Nutritional Disparities Research Articles

Fish and Complementary Feeding Practices for Young Children: Qualitative Research Findings From Coastal Kenya

ObjectivesTo assess the potential barriers and facilitators to fish consumption during the complementary feeding period in two coastal counties of Kenya with high rates of child malnutrition. MethodsThis qualitative study was part of a mixed-methods formative research investigation to examine the role of sustainable fish production and access to fish foods in coastal communities in Kenya. Twenty in-depth interviews were conducted with primary caregivers of children less than five years (n = 12) and community health workers and nutritionists (n = 8) in Kilifi County and Kwale County. Interviews were transcribed, translated and analyzed. A conceptual framework was developed based on the analysis to illustrate major factors and pathways influencing decisions to feed fish in the complementary feeding period. ResultsComplementary feeding practices reported by caregivers showed a low level of fish consumption in young children and delayed introduction of fish to the diet. Findings indicate that fish consumption was impacted by factors related to accessibility, food preferences, and caregiver’s knowledge and beliefs. Access to fish was driven primarily by cost, proximity to locations where different fish types were sold, gendered purchasing behavior and the seasonal availability of fish foods. In some cases, the high cost of fish outweighed positive associations or perceived nutritional benefits when deciding whether to feed fish to children. Caregivers’ knowledge, beliefs, and food preferences also impacted consumption, with mixed perceptions regarding the importance of fish as a source of protein and other nutrients. These direct factors were influenced by prominent community figures such as elder women and health workers, whose own beliefs and understandings were impacted by underlying cultural norms, potentially limiting fish consumption. ConclusionsUnderstanding current attitudes and beliefs toward fish consumption during the complementary feeding phase is a critical first step towards the creation of more effective policies and interventions that incorporate sustainable fish foods to address significant nutritional disparities that exist in the study population. Funding SourcesThis study was supported by the United States Agency for International Development (USAID) Feed the Future Innovation Lab for Fish.

Food Deserts: Myth or Reality?

In 2010, the White House announced the goal of eradicating food deserts—low-income neighborhoods without nearby supermarkets—in seven years. The efficacy of this initiative is premised on the presumption, mostly untested in 2010, that food deserts significantly contribute to health disparities in low-resourced communities. We synthesize the post-2010 line of research that seeks to establish causality in the relationship between food access and nutrition/health. All things considered, there is so far little evidence that food deserts have a causal effect of meaningful magnitude on health and nutrition disparities. The causes of diet quality disparity lie more on the side of food demand than on supply. Therefore, from the public health perspective, policies that lower the relative price of healthy food or change the “deep parameters” of preferences in favor of healthy food would be more appealing than eliminating food deserts.

New policy papers address health care disparities and discrimination

New policy papers address health care disparities and discrimination

Region-specific nutritious, environmentally friendly, and affordable diets in India

Region-specific nutritious, environmentally friendly, and affordable diets in India

A Qualitative Exploration of Predominantly White Non-Hispanic Tennessee WIC Participants’ Food Retail and WIC Clinic Experiences During COVID-19

BackgroundThe novel coronavirus disease 2019 (COVID-19) has widened many existing nutrition disparities. In response, federal nutrition assistance programs have introduced flexibility waivers in programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), to rapidly respond to support the nutritional health status of income-eligible participants during COVID-19. Waivers were approved that permitted flexibilities in the WIC food package, WIC vendor guidelines, and WIC clinic experience. The impact of these waivers on WIC participants’ retail and clinic experiences remains unknown. ObjectivesOur aims were to understand the experiences of WIC participants in food retail settings and with WIC clinics during the COVID-19 pandemic and to explore WIC participants’ perceptions of the impact of COVID-19 on their family’s overall health, well-being, and daily lives. DesignWe conducted semi-structured phone interviews between April 30 and May 7, 2020. Participants/settingParticipants were 24 adults in WIC-enrolled families residing in Tennessee. AnalysisUsing grounded theory as the analytical framework, 2 coders completed an iterative, data-driven analytic process within NVivo, version 12. Hierarchical maps, coding matrices, and concept maps were used to aid direct content analysis for theme detection. ResultsFive primary themes emerged, including shopping barriers (existing compounded with new), coping strategies, impact on mental and emotional health, social comparison, and unintended consequences of COVID-19 on WIC families. ConclusionsCOVID-19 created additional barriers to food security among WIC families and negatively affected their health and well-being. To meet the needs of this vulnerable population during and beyond the pandemic, the carryover of WIC flexibilities (ie, physical presence and food package substitution waivers) after COVID-19 may improve the ease of overall program participation.

