Nutrition-related Non-communicable Diseases Research Articles

Assessing nutrition literacy and nutrition counseling proficiency following an interdisciplinary culinary medicine elective.

Culinary medicine (CM) is a growing field of education that aims to bridge the gap between the clinical need for nutritional counseling and the lack of education on the topic. Healthcare professionals can aid in nutrition-related noncommunicable disease (NCD) prevention by improving a patient's dietary behavior. However, the presence of nutrition education in healthcare curricula is lacking. Early evidence indicates that CM could address this gap. The objectives of this study are to determine ifthe provision of an interdisciplinary CM elective will improve student knowledge and confidence with counseling on nutrition and culinary principles, and to improve personal dietary habits of students. This was a one-group pretest-posttest quasi-experimental design. First- and second-year osteopathic medical students (OMS) and nurse practitioner students were recruited to participate in a CM elective via email. Participants were excluded if they were not in good academic standing at their respective institutions. Twelve individuals (n=8 medical; n=4 nursing) were enrolled in the course. Participants completed pre- and postcourse surveys to determine changes in nutrition literacy (Nutrition Literacy Assessment Instrument [NLit42]), nutrition counseling proficiency (Nutrition Survey for Family Practitioners), and dietary quality (Automated Self-Administered 24-h dietary assessment tool; ASA24®). A two-sided, paired t test was conducted to determine changes in outcome variables. All 12 participants completed the precourse assessments, and 8 participants completed the postcourse assessments. Culinary activity attendance was 94.5 %. Participants exhibited a statistically significant increase in their overall nutrition literacy scores after completing the CM elective (p=0.006). Literacy subcategories indicated that the improvement came from the participant's ability to understand household measurements (p=0.005) better. Increases in self-reported proficiency were observed for participants' confidence to counsel on nutrition and prevention/wellness (p=0.02) and macronutrients in health and food safety (p=0.01). No statistically significant changes in the personal dietary pattern or quality were observed. The interdisciplinary CM elective improved nutrition literacy and some aspects of counseling proficiency. Although small shifts in dietary variables were observed, the elective did not statistically improve participants' dietary pattern. However, some changes that were observed may lead to clinically relevant outcomes if maintained long-term. These findings are encouraging. Implementing CM as an educational tool could improve healthcare practitioners' ability to understand and counsel patients on nutrition to prevent the nutrition-related NCDs.

Stress factors and food purchase prioritization during the pandemic of coronavirus disease 2019

BackgroundThe pandemic of coronavirus disease 2019 (COVID-19) pandemic confinement has an impact on stress levels, which causes changes in food purchase and consumption behaviors. The objective of this study is to associate food purchase prioritization with stress level during the COVID-19 pandemic confinement. MethodsMulticenter, observational and cross-sectional study, an online questionnaire that included data on sociodemographic variables, stress factors and food purchase prioritization was disseminated through digital platforms and social networks. ResultsA number of 6,357 participants were included, of whom 83.6% were female, 56.3% were from the middle socioeconomic level, 71.2% had completed higher education and 78.3% had a job. At greater stress levels it was observed a higher prioritization of canned foods (Odds ratio (OR): 1.91, 95% CI: 1.56; 2.34), sweets (OR: 1.58, 95% CI: 1.06; 2.34) and flours (OR: 1.45, 95% CI: 1.25; 1.68). While lower stress levels are associated with nuts (OR: 0.75, 95% CI: 0.66; 0.85), vegetables (OR: 0.82, 95% CI: 0.72; 0.94), and fruits (OR: 0.90, 95% CI: 0.80; 1.01), after adjusting for confounders. ConclusionsThere is an association between food purchase prioritization and stress level during the COVID-19 confinement. At greater stress levels, individuals purchase more food, both healthy and unhealthy. The later may have a negative impact on people's health, leading to or further aggravating malnutrition by excess and nutrition-related noncommunicable diseases.

