Adult Nutrition Research Articles

Relationship between both duration and quality of sleep, and metabolic syndrome identified by classification tree model in midlife population in Tianjin

Objective: To study the association of duration and quality of sleep with metabolic syndrome. Methods: Multi-stage cluster random sampling method was used to extract data from the '2015 adult chronic disease and nutrition monitoring population project' from 42 communities of 7 districts in Tianjin. A total of 1 388 residents aged 45 to 59 years old were selected to analyze the relationship between both duration and quality of sleep and the metabolic syndrome. χ(2) test, non-conditional logistic regression and classification tree models were used for data analysis. Result: The prevalence of metabolic syndrome appeared as 30.4%, 37.4 % and 43.1% in the poor, common or well sleep groups respectively. The prevalence rates of metabolic syndrome in the sleep time <6.0 h and >7.5 h, 6.0-7.5 h groups were 36.5% and 30.6% respectively. After adjusting for gender and age, results from the logistic regression analysis showed that short or long sleep duration, as well as poor sleep quality all appeared as risk factors on metabolic syndrome (P<0.05). According to the classification tree model, factors as gender (importance: 0.004, standardized importance: 100%), quality of sleep (importance: 0.004, standardized importance: 99.5%), duration of sleep (importance: 0.002, standardized importance: 38.6%), education level (importance: 0.001, standardized importance: 22.3%) and salt intake (importance: 0.001, standardized importance: 22.2%) were all important on metabolic syndrome and with interactive effects. Conclusions: Both quality and duration of sleep were important influencing factors on metabolic syndrome among midlife population in Tianjin. More attention should be paid to sleep and health status among the midlife population. Ability on self-management of health should also be strengthened through health education, to prevent metabolic syndrome and other chronic diseases in this population.

Sociodemographic factors associated with consumption of confectionery among obese and non-obese adults: A secondary analysis

The objective of the present study is to examine sociodemographic factors associated with consumption of confectionery among obese and non-obese adults in Malaysia. Secondary analysis of the Malaysian Adult Nutrition Survey (MANS) 2014 was performed. The survey was conducted in urban and rural areas in the 14 states of Malaysia, including the Federal Territory of Kuala Lumpur. Adults aged 18 years and above (n = 2696) were interviewed. The dependent variable was the total servings of confectionery consumed per week. An ordered logistic regression model was used to examine the associated sociodemographic factors in the decision of people to consume 0, 1−2, 3−5 and ≥6 servings of confectionery. Marginal effects of sociodemographic variables on confectionery consumption were calculated. Analyses stratified by bodyweight group were conducted. The results showed that income, education, gender, ethnicity, and employment status were significantly associated with consumption of confectionery. In particular, income, education, gender, ethnicity and employment status affected confectionery consumption, but not the other way around. However, no relationship was evidenced between age, marital status, household location and confectionery consumption. In conclusion, sociodemographic factors were related to consumption of confectionery. Policies aimed at discouraging consumption of confectionery should focus primarily on high income earners, well-educated individuals and Bumiputera.

Adoção de terapias nutricionais enteral e parenteral associada à redução da taxa de óbitos de pacientes neoplásicos

Modelo do estudo: Estudo descritivo transversal. Objetivo: Este estudo analisou a relação entre a adoção da nutrição enteral e parenteral adulta e o tempo de permanência médio, a taxa de óbitos e o custo das internações de pacientes neoplásicos em hospitais do Rio Grande do Sul. Método: Foram analisados os dados dissemináveis disponíveis no SIH/SUS de 2017 do Rio Grande do Sul específicos para internações realizadas sob o diagnóstico principal associado ao CID Cap. II (Neoplasmas). Os dados foram analisados por observação da média e teste de Kruskal Wallis. Resultados: Foi observada taxa de óbito significativamente inferior em pacientes neoplásicos que foram internados em UTI e que foram submetidos às terapias dietéticas enterais e/ou parenterais, em relação aos pacientes que não receberam tais suplementos, em casos de diagnóstico de neoplasias malignas no esôfago (C15), no intestino delgado (C17) e no pâncreas (C25). Já o tempo médio de permanência e valor total médio de internações de pacientes neoplásicos tendem a ser maior em pacientes que recebem terapias dietéticas enterais e/ou parenterais, possivelmente devido à gravidade do quadro clínico. Conclusão: A adoção de nutrição enteral e parenteral apresenta potencial significativo na redução da taxa de mortalidade de pacientes com câncer no sistema digestivo, principalmente dos casos mais graves que necessitam de internação em UTI.