Impact of socio-economic status (SES) and nutrition health education on nutritional status of adolescent girls

The present status of nutrition disparities in Asia is considered to vary by economic level of the country. For developing countries in Asia, India and Vietnam, SES associates with BMI positively in women. For relatively developed countries in Asia, Korea and Japan, SES associates with BMI negatively in women. Low SES groups consume more carbohydrate, and less protein and fat, so not only micronutrient but also macronutrient intake is affected by SES both in developing and in developed Asian countries. There are some studies on the pathway from SES to diet/nutrition. Objective: To assess the impact of socio-economic status (SES) and nutrition health education (NHED) on their Nutritional status of non-school going and school going AGLs. Method: A pre test post test experimental design questionnaire was employed and the study was a cross sectional study. From 4ICDS Project areas of Banka district, total 600 Adolescents girl selected for this research study in which 300 school going and 300 non-school going girls were randomly selected. Result: AGLs clearly shows the declining trend of malnutrition with the increasing education of mothers, i.e. Highest per cent of undernourished AGLs were the daughters of Illiterates mothers (98%) and lowest per cent of undernourished AGLs were the daughters of intermediate mothers and graduate mothers.The per cent of normal AGLs was highest with the highly educated fathers lower with poorly educated and lowest with illiterate fathers. The prevalence of normal AGLs was higher with better income though their number is less. But even the little increase of income has shown the better performance. However, the data confirms, the effect of income on nutritional status of AGls.

Changes in Diet Quality in Youth Living in South Carolina From Fifth to 11th Grade

ObjectiveTo examine diet quality levels and changes in a diverse sample of youth from fifth to 11th grade, and interactions by race/ethnicity and socioeconomic status. DesignTransitions and Activity Changes in Kids prospective cohort study. SettingElementary, middle, and high schools in South Carolina. ParticipantsA sample of 260 fifth-graders (106 boys and 154 girls) with complete data at baseline and at least 1 time point each in middle school and in high school. Main Outcome MeasureDietary intake assessed with the Block Food Screener for Kids (last week). Diet quality was assessed using energy-adjusted intakes of 5 food groups. AnalysisDescriptive statistics and growth curve models for the total group and by gender for diet quality from fifth to 11th grade (P < 0.05). ResultsBoth boys and girls had low levels of diet quality, which continued to decline through 11th grade. Significant main effects by race and poverty as well as a race by poverty interaction were observed. Conclusions and ImplicationsPrograms and policies that support healthy dietary patterns in children transitioning from elementary to middle and high school are needed. Specific efforts that focus on nutrition disparities in children from low-income and minority backgrounds are warranted.

Nutrition Disparities and Cardiovascular Health.

This review is an assessment of the state of the science on nutrition disparities and their contribution to disparities in cardiovascular health. Nutrition disparities remain pervasive by race/ethnicity, sex/gender, socioeconomic status, and geography. They are rooted in differences in social, cultural, and environmental determinants of health, behavioral and lifestyle factors, and the impact of policy interventions. Systematic differences in diet quality, dietary patterns, and nutrient intakes contribute to cardiovascular disparities and are mediated by microbiota, and CVD risk factors including high levels of blood pressure, low density lipoprotein cholesterol (LDL), and glucose; oxidative stress, pro-inflammatory cytokines, and endothelial dysfunction. Despite the progress made in nutrition research, important gaps persist that signal the need for more effective interventions at multiple levels to reduce cardiovascular disparities. Research opportunities include (1) exploring the gene-nutrient-environment interactions in the context of ancestral diversity; (2) investigating the causal link between diet and gut microbiota and impact of social determinants of health; (3) understanding resilience; (4) testing the effectiveness of multi-level interventions that address social and environmental determinants; and (4) supporting intervention research informed by validated implementation science frameworks.

