Household food security, HIV knowledge and dietary patterns among Trinidadian adults: A cross-sectional study

OBJECTIVE: To determine the relationship between food consumption patterns and prevalence of food insecurity among Trinidadian adults. METHODS: A convenience sample of two hundred and twenty selected households participated in the study. Data were collected over a three-month period in the year 2015. A structured paper-based questionnaire was used to collect data on HIV knowledge, food consumption frequency, food security status and sexual risk behaviours. Principal component analysis was used to derive dietary patterns. Multiple logistic regression models were used to determine the association between household food security and HIV knowledge and dietary pattern scores. All models were adjusted for gender, age, ethnicity, employment status and educational status. RESULTS: Two dietary consumption patterns were identified, namely westernized and prudent patterns. Overall, household food insecurity was approximately 65%, with food insecurity with children being that of 41% and without children 63%. Average HIV knowledge was 61.48 ± 15.16% among participants. Higher HIV knowledge (OR = 0.84; p = 0.002) and prudent dietary factor scores (OR = 0.64; p < 0.001) were associated with a greater odds of being food secure. Conversely, higher westernized dietary factor scores (OR = 1.33; p = 0.008) were associated witha greater likelihood of being food insecure. CONCLUSION: Greater awareness to HIV and healthier dietary patterns were seen among individuals from food secure households while persons who had westernized lifestyles were more likely to be from food insecure households. A greater effort is needed by governmental and public health institutions to help reduce the burden of food insecurity in the Caribbean.

Maternal infant feeding styles and the risk for overweight in Caribbean infants

OBJECTIVE: To examine the role of maternal feeding styles on the risk of overweight in a cohort of Caribbean infants. DESIGN AND METHODS: Data from mother-child pairs participating in an intervention study from 3 Caribbean islands were analysed. At recruitment, maternal and infant socio demographic and anthropometric data were collected and maternal depression assessed usingthe Center for Epidemiology Studies (CES) depression scale questionnaire. At 12 months, feeding styles was assessed in mothers by questionnaire. Factor analysis yielded five feeding styles: uninvolved, indulgent, forceful, restrictive and responsive. Infant length and weight were measured using standardized protocols at 18 months and BMI Z-scores were calculated from World Health Organization 2006 growth charts. Z-scores ≥ 1 were classified as at risk for overweight. Associations between maternal feeding styles and risk for infant overweight were assessed using multilevel logistic regression accounting for country and clinic. RESULTS: Data from 366 mother-child pairs (mean age 26.08ñ7.05 years, 55.5% high school graduates, 67.5% employed) were evaluated. No association was found between uninvolved, indulgent, forceful and responsive feeding styles with risk for infant overweight. Restrictive feeding was associated with increased risk for infant overweight (β=0.46; 95%CI=0.21,0.72) and the association remained after adjustment for infant birth weight, maternal age, education, socio-economic status and BMI (β=0.48;95%CI=0.21,0.74). This associationstrengthened after adjusting for maternal depression (β=0.55;95%CI=0.27,0.82). CONCLUSION: Restrictive feeding increased the risk of infant overweight. Overweight/obesity prevention interventions focusing on identifying suitable maternal feeding control as well as larger studies aimed at understanding the underlying mechanisms for this association are important approaches to tackling childhood overweight.

Everything with a pinch of salt: what knowledge have adult Barbadians gained from recent salt reduction messages and what impact have the messages had on their dietary choices?

