31st 2022 were examined for instances of food marketing. Food products/brands were identified and frequencies were calculated for the number of posts promoting food products/brands, posts promoting products/brands classified as less healthy according to Health Canada’s Nutrient Profile Model (2018) and marketing techniques utilized.ResultsYouTube had the highest average rate of food marketing instances per post, at a rate of 1 food marketing instance every 0.7 posts, while TikTok and Instagram had instances every 10.2 posts and 19.3 posts, respectively. Overall, fast food restaurants was the most promoted food category (21%), followed by regular soft drinks (13%), snacks (11%), candy and chocolate (11%) and water (8%). The most frequently used marketing techniques were appeals to fun/cool (37%), the use of songs or music (28%) and the product being consumed (25%). In terms of healthfulness, 83% of the products/brands (87% of brands and 82% of products) promoted were classified as less healthy.ConclusionsSocial media influencers play a substantial role in promoting unhealthy food products to children, primarily fast food items. Given the significant impact of such marketing on children, there is a need for ongoing government-led monitoring, and it is crucial to include social media and influencer marketing in marketing restrictions targeting children in Canada to safeguard this vulnerable demographic.

The double burden of malnutrition in individuals: Identifying key challenges and re-thinking research focus.

The 'double burden of malnutrition' is a global health challenge that increasingly affects populations in both low- and middle-income countries (LMICs). This phenomenon refers to the coexistence of undernutrition and overweight or obesity, as well as other diet-related non-communicable diseases, in the same population, household or even individual. While noteworthy progress has been made in reducing undernutrition in some parts of the world, in many of these areas, the prevalence of overweight and obesity is increasing, particularly in urban areas, resulting in greater numbers of people who were undernourished in childhood and have overweight or obesity in adulthood. This creates a complex and challenging situation for research experts and policymakers who must simultaneously address the public health burdens of undernutrition and overweight/obesity. This review identifies key challenges and limitations in the current research on the double burden of malnutrition in individuals, including the need for a more comprehensive and nuanced understanding of the drivers of malnutrition, the importance of context-specific interventions and the need for greater attention to the food environment and food systems. We advocate for the re-evaluation of research strategies and focus, with a greater emphasis on multidisciplinary and systems approaches and greater attention to the synergistic relationship between the biological, environmental, commercial and socio-economic determinants of malnutrition. Addressing these key challenges can enable us to better comprehend and tackle the multifaceted and dynamic issues of the double burden of malnutrition, particularly in individuals and work towards more effective and sustainable solutions.

Motivators and facilitators of fruit and vegetable intake in Tonga

Food choice is complex and is heavily influenced by the environment one lives in(1). Pacific Island food environments, including those in Tonga, have changed considerably in recent years, making healthier food choice more challenging(2). A widespread nutrition transition across the region has contributed to an increase in the availability of, and accessibility to, highly-processed foods, and high rates of diet-related non-communicable diseases(3). While system change is needed to support the availability, accessibility and affordability of healthy foods, nutrition education plays an important role in supporting individuals, communities, and populations to navigate their rapidly changing food environments, and to encourage healthy food choice and behaviour change. Approaches to nutrition education in the Pacific Islands region vary and do not always consider the socio-cultural aspects of the food environment, especially when focusing on fruit and vegetable consumption. This work was driven by an intent to develop contextually appropriate nutrition education plans using a structured process, Design Online(4). However, to develop a nutrition education plan a critical analysis of the current motivators and facilitators for the behaviour are required. When reviewing the scientific literature there is limited information on determinants of food choice within Tonga, and more broadly within the Pacific Islands context. Therefore, the aim of this cohort study was to qualitatively explore and document the motivating and facilitating determinants of fruit and vegetable consumption in Tonga. Data collection took place during August and September 2023 on the main island of Tongatapu. Semi-structured interviews (n = 5 men, 3 women) and a focus group (n = 4 women) based on the most appropriate method of engaging with participants, were conducted in Tongan. Guiding questions were derived from Design Online and proposed within the following categories: motivating determinants and facilitating determinants. Interview responses were qualitatively analysed using an inductive content analysis model. Key categories for motivating determinants included health and nutrition knowledge, normal consumption patterns, availability and access, production, financial considerations and preferences, perceptions and practices. Key categories for facilitating determinants included education, community engagement, environmental factors, food preference, finance, and accessibility. While this work has explored motivating and facilitating determinants for fruit and vegetable consumption in Tonga with a small sample, it makes an important contribution to the limited literature. The findings of this study can be used to underpin activities, such as the design of nutrition education plans. The findings also provide a foundation for further exploration of determinants of food choice. This study was undertaken on the main island of Tongatapu, but it is of interest to explore determinants with communities who live in the outer islands, and at different time points during the year to reflect seasonality.