A higher education snapshot of nutrition degree programs in Iraq: implications for public health and nutrition practice

PurposeBurdened by undernutrition, micronutrient deficiencies and overweight and obesity as a consequence of both internal conflict and the global nutrition transition, Iraq is in need of adequate public health nutrition education to mitigate nutrition-related outcomes and risks. To address nutrition-related health outcomes, trained nutrition professionals are warranted. This paper examines current nutrition-affiliated programs offered across post-secondary institutions in Iraq.Design/methodology/approachAn electronic review of universities and colleges’ websites, department webpages and academic programs’ homepages and resources of all the private and public universities in Iraq was conducted to find programs related to nutrition, nutrition sciences and dietetics.FindingsAll identified programs belonged to the governmental sector, were administered and financed by the Iraqi Government and were under the purview of the Iraqi Ministry of Higher Education. The review highlighted a predominant focus on food sciences in agricultural departments rather than public health or clinical nutrition. Advanced education in topics such as human metabolism, medical nutrition therapy and public health nutrition are required to adequately address over- and undernutrition in Iraq.Originality/valueThe current state of public health and nutrition-related postsecondary education in Iraq warrants an increased emphasis on clinical and public health nutrition education. Despite a commendable focus on food science studies, the country’s ongoing challenges with obesity, nutrition-related noncommunicable diseases and conflict-associated food insecurity signal an urgent need for balancing this focus with grounding in postsecondary training in public health nutrition.

Physicochemical, in vitro starch digestibility and sensory characteristics of biofortified yellow maize-cowpea composite flours and biscuits

The consumption of whole grain cereals, pulses and their products, such as biscuits, is associated with protection against nutrition-related non-communicable diseases. Hence, the aim of this study was to evaluate the physicochemical qualities and in vitro starch digestibility of flours and biscuits formulated with biofortified yellow maize (M-f) and cowpea (C-f) composites, as well as the biscuits’ sensory attributes. Biscuits, coded M-b, MC-b1, MC-b2, MC-b3, and C-b, were baked from composite flours of M-f and C-f (M-f:C-f, w/w) at the proportions of 100:0, 75:25, 50:50, 25:75, and 0:100, respectively. Refined wheat flour (W-f) and its biscuit (W-b) served as controls. Individually, the final viscosities of M-f (157.36 RVU) and W-f (159.12 RVU) were comparable (p > 0.05); but both were significantly higher (p < 0.05) than that of C-f (93.15 RVU). Among the composite flours, MC-f2 and MC-f3 had the highest final (175.43 RVU) and peak (65.52 RVU) viscosities, respectively. The total carbohydrate, crude fat, and energy value increased significantly (p < 0.05) with increasing proportion of M-f in the composite flours and biscuits, while the crude protein and ash contents increased with an increasing proportion of C-f. The ranges of total carbohydrate, crude fat, and food energy in the biscuits were 51.03 (C-b) - 68.27% (W-b), 12.15 (W-b) - 19.02% (M-b), and 414.33 (C-b) - 455.91 kCal/100 g (M-b), respectively. The concentrations of starch, amylose, amylose/amylopectin ratio, starch hydrolysis index (HI), as well as estimated glycaemic index (eGI) of the composite flours and biscuits decreased significantly with an increasing proportion of C-f. Thus, the ranges of starch and eGI in the biscuits were 41.02 (C-b) - 68.01% (W-b) and 34.99 (C-b) - 57.19% (W-b), respectively. Crude protein (r = − 0.715, − 0.696), starch (r = 0.966, 0.954), amylose (r = 0.947, 0.931), and amylopectin (r = − 0.947, − 0.931) significantly correlated with eGI and HI, respectively. The sensory acceptability of the composite biscuits improved as the proportion of C-f increased. Hence, it is concluded that increasing the level of cowpea in biofortified yellow maize-cowpea composite flours and biscuits enhanced their physicochemical and sensory attributes, and reduced their estimated GI.Graphical

Dietary knowledge assessment among the patients with type 2 diabetes in Madinah: A cross-sectional study .