OBJECTIVE: To ascertain whether adult Barbadians, 25-55 years, could identify and understand messages contained in phase one of the ‘Battling the Hidden Enemy” Salt Reduction Campaign, and to assess if these messages impacted dietary choices, particularly salt consumption. DESIGN AND METHODS: Purposeful sampling was used to recruit 22 Barbadians from a public and a private clinic to participate in five focus groups. Recorded group sessions were analysed using inductive and deductive reasoning and data was classified and organised according to key themes, concepts and emergent categories using framework analysis, aided by the software programme, Atlas.ti. RESULTS: Participants could identify and understood the public service announcement (PSA) messages but did not report an increase in skills and self-efficacy in selecting low salt food options as they were still unable to read labels and make better food choices. Mainly female participants stated an inability to limit their salt intake and pointed to barriers to changing their behaviours such as heavily advertised products, low-cost foods high in salt, addiction to tasty (salty) foods, inadequate labeling and a lack of nutritional information in food establishments. CONCLUSIONS: Education alone was ineffective in reducing the perceived salt consumption levels of focus group members, who judged the PSAs as educational but not effective. A multi-pronged approach should be used including a targeted, consistent campaign, supported by interventions that change the food environment in ways that encourage population-wide behaviour change.

Correlates of vigorous physical activity in adolescents in five secondary schools in Trinidad

OBJECTIVE: To determine the correlates of vigorous physical activity in adolescents in Trinidad. DESIGN AND METHODS: Adolescents (n = 344) between 11-15 years from five secondary schools in North-central Trinidad were cross-sectionally surveyed. Behavioural risk factors: alcohol and smoking use, physical activity and diet were obtained by a pilot tested interviewer administered questionnaire. In addition, anthropometric measures were obtained on site at school. Multivariate logistical regression was used to analyze correlates of vigorous physical activity by sex. RESULTS: Fruit and vegetable intake (p < 0.001) and religion (p = 0.034) were correlated with vigorous physical activity in females. Lower waist circumference (p = 0.014), age (p = 0.046) and diastolic blood pressure (p < 0.01) were correlated with vigorous physical activity in males. Body mass index (BMI) for age data indicated that 41.3% of the children were overweight or obese. However, vigorous physical activity did not correlate with BMI for age in either sex. In the final logistic regression models, higher vigorous physical activity was associated with lower diastolic blood pressure in males (p < 0.05) and an increased daily intake of fruit and vegetables in females (p < 0.001). CONCLUSION: Increased dietary intake of fruits and vegetables in females and lower diastolic blood pressure in males were associated with higher vigorous physical activity. Prospective studies are required to determine and clarify the relative importance of diet and physical activity in overweight adolescents and their risk of chronic metabolic disease.

Intakes of high-iron and high-vitamin C foods by students at high risk for the development of iron deficiency anaemia

OBJECTIVE: To assess intakes of high-iron and high-vitamin C foods among year one students at the University of the West Indies (UWI), St Augustine Campus, who are at high risk for the development of iron deficiency anaemia stratified by gender, ethnicity and vegetarian status. DESIGN AND METHODS: The sample included 170 year one UWI students. Participants were divided equally based on gender using quota sampling. Frequency of consumption of high- and low-iron foods, as well as vitamin C consumption was assessed based on a food frequency questionnaire (FFQ). RESULTS: About one-half (48%) of the participants consumed vitamin C supplements every day. Through dietary assessment, 57% of the students were found to be at risk for the development of iron deficiency anaemia. Only 10% of the participants never consumed any of the foods decreasing iron bioavailability listed in the FFQ. Overall, 30% of the participants never consumed high-iron containing foods. Only 36% of the participants consumed foods that increase iron absorption every day, whereas 4% never consumed them. No significance difference was found between the risk for the development of iron deficiency anaemia and the intakes of vitamin C, by ethnicity, vegetarian status and gender. CONCLUSION: Males were found to consume more high-iron containing foods. Females were more at risk for the development of iron deficiency anaemia. Participants of African descents consumed more high-iron containing foods. Participants of African and mixed raced consumed less foods that decrease iron absorption.

Diet and pain (2)

There is a strong association between diet and the development of chronic diseases namely, cardiovascular diseases, Type 2 diabetes, hypertension, some cancers and Alzheimer's disease. Studies have found that a diet low in fat and high in fibre not only helps to reduce the risk of chronic diseases but is also essential in reducing inflammation. Inflammation is in fact, a critical aspect in the development of the above-mentioned conditions which are characterised by low-grade inflammation. The pain associated with these conditions may not be immediate as the effects of these conditions accumulate over many years before being detected.