Navigating the Clinical Landscape of Severe Acute Malnutrition in India’s Pediatric Demographic

Background: The consequences of malnutrition are increases in childhood death and future adult disability, including diet-related non-communicable diseases (NCDs), as well as enormous economic and human capital costs. According to UNICEF, one in three malnourished children in the world is Indian. It is estimated that reducing malnutrition could add some 3% to India’s GDP.4 Combating child malnutrition is of great public health importance to the future economic development and social well-being of countries, but there is very minimal information on the clinical profile and outcome of SAM.  Objectives: To study the Clinical Profile and Outcome of Severe Acute Malnutrition in children aged between 6 and 59 months.  Methodology: An Observational hospital-based time bound study includes 60 children of 6 to 59 months age satisfying inclusion criteria admitted in BCHI and Chigateri District Hospital. The children were classified according to WHO guidelines and managed according to standard WHO case management protocol and re-evaluation were done on a daily basis during the course of hospital stay. The outcome was assessed in term of improvement, number of days of hospitalization, residual problems at discharges, left against medical advice and number of deaths.  Results: Nearly all the subjects presented with visible wasting with eight for age &lt;-3SD and MUAC, 11.5 cm. Half of the study population had incomplete immunization. Acute GE and ARI, anemia were the most common comorbidities and severe dehydration was the most complication seen. Majority i.e., 75 (75.8%) were discharged with target weight, 20 (20.2%) were discharged without reaching target weight and 4 (4%) were defaulters.  Interpretation &amp; Conclusion: The study concluded that effective community-based program for early detection and treatment, most children with SAM can be cared for by their mothers and families at home while NRCs are reserved for children with SAM and medical complications.

Unlocking the potential of forage fish to reduce the global burden of disease

Red meat consumption is associated with an elevated risk of mortality from non-communicable diseases (NCDs). In contrast, forage fish, as highly nutritious, environmentally friendly, affordable, and the most abundant fish...

Double burden of malnutrition and associated factors among mother-child pairs at household level in Bahir Dar City, Northwest Ethiopia: community based cross-sectional study design.

The double burden of malnutrition refers to the simultaneous presence of under nutrition and overweight, obesity, or diet-related non-communicable diseases which might occur at the population, household, and individual level. The simultaneous presence of overweight/obese mothers with undernourished children in the same household, as well as overweight children with underweight mothers, holds particular significance. This phenomenon primarily impacts low-income and middle-income countries. The prevalence of double-burden malnutrition at the household level has increased significantly in sub-Saharan African countries. However, there is limited knowledge regarding the extent and factors associated with the double burden of malnutrition among mother-child pairs in Ethiopia. Consequently, the objective of this study was to assess the prevalence and determinants of the double burden of malnutrition among mother-child pairs at the household level in Bahir Dar City, Ethiopia. In the year 2021, a community-based cross-sectional study design was employed among 702 mother-child pairs in Bahir Dar City from February 28 to March 23. A multistage sampling technique was used to identify study participants who were interviewed using an interviewer-administered questionnaire. The nutritional status of children was evaluated using WHO Anthro Software. To determine the strength of the association, multivariable logistic regression analysis was performed, and adjusted odds ratios with their respective 95% confidence intervals were computed. The prevalence of the double burden of malnutrition among mother-child pairs was 14.5% (95% CI: 12.8, 15.7%}. Participants who were in the richest wealth index were 2.72 {AOR = 2.72, 95% CI 2.01, 5.63} times more odds of double burden of malnutrition than the poorest. The odds of the double burden of malnutrition among children who had high dietary diversity decreased by 63% {AOR = 0.37, 95% CI 0.22, 0.61} than low dietary diversity. Food secure households were 1.96 {AOR = 1.96, 95% CI 1.13, 3.39} times more likely to have the double burden of malnutrition than food insecure households. The odds of the double burden of malnutrition among mothers who completed college and above decreased by 74% {AOR = 0.26 95% CI 0.121, 0.549} than those unable to read and write. The magnitude of the double burden of malnutrition was lower than the Ethiopian Demographic and Health Survey. Wealth index, dietary diversity, food security, and educational status were significantly associated with the double burden of malnutrition. Therefore, it is recommended to implement public health interventions that target the identified associated factors in order to reduce the burden of double malnutrition.