There is a huge burden of nutrition-related non-communicable diseases, and diabetes is one of the leading chronic nutrition-related diseases affecting more than 500 million people globally. Collecting information regarding the awareness of dietary and nutrition knowledge among diabetic patients is the first step to developing a disease prevention program. Thus, this study primarily aims at assessing the dietary awareness of diabetes patients attending the diabetic centre in Madinah governorate, Saudi Arabia. The study was started in November 2020 and ended in October 2021. The study participants (315) were type 2 diabetes mellitus (T2DM) patients attending a diabetic centre in Madinah, Saudi Arabia. A self-prepared dietary knowledge questionnaire (DKQ) was used in this research. The variables include balanced diet, food type, food choice, carbohydrate, protein, and fat. Knowledge score was, and the total score was levelled/categorized into 'good', 'average', and 'poor'. Data were analysed by SPSS v.26. The study results identified the current knowledge of T2DM patients about different dietary items. The knowledge score of 62.2% of participants showed an average level of dietary knowledge, which is statistically significant. When we separately evaluated their understanding of different dietary components, we found that T2DM patients had poor knowledge of carbohydrates (30.15%), fat, food choices (47.7%), and type (34.6%). However, they had acceptable knowledge of proteins (56.5%). Our participants exhibited acceptable knowledge about proteins but poorer knowledge of other food groups. A healthy, well-balanced diet is essential for excellent glycaemic control. Educating and arranging a health education program regarding dietary knowledge is recommended, specially designed for diabetic patients so that patients can opt for a healthier lifestyle.

A review of international trade and investment agreements and nutrition policy space in the Pacific.

Small Island Developing States (SIDS) in the Pacific are heavily reliant on imported foods which are often nutritionally deficient, and typically high in salt, fat, and sugar. To curb nutrition-related non-communicable diseases, nutrition policies are needed to create food environments that promote healthy diets. However, international trade and investment agreements (TIAs) may interfere with the policy space for SIDS to regulate their food environments by requiring member states to meet trade obligations that could conflict with their nutrition policy goals. In this review, we identify real examples of where TIAs have been responsible for changes in Pacific SIDS' nutrition policies alongside the potential for further constraints on healthy nutrition policies from Pacific Island participation in TIAs. In addition, we note the effects of regulatory chill from TIA obligations in Pacific SIDS, whereby healthy nutrition policies are not considered, developed, or implemented due to the threat of trade disputes or the complexity of TIA procedural requirements. Existing literature indicates that TIAs have shaped nutrition policies to fit within the global trade paradigm despite SIDS' nutrition policy imperatives. More can be done locally, regionally, and internationally to increase the importance of nutrition in the trade agenda, leverage regional institutions to champion nutrition regulation and support SIDS in navigating the trade and nutrition policy environment.

Dietary knowledge assessment among the patients with type 2 diabetes in Madinah: A cross-sectional study

Background: There is a huge burden of nutrition-related non-communicable diseases, and diabetes is one of the leading chronic nutrition-related diseases affecting more than 500 million people globally. Collecting information regarding the awareness of dietary and nutrition knowledge among diabetic patients is the first step to developing a disease prevention program. Thus, this study primarily aims at assessing the dietary awareness of diabetes patients attending the diabetic centre in Madinah governorate, Saudi Arabia. Methods: The study was started in November 2020 and ended in October 2021. The study participants (315) were type 2 diabetes mellitus (T2DM) patients attending a diabetic centre in Madinah, Saudi Arabia. A self-prepared dietary knowledge questionnaire (DKQ) was used in this research. The variables include balanced diet, food type, food choice, carbohydrate, protein, and fat. Knowledge score was, and the total score was leveled/categorized into ‘good’, ‘average’, and ‘poor’. Data were analyzed by SPSS v.26. Results: The study results identified the current knowledge of T2DM patients about different dietary items. The knowledge score of 62.2% of participants showed an average level of dietary knowledge, which is statistically significant. When we separately evaluated their understanding of different dietary components, we found that T2DM patients had poor knowledge of carbohydrates (30.15%), fat, food choices (47.7%), and type (34.6%). However, they had acceptable knowledge of proteins (56.5%). Conclusion: Our participants exhibited acceptable knowledge about proteins but poorer knowledge of other food groups. A healthy, well-balanced diet is essential for excellent glycaemic control. It is recommended to educate and arrange a health education program regarding dietary knowledge, specially designed for diabetic patients so that patients can opt for a healthier lifestyle.

