Nutrition and Health

Background: In Germany, the nutritional situation of adults and children living in households at risk of poverty has been insufficiently studied so far. Aim: The aim of the mixed-methods study MEGA_kids is to gain a deeper understanding of the nutritional situation including socioeconomic, behavioral, and attitudinal factors and health characteristics among persons living in families at risk of poverty. Method: MEGA_kids is a mixed-methods cross-sectional study consisting of four modules combining quantitative and qualitative methods. The first module (A) applies self-administered questionnaires to assess the individual's diet, household food insecurity, and several other factors among adults and children of 500 households. Cash receipts are used to assess household's food expenses. For the second module (B), a semistructured interview guide is used to identify factors influencing food security and nutritional quality from the perspective of a subsample of module A (n = 20). The third module (C) applies the participatory World Café technique to explore experiences and generate ideas for tailored support measures for a healthy diet from the perspective of 40 parents participating in module A. Finally, the fourth module (D) investigates the knowledge and usage of existing nutrition-related preventive measures among 200 parents at risk of poverty by using an online questionnaire. Conclusion: By providing a comprehensive picture of nutritional aspects of families living at risk of poverty, MEGA_kids will guide officials to target and prioritize public health nutrition measures, inform policy makers to implement and improve healthy policies and, finally, identify research gaps to be prioritized.

Foods contain substances impacting the acid-base balance. The Western diet is often viewed as being overly acid due to its high-level of animal-based protein and low-level of vegetable intake. Meanwhile, with ageing the ability to excrete acid compounds is reduced as kidney function declines and so there is a risk of acid retention and subsequent interstitial acidosis. Two systems used for calculating the Dietary Acid Load (DAL): the potential acid load of foods (PRAL) and the net endogenous acid production (NEAP). This report outlines weaknesses in these formulas and concludes that dietitians and nutritionists lack the necessary tools to research the acid-base hypothesis. Additionally, the report emphasizes the importance of food selection in the ageing population. Background: Foods contain substances impacting the acid-base balance. The Western diet is often viewed as being overly acid due to its high-level of animal-based protein and low-level of vegetable intake. There are concerns that the disproportionate acid intake promotes low-grade metabolic acidosis in the interstitial fluid, interstitial acidosis, and may lead to chronic disease. Two formulas are used for calculating the DAL: the PRAL and the NEAP. Both PRAL and NEAP are based on levels of protein and minerals. Aim: To identify additional food constituents that impact DAL. Methods: Review of the literature concerning the acid-forming and alkaline-forming constituents of foods. Results: Five additional food constituents were identified as potentially having a meaningful impact on DAL. The oxidation of taurine and the metabolism of fructose and purines increase acidity, whereas organic acids increase alkalinity. Additionally, polyphenols affect the microbiota which break down uric acid excreted in the intestinal tract. Conclusions: Neither PRAL nor NEAP provides complete assessments of the impact of foods on DAL. These formulas could be improved by the inclusion of dietary amino acids rather than protein, taurine, purines, fructose, organic acids and polyphenols. Currently, dietitians and nutritionists lack the necessary tools both to research the acid-base hypothesis and recommend managed diets. Managed diets are of particular importance for the elderly because of their reduced kidney function which increases the risk of acid retention and subsequent interstitial acidosis.

Background: Energy expenditure may be difficult to assess when hiking difficult trails. Case presentation: We measured physical activity exercise energy expenditure (PAEE) directly from oxygen uptake using a mobile device (cardiopulmonary exercise testing, CPET), and by using a formula based on heart rate (HR), or metabolic equivalent values from the Compendium of Physical Activity, and other physiological outcomes. Outcomes and implications: Total PAEE (1342 kcal) using CPET showed a two-fold difference between ascending and descending (887 vs. 455 kcal) during a 124-min hike. For HR, PAEE was 1893kcal (+551 kcal overreporting), while compendium-based scenarios ranged from 1179 to 1446 kcal, which was in closer range (−163 to +104 kcal/min) compared to the CPET data. Fluid consumption was 1300 mL/hour, with 1.1% bodyweight loss, peak skin temperature of 35.2°C and core body temperature of 39.2°C. Recommendations: Tables reasonably predict energy expenditure while not precisely reflecting the actual situation.

Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration (_UD; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or _UD is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake—a simple and cost-effective dietary modification.

Background: Community-based nutrition interventions have been established as the standard of care for identifying and treating acute malnutrition among children 6–59 months in low- and lower-middle-income countries. However, limited research has examined the factors that influence the implementation of the community-based component of interventions that address severe acute malnutrition and moderate acute malnutrition among children. Aim: The objective of this review was to identify and describe the facilitators and barriers in implementing complex community-based nutrition interventions to address acute malnutrition among children in low- and lower-middle-income countries. Methods: This review used a systematic search strategy to identify existing peer-reviewed literature from three databases on complex community-based interventions (defined as including active surveillance, treatment, and education in community settings) to address severe acute malnutrition and moderate acute malnutrition in children. Results: In total, 1771 sources were retrieved from peer-reviewed databases, with 38 sources included in the review, covering 26 different interventions. Through an iterative deductive and inductive analysis approach, three main domains (household and interpersonal, sociocultural and geographical; operational and administrative) and eight mechanisms were classified, which were central to the successful implementation of complex community-based interventions to address acute child malnutrition. Conclusion: Overall, this review highlights the importance of addressing contextual and geographical challenges to support participant access and program operations. There is a need to critically examine program design and structure to promote intervention adherence and effectiveness. In addition, there is an opportunity to direct resources towards community health workers to facilitate long-term community trust and engagement.

Background: The imminent increase in overweight and obesity prevalence constitutes a pervasive concern for the adult and pediatric Colombian population. Nonetheless, the unequal distribution across distinct social groups limits the implementation of public health policies targeting these escalating rates. Aim: This study aimed to compile existing evidence regarding the prevalence of overweight and obesity in relation to the socioeconomic status (SES) of the Colombian population. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews parameters in MEDLINE (PubMed), EMBASE, and LILACS databases for inclusion of investigations published up to January 2024. Results: Twenty-two cross-sectional studies were included. A higher prevalence of overweight and obesity was documented in adults with lower SES defined by social stratum and monetary income, while in particular for nonpregnant adult women, the prevalence of excess weight was higher in the medium-low socioeconomic stratum. In the pediatric population, higher SES defined by social stratum was directly related to an increased prevalence and risk of overweight and obesity. The ownership of household assets, however, was positively related to the risk of overweight in both adult and pediatric populations. Conclusion: The findings of this investigation disclose a socioeconomic gradient in overweight and obesity in Colombia that resembles the epidemiological distribution in high-income countries for adults, though similar to low-income countries for the pediatric population. Further intersectoral interventions aimed at the most vulnerable groups are imperative to mitigate the inequalities that condition their predisposition to overweight and obesity.

Purpose - Political globalization is a crucial and distinct component of strengthening global organizations. Obesity is a global epidemic in a few nations, and it is on the verge of becoming a pandemic that would bring plenty of diseases. This research aims to see how the political globalization index affects worldwide human obesity concerning global human development levels. Methods- To assess any cross-sectional dependence among observed 109 nations, the yearly period from 1990 to 2017 is analyzed using second generation panel data methods. KAO panel cointegration test and Fully Modified Least Square model were used to meet our objectives. Finding- Low level of political globalization tends to increase global human obesity because countries cannot sway international decisions and resources towards them. While the high level of political globalization tends to reduce obesity because it can control and amends international decisions. For the regression model, a fully modified Least Square model was utilized. The study observed that the R squared values for all models are healthy, with a minimum of 87 percent variables explaining differences in global obesity at the country level. Originality: There is very important to tackle the globalization issue to reduce global human obesity. With the simplicity of dietary options and the amount of physical labour they undergo in their agricultural duties, an increase in rural population percentage tends to lower the average national obesity value.