The Nexus between Climate Change and Nutrition Security and the Impact of this Relationship on Diet-Related Non-Communicable Diseases

Life-threatening climate change, and burgeoning nutrition insecurity compounded by a steady rise in chronic non-communicable diseases (NCDs) are the defining issues of our time. This study is an exploration of the nexus between climate change and nutrition and the impact of this relationship on diet related NCDs. Quantitative methodologies, utilizing a descriptive cross-sectional study design was adopted. The study was carried out across Kenya, informed by the devastating climate changes and NCD cases the country has experienced recently. To recruit the study participants, a random sampling technique was adopted to select a sample size of 190. The study utilized an online questionnaire uploaded on KoboCollect and the link to the questionnaire was shared via WhatsApp, Facebook, Twitter, LinkedIn, and email. The quantitative data was downloaded and synchronized with Statistical Package for Social Science (SPSS version 26.0) which was used to analyse the data. The study found that an increase in the price of basic food commodities, reduced amount of reliable agricultural output, destruction of crops, and change in the nutritional content and food composition are some of the major effects of climate change on nutrition security. Moreover, the study found that depletion of nutrition sources leads to diet-related NCDs (diabetes and hypertension) through increased consumption of unhealthy foods (calory and fat-dense diets), reduced access to recommended food for those living with diabetes and hypertension, and lack of food diversification. The study also found that increased demand for healthy foods has both positive and negative implications. Positive impacts reported include increased agricultural activities and innovations to address the growing demand for healthier. Negative impacts reported include strain on food production capacity and unsustainable agriculture practices that have long-term health effects. Policymakers are called upon to formulate policies that guarantee public health even amid the evolution of innovations that promise to address shortfalls in food availability, accessibility, reliability, and utilization

Global nutrition challenges: A public health review of dietary risks and interventions

This public health review addresses the intricate challenges posed by global nutrition and examines the impact of dietary risks on the well-being of populations worldwide. In an era marked by diverse dietary patterns, the prevalence of both undernutrition and overnutrition presents a complex public health landscape. This paper encapsulates the key aspects explored in the comprehensive analysis, emphasizing the urgent need for targeted interventions. The review delves into the multifaceted nature of global nutrition challenges, considering factors such as food insecurity, inadequate dietary diversity, and the rising prevalence of diet-related non-communicable diseases. Highlighting the interconnectedness of nutrition and public health, the document scrutinizes the disparities in nutritional outcomes across different regions, socioeconomic groups, and age categories. Moreover, the paper outlines evidence-based interventions aimed at addressing these challenges. These interventions encompass policy initiatives, community-based programs, and educational campaigns designed to promote healthier dietary choices. Special emphasis is placed on the role of stakeholders, including governments, non-governmental organizations, and the food industry, in fostering a supportive environment for improved nutrition. The paper concludes by emphasizing the urgency of a concerted global effort to tackle nutrition challenges comprehensively. It underscores the significance of adopting a multifaceted approach that integrates preventive measures, policy changes, and community engagement to foster a sustainable and equitable impact on global nutrition. The insights presented in this review serve as a call to action for policymakers, healthcare professionals, and public health advocates to collaborate in mitigating the adverse effects of dietary risks and building a healthier, more resilient global population.