Diet and pain (1)

Most, if not all human beings have some point in time experienced even the slightest bit of pain which occurs as a result of a minor injury, mentrual pain or the pain which accompanies a sickness/disease; it is known fact that pain is a fairly common occurence and an inevitable part of life.

Raw foods and you Health

Raw foods are foods (usually plant foods) that have not been cooked (heated) of processed in any way. Such foods include fresh fruits and vegetables, grains, nuts, seeds and beans.

Food insecurity definitions and body mass index. Response

In his commentary, Dr Edward A. Frongillo criticizes our use of a well-described household food security scale in Trinidad. There will always be some uncertainty concerning the application of a given measure as there is no perfect instrument to evaluate food security or dietary patterns in any population. The household food security measure was used in the US national Current Population Survey (which provided the comparison data used in Dr Frongillo's commentary) but the application of the instrument to all groups in the multilingual, culturally diverse US population 'has not been examined sufficiently' (ref. 3, p. 8). Questionnaire evaluation must be considered when differences in literacy, language, dialect, or culture, as well as socioeconomic status, may influence responses and this consideration might suggest that an instrument should be tailored to local requirements. It is advisable, however, to be judicious in modifying such measures so as not to compromise the validity or comparability of an instrument. Departures from a previously tested template should only be undertaken to guarantee enhanced performance of a measure. Dr Frongillo's comments appear to underestimate both the weight of evidence required to justify an alteration to an established measure and the limitations of local 'validation' studies. Before concluding that a measure gives unsatisfactory results in a given local population, or a particular group within a population, it is essential to ensure that the findings cannot be ascribed to error or bias. There is a relatively high risk that local questionnaire evaluation studies, implemented within the short time scales suggested, will lead to erroneous conclusions if sample sizes are too small or if subjects are insufficiently representative.

Commentary: Assessing food insecurity in Trinidad and Tobago

Gulliford and colleagues report in this issue of the International Journal of Epidemiology on a study in Trinidad and Tobago that investigated whether household food insecurity was associated with obesity in this middle-income country. They found that food insecurity was associated with underweight but not with obesity. Food insecurity was also associated with decreased consumption of fruits and vegetables, a result previously reported in several studies, and with physical limitations, a result previously reported for elders in the US.

Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago

BACKGROUND: This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS: A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS: Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS: Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.

What do we do about the problem of overweight and obesity in the Americas?

Within the last two decades the prevalence of obesity in the developed world has moved from single digits to near 20 percent. Even more alarming is that within the same time frame the prevalence of overweight in the developing world has exceeded that in the developed countries, with. for example, rates of up to 30 percent in adult females being reported in the Caribbean. This disproportionate increase in the developing world is expected to accelerate even further since individuals, health care providers, and planners have been slow to either recognize or react to the problem. Individuals have been blinded by cultural factors that interpret obesity as desirable and a sign of wealth and economic success. Many planners lack sufficient financial resources and personnel-and, most importantly, adequate local data with which to influence public policy decisions. Clinicians have been coached in the model of acute care, and they operate in environments ill suited to handling chronic, lifestyle-related diseases.

Perception of a healthy diet: a survey among fourth form students in Trinidad [abstract]