Perceived neighbourhood food environment and overweight and obesity among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) participants in the Midwest US.

To evaluate the relationship between neighbourhood food environment perceptions and obesity among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) or Expanded Food and Nutrition Education Program (EFNEP) participants. A cross-sectional study conducted during SNAP-Ed or EFNEP programme participation in six states in the Midwest US between May 2016 and November 2017. Community centres, food pantries and other SNAP-Ed or EFNEP recruitment locations. Convenience sample of 1743 low-income, adult nutrition education programme participants. Controlling for participant location and other demographic variables, those who perceived that a large selection of fruits and vegetables were available to them were 22 % less likely to be obese (adjusted odds ratio 0·78, 95 % CI 0·63, 0·97). In addition, participants who perceived the distance to the grocery store where they purchased most of their groceries to be greater than 5 miles were 1·36 times more likely to be overweight or obese than those who travelled shorter distances for their groceries. SNAP-Ed or EFNEP participants' weight status may be associated with their perceptions of their neighbourhood food environments. Programmes incorporating nutrition education and food access initiatives should attempt to better understand participant perceptions in order to address barriers in their efforts and to ensure that healthy food is accessible to low-income residents.

Use of vegetable and fruit powder in the production technology of functional food snacks

The article provides information on the development of formulations and production technology of functional food snacks (bars, tablets, cubes) from vegetables, fruit and secondary raw materials from the production of direct-pressed fruit and vegetable juices for a healthy snack during the day (morning, afternoon, evening) in accordance with the current trend of nutrition: “The right products at the right time”. In a balanced diet, a person needs two to three snacks during the day between main meals. Each snack should have an individual combination of proteins, fat, carbohydrates, fiber and with the given parameters of calorie content and antioxidant activity. Developments of the authors of the article are related to vegetable and vegetable-fruit snacks (bars, tablets and cubes) with low calorie content, which can be used as a light snack “on the go”, as an addition to food or a light snack. Products based on vegetable and fruit raw materials are included in the consumer subcategory in the market of snacks (bars, tablets, cubes) along with snacks made from cereal-muesli, fruit-nut, energy, but they differ significantly from them in low calorie, high fiber and antioxidant content. The scientific component of the development of formulations and technology for vegetable and fruit and vegetable snacks is not to create them with ingredients that no one has used yet, but that these products are required for the healthy nutrition of adults and the full development of children. All researches, developments and manufacture of samples were carried out on instruments and equipment of laboratories and departments of Michurinsk State Agrarian University.

Association between diet quality and obesity indicators among the working-age adults in Inner Mongolia, Northern China: a cross-sectional study