Nutrition knowledge and influence on diet in the carer-client relationship in residential care settings for people with intellectual disabilities.

People with intellectual disabilities generally have poorer health outcomes compared with those who do not, including outcomes related to nutrition-related non-communicable diseases. Carers support people with intellectual disabilities in many aspects including habitual shopping and preparation of food, but their own nutrition knowledge and the influence this may have on dietary intakes of clients is unknown. We explored the nutrition knowledge of carers of people with intellectual disabilities in residential care settings, their dietary habits and their influence on clients' food shopping and preparation and therefore the diet consumed by their clients. Ninety-seven carers belonging to a large independent care sector organisation specialising in the care of people with an intellectual disability completed a validated general nutrition knowledge and behaviour questionnaire. Seventeen carers from the residential care settings were interviewed to contextualise practice. Knowledge about key dietary recommendations scored highly. Carers who had more work experience were found to have higher scores in 'making everyday food choices' (p=0.034). Daily consumption of fruit and vegetables (at least one portion per day) was observed (for fruit by 46% of the carers and for vegetables by 60% of the carers), whilst most carers reported avoiding consuming full-fat dairy products, sugary foods and fried foods. The concept of a healthy diet; typical dietary habits of clients; role in food acquisition; and training in nutrition emerged as themes from the interviews. Carers discussed various topics including the importance of a balanced diet, cooking fresh foods and control of food portion sizes for clients relative to the care philosophy of a client-centred approach, which encapsulates client autonomy. Gaps in knowledge around specific nutrients, making healthy choices and cooking skills remain. Carers have an influence on clients' dietary choices; they are able to provide healthy meals and share good dietary habits with clients. Further training in nutrition is recommended for impact on clients' health.

Sustainable and Health-Protecting Food Ingredients from Bioprocessed Food by-Products and Wastes

Dietary inadequacy and nutrition-related non-communicable diseases (N-NCDs) represent two main issues for the whole society, urgently requesting solutions from researchers, policy-makers, and other stakeholders involved in the health and food system. Food by-products and wastes (FBPW) represent a global problem of increasing severity, widely recognized as an important unsustainability hotspot, with high socio-economic and environmental costs. Yet, recycling and up-cycling of FBPW to produce functional foods could represent a solution to dietary inadequacy and risk of N-NCDs onset. Bioprocessing of FBPW with selected microorganisms appears to be a relatively cheap strategy to yield molecules (or rather molecules mixtures) that may be used to fortify/enrich food, as well as to formulate dietary supplements. This review, conjugating human health and sustainability in relation to food, describes the state-of-the-art of the use of yeasts, molds, and lactic acid bacteria for producing value-added compounds from FBPW. Challenges related to FBPW bioprocessing prior to their use in food regard will be also discussed: (i) loss of product functionality upon scale-up of recovery process; (ii) finding logistic solutions to the intrinsic perishability of the majority of FBPW; (iii) inserting up-cycling of FBPW in an appropriate legislative framework; (iv) increasing consumer acceptability of food and dietary supplements derived from FBPW.

Interventions in Small Island Developing States to improve diet, with a focus on the consumption of local, nutritious foods: a systematic review

IntroductionFood security in Small Island Developing States (SIDS) is an international policy priority. SIDS have high rates of nutrition-related non-communicable diseases, including obesity and type 2 diabetes, micronutrient deficiencies and,...