Dietary fiber and blueberry intervention lowers gestational weight gain and C-reactive protein in women at high risk for gestational diabetes

Background: The prevalence of GDM has been shown to be higher in specific ethnicities (e.g. Asian, Black and Hispanic origin vs. non-Hispanic whites), who also disproportionately carry the burden of obesity, low socioeconomic status, and nutritional disparities as prominent risks. Dietary bioactive compounds, such as polyphenols and fiber have been shown to play an important role in the management of diabetes, but there is a lack of studies in GDM. The objective of this randomized controlled trial was to examine the effects of a 20-week dietary intervention (blueberry +soluble fiber) vs. control (standard prenatal care) on gestational weight gain and cardio-metabolic parameters in high-risk Hispanic women with obesity and previous history of GDM. Women [n=25; BMI: 36.3±4.3 (means±SD] were recruited in early pregnancy (14±4 weeks gestation), and data were collected at baseline (< 20wk), 24-28wk and at 32-36wk gestation. Those in the intervention group were provided with frozen blueberries (2 cups/day) and soluble fiber (12g/day); both groups received nutrition education based on Dietary Guidelines for Americans. Results: The prevalence of GDM was observed as follows: one in the dietary intervention (n=12; 8%) and three in standard care group (n=13; 23%). Gestational weight gain and serum C-reactive protein was significantly lower in the dietary intervention vs. standard care (16.5&#177;9.2lb vs. 27.0&#177;11.3lb, respectively; 7.0&#177;3.1 mg/L vs. 17.0&#177;10.2 mg/L, respectively, mean&#177;SD, all p<0.05). Conclusions: Dietary strategies that increase fiber and fruit intake may ameliorate excess gestational weight gain and subsequently reduce the risk of GDM in obese women with previous history of GDM.

Examining Household Changes in Produce Purchases Among New Parents

ObjectiveTo measure whether parenthood is associated with changes in produce purchasing behavior, overall and stratified by income. DesignRetrospective examination of retail grocery purchases in the Nielsen Consumer Panel, a nationally representative sample of US households, 2007–2015. Participants and SettingA total of 21,939 households in the US, aged 25–49 years, observed ≤ 8 years; 508 households initiated parenthood during the study period. Main Outcome MeasurePercentage of household grocery budget spent on produce each year. AnalysisDifference-in-differences design was used to measure change in the percentage of the grocery budget spent on produce after becoming a parent, relative to households that did not become parents, overall and stratified by income level. Ordinary least-squares regressions was used to adjust for confounders. ResultsPercentage of the grocery budget spent on produce increased by 1.7 percentage points (15.7%) after initiating parenthood. Among higher-income households, produce purchases increased by 1.9 percentage points; no detectable change was found among low-income households. Conclusions and ImplicationsInitiation of parenthood increased grocery expenditures on produce. Because new parenthood is a critical time in a person's life, this behavior change could create the opportunity for interventions with long-term effects. However, heterogeneous impacts by income indicated that lower-income households need more support and reveal 1 mechanism for income-related disparities in childhood nutrition.

Stratification of BMI categories among older adults within and across countries.

Within- and across-country nutritional disparities were examined among older adults in six different countries at varying levels of development. Cross-sectional study. Older adults (aged 50 years or over) in China, Ghana, India, Mexico, Russia and South Africa using the Study on global AGEing and adult health (SAGE). While the distribution of BMI categories varied by country, development-related characteristics were generally related to BMI category in a similar way: urban-living, educated and wealthier individuals were typically more likely to be in a higher BMI category. However, there were some exceptions that corroborate findings in more developed countries. Indeed, a pooled partial proportional odds model which included gross domestic product per capita interactions made the case for intertwining processes of development and the nutrition transition. Population segments to be targeted by nutrition policy and programme implementation might need to change over the course of development.

Latino/Hispanic Participation in Community Nutrition Research: An Interplay of Decisional Balance, Cultural Competency, and Formative Work

BackgroundLatinos/Hispanics are among the populations at high risk of nutrition disparities. Adequate participation of this group in community nutrition research is necessary to better understand such disparities and propose sensible solutions. ObjectiveTo identify factors influencing participation and strategies to effectively reach Latinos/Hispanics for community nutrition research. DesignIn-depth interviews with experienced community nutrition researchers across the United States, conducted from February to June 2013. Participants/settingNine academics, including four registered dietitian nutritionists with extensive experience in community nutrition research with Latino/Hispanic groups, were interviewed in person (n=3) or via telephone/Skype (n=6). Main outcome measuresPerceived participation barriers, facilitators, and structural factors affecting Latino/Hispanic participation were explored. Successful and unsuccessful recruitment strategies to reaching this group were identified. AnalysisA Grounded Theory approach was applied for inductive identification of relevant concepts and deductive interpretation of patterns and relationships among themes. ResultsFormative work, cultural competency, and decisional balance emerged as the three interdependent factors influencing participation of Latinos/Hispanics in community nutrition research. Several approaches to influence participation were reported to be operationalized at the interpersonal, community and settings, and systems levels of influence. Trust, time, and tailoring were central concepts, postulated to moderate the relationship between the main themes and influence the effectiveness of recruitment tactics. ConclusionsExperienced community nutrition researchers identified actions ascribed to formative work as the bedrock of successful reach of Latinos/Hispanics. A robust formative work plan is necessary to achieving a functional level of trust, time, and tailoring tactics, which appear to critically influence participation.

