Development and validation of a photograph-based instrument to assess nutrition literacy: The NUTLY project.

Most instruments measuring nutrition literacy evaluate theoretical knowledge, not necessarily reflecting skills relevant to food choices. We aimed to develop and validate a photograph-based instrument to assess nutrition literacy (NUTLY) among adults in Portugal. NUTLY assesses the ability to distinguish foods with different nutritional profiles; from each of several combinations of three photographs (two foods with similar contents