Trends in ultra-processed food availability and its association with diet-related non-communicable disease health indicators in the Portuguese population.

Broad variations in dietary and physical activity patterns are part of nutritional transition concept. An additional nutritional transition has as main characteristic the change of consumption of processed foods for ultra-processed foods (UPF). This study aims to evaluate trends of UPF availability in Portuguese population and its association with diet-related non-communicable diseases (NCD) health indicators. This ecological study used data from the Household Budget Surveys conducted by the National Statistics Institute each 5 years within a national representative sample of households. The percentage of UPF was calculated based on the total daily amount of food and beverages available per capita (in grams). Data from the years 1990, 1995, 2000 and 2005 were used, which were retrieved from DAFNE-Anemos Software. NCD age-standardised mortality, prevalence and incidence were obtained from the Global Burden of Disease database, for the years 2000, 2005, 2010 and 2015. Between 1990 and 2005, the UPF availability increased from 3·9 % to 13·8 %. Over the years, almost all food and beverages categories increased the UPF availability contribution, mainly noticeable for milk, sugar, cereal and meat products. Positive correlations were observed between UPF availability and digestive diseases both in prevalence (r = 0·062; P = 0·037) and incidence (r = 0·005; P = 0·010) measures. Neoplasms incidence also showed positive correlation with UPF availability (r = 0·002; P = 0·012). Trends in UPF availability in Portugal increased exponentially. At the same time, there is a trend towards a decrease in unprocessed and processed food availability. The Portuguese population should be made aware of the health risks resulting from excessive consumption of UPF.

Factors Contributing to the Comprehensive Use of Food Labels in Jordan

Food labels are low-cost, informational tools that can help curb the spread of diet-related non-communicable diseases. This study described consumers’ knowledge, attitudes, and practices related to food labels in Jordan and explored the relationship between knowledge and attitude with comprehensive use of food labels. A cross-sectional, online survey assessed Jordanian adult consumers’ ability to comprehend the nutritional contents of food labels (knowledge score), their attitudes towards food labels (attitude scale), and how frequently they used different parts of food labels (practice scale). Multivariate logistic regression models assessed predictors of comprehensive use of food labels. A total of 939 adults participated in the study. Total mean scores for the practice scale (14 questions), attitude scale (8 questions), and knowledge score (4 questions) were 49.50 (SD, 11.36; min, 5; max, 70), 29.70 (SD, 5.23; min, 5; max, 40), and 1.39 (SD, 1.33; min, 0; max, 4), respectively. Comprehensive users of food labels (26.4%) were more likely female, responsible for grocery shopping, and had higher mean knowledge and attitude scores. Jordanian consumers seem to have good practices and attitudes related to food label use but suboptimal knowledge regarding content. Future interventions should focus more on enhancing knowledge and awareness related to food labels.

Assessing the potential for healthier consumer food substitutions in Canada: population-level differences in dietary intakes of whole grains, refined grains, red meats, and legumes.

The potential for healthier consumer food substitutions is an important factor in the study of food environments, dietary choices, and population nutrition promotion. The burden of diet-related non-communicable diseases is unevenly distributed across Canada and variation in the food environment sub-nationally may be an important explanation. We used population-based 24 h dietary recall data from the 2015 Canadian Community Health Survey-Nutrition for Canadian adults (n=13 919) to examine dietary intakes of two food group pairings (whole grains/refined grains and legumes/red meats) where consumer substitutions have been recognized to be of importance in promoting healthy and sustainable population diet. We used an ANOVA followed by pairwise comparisons with Bonferroni correction to estimate differences in intakes between provinces for daily weight and proportion of total energy consumed. Based on the Global Burden of Disease Study, Canadians consumed below the average daily requirements of legumes and whole grains and well above the required range of red meat, suggesting room for broad improvements to population diet. Findings also demonstrate that there is potential for targeted shifts in dietary intakes among non-consumers of certain foods (e.g., legumes). This study may inform intervention development for the consumer nutrition environment including food accessibility and affordability to reduce non-communicable disease risk.