Opportunities in the integration of primary care and public health nursing: Two case exemplars on physical activity and nutrition.

The integration of primary care and public health nursing may provide new opportunities for transforming nursing practice that addresses population health. Effective programs emphasize multilevel approaches that include both downstream (education) and upstream (policy change) actions. The purpose of this article is to identify downstream and upstream nursing actions that integrate public health and primary care practice through two case exemplars concerning disparities in physical activity and nutrition. Describe two research case exemplars: (1) a secondary analysis of school physical activity policy for female adolescents in 36 public middle schools and (2) a focus group study of African American adults in a community kitchen program. In exemplar 1, school policies lacked population-based standards and presented structural disadvantages to African American girls who were already obese. In exemplar 2, participants found the community kitchen program to be more effective than the federally funded nutrition program. Integrating primary care and public health nursing could improve the tailoring of physical activity and nutrition programs to local populations by following core principles of community engagement, infrastructural sustainability, aligned leadership, and data sharing for population health improvement.

Supermarket Shopping and The Food Retail Environment among SNAP Participants

ABSTRACTMuch of the research on food deserts has focused on the relationship between the food retail environment and nutrition and health outcomes. Intermediary differences in food shopping patterns are often implicitly assumed to drive these relationships (environment hypothetically affects shopping, which hypothetically affects consumption). Research is limited, though, on whether these food shopping discrepancies exist. This article investigates whether a number of food shopping outcomes and the food retail environment are in fact associated and in which kinds of neighborhoods, using the Electronic Benefit Transfer (EBT) records of over 40 000 households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in western Massachusetts. In some, though not all, food retail environments, we find a small but statistically significant negative association between continuous distance and both the percentage of SNAP redemptions spent at supermarkets and the number of benefit-spending trips taken to supermarkets. Nonetheless, SNAP households located in neighborhoods with what would be considered poor access to supermarkets still spent, on average, more than 75% of their redemptions at these retailers, only 5 percentage points lower than households located one block from a supermarket. These results suggest that SNAP participants’ inability to reach healthy food retailers is at most a minor driver of geographic disparities in nutrition and health outcomes.

Nutritional Disparities Among Women in Urban India

Food inflation, meagre wages, cash-based economy, and involvement in strenuous manual work in informal/unorganized sector, unprotected by labour laws of maternity leave, heighten the risk of undernutrition among urban underprivileged women, thus adversely affecting their future and that of their children.National and state-level information about maternal nutrition situation among urban poor in India, based on representative datasets, is still not available. This study is among the first attempts to analyze large scale secondary data, such as from Demographic and Health Survey (DHS) to unmask the extent of disparities in nutritional status and access to services of Indian women belonging to the poorest wealth quartile of the country’s urban population compared to the rest of the urban population. The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/ severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8 times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. Night blindness or difficulty in seeing at dusk, a result of chronic vitamin A deficiency, was reportedby 7% women in the poorest urban quartile, which was 2.9 times higher than the rest of the urban population (2.4%).One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%). The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes, (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days. contamination of water is also high, increasing the risk of intestinal worm infestation and calling for expeditious efforts to improve access of the urban poor and deprived populations to safe drinking-water and measures to prevent helminthic infestations would also require to be strengthened, more so in slum settings where many women work or walk barefoot (and hence at a risk of hookworm infestation).Given the large proportion of undernourished urban poor women, there is a need to assess undernutrition among women either periodically by grassroots-level workers in the nutrition and health programmes as part of the Government or NGO outreach programmes, e.g. health and nutrition days, or by students from social work, public health nutrition institutions or medical schools as part of their practicum. Corrective/mitigation measures for women identified as undernourished need to be instituted. These could include providing an additional food supplement to such women (on similar lines as being done for severely-underweight children), enrolling undernourished women for behaviour promotion plus self-confidence enhancement sessions, improving their access to food subsidy and linkage to poverty alleviation programmes since such women often come from food-insecure families owing to irregular/low wages and poor access to food subsidy.