Background: Although Calorie Restriction (CR) is primarily considered in obesity management, behavioral studies of CR and its methodology of implementation are not well-defined. Objective: The study aimed to determine the efficacy of the extensively researched method of CR—abrupt calorie restriction (ACR) and a newly proposed gradual calorie restriction (GCR) in terms of body weight, behavioral and biochemical parameters in the obese animal model—C57BL/6J mice. Design: Male obese mice were subjected to GCR regimen for 14 weeks which was compared and evaluated for anxiety-like behavior and stress levels with ACR. Plasma corticosterone was measured before initiation of CR and every three weeks following GCR and ACR, whereas plasma insulin was measured twice—after obesity induction and post 14 weeks of CR. The behavioral assessments were conducted before inducing CR and every three weeks following ACR and GCR. Results: A significant anxiety-like behavior and an increase in plasma corticosterone were observed in mice on GCR during the critical initial six weeks of CR (p < 0.05). Both groups showed a decrease in plasma glucose levels; however, the GCR group showed a significant reduction (p < 0.01). There was a significant decrease in social interaction in both groups with an increase in the latency period and a decrease in time spent with the stranger animal during the social interaction test (p < 0.05). Conclusion: The mice on GCR regimen demonstrated lesser anxiety-like behavior and low plasma corticosterone levels compared to those on ACR. This gives us a new avenue in CR research to evaluate the methodologies of implementing CR.

Background: Under nutrition has been a major problem in developing countries including Tanzania; hence, contributing to about half of the deaths among young children. Objective: The current study aimed at identifying child feeding practices and determinants of stunting in children under the age of five years in Mvomero District. Methods: A cross-sectional study involving 150 mother-child pairs was carried out in Turiani ward, Mvomero district in Morogoro region. Bivariate and multivariate logistic regression models were used to identify factors associated with stunting. A p-value ≤ 0.05 was considered sta­tistically significant. Five focus group discussions comprising 5–9 mothers with children below five years participated in the study. Thematic analysis was used to analyse data from the in-depth interviews. Results: The prevalence of underweight, stunting and wasting in Mvomero district was 16.8, 42.2, and 6.2% respectively. Pre-lacteal feeding was common in the study area (40%). Children were introduced to complementary food too early (<6 months) with plain maize porridge being the first food introduced. About 57.2% of children were on the lowest tercile (≤3 food groups per day) dietary diversity score. Significant determinants of stunting were the family source of income (AOR 1.63, 95% CI: 1.99–2.3), age of a child (AOR 2.66, 95% CI: 1.03–3.50) and family size (AOR 3.22, 95% CI: 1.61–4.27). Other factors were consumption of animal foods (AOR 5.30, 95% CI: 0.26–0.60) and dietary diversity score (AOR 1.615, 95% CI: 1.014–2.574). Conclusion: Child feeding practices in the study area are sub-optimal. These findings have important implications for interventions to address stunting among children.

Purpose: Recent studies in economics showed that humans are bounded rational. This being consumers, they are not perfect judges of what matters for the standard of living. While with a marked increase in economic and social wellbeing, there is a consistent rise in obesity levels, especially in the developed world. Thus, this study intends to explore the empirical and socio-economic antecedents of human obesity across countries using six global indexes. Methods: This study used the data of 40 countries between 1975 to 2018 and used the Panel FGLS Regression with the quadratic specification. Findings: The results showed that health and food indicators increase global human obesity, environment and education indicators decrease global human obesity, and economic and social indicators follow an inverted U-shaped pattern in affecting global human obesity. Originality: Previous studies have used infant mortality and life expectancy as the major health indicator in determining the standard of living while overlooking global human obesity as a major deterrent to welfare. This study has provided a holistic assessment of the causes of obesity in global contexts.

