Socio-Economic Variables and Nutrient Adequacy of Women in the Vaal Region of South Africa

The aim of this cross-sectional, observational baseline survey was to examine the association between nutrient intakes and selected socio-economic variables in 722 women, aged 19 to 90 years living in peri-urban settlements. Measurements included socio-demographic data and 24-hour recall dietary intake data. The results showed poor nutrient intakes with the Estimated Average Requirement (EAR) not met for the mean intakes of all nutrients except carbohydrates, phosphorus, and vitamin B12. The inadequate energy intakes were significantly higher among the women who had lower education (p = .015), lower income (p = .028), and were unemployed (p = .015). The epidemiological value of the study findings is in the contribution to the rationale of appropriate interventions such as income-generating projects as well as household agricultural projects to improve food and nutrient intakes.     

Higher Dietary Energy Density is Associated with Stunting but not Overweight and Obesity in a Sample of Urban Malaysian Children

Although diets with high energy density are associated with increased risk of overweight and obesity, it is not known whether such diets are associated with undernutrition. This study assessed the relationship between dietary energy density (ED) and nutritional status of 745 urban 1- to 10-year-old children. Dietary intakes were obtained using food recall and record for two days. Dietary energy density was based on food and caloric beverages. Higher dietary ED was associated with lower intakes of carbohydrate, sugar, vitamins C and D, and calcium but higher fat, fiber, iron, and folate intakes. While intakes of fruits and milk/dairy products decreased, meat, fish, and legume intakes increased with higher dietary ED. Stunting, but not other growth problems, was associated with higher dietary ED. Future studies should confirm the cause-and-effect relationship between higher dietary ED and stunting.     

Sex Differences in the Associations of Nutrient Patterns with Total and Regional Adiposity: A Study of Middle-Aged Black South African Men and Women

The study evaluated the association between nutrient patterns with body fat and regional adiposity in middle-aged black South African (SA) men and women and determined if this differed by sex. Body fat and regional adiposity (dual-energy x-ray absorptiometry), and dietary intake (7-day quantified food frequency questionnaire) were measured in black SA men (n = 414) and women (n = 346). Using principal component analysis, nutrient patterns were computed from 25 nutrients in the combined sample. Four nutrient patterns were extracted, explaining 67% of the variance in nutrient intake. Animal and fat, as well as the vitamin C, sugar, and potassium driven patterns, were positively associated with total adiposity. In contrast, the retinol and vitamin B12 pattern was associated with the centralisation of fat. Notably, the strength of the association between the animal-driven nutrient pattern and BMI was greater in men (1.14 kg/m², 95% CI (0.63–1.66)) than in women (0.81 kg/m², 95% CI (0.25–1.36)) (P_int = 0.017). In contrast, the plant-driven pattern was associated with higher abdominal subcutaneous adipose tissue (SAT) in women (44 cm², 95% CI (22–67)) but not men (P_int = 1.54 × 10⁻⁴). These differences suggest that although men and women have similar nutrient patterns, their associations with the whole body and regional body fat are different.     

Dietary Patterns as Characterized by Food Processing Levels and Their Association with the Health Outcomes of Rural Women in East Africa

Overweight and obesity are rapidly rising in Sub-Saharan Africa including in rural areas. However, most studies focus on urban centers, and have attributed this epidemic to the consumption of processed foods without their clear characterization. This study investigated food intake patterns defined by food processing levels and their association with overweight/obesity in rural areas. Four 24-h dietary recalls, anthropometric measurements, and socio-demographic characteristics were collected from 1152 women in Kenya, Tanzania, and Uganda. The PCA method was used to extract patterns characterized by food processing levels. The association between patterns and overweight/obesity was ascertained with regression models. The overweight/obesity rate was 47%, 42%, 26%, and 38% in Kenya, Tanzania, Uganda, and East Africa (as pooled data), respectively. Several patterns were identified, yet a “plant-based pattern” largely characterized by unprocessed and minimally processed foods and a “purchase pattern” mainly distinguished by highly processed foods were dominant. The “plant-based pattern” was inversely or not associated with overweight/obesity, while the “purchase pattern” had a positive association or no association. A clear distinction on processed foods as healthy and unhealthy should be made based on their nutrient provision to avoid their mischaracterization as unhealthy. Policies to reverse consumption of unhealthy processed foods while promoting healthy ones should be pursued.     