BackgroundObesity is a major risk factor for the global burden of disease in countries that are economically developed or not. This study aimed to investigate the association between diet quality and obesity indicators applying DASH and aMed.MethodsThis cross-sectional study on adult nutrition and chronic disease in Inner Mongolia (n = 1320). Dietary data were collected using 24-h diet recall for 3 consecutive days and weighing method. DASH and aMed were used to assess the dietary quality. WC, BMI and WC-BMI were used as obesity indicators. Logistic regression models were used to examine the associations between diet quality and obesity indicators.ResultsHigher diet quality, assessed by DASH, was only associated with WC. The odds ratio (OR) for abdominal obesity in the highest tertile of DASH scores compared with the lowest was 0.71 (95% confidence interval (CI) 0.53, 0.96; Ptrend = 0.03). Furthermore, aMed was inversely associated with obesity indicators. OR for abdominal obesity in the highest tertile of aMed score compared with the lowest were 0.63 (95% CI 0.47, 0.87; Ptrend = 0.005) and 0.57 (95% CI 0.41, 0.77; Ptrend = 0.02) for overweight and obesity, respectively, and 0.60 (95% CI 0.44, 0.81; Ptrend = 0.02) for high obesity risk.ConclusionsOur findings suggest that dietary quality assessed using aMed is more closely associated with obesity than assessment using DASH in working-age adults in Inner Mongolia. The Mediterranean diet can be recommended as a healthy diet to control weight.

Investigation on knowledge, attitudes and practices about food safety and nutrition in the China during the epidemic of corona virus disease 2019.

To investigate the knowledge, attitudes and practices (K-A-P) about food safety and nutrition in Chinese adults who were recruited to the online survey during the epidemic of corona virus disease 2019 (COVID-19). Participants were recruited by an online snowball sampling method. An electronic questionnaire was sent to our colleagues, students, friends, other professionals and their referrals helped us recruit more participants. The questionnaire included socio-demographic information, the attention paid to COVID-19, K-A-P about food safety and nutrition. Multiple and logistic regression analyses were used to explore related factors of K-A-P. Totally, 2272 participants aged 24·09 ± 9·14 years, from twenty-seven provinces, autonomous districts or municipalities, with 18·3 % male and 83·4 % with a medical background. The total possible knowledge score was 8·0, the average score was 5·2 ± 1·6 and 4·2 % obtained 8·0. The total possible attitudes score was 8·0, the average score was 6·5 ± 1·4 and 36·1 % obtained 8·0. The total possible food safety practices score was 5·0, the average score was 3·7 ± 1·0 and 20·7 % obtained 5·0. During this public emergency, 79·4 % participants changed diet habits, including increasing vegetables, fruit and water intake and reducing sugary drinks and snacks. Gender, age, educational and professional background, disease history, the attention paid to COVID-19 and related knowledge were associated with K-A-P. There was room for the improvement of K-A-P in participants during this public health emergency and further strengthening education about food safety and nutrition is needed. Findings indicate that education should address biased or misleading information and promote nutritious food choices and safe food practices.

Understanding food westernisation and other contemporary drivers of adult, adolescent and child nutrition quality in urban Vietnam.

To examine the association between consumption of western foods purchased and consumed away from home and measures of nutrition quality: average daily caloric intake and macronutrient (carbohydrates, fat and protein) shares, for urban consumers in Vietnam, a country undergoing economic transition. Cross-sectional observational data were collected using household surveys and 24-h food diaries. Outcome variables were individual average daily caloric intake and shares of calories from macronutrients: carbohydrates, fat and protein. The key explanatory variable was individual daily share of calories from western food purchased and consumed away from home. Ordinary least squares and multivariate regression analyses were used to examine the association between the outcome variables: caloric intake and macronutrient shares and the share of calories from western food consumed away from home. Hanoi and Ho Chi Minh City in Vietnam. In total, 1685 households and 4997 individuals, including adults (aged $$ \ge $$ 18 years), adolescents (aged 10-17 years) and children (aged 0-9 years). The share of calories from western food away from home was significantly associated with higher caloric intake among male and female adults (P < 0·01), adolescents (P < 0·01) and male children (P < 0·10) and was associated with higher shares of fat for male and female adults (P < 0·01), adolescents (P < 0·01) and male children (P < 0·01). Policymakers must be conscious of the numerous factors associated with poor nutrition quality, especially in younger Vietnamese individuals. Relevant interventions targeting at risk groups are required if nutrition improvement is a long-term goal.