Background & Aims: University students are prone to changes in their health status and lifestyle due to changes in their living environment and associated stress and anxiety. These changes may affect them in later life. This study utilized a cross-sectional study among Japanese female university students to examine dietary factors affecting their fecal microbiota. Methods: Sixty-eight healthy female university students were evaluated using an eating behavior assessment and diet history questionnaire. The 12-component Japanese diet index (JDI-12) was then calculated. A quantitative real-time PCR method was used to analyze the predominant bacterial species in the gut, and the Firmicutes/Bacteroidetes ratio (F/B ratio) at the phylum level was calculated. The partial correlation between the fecal microbiota and eating behavior abnormality score was assessed, and dietary habits associated with the F/B ratio were analyzed. Results: A significant correlation was identified between F/B ratios and the eating behavior abnormality score (r = 0.26, FDR = 0.064). Additionally, multiple regression analysis identified a negative correlation trend between the F/B ratio and JDI-12 score (β = −0.22; p = 0.091), and exploratory analysis found a negative association between the F/B ratio and consumption of beef and pork, one of the less beneficial JDI-12 components (β = −0.33, FDR = 0.120). Conclusion: In healthy female university students, there was a positive correlation between eating behavior abnormality and the F/B ratio, indicating that adherence to the Japanese diet pattern may be associated with a lower F/B ratio.

Background: As nutritional needs increase in adolescence, dairy consumption can play a key role in health and disease prevention; however, unfortunately, inadequate consumption of milk and dairy products has often been reported in adolescents. Aim: The purpose of this study was to investigate the relation between decisional balance, self-efficacy, and the processes of change with the stages of change for dairy consumption in female high school students in Shaft county located in the west of Gilan Province, Iran. Methods: A total of 385 female high school students in Shaft County were studied through the census method in 2019. The data collection instrument was a valid and reliable questionnaire consisting of demographic information, stages of change and items of transtheoretical model constructs including the processes of change (cognitive process: consciousness-raising, dramatic relief, self-reevaluation, environmental reevaluation, and social liberation; behavioral process: self-liberation, counter conditioning, reinforcement management, stimulus control and helping relationships), decisional balance and self-efficacy. Data were analyzed using SPSS 21 software. Results: A total of 208 (54%), 53 (13.8%), 56 (14.5%), 32 (8.3%) and 36 (9.4%) students were in the pre-contemplate, contemplation, preparation, action and maintenance stages, respectively. As the subjects progressed through the stage of change for dairy consumption, an increase in the mean score of self-efficacy, decisional balance, and processes of change was observed (P < 0.01). Conclusion: The constructs of the transtheoretical model should be considered in designing educational interventions to promote dairy consumption with regard to the stage of change for dairy consumption in the subjects.

Background: Disordered eating is common among late adolescents and young adults who pursue an idealised body image. Aims: This study aims to determine the prevalence of disordered eating between males and females and its associated factors among college and university students in Sarawak. Methods: A cross-sectional study involving 20 public and private colleges and universities in Sarawak, from September 2017 to March 2020. Respondents completed self-administered questionnaires both in the English and Malay language. Data about sociodemographic characteristics, body mass index, eating attitude, body dissatisfaction, perceived sociocultural pressure, self-esteem, drive for muscularity and perfectionism were collected. Results: A total of 776 respondents (male: 30.9%; female: 69.1%) aged 19 to 25 years old took part in the study. The overall prevalence of disordered eating was 25.2% (95% confidence interval (CI) 21.9; 28.7) with females (28.6%, 95% CI 24.6; 32.9) higher than males (15.6%, 95% CI 10.5; 21.9). Multivariate analysis showed for both male and female models, perceived sociocultural pressure (male: β = 1.125, p < 0.01; female: β = 1.052, p = 0.003), drive for muscularity (male: β = 1.033, p = 0.017; female: β = 1.032, p < 0.01) and perfectionism (male: β = 1.098, p = 0.02; female:β = 1.119, p < 0.01) were predictors for disordered eating. Conclusion: The prevalence of disordered eating among college and university students in Sarawak was high. The findings suggest that although there were gender differences in the prevalence of disordered eating, its associated factors were the same. The findings of this study will be useful for designing and implementing disordered eating prevention and intervention programme.