Effects of Sedentary Lifestyle and Dietary Habits on Body Mass Index Change among Adult Women in India: Findings from a Follow-Up Study

We examined the effects of sedentary lifestyle and dietary habits on body mass index (BMI) change in a follow-up study of 325 women (aged 15–49 years) in Delhi, systematically selected from the 1998–1999 National Family Health Survey samples who were re-interviewed after 4 years in 2003. Information was collected on height, weight, dietary habits, and sedentary lifestyle through face-to-face interviews. Overall, a 2.0-point increase in mean BMI was found among women in just 4 years. Every second normal-BMI woman, two in five overweight women, and every fourth obese woman experienced a > 2.0-point increase in her mean BMI. High sedentary lifestyle (OR: 2.63; 95% CI: 1.29–5.35) emerged as the main predictor of a > 2.0-point increase in mean BMI in adjusted analysis, but there was weak evidence of association with the dietary covariates. Our findings suggest that a high sedentary lifestyle is a determinant of weight gain among adult women in urban India.     

Real-World Data of a Group-Based Formula Low Energy Diet Programme in Achieving Type 2 Diabetes Remission and Weight Loss in an Ethnically Diverse Population in the UK: A Service Evaluation

(1) Background: Formula low energy diets (LED) are effective at inducing weight loss and type 2 diabetes (T2DM) remission. However, the effect of LED programmes in ethnic minority groups in the UK is unknown. (2) Methods: A service-evaluation was undertaken of a group-based LED, total diet replacement (TDR) programme in London, UK. The programme included: a 12-week TDR phase, 9-week food reintroduction and a 31-week weight maintenance phase and was delivered by a diabetes multi-disciplinary team. (3) Results: Between November 2018 and March 2020, 216 individuals were referred, 37 commenced the programme, with 29 completing (78%). The majority were of Black British (20%) ethnicity with a mean (SD) age of 50.4 (10.5) years, a body mass index of 34.4 (4.4) kg/m² and a T2DM duration of 4.2 (3.6) years. At 12 months, 65.7% achieved T2DM remission, with a mean bodyweight loss of 11.6 (8.9) kg. Completers lost 15.8 (5.3) kg, with 31.4% of participants achieving ≥15 kg weight loss. Quality of life measures showed significant improvements. (4) Conclusions: This service evaluation shows for the first time in the UK that a group-based formula LED programme can be effective in achieving T2DM remission and weight loss in an ethnical diverse population.     

An Evaluation of Probability of Adequate Nutrient Intake (PANDiet) Scores as a Diet Quality Metric in Irish National Food Consumption Data

Identifying reliable metrics which measure the quality of a diet to promote nutrient adequacy and long-term health is an important step in the development of a sustainable food system. The Probability of Adequate Nutrient Intake (PANDiet) scoring system has been used as a measure of dietary quality in interdisciplinary research in recent years. The aim of the current study is to apply the PANDiet scoring system, and to assess the validity of the score as a metric of nutritional adequacy, within the Irish population. The Irish National Adult Nutrition Survey is a representative database with detailed data on nutrient intakes (18–90 years; n = 1051 valid-reporters; 2008–2010) and biofluid analytes (blood n = 786; urine n = 778). The PANDiet scoring system was expanded to include seven macronutrients, twelve micronutrients, nine minerals, and total energy using an established methodology. PANDiet scores were assessed against the Alternate Healthy Eating Index (AHEI) and Alternate Mediterranean Diet (aMED) food-based scores. The average score for the population (μ) was 63.69 ± 0.23 and ranged from 38.27 to 89.74. Higher PANDiet scores were significantly associated with males, higher educated participants, non-smokers, and low-energy-dense diets (p < 0.001). Females between the ages of 18 and 35 had a significantly lower nutrient adequacy score (μ 59.17). PANDiet scores were significantly correlated with serum folate, riboflavin status, serum vitamin D (p < 0.05) and with AHEI and aMED scores (R_s 0.45 and 0.43, p < 0.0001). The nutritional contribution of food groups varied between genders and low, moderate, and high nutritional adequacy groups. The PANDiet scoring system facilitated a detailed analysis of nutritional adequacy across sub-groups of the population, and is a comprehensive and valid diet quality metric in Irish databases.     

Comparison of a Full Food-Frequency Questionnaire with the Three-Day Unweighted Food Records in Young Polish Adult Women: Implications for Dietary Assessment