Challenge to evaluate regulatory compliance for nutrients in infant formulas with current state-of-the-art analytical reference methods

Infant formulas are strictly regulated and rigorously tested for compliance. Recently, new official analytical methods/standards have been established for nutrient analyses in these product categories through the Stakeholder Panel on Infant Formula and Adult Nutritionals (SPIFAN), governed by AOAC INTERNATIONAL. Many of these methods have been adopted or are in the process of being adopted as reference methods by Codex Alimentarius. The purpose of this paper is to assess the ability of these cutting-edge analytical methods to deliver acceptable results in the context of established regulatory limits for nutrients in food standards and regulations. For this evaluation, the analytical method variability is considered as one of the three main sources of overall process variability, which also includes variation in raw materials/ingredients and the manufacturing process.The process capability (Cp) is a concept for determining the overall process variability relative to specification limits for a parameter in the final product. Based on this principle an analytical method capability (Cm) was defined and calculated for SPIFAN methods. Global regulatory requirements were evaluated including minimum and maximum limits and tolerances from the declared label values. Compared to these requirements, analytical methods for vitamins A, B12, D and folic acid are of particular concern in relation to the requirements in China, some EU member states, Pakistan, Russia, Singapore, South Africa and Thailand. For a product with a manufacturing target at the midpoint of the regulatory range for these nutrients, the probability of obtaining an analytical result outside the regulatory requirements due to analytical variation alone can be as high as 19%. This does not consider variability caused by the production process and/or raw materials/ingredients.These currently used analytical methods are state-of-the-art and represent the latest developments in technology. However, this work demonstrates that continuous method improvements for the nutrients identified must be pursued. In addition, this work supports a risk management approach that takes into consideration analytical method capability when establishing regulatory limits for nutrients in infant formulas. Ongoing efforts towards harmonization of regulatory requirements across global markets will facilitate evaluation of regulatory compliance in infant formulas.

Nutrition in older adults living with diabetes

AbstractPeople in the UK are living longer, consequently an increasing number of adults are living with type 1 and type 2 diabetes to an older age. Diabetes is a complex condition to manage, requiring consideration of several different dietary recommendations. In addition, there are many nutritional issues and social barriers associated with older age, which may make following these recommendations more difficult.Older adults represent a diverse age group with varying needs. In order to give the most appropriate advice, clinicians need to consider the functional status of the older adult. Some older adults will continue to manage their diabetes and nutrition in the same manner as their younger peers. Others may have increased needs due to disease or social circumstance, which may affect how they should be advised to manage their diabetes.Both obesity and malnutrition are prevalent in older adults. They impact both nutritional status and diabetes management and are important to consider. Sarcopenia, the loss of muscle mass, increases frailty in older adults which may exacerbate hypoglycaemic episodes. Nutrition support and tailored dietary interventions by a registered dietitian to help manage these conditions are essential. This, in addition to consideration of the many social, financial and physical barriers to nutrition, is key management of diabetes in older adults.This review aims to explore the complex challenges in nutrition for older adults with diabetes. Copyright © 2020 John Wiley &amp; Sons.

P71 Nutrition Education with Incentive at NYC Farmers Markets May Contribute to Longer-Term Increases in Produce Consumption