The objective of this study was to determine the percentage of students with the correct perception of a healthy diet and whether perception varied with gender, type and geographic location of schools, religion, ethnicity, family history of chronic disease and exposure to nutritional information. A cross-sectional survey of 795 randomly chosen 4th form students, from randomly chosen secondary schools throughout Trinidad, was conducted over two weeks. Students who passed all six sections of a self-administered, anonymous questionnaire, with at least 50 percent correct responses in each section, were deemed to have the correct perception of a healthy diet. One hundred and sixty-five (21 percent) students had the correct perception of a healthy diet and 102 (23.9 percent) females vs 63 (17.7 percent males passed (p= 0.036). A significantly higher proportion (p= 0.008) of government-assissted school students (30.8 percent) passed, compared with students from Government schools (19.6 percent). Concerning "Healthy Choices", 87.3 percent of students passed whereas the "Dietary Beliefs" section had the lowest pass rate of 30.8 percent. Of the 676 students who reported being exposed to nutritional information, 153 (22.6 percent) had the correct perception. However, 11.3 percent of the students who reported no previous exposure to such information passed (p= 0.008). Religion, ethnicity and family history of chronic disease had no significant influence on students' perception. In conclusion, it was found that the majority of students sampled had an incorrect perception of a healthy diet. Perception varied with gender, exposure to nutritional information, type and geographic location of school attended. (AU)

Dietary patterns, nutritional status and activity levels of forth form secondary school children in Trinidad

Proper nutrition during adolescence in important for growth, long-term health promotion, and eating habits and physical inactivity are powerful determinants of some non-communicable chronic disease. The objective was to determine the dietary habits, nutritional status and physical activity patterns of adolescents in 4th form in Trinidad. A cross-sectional design study was used and a random sample of 1512 subjects identified. A qualitative food frequency questionnaire and a physical activity questionnaire were used to determine dietary and physical activity patterns. Weights, heights and triceps skin folds were measured. Adolescents were classified as being thin, normal overweight or obese. 619 girls and 601 boys, ages 14-17 participated. 34 percent was of East Indian descent, 32 percent African, 32 percent of mixed ethnicity and 2 percent other. The results indicated that 14 percent were thin, 74 percent had normal weight, 7 percent overweight and 5 percent obese. More adolescents of East Indian ethnicity were found to be thin. (p>0.001). Although fruits were consumed more regularly than vegetables, few adolescents consumed them daily. Rice and white bread/roti were the most commonly consumed staples. High fibre foods were not frequently eaten. Chicken was the most commonly consumed food from animals. 14 percent ate chicken daily. Fast foods were eaten on a weekly basis. The most important were chicken and chips, hotdogs, doubles, cakes and chocolates. 51 percent consumed alcoholic beverages; 1 percent drank them daily. 12 percent did not participate in any physical activity, while 32 percent exercised less than three hours per week. Walking, weight training, running/jogging and cricket were the most frequently reported activities. 78 percent did not participate in physical education at school. There was no association between body size and exercise, not were there any consistent associations between body size and diet. This study indicated a problem of both thinness and obesity in this population. Eating-related concerns are numerous, and must be addressed. Inclusion of regular physical activity as a tool for enhancing overall health and social values are of paramont importance (AU)

Obesity in the Caribbean: comparative gender analysis of dietary and exercise behaviour [abstract]

OBJECTIVE: The study was initiated to establish guidelines for the application of theory-based health promotion strategies in diet and exercise behaviour. The selected theory is the Trans-theoretical Model of Behaviour Change. The study utilizes three of the core constructs of the trans-theoretical model: the stages of change (the central organizing construct); decisional balance; and self-efficacy in examining fruit and vegetable consumption and exercise participation among adults 18 to 65 years old. The qualitative results are highlighted in this report. METHODS: The qualitative phase of the study was conducted in four countries: Belize, Jamaica, St.Kitts/Nevis and Trinidad and Tobago. Between 7 and 10 focus group discussions were conducted in each country. The variables for selecion of participants were: age range, gender, obesity stage, residential location and socio-economic status. RESULTS: The qualitative phase results indicated that, in the population studied, size was a very important determinant of perceived beauty, social adequacy, functioning and responsiveness. Knowledge relating to lifestyle is high but there is reluctance to effect lifestyle changes in dietary intake and physical activity. Cable television was identified as contributing to these current perceptions. Men were less concerned than women about their weight. Neither fruits nor vegetables were frequently mentioned as forming a part of daily diets of the majority of participants. Physical exercise was generally regarded ad hard work. CONCLUSIONS: The qualitative results of this study show that our approach to obesity prevention requires radical change. (AU)