Type, density, and healthiness of food-outlets in a university foodscape: a geographical mapping and characterisation of food resources in a Ghanaian university campus

IntroductionFood environments are viewed as the interface where individuals interact with the wider food system to procure and/or consume food. Institutional food environment characteristics have been associated with health outcomes including obesity and nutrition-related non-communicable diseases (NR-NCDs) in studies from high-income countries. The objectives of this study were (1) to map and characterise the food-outlets within a Ghanaian university campus; and (2) to assess the healthiness of the food outlets.MethodsData collection was undertaken based on geospatial open-source technologies and the collaborative mapping platform OpenStreetMap using a systematic approach involving three phases: remote mapping, ground-truthing, and food-outlet survey. Spatial analyses were performed using Quantum Geographical Information System (QGIS) and comprised kernel density, buffer, and average nearest neighbour analyses to assess outlet distribution, density, and proximity. A classification system was developed to assess the healthiness of food-outlets within the University foodscape.ResultsFood-outlets were unevenly distributed over the University foodscape, with many outlets clustered closer to student residencies. Informal food-outlets were the most frequent food-outlet type. Compared to NCD-healthy food-outlets, NCD-unhealthy food-outlets dominated the foodscape (50.7% vs 39.9%) with 9.4% being NCD-intermediate, suggesting a less-healthy university foodscape. More NCD-unhealthy food outlets than NCD-healthy food outlets clustered around student residences. This difference was statistically significant for food outlets within a 100-m buffer (p < 0.001) of student residence and those within 100 and 500 m from departmental buildings/lecture halls (at 5% level of significance).ConclusionFurther action, including research to ascertain how the features of the University’s food environment have or are influencing students’ dietary behaviours are needed to inform interventions aimed at creating healthier foodscapes in the study University and other campuses and to lead the way towards the creation of healthy food environments at the home, work, and community levels.

How healthy and food secure is the urban food environment in Ghana?

The importance of the food environment in influencing dietary choices of consumers has been widely acknowledged, but little attention has been paid to the urban food environment in Africa despite the rise in incidence of obesity and other nutrition-related noncommunicable diseases (NR-NCDs). We contribute to the literature on urban food environments by conducting an observational macro-scan of the food environment in three cities – Accra, Cape Coast, and Koforidua – with a view to unravelling the nature of the urban food environment in Ghana. We examine the food environment based on two dimensions of food security – availability and accessibility (affordability) – and also assess the extent to which foods are processed. The results show that all four food categories – unprocessed, processed, processed culinary, and ultra-processed – are available, accessible, and affordable. Ultra-processed foods are just as highly available, accessible, and/or affordable as unprocessed foods. The results also show that processed foods account for the larger share of all foods in Ghana’s urban food environment, and ultra-processed foods account for more than 30% of all processed foods. Overall, these results suggest that physical and economic access to food are not major constraints in urban Ghana. This is certainly a welcome finding from a food policy perspective; however, the high availability and accessibility of ultra-processed foods has serious potential health implications. Regulation will be needed to prevent overconsumption of ultra-processed foods and the resulting increase in obesity and other NR-NCDs.

The 2018 Revision of Italian Dietary Guidelines: Development Process, Novelties, Main Recommendations, and Policy Implications.

The fourth edition of the Italian Dietary Guidelines (IDGs) for Healthy Eating was published in 2019. The objective of this paper is to describe the developmental process of IDGs, the main recommendations, the differences with previous revisions, and the concordance and differences with international guidance on a healthy diet. A National Commission oversaw IDG development. A Scientific Dossier (SD), including analysis on nutrition, health, and risk factors status in Italy, was the reference for IDGs preparation. The IDGs are based on the principles of the Mediterranean Diet and are mainly aimed to prevent obesity and nutrition-related non-communicable diseases. The IDGs included 13 directives that were divided into four conceptual blocks: i) how to balance weight; ii) foods to be promoted; iii) foods to be limited; and iv) how to ensure a varied and sustainable diet. Each directive has a box summarizing the key recommendation, myths lists, and false beliefs to be dispelled. The topics of sustainability and the correct approach to food supplementation and weight-loss diet were introduced in the present edition of IDGs. This paper contributes to the debate on the complexity of derivation of Dietary Guidelines and their adaptation to the national context.