<h3>Background</h3> Farmers' markets (FMs) present opportunities for health promotion. In New York City (NYC), the Just Say Yes to Fruits and Vegetables Stellar FM Program (Stellar) provides free nutrition and cooking demonstrations for adults from July-November at select FMs coupled with distribution of one $2 Health Bucks (HB) coupon, redeemable toward fresh produce at all NYC FMs. <h3>Objective</h3> Evaluate the relative impact of Stellar and HB distribution on initial and longer-term changes in produce consumption. <h3>Study Design, Setting, Participants</h3> This quasi-experimental, longitudinal evaluation recruited the following groups from NYC FMs located in neighborhoods with low incomes from July-August 2016: Stellar (n = 110): Stellar attendees from 2 FMs; HB (n = 330): shoppers at 2 non-Stellar FMs who received $6 HB at recruitment, and $6 HB/month for 3 months; Controls (n = 325): shoppers at 2 other non-Stellar FMs. Baseline surveys were conducted at recruitment. Phone/mail follow-up surveys were conducted from August-September 2016 (Wave 2) and February-April 2017 (Wave 3). Participant retention at Waves 2 and 3, respectively, were: Stellar 67%/49%; HB 37%/33%; Controls 38%/37%. <h3>Measurable Outcome/Analysis</h3> Daily fruit and vegetable (FV) consumption were measured using the NHANES Dietary Screener Questionnaire. Linear regression models accounting for participant-level clustering and fixed effects for wave, group, wave*group, education, race/ethnicity, and income-assessed adjusted average intake and within-group changes from baseline (α = 0.05). <h3>Results</h3> Baseline total FV intake averaged 2.81 times/day (Controls), 2.80 (HB), and 2.63 (Stellar). At Wave 2, all groups had non-significant increases (Controls: 0.04, <i>P</i> = .734; HB: 0.22, <i>P</i> = .088; Stellar: 0.28, <i>P</i> = .114). At Wave 3, Controls and HB had non-significant changes from baseline by −0.22 (<i>P</i> = .131) and −0.27 (<i>P</i> = .054), respectively, while Stellar significantly increased by 0.41 times/day (<i>P</i> = .041). <h3>Conclusions</h3> These findings indicate that Stellar programming, which includes HB, may support sustained increased FV consumption more than HB distribution alone. This study is limited by unexpectedly small sample sizes and seasonal variation between survey waves.

Weak and Dizzy–Another Explanation to Explore: Poor Nutrition in the Older Adult

Weak and Dizzy–Another Explanation to Explore: Poor Nutrition in the Older Adult

P153 A Homeless Health and Wellness Study

<h3>Background</h3> Utah State University Extension, Brigham Young University, the Utah Supplemental Nutrition Assistance Program-Education (SNAP-Ed), and a local homeless resource center, the Food and Care Coalition (FCC), have partnered to develop and evaluate the effectiveness of a nutrition and physical activity program aimed to improve behaviors of adults experiencing or transitioning out of homelessness. <h3>Objective</h3> Formative research was conducted to identify factors influencing healthy food and physical activity choices among people experiencing or transitioning out of homelessness in Utah. The information obtained was used to modify an adult nutrition education curriculum, Create Better Health, for this specific population. <h3>Study Design, Setting, Participants</h3> Trained research assistants conducted semi-structured, in-person interviews with key stakeholders at the FCC. Nine interviews were conducted with FCC's administration/staff (n = 4) and transitional housing residents (n = 5). Interviews lasted about 60 minutes and were audio-recorded and transcribed. Questions included topics of interest for nutrition classes, the structure of transitional housing units, challenges to healthy eating and physical activity, influences on food choices, and local healthy food access. <h3>Measurable Outcome/Analysis</h3> Transcriptions were independently coded by 4 reviewers with expertise in nutrition, exercise science, and health education. Codes were then compared to identify patterns and overarching themes. Data was used to tailor the Create Better Health curriculum. <h3>Results</h3> Preliminary analysis identified emergent themes including: how residents obtain food; barriers to healthy eating, exercise, and obtaining food; food preparation resources and living environment; and ideas for effective program implementation. <h3>Conclusions</h3> Formative evaluation is essential to developing effective programming to improve behaviors of specific populations, including those transitioning out of homelessness. Improving dietary and physical activity behaviors may help individuals build a foundation of wellness.