Background Diosgenin, extracted from Dioscorea esculenta, has been reported to decrease prostaglandin E₂ (PGE₂) levels and any other inflammatory cytokine in rodents. However, it is still unclear whether D. esculenta intake suppressed PGE₂ production and menstrual pain and premenstrual syndrome (PMS) in younger female. Aim This study aims to investigate the effect of D. esculenta intake on PGE₂ and cytochrome c oxidase subunit 2 (COX-2) levels and on menstrual pain and PMS in young women. This is a randomized, double-blind, placebo-controlled, crossover study. Methods Ten healthy young females were administered either a placebo or D. esculenta (300 mg/day) for 4 weeks, followed by a 4-week washout period. Fasting blood sample was taken from the fingertips on the second day of menstrual cycle began and obtained 24h before the last D. esculenta to avoid acute effects. Participants then switched treatments for 4 weeks as a second trial. Plasma PGE₂ and COX-2 levels were measured before and after each trial. The visual analogue scale (VAS), McGill pain questionnaire (MPQ), and Daily Record of Severity of Problems (DRSP) were also evaluated. The study was set and conducted from 2019 to 2020. Results PGE₂ and COX-2 levels significantly decreased after D. esculenta intake compared to placebo (p = 0.038, p = 0.042 each). The VAS and DRSP scores were also significantly lower after D. esculenta intake (p = 0.046, p = 0.035 each). Conclusion Four-week D. esculenta intake suppressed PGE₂ and COX-2 levels resulting in an improvement in PMS symptoms and menstrual pain in young women.

Background: A major cause of morbidity and mortality amongst children in displaced settings is malnutrition. Approximately, 45% of deaths are linked to undernutrition among children under 5 years of age. The study aimed to determine the prevalence and associated factors of malnutrition among internally displaced (IDP) children from 6 to 59 months. Methods: A community-based cross-sectional study with an analytical approach was conducted from May to June 2021. A multistage cluster sampling method was used to select mothers/caregivers and administer a structured questionnaire that consisted of three sections: sociodemographic and environmental characteristics, health-related factors and anthropometric measurements) was used to collect data. Data were analysed using SPSS version 27.0. Bivariate analysis was done at p < 0.20 and logistic regression at a 5% level of significance. Results: Overall, 395 children were enrolled with a mean age of 31.4  ±  9.1 months and 59.0% were males. Findings revealed that 52% of children were malnourished; stunted (22.1%), wasted (4.8%), underweight (6.3%) and overweight (35.4%). Independent predictors of overall malnutrition were the age of the mothers/caregivers (AOR: 8.0, 95% CI: 2.0 – 32.1), children who had not taken all their vaccines (AOR: 2.3, 95% CI: 1.4 –3.8), children not dewormed (AOR: 2.9, 95% CI: 1.3–6.3), Children not exclusively breastfed (AOR  =  3.3, 95% CI: 1.1–9.6). Conclusion: The prevalence of malnutrition was high among children living in internally displaced households. Thus, there is a need for vaccination and deworming campaigns, and nutritional and educational intervention programmes to improve both forms of malnutrition: undernutrition and over-nutrition.

Background: Increased consumption of ultra-processed foods and drinks high in unhealthy fats, salt and sugar is a major driver behind rising non-communicable disease rates in Asia-Pacific. Urban residence is considered a risk factor for increased consumption of these products; yet, evidence on consumption behaviours and drivers from urban populations in the region remains limited. Aim: To understand perceptions and drivers of unhealthy fats, salt and sugar foods and drinks consumption and eating out behaviours in Yogyakarta city, Indonesia. Methods: In-depth qualitative data were collected through open-ended interviews and prolonged interactions in the local food environment, from a purposeful sample (N = 45) equally distributed across three urban communities. Data were analysed according to the principles of content analysis and following an iterative approach. Results: Despite showing high nutritional health awareness, respondents and their household members consumed ultra-processed foods high in unhealthy fats, salt and sugar regularly. Home consumption of these products was based primarily on economic considerations and convenience, but also related to attending requests from other family members, individual preferences and tastes, and social functions. Similarly, despite a reported preference for home-cooked traditional foods, several participants or their family members would frequently eat ready-made meals away from home, due to conflicting school or work commitments. Discussion: Results suggest that public health interventions focused on nutrition education among Indonesian communities should be coupled with measures addressing urban food environment characteristics that promote the consumption of unhealthy diets, be tailored to specific age groups, and leverage traditional food cultures.