US Household Food Shopping Patterns: Dynamic Shifts Since 2000 And Socioeconomic Predictors.

Under the assumption that differential food access might underlie nutritional disparities, programs and policies have focused on the need to build supermarkets in underserved areas, in an effort to improve dietary quality. However, there is limited evidence about which types of stores are used by households of different income levels and differing races/ethnicities. We used cross-sectional cluster analysis to derive shopping patterns from US households' volume food purchases by store from 2000 to 2012. Multinomial logistic regression identified household socioeconomic characteristics that were associated with shopping patterns in 2012. We found three food shopping patterns or clusters: households that primarily shopped at grocery stores, households that primarily shopped at mass merchandisers, and a combination cluster in which households split their purchases among multiple store types. In 2012 we found no income or race/ethnicity differences for the cluster of households that primarily shopped at grocery stores. However, low-income non-Hispanic blacks (versus non-Hispanic whites) had a significantly lower probability of belonging to the mass merchandise cluster. These varied shopping patterns must be considered in future policy initiatives. Furthermore, it is important to continue studying the complex rationales for people's food shopping patterns.

What Drives Nutritional Disparities? Retail Access and Food Purchases Across the Socioeconomic Spectrum

The poor diets of many consumers are often attributed to limited access to healthy foods. In this paper, we use detailed data describing both the healthfulness of household food purchases and the retail landscapes facing consumers to measure the role that access plays in explaining why some people in the United States eat more nutritious foods than others. We first confirm that households with lower income and education purchase less healthful foods. We then measure the spatial variation in the average nutritional quality of available food products across local markets, revealing that healthy foods are less likely to be available in low-income neighborhoods. Though significant, spatial differences in access are small and explain only a fraction of the variation that we observe in the nutritional content of household purchases. Systematic socioeconomic disparities in household purchases persist after controlling for access: even in the same store, more educated households purchase more healthful foods. Consistent with this result, we further find that the nutritional quality of household purchases responds very little to changes in the retail environment, especially among households with low levels of income and education. Together, our results indicate that policies aimed at improving access to healthy foods in underserved areas will leave most of the socioeconomic disparities in nutritional consumption intact.

Effects of Socioeconomic Status on Nutrition in Asia and Future Nutrition Policy Studies

Evidence of health disparities has been reported around the world. One of the intermediate factors between socioeconomic status (SES) and health is nutrition. Many studies reported socioeconomically disadvantaged people had more risk of obesity and lifestyle-related diseases than others in western society. Micronutrient intake affected by SES, but little evidence indicates that SES affects either energy intake or the macronutrient composition of the diet in western countries. In contrast, there is not enough evidence of a consistent relationship between SES and nutrition in Asian countries at present. The present status of nutrition disparities in Asia is considered to vary by economic level of the country. For developing countries in Asia, India and Vietnam, SES associates with BMI positively in women. For relatively developed countries in Asia, Korea and Japan, SES associates with BMI negatively in women. Low SES groups consume more carbohydrate, and less protein and fat, so not only micronutrient but also macronutrient intake is affected by SES both in developing and in developed Asian countries. There are some studies on the pathway from SES to diet/nutrition. The association between low SES and obesity may be mediated, in part, by the low cost of energy-dense foods, concern about food price and dietary knowledge. Nutrition policy research is required to reduce nutrition disparities in Asia. We need a collaborative study of the impact of potential political options on diet and on health with other academic fields.

High Risk Neighborhoods with Increased Poverty, Lack Nutritional Resources in Tulsa County

Background: This document reviews factual evidence presented by other organizations to establish barriers related to poverty and nutritional resources. Methods: An investigation using previous U.S. Census Bureau data and other external community reports analyzing the trends within specific zip codes. Learning Objective: Recognize the factors that influence nutritional disparities, while acknowledging the lack of inadequate resources. Conclusion: Families residing in these zip codes lacked appropriate nutritional resources and incur a higher prevalence of poverty.

Growing Fat on Reform: Obesity and Nutritional Disparities among China's Children, 1979–2005

AbstractEconomic growth over the past three decades has greatly improved the nutrition and living standards of people in China. However, increasingly, the Chinese are becoming heavier. As many as a quarter of Chinese school-age urban boys are overweight or obese, yet a third of Chinese children remain underweight. Drawing on six national surveys of children's health conducted since 1979, the article reports on trends in nutritional status and regional disparities. It shows that the drivers behind the increase in mean body mass and in nutritional inequality are associated with rising household incomes and associated inequalities between provinces.