P128 Measuring the Long-Term Effectiveness of a SNAP-Ed Curriculum

<h3>Background</h3> The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) aims to improve the dietary, physical activity and food resource management behaviors of limited resource individuals to decrease their risk of chronic diseases. Several SNAP-Ed nutrition curricula are known to be effective at changing participants' short-term behaviors. However, less research has been done to determine the long-term effectiveness of such curricula on behavior change. <h3>Objective</h3> The objective of this study was to evaluate the long-term effectiveness of the Utah's Create Better Health adult nutrition curriculum 6 months after participants completed the program. Impact on nutrition, physical activity, food safety, and food resource management behaviors were evaluated. <h3>Study Design, Setting, Participants</h3> Adult participants (n = 150) in SNAP-Ed classes were contacted via email or phone 6 months after completing a series of 4-8 Create Better Health classes. Participants completed a 24-question retrospective pre-post survey. Survey respondents were asked 24 nutrition, physical activity, and food resource management questions. <h3>Measurable Outcome/Analysis</h3> Respondents were asked to identify the frequency of behaviors prior to and after participating in the Create Better Health series. Questions included the frequency of making healthy food and physical activity choices consistent with the Dietary and Physical Activity Guidelines for Americans. Food resource management practices were also assessed. Responses were compared using paired t-tests and effect size was calculated using Cohen's d. <h3>Results</h3> Respondents reported statistically significant improvements in several behaviors 6 months after participating in Create Better Health classes including consuming recommended amounts of fruits (<i>P</i> < .001, r = 1.01), vegetables (<i>P</i> < .001, r = .85), stretching food dollars to last the month (<i>P</i> < .001, r = .56), and being active for at least 30 minutes 5 times a week (<i>P</i> < .001, r = .85). <h3>Conclusions</h3> Utah SNAP-Ed's curriculum, Create Better Health, helps adult participants make and sustain healthy behavior changes for at least six months after participating in classes. This long-term behavior changes may help reduce some of the health disparities often experienced by limited resource individuals.

O1 Using Comprehensive Approach to Implement Plan Shop Safe Cook Curriculum in a Low-income Hispanic Community

Objective To implement and evaluate a comprehensive approach to adult nutrition education program in a Hispanic low-income community. Use of Theory or Research Based on Social Ecological Model, nutrition education intervention is more effective when it not only focuses on individual level but also levels of interpersonal, organizational, and environmental. Plan Shop Safe Cook (PSSC) is a nutrition family and consumer science curriculum that showed evidence of increased knowledge, skills, and intention to change. Our comprehensive approach will enhance the healthy behavior change by collaborating with the administer of low-income housing authorities to make policy, system, and environment (PSE) change for participants. Target Audience CalFresh Healthy Living Program (CHLP) adult participants who are living in low-income housing authorities in a Hispanic dominated community. Program Description CHLP educators teach a 4-lesson series on meal planning, reading labels, shopping, and cooking annually at the sites. In 2018, our team collaborated with sites managers to make a PSE change by allowing us to build community gardens, give outs seeds and soil, and support container gardens outside their apartments. In Year 2019 PSSC lessons, educators adapted recipes to include vegetables that harvested in their gardens in the cooking lesson and did taste testing. Evaluation Methods Participants complete a pre- and post-test at the beginning and end of the series. The pre/post evaluation tool included 6 resource management items and 1 food security question using a 5-option Likert-type response and 1 open-end question on behavior change they have made after classes. Results Eighty-two percent of participants (n = 124, 88% female, 95% Latino, 33% age 60 years or older) increased at least 1 resource management behaviors and 44% reported greater food security. Three self-reported behavior change themes were merged: freezing their extra produce; adding more vegetables to their diets; and eating less salt and less sugar. Conclusions Building community gardens as PSE change strategy is an effective way to enhance nutrition education towards behavior change in low-income housing authorities. Funding Supplemental Nutrition Assistance Program - Education.