2.A. Workshop: (Re)imagining food: representations of food to move towards more sustainable food cultures

Abstract How food is produced, sold and consumed reveals much about people, culture, policies and environments, and the relationships between them. Food has ‘meaning’. These meanings matter: they helps to express our values and what we are connected to. The various meanings of food in society are shaped by how food is represented. These representations develop and vary in time and between fields. Recent years have also witnessed growth food meanings developing in discourses on the environment. How food is represented in various fields - not least news media, social media, video games, accounts, policies and regulations, and popular culture - shape our views on health and sustainability. This workshop will explore contemporary policy and public debates about food and sustainability. It will uncover how societies approach and conceive the relationships between food, environment, and human health. The workshop will explore several themes, including the following: • Understanding representations of food and the natural environment in fields (eg science and technology) and in various media. • How these representations create meaning. • How these meanings become drivers of food and sustainability movements. • How movements contribute to laws and policies which can support or undermine effective action on promoting sustainable consumption. • How stakeholders - including consumers, journalists, governments and politicians, and commercial actors - can enhance narratives and their communication strategies towards a transition to a more sustainable food system. With its interdisciplinary methodologies, this workshop will be of interest to a wide range of policy makers, practitioners and researchers working on reducing obesity and other diet-related non-communicable diseases while promoting environmental sustainability to preserve and improve the ability of generations to meet their own needs. Presentations will be short (5 minutes each) and will stimulate debates with the audience not only to disseminate knowledge but also develop policy recommendations. Key messages • Representations of food and the environment create meanings which, in turn, influence views, policies and strategies affecting health and environmental sustainability. • Understanding how different actors construct representations can help enhance narratives and communication strategies to help transition towards a more sustainable food system.

Systems dynamics for healthy and sustainable local food environments

Abstract Background Current food environments steer unhealthy food choices, increasing the risk for diet-related non-communicable diseases. Changing food environments is complex and underlying system dynamics of local food environments are relatively unclear. This study aimed to identify factors and leverage points that shape local food environments and to develop systemic actions with local stakeholders to improve food environments. Methods Two workshops (in 2022) were held in a Dutch municipality using a community-based system dynamics approach in which a variety of stakeholders (n = 13) participated (e.g., policy maker, retailers, health coach, citizens). Group model building exercises were used to identify factors shaping the local food environment and to develop a causal loop diagram. Subsequently, leverage points and actions to improve food environments were identified by the stakeholders. Results Based on the first workshop, a total of 46 factors influencing the local food environment were identified and categorized into four subsystems including commercial-, political-, global- and societal factors. The leverage points included the anti-lobby from food industry, food industry's willingness to change, Government/consumer priority on healthy food, food policy, e-commerce and platform economy, demand for healthy food, time to prepare/consume meals. In correspondence, 20 actions to improve the local food environment were identified during the second workshop. Moreover, the exercises initiated dialogues and collaborations between the participating stakeholders to adapt their local food environment. Conclusions This research yielded one of the first causal loop diagrams showing the multiple and varied factors influencing the local food environment. It underlines the importance of using a systems approach to adapt and improve food environments. More work is needed to implement the developed actions and to translate the system dynamics approach for use by non-academics. Key messages • Food environments are complex adaptive systems, which require a systems dynamic approach to generate change. • Food environments need to be adapted at multiple levels requiring multiple pathways and stakeholders to succeed, and thus move away from single component interventions.

Nutritional concepts of health promotion in sub urban community: focus on obesity and hypertension

Many obese and hypertensive individuals reside in suburban areas with poor health infrastructure and low levels of public awareness. The adult morbidity and mortality rates are currently being dominated by diet-related non-communicable diseases like obesity, hypertension, and metabolic syndrome in various countries. Applying both individualized and community-based health promotion strategies can result in the prevention and control of obesity and hypertension. This study examined the role of nutrition in promoting good health, preventing and treating obesity and hypertension in suburban areas. The prevalence of diet-related non-communicable diseases has been notably reduced as a result of health promotion programs. A diet high in dietary fiber, rich in fruits, vegetables, whole grains, lean meats, fish, legumes, non-tropical vegetable oils, and nuts (in moderation) has been promoted. This needs to be adjusted to take into consideration the required calorie intake, unique dietary preferences based on culture and individual, as well as nutrition therapy for various medical conditions.

Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs): a qualitative systematic review using the Consolidated Framework for Implementation Research (CFIR)

BackgroundLow- and middle-income countries (LMICs) are particularly vulnerable to the double burden of malnutrition: co-existence of underweight, overweight, obesity, and/or diet-related non-communicable diseases. Nutrition-related double-duty actions in school settings have been identified as one of the ways to address this challenge. However, to be able to take full advantage of the potential impact, it is important to understand their implementation as well. The aim of this paper is to systematically review qualitative research on barriers and facilitators to the implementation of nutrition-related actions in the school settings in LMICs.MethodsThe following databases were searched: EMBASE, ERIC, MEDLINE, Global Health and PsycInfo (all on Ovid), Scopus (Elsevier), the Web of Science Social Sciences Citation Index, and Global Index Medicus from the World Health Organization. Of the 4253 identified records, 4030 were excluded after the abstract and title screen, leaving 223 for the full-text screen. A final 36 papers were included in this review. The consolidated framework for implementation research (CFIR) was used in the analysis.ResultsWe identified barriers and facilitators to implementation linked to the following CFIR constructs/sub-constructs: design quality and packaging, cost (intervention characteristics); target group needs and resources, cosmopolitanism, external policy and incentives (outer setting); structural characteristics, readiness for implementation (inner setting); knowledge and beliefs (characteristics of individuals) and engaging, executing (process). All identified constructs apart from target group needs and resources, knowledge and beliefs, and engaging were predominantly barriers. Available resources were the most prevalent barriers across studies.ConclusionThis review identified barriers and facilitators to the implementation of nutrition-related actions based on qualitative articles in the school setting in LMICs, using the CFIR. Schools face continuous challenges in regard to funding and the government sector may have a role to play not only by offering financial assistance, but also through policy-making that would support healthy eating practices on school grounds.RegistrationPROSPERO ID: CRD42022296159.

Prevalence and Determinants of Multiple Forms of Malnutrition among Adults with Different Body Mass Index: A Population-Based Survey in the Philippines.

The multiple forms of malnutrition, including overnutrition, undernutrition, and diet-related noncommunicable diseases, are emerging crises in Asian countries. Past studies have focused more on malnutrition among overweight/obese individuals; however, limited research has examined chronic energy-deficient adults. Therefore, this study is aimed at investigating the prevalence and determinants of different forms of malnutrition among adults with different body mass index, using the Philippines as an example. Findings from this study will guide the development and implementation of public health nutrition programs and policies. A representative dataset from the 2013 Philippine National Nutrition Survey was used in the study. Adults aged ≥20 years (n = 16,826) were included in the analysis after excluding those with missing values. Six phenotypes of malnutrition were assessed, including three in overweight/obese adults (overweight/obese with metabolic syndrome; those with micronutrient deficiency-anemia, vitamin A deficiency, and iodine insufficiency; and those with both metabolic syndrome and micronutrient deficiency) and three in chronic energy-deficient (CED) adults (CED with either metabolic syndrome or micronutrient deficiency and with both metabolic syndrome and micronutrient deficiency). Sociodemographic and lifestyle factors were examined as the determinants of different forms of malnutrition, and multinomial logistic regression analyses were performed. The prevalence of the six phenotypes of malnutrition ranged from 0.4% to 10.2%, where overweight/obese with metabolic syndrome was the most predominant type. The multinomial logistic regression models indicated that older age was the major risk factor across all phenotypes. Sex was associated with the outcomes in the overweight/obesity group, whereas employment status was correlated with CED adults. Furthermore, higher educational levels, being married, living in affluent households, and not smoking were protective factors for conditions related to CED but not overweight/obese individuals. Malnutrition in all its forms is a significant public health concern that must be understood and addressed. Policymakers should implement appropriate intervention programs to control these nutritional problems considering the specific risk factors for the adult population.