The efficacy of acarbose in type 2 diabetes mellitus in Jamaica

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8 percent) did not complete the study and were excluded from further analysis. Six (13 percent) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n=15), [Gp B], oral hypoglycaemic agents, OHAs (n=17), [Gp C], or insulin (n=8), Gp D]. In addition, during the run in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3 month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 ñ 1.1 to 8.4 ñ 0.9 (p<0.027) and, from 11.0 ñ 1.0 to 8.7 ñ 0.7 (p<0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 ñ 1.1 percent to 12.2 ñ 1.0 percent (p<0.016) in Gp B, from 14.8 ñ 1.1 to 11.9 ñ 1.1 percent (p<0.002) in Gp C, and from 14.1 ñ 1.4 to 11.8 ñ 1.4 (p<0.02) in Gp D. Twenty-three per cent (23 percent) of the patients experienced flatulence; 7.5 percent changes in bowel habits and 5 percent, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.(Au)

Essentials of home theatre

After a hard day at work, there is nothing else like relaxing at home in one's favourite easy chair with favourite beverage and Miles Davis blowing his tunes. Many people are able to enjoy this with the traditional home stereo system. Now, however, the technology has grown to allow you to listen multi-channel music, which completely envelopes one with sound. The audio technology keeps growing at a phenomenal pace. Video is equally intriguing. With options ranging from direct view television to advanced projection systems and combined with an anvanced audio system you can have a home theater which will make you not want to go out to the movies ever again! In this presentation, I will show you how. This is truly technology to own which will reward you for all your hard work. (AU)

Profile of Uncontrolled Hypertensive patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies

The purpose of this study was to describe the knowledge of hypertension, its management, anthropometric measurements, blood pressure (BP), medication use, and current lifestyles of patients with persistent hypertension. Patients (n=80) attending the Specialist Hypertension Clinic at the University Hospital of the West Indies (UHWI) who had a baseline systolic BP> 140 mmHg and/or a diastolic BP> 90 mmHg were invited to participate in the study. Blood pressure, height, weight, waist and hip circumferences were measured. Body mass index (BMI) and waist/hip ratio (WHR) were calculated. A pretested questionannaire with 40 items eliciting demographic data, level of activity, dietary habits, knowledge of hypertension, medication compliance, use of alternative medicines, and substance use was administered to each participant. Mean BMI for men was 27.65 (95 percent CI 25.7 - 29.6); mean BMI for women was 30.89 (95 percent CI 26.1 - 35.7). In men, there was an association between BMI and WHR, r = 0.62, p<0.05, an association between BMI and diastolic BP and a negative association between BMI and activity level (r= -0.42, p<0.05). Although the majority of both men and women were classified as obese, only 12 percent of men and 7 percent of women recognized diet and overweight as contributing to high blood pressure. Reported diets tended to be high in fat, salt and meats and low in vegetables and fruits; the majority of the participants were sedentary. Medication compliance was good, with a mean of only four days of medications missed per month. These findings suggest that to lower blood pressure in this population, the use of nonpharmacologic theraphy involving lifestyle changes such as improved diet, weight loss and increased physical activity will be important.(AU)

Guidelines for young children feeding in the Caribbean - part II

This is the second of a three-part series by the Caribbean Food and Nutrition Institute (CFNI) on revised guidelines for young children feeding in the Caribbean. In Part I, the guidelines dealt with the period before birth. These covered maternal nutrition and guidelines for promoting, protecting and supporting breastfeeding. This part covers the broad area of breastfeeding, nutrition of the newborn with low birthweight or other special requirements, and replacement feeding for infants who are not breastfed. It also discusses the introduction of complementary foods with emphasis on the continuation of breastfeeding for two years and beyond.(AU)