Developing and Pilot Testing a Population-focused Nutrition Screen Incorporating Social Determinants of Health

Introduction: Given that nutrition status is directly related to a variety of health outcomes, nutrition screening is a prime focus of public health nutrition practice. &#x0D; Objectives: The purposes of this pilot study were to develop and pilot test a Rural Adult Nutrition Screen (RANS) that includes criteria addressing social determinants of health and to explore possible applications of the screen development methodology in other settings.&#x0D; Methods: Mixed-methods research including interviews and survey dissemination was conducted among a rural southern Appalachian population in the United States. Themes identified in the research were used to construct a preliminary rural adult nutrition screen (RANS-1). The RANS-1 was pilot-tested among a sample of community-dwelling rural residents (n = 83), and was revised based on participant, administrator, and nutrition practitioner comments. The revised screen, the RANS, was pilot-tested among a sample of attendees of a free community medical clinic (n = 37). Nutrition risk as determined by the RANS was compared with the Nutrition Triage Score of the Patient-Generated Subjective Global Assessment (PG-SGA), the United States Department of Agriculture 6-item Household Food Security Survey Module (USDA-6), and nutrition assessment performed by a Registered Dietitian Nutritionist who was also credentialed as a Physician Assistant (RDN, PA). Non-parametric statistical tests were used to compare the results of the PG-SGA NTS and the USDA-6 with the RANS regarding “at risk” and “low risk” status.&#x0D; Results: In this small pilot study, no statistically significant differences were found among either comparative instrument and the RANS in determination of “at risk” and “low risk” status. The RDN, PA’s agreement with the RANS was 100%. &#x0D; Conclusion: This pilot study provides some evidence that the RANS may be used to screen rural, community-dwelling adults for nutrition needs in light of social determinants of health common in rural settings. Further research and formal validation of the RANS are needed in order to establish this tool as a valid nutrition screen for use in the rural community setting. Procedures used to develop the RANS may be applicable to the development of population-specific nutrition screens in other rural and urban global populations.

The nutrition transition in Malaysia; key drivers and recommendations for improved health outcomes

BackgroundThe main purpose of this paper is to understand the multidimensional phenomenon of the nutrition transition in Malaysia, from 1980 to 2014, to inform future policies for a healthier nation.MethodsFood and health data were obtained through Food Balance Sheets, Malaysian Adult Nutrition Survey (MANS) and National Health and Morbidity Surveys (NHMS) for year-to-year review. Interaction between changes in food supplies and dietary trends and the progression of diet-related diseases and risk factors in tandem with demographic and socioeconomic transitions were observed using quasi-historical approach.ResultsThe period-under-review has seen Malaysia becoming more affluent, urbanised and modernised. Energy supply for Malaysian population remained consistently in excess of average calorie needs by a minimum of 30%. There were significant signs of shifting food trends, particularly in the supply of wheat (+ 56.5%), rice (− 23.7%), sugar and sweeteners (+ 23.9%), meat (+ 49.3%), fish and seafood (+ 38.7%), and eggs (+ 55.7%). The plant/animal protein ratio has decreased over time. Prevalence of NCD and associated risk factors has increased rapidly, some as high as 170%, despite various policy efforts to reduce them.ConclusionThe study highlights the importance of policymakers taking a relook into its policies and strategies, and formulate sustainable, comprehensive and multifaceted actions together with all relevant stakeholders to ensure a conducive, healthy and nutritious food systems and environment for its population.

Factors associated with the overlap of frailty and nutrition in institutionalized older adults: A multicenter study