The food frequency questionnaire (FFQ) and the food record (FR) are among the most common methods used in dietary research. It is important to know that is it possible to use both methods simultaneously in dietary assessment and prepare a single, comprehensive interpretation. The aim of this study was to compare the energy and nutritional value of diets, determined by the FFQ and by the three-day food records of young women. The study involved 84 female students aged 21–26 years (mean of 22.2 ± 0.8 years). Completing the FFQ was preceded by obtaining unweighted food records covering three consecutive days. Energy and nutritional value of diets was assessed for both methods (FFQ-crude, FR-crude). Data obtained for FFQ-crude were adjusted with beta-coefficient equaling 0.5915 (FFQ-adjusted) and regression analysis (FFQ-regressive). The FFQ-adjusted was calculated as FR-crude/FFQ-crude ratio of mean daily energy intake. FFQ-regressive was calculated for energy and each nutrient separately using regression equation, including FFQ-crude and FR-crude as covariates. For FR-crude and FFQ-crude the energy value of diets was standardized to 2000 kcal (FR-standardized, FFQ-standardized). Methods of statistical comparison included a dependent samples t-test, a chi-square test, and the Bland-Altman method. The mean energy intake in FFQ-crude was significantly higher than FR-crude (2740.5 kcal vs. 1621.0 kcal, respectively). For FR-standardized and FFQ-standardized, significance differences were found in the mean intake of 18 out of 31 nutrients, for FR-crude and FFQ-adjusted in 13 out of 31 nutrients and FR-crude and FFQ-regressive in 11 out of 31 nutrients. The Bland-Altman method showed an overestimation of energy and nutrient intake by FFQ-crude in comparison to FR-crude, e.g., total protein was overestimated by 34.7 g/day (95% Confidence Interval, CI: −29.6, 99.0 g/day) and fat by 48.6 g/day (95% CI: −36.4, 133.6 g/day). After regressive transformation of FFQ, the absolute difference between FFQ-regressive and FR-crude equaled 0.0 g/day and 95% CI were much better (e.g., for total protein 95% CI: −32.7, 32.7 g/day, for fat 95% CI: −49.6, 49.6 g/day). In conclusion, differences in nutritional value of diets resulted from overestimating energy intake by the FFQ in comparison to the three-day unweighted food records. Adjustment of energy and nutrient intake applied for the FFQ using various methods, particularly regression equations, significantly improved the agreement between results obtained by both methods and dietary assessment. To obtain the most accurate results in future studies using this FFQ, energy and nutrient intake should be adjusted by the regression equations presented in this paper.     

The Impact of the Universal Infant Free School Meal Policy on Dietary Quality in English and Scottish Primary School Children: Evaluation of a Natural Experiment

The Universal Infant Free School Meal (UIFSM) policy was introduced in September 2014 in England and January 2015 in Scotland and offered all infant schoolchildren (ages 4–7 years) a free school lunch, regardless of income. Yet, impacts of UIFSM on dietary intakes or social inequalities are not known. A difference-in-differences study using the National Diet and Nutrition Survey assessed pooled pre-UIFSM (2010–2014) and post-UIFSM (2014–2017) dietary data. English or Scottish infant schoolchildren (4–7 years; n = 458) were the intervention group, with junior schoolchildren (8–11 years; n = 401) as controls. We found that implementation of UIFSM led to an increase in infant schoolchildren having a school meal. Impacts on key food groups such as fruit and vegetables or sweetened beverages were not seen. However, there was evidence that the UIFSM policy lowered consumption of foods associated with packed lunches, such as crisps, and some nutrients, such as total fat and sodium. Policy impacts differed by income group, with larger effect sizes in low-income children. In conclusion, evaluation of UIFSM demonstrated some improvements in dietary quality but the findings suggest school meal quality needs to be improved to fully realise the benefits of UIFSM.     

"There is such a thing as too many daughters, but not too many sons": A qualitative study of son preference and fetal sex selection among Indian immigrants in the United States

In response to concerns from feminists, demographers, bioethicists, journalists, and health care professionals, the Indian government passed legislation in 1994 and 2003 prohibiting the use of sex selection technology and sex-selective abortion. In contrast, South Asian families immigrating to the United States find themselves in an environment where reproductive choice is protected by law and technologies enabling sex selection are readily available. Yet there has been little research exploring immigrant Indian women's narratives about the pressure they face to have sons, the process of deciding to utilize sex selection technologies, and the physical and emotional health implications of both son preference and sex selection. We undertook semi-structured, in-depth interviews with 65 immigrant Indian women in the United States who had pursued fetal sex selection on the East and West coasts of the United States between September 2004 and December 2009. Women spoke of son preference and sex selection as separate though intimately related phenomena, and the major themes that arose during interviews included the sociocultural roots of son preference; women's early socialization around the importance of sons; the different forms of pressure to have sons that women experienced from female in-laws and husbands; the spectrum of verbal and physical abuse that women faced when they did not have male children and/or when they found out they were carrying a female fetus; and the ambivalence with which women regarded their own experience of reproductive "choice." We found that 40% of the women interviewed had terminated prior pregnancies with female fetuses and that 89% of women carrying female fetuses in their current pregnancy pursued an abortion. These narratives highlight the interaction between medical technology and the perpetuation of this specific form of violence against women in an immigrant context where women are both the assumed beneficiaries of reproductive choice while remaining highly vulnerable to family violence and reproductive coercion.