Strengthening the role of blue foods in coastal Pacific food systems

ABSTRACT Blue foods, primarily coastal pelagic fish, reef fish, and invertebrates, are integral to coastal food systems in Pacific Island Countries and Territories (PICTs) and are increasingly embedded in food policy platforms. This paper discusses the collaborative development of a Blue Food Assessment for the Pacific (BFA-P). The BFA-P aims to strengthen the role of blue foods in food systems thinking and actions in PICTs in the face of climate change, a dependence on food imports, and high rates of diet-related non-communicable diseases. It focuses on six main research themes that support a coastal food systems approach to improve environmental outcomes, nutrition and human health, and social and economic objectives in PICTs. Climate change, effective governance, innovative partnerships, and equity underpin all areas of research. Combining current scientific evidence with traditional and indigenous knowledge will be essential for sustaining coastal Pacific food systems and the long-term resilience and prosperity of Pacific people.

Assessing the per Capita Food Supply Trends of 38 OECD Countries between 2000 and 2019-A Joinpoint Regression Analysis.

Food supply has an impact on the prevalence of diet-related non-communicable diseases. We aimed to analyze the protein, fat (g/capita/day) and calorie (kcal/capita/day) supply from 2000 to 2019 as derived from the OECD Health Statistics database. A joinpoint regression was used to examine the number and location of breakpoints in the time series. The annual percent change (APC) was calculated using Joinpoint 4.9.0.0. The per capita daily kcal per nutrient was calculated for each country and the resulting percentage distributions were compared to the acceptable macronutrient distribution ranges. Protein, fat and calorie supplies have increased significantly between 2000 and 2019. Each started to show a much steeper, positive change between 2012 and 2014 (APCfat: 1.0; 95%CI: 0.8-1.1; APCprotein: 0.5; 95%CI: 0.3-0.6; APCkcal: 0.4; 95%CI: 0.3-0.5). In terms of the composition of the daily calorie intake per capita, the overall share of fat (+4.9%) and protein (+1.0%) increased between 2000 and 2019. We found significant differences among countries and also an increasing and optimal proportion of consumed protein per total calorie in all countries over the last two decades. We concluded that several countries have access to fat availability above the optimal level, which deserves particular attention from health policy makers in the fight against obesity and diet-related diseases.

Evaluation and prioritization of food environment policies in Norway using the Healthy Food Environment Policy Index (Food-EPI)

Background: Government policies promoting healthier food environments can contribute to healthier diets and prevent obesity and diet-related non-communicable diseases.&#x0D; Objective: To assess the level of implementation of internationally recommended food environment policies in Norway and establish prioritised actions to create healthier food environments.&#x0D; Design: The Healthy Food Environment Policy Index (Food-EPI) was adapted to the Norwegian context. It comprised 45 good practice indicators of government food environment policy and infrastructure support. Systematically compiled evidence of relevant policies was verified by government officials and formed the basis for assessing the level of implementation of these policies compared against international best practice benchmarks. The assessment was done by a national non-government expert panel (n = 35). The experts thereafter proposed and prioritized policy actions for government implementation.&#x0D; Results: Most indicators were rated at a medium or high degree of implementation in both the policy action (69%) and the infrastructure support (77%) components. No indicators were rated as having ‘none or very little implementation’. Among the 14 recommended policy actions, active use of price regulation to increase the price of unhealthy foods and decrease the price of healthy foods was the highest priority. Other top priorities were ensuring healthy food environments in public settings and introducing free school meals. Demonstrating knowledge-based and coherent political leadership in public health nutrition policies was the highest priority among the 11 recommended infrastructure support actions.&#x0D; Conclusion: The overall policies in Norway to promote a healthy diet show a medium to high level of implementation. This study highlights that there is still room for additional improvements in Norwegian policies and infrastructure support to promote healthy food environments.