ObjectivesThis multicenter cross-sectional study aimed to investigate the factors associated with the overlap of frailty and nutrition in older adults residing in nursing homes. MethodOlder adults (n = 344, mean age ± SD = 77.7 ± 9.1) were selected from 17 nursing homes, 10 in Piracicaba and seven in João Pessoa, Brazil. The modified Fried’s questionnaire and the Mini Nutrition Assessment Short-Form (MNA-SF) were used for screening frailty phenotypes and nutritional status, respectively. These variables overlapped into (1) frail and malnourished; (2) nonfrail and malnourished or frail and nourished; and (3) nonfrail and nourished. The independent variables were sex, age, mobility, number of medications, dependence for activities of daily living (ADL), maximal grip strength, muscle mass, body fat and body mass index (BMI). Spearman’s correlation and Poisson regression were used to analyze the data (α = 0.05). ResultsThe Spearman’s test demonstrated a moderate correlation (r2=-0.441) between frailty (mean ± SD = 2.8 ± 1.7) and nutritional status (mean ± SD = 10.5 ± 2.9). Regarding the overlap of frailty and nutrition, 139 participants (40.5 %) were frail and malnourished, 121 (35.3 %) were nonfrail and malnourished or frail and nourished, and 83 (24.2 %) were nonfrail and nourished. The Poisson regression showed association of the coexistence of frailty and malnutrition with age (PR = 1.009, 95 % CI = 1.003−1.016), number of medications (PR = 1.016, 95 % CI = 1.006−1.027), dependence for ADL (PR = 1.061, 95 % CI = 1.016−1.108), maximal grip strength (PR = 0.992, 95 % CI = 0.986−0.998) and BMI (PR = 0.997, 95 % CI = 0.996−0.998). ConclusionsThe findings showed that frailty and malnutrition were prevalent in institutionalized older adults and associated with advanced age, greater use of medicines, dependence for ADL, lower maximal grip strength and lower BMI.

Factors Associated With Central Line-Associated Bloodstream Infections in a Cohort of Adult Home Parenteral Nutrition Patients.

Central line-associated bloodstream infection (CLABSI) is a potentially life-threatening complication in home parenteral nutrition (HPN) patients. We investigated potential predictors of CLABSI in a cohort of adult HPN patients METHODS: Patients managed by the HPN service at the Hospital of University of Pennsylvania on January 1, 2018, were included and followed through June 30, 2019, using existing medical records to collect demographic and clinical data. CLABSIs were adjudicated prospectively by infectious disease experts. Variables with P ≤ .2, when comparing patients with CLABSIs and those without, were included in logistic regression models. Among 114 patients, mean age was 54 ± 16 years, 78/114 were female, and BMI was 25 ± 5.6. Median experience with HPN was 516 days (range, 15-10,281), and 30 had prior CLABSI. Catheter types were peripherally inserted central catheters (83/114), tunneled (27), and implanted (4). The incidence of CLABSI was 0.89 per 1000 catheter days. One multivariate model identified ostomy/wound (odds ratio [OR], 22.0; 95% CI, 4.8-101.7), tunneled/implanted catheter (OR, 4.4; 95% CI, 1.4-13.9), and BMI < 18.5 (OR, 5.9; 95% CI, 1.4-24.2) as predictors of CLABSI. A second model identified patients with 2 potential predictors (OR, 22.9; 95% CI, 5.6-93.5) and tunneled/implanted catheter (OR, 6.7; 95% CI, 2.1-21.8) at high risk of CLABSI. Whether CLABSIrates might be reduced by more intense training in wound or catheter care (especially for those with multiple predictors), different types of catheters, or rapid treatment of malnutrition will require further study.

Effects of Modern Food Retailers on Adult and Child Diets and Nutrition.

In many developing countries, food environments are changing rapidly, with modern retailers—such as supermarkets—gaining in importance. Previous studies have suggested that the rise of modern retailers contributes to overweight and obesity. Effects of modern retailers on dietary quality have not been analyzed previously due to the unavailability of individual-level dietary data. Here, we address this research gap with data from randomly selected households in Lusaka, Zambia. Anthropometric and food-intake data from 930 adults and 499 children were analyzed to estimate effects of purchasing food in modern retailers on body weight, height, and dietary quality while controlling for income and other confounding factors. The food expenditure share spent in modern retailers was found to be positively associated with overweight in adults, but not in children. For children, a positive association between expenditures in modern retailers and height was identified. Modern retailers contribute to higher consumption of ultra-processed foods and calories. But they also increase protein and micronutrient intakes among adults and children, mainly through higher consumption of meat and dairy. The findings underline that modern retailers can influence diets and nutrition in positive and negative ways. Differentiated regulatory policies are needed to shape food environments for healthy food choices and nutrition.