A Novel Method to Improve Quality of Drinking Water, Based on the Eye’s Biology

Water represents a critical nutrient, the absence of which will be lethal within days. Water’s importance for the prevention of nutrition-related noncommunicable diseases has received more attention recently. There are major gaps in knowledge related to the measurement of total fluid intake and hydration status at the population level. It is poorly understood the effects of chronic mild dehydration and fluid consumption on specific health outcomes including obesity. Urolithiasis is the only disorder that has been consistently associated with chronic low daily water intake. Water is an essential nutrient required for life, but until now, it was considered mainly as a universal solvent, which served to prepare the broth of life inside the cells, but the function of water now takes unusual importance with our discovery of the unsuspected ability of the human body to transform the power of light into chemical energy by dissociating the molecule from water, as it happens in plants. The process that we replicated in the laboratory for the first time in 2007, represents a light at the end of the tunnel, in the growing and serious problem of contamination of the mysterious and vital liquid that we call water.

Nutrition and Food Security in Bangladesh: Achievements, Challenges, and Impact of the COVID-19 Pandemic.

BackgroundBangladesh has experienced remarkable transformation in demographic, health, and nutritional status of the population. The changes have exposed the population to a number of challenges, the detrimental effect of which on health and nutrition is likely to be increased by the coronavirus disease 2019 (COVID-19) pandemic. We provide an overview of health and nutritional challenges in Bangladesh in relation to demographic transition and the COVID-19 pandemic.MethodsWe identified and reviewed recent reports, published articles, and pertinent gray literature on nutrition and food security in Bangladesh to provide historical and contextual information.ResultsThe review identifies the progress as well as existing burden regarding nutrition and food security in Bangladesh and highlights the challenges in the coming days in regard to population growth and the COVID-19 pandemic. The country is on track to reduce all forms of childhood undernutrition, while the proportion of nutrition-related noncommunicable diseases is rising owing to changes in dietary intake, low physical activity, and sedentary lifestyle.ConclusionsDespite remarkable progress, health and nutritional status of the population in Bangladesh faces challenges, particularly in relation to demographic transition and compounded by the COVID-19 pandemic, which require concerted attention from policymakers as well as stakeholders.

The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable.

SummaryThe Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high‐income and many low‐ and middle‐income countries are in a stage of the transition where nutrition‐related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low‐ and middle‐income countries face rapid growth in consumption of ultra‐processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high‐income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra‐processed food intake and increasing prevalence of nutrition‐related noncommunicable diseases.

Providing Measurement, Evaluation, Accountability, and Leadership Support (MEALS) for Non-communicable Diseases Prevention in Ghana: Project Implementation Protocol.

Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support public sector actions that create healthy food marketing, retail, and provisioning environments for Ghanaian children using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS).Methods: The protocol for this observational study draws substantially from the INFORMAS' Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve food environments of Ghanaian children, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the community readiness model (CRM) into the INFORMAS approaches. The setting is Ghana, and the participants include health and nutrition policy-makers, nutrition and food service providers, consumers, school authorities, and pupils of Ghanaian basic schools.Results: The study establishes a standardized approach to providing implementation science evidence for the prevention of non-communicable diseases (NCDs) in Ghana. It demonstrates feasibility and the innovative application of the INFORMAS expanded food promotion and food provision modules, together with the integration of the CRM in a lower-middle income setting.Conclusion: The research will facilitate the understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle income African context. The protocol could be adapted for similar country settings to monitor relevant aspects of food environments of children.

The WHO South-East Asia Region Nutrient Profile Model Is Quite Appropriate for India: An Exploration of 31,516 Food Products.

The rapid rise in prevalence of overweight/obesity, as well as high prevalence of type 2 diabetes and other nutrition-related noncommunicable diseases, has led the Food Safety and Standards Authority of India (FSSAI) to propose a front-of-package labeling (FOPL) regulation. An effective FOPL system applies a nutrient profile model that identifies foods high in sugar, sodium, and saturated fat that would receive a warning label for consumers to effectively discern between more and less healthy foods. Previous Nutrition Alchemy data collected by the food industry (n = 1306 products) estimated that approximately 96% of foods in India would have at least one warning label based on the FSSAI proposed FOPL. This near universal coverage of warning labels may be inaccurate and misleading. To address this, the current study compared two nutrient profile models, the WHO South-East Asia Region Organization (SEARO) and the Chilean Warning Octagon (CWO) Phase 3, applied to food products available in the Indian market from 2015–2020, collected through Mintel Global New Products Database (n = 10,501 products). Results suggest that 68% of foods and beverages would have at least one ‘ high-in’ level warning label. This study highlights the need to include a more comprehensive sample of food products for assessing the value of warning labels.

The Role of Stakeholder Framing in Nutrition Agenda-Setting to Address the Double Burden of Malnutrition in Tamil Nadu, India

ObjectivesAddressing the double burden of malnutrition in many low- and middle-income countries through double duty strategies requires understanding of how stakeholder framing influences nutrition agenda-setting at the subnational level where policies are translated to address local context. We aimed to identify differences in frames of undernutrition and nutrition-related non-communicable diseases (NCDs) in Tamil Nadu, India and to show how the frames reflect stakeholder intention and action regarding nutrition actions. MethodsTamil Nadu is experiencing chronic undernutrition and increasing NCDs and has a history of commitment to addressing undernutrition. We conducted in-depth interviews with stakeholders from nutrition-sensitive disciplines using semi-structured questionnaires (n = 28). Stakeholder responses and established policy process frameworks guided interview coding and thematic analysis. ResultsThe frames of undernutrition and NCDs comprised five domains: problem identification, risk factors, target populations, roles for stakeholders, and policy and program response. To address undernutrition, stakeholders consistently identified problems, risk factors, and target populations. Roles and responsibilities for stakeholders were defined, resulting in multisectoral strategies. For NCDs, stakeholders inconsistently identified the same domains, resulting in lack of convergence and bottlenecks to implementing double duty actions. ConclusionsNutrition-related NCDs have not reached a critical level of priority and coherence among state-level stakeholders regarding problem identification, risk factors, target populations, responsibility, and solutions, preventing political commitment to addressing them through inclusion in the policy agenda, dedicated resources, and convergence of multisectoral efforts. Development and implementation of multisectoral double duty strategies likely to be effective at the subnational level will require stakeholders to address three challenges in agenda-setting: adequate priority given to the problem, coherence of the policy community, and convergence of actions by multisectoral stakeholders. Funding SourcesThe Bill & Melinda Gates Foundation through POSHAN, led by the International Food Policy Research Institute.

Policy Action Within Urban African Food Systems to Promote Healthy Food Consumption: A Realist Synthesis in Ghana and Kenya.

Background: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanisation and changing food environments. Policy action has been limited - and influenced by high income countries. Socio-economic/political environments of African food systems must be considered in order to understand what policy might work to prevent NR-NCDs, for whom, and under what circumstances. Methods: A realist synthesis of five policy areas to support healthier food consumption in urban Africa: regulating trade/foreign investment; regulating health/nutrition claims/labels; setting composition standards for processed foods; restricting unhealthy food marketing; and school food policy. We drew upon Ghana and Kenya to contextualise the evidence base. Programme theories were generated by stakeholders in Ghana/Kenya. A two-stage search interrogated MEDLINE, Web of Science and Scopus. Programme theories were tested and refined to produce a synthesised model. Results: The five policies operate through complex, inter-connected pathways moderated by global-, national- and local contexts. Consumers and the food environment interact to enable/disable food accessibility, affordability and availability. Consumer relationships with each other and retailers are important contextual influences, along with political/ economic interests, stakeholder alliances and globalized trade. Coherent laws/regulatory frameworks and government capacities are fundamental across all policies. The increasing importance of convenience is shaped by demographic and sociocultural drivers. Awareness of healthy diets mediates food consumption through comprehension, education, literacy and beliefs. Contextualised data (especially food composition data) and inter-sectoral collaboration are critical to policy implementation. Conclusion: Evidence indicates that coherent action across the five policy areas could positively influence the healthiness of food environments and consumption in urban Africa. However, drivers of (un)healthy food environments and consumption reflect the complex interplay of socio-economic and political drivers acting at diverse geographical levels. Stakeholders at local, national, and global levels have important, yet differing, roles to play in ensuring healthy food environments and consumption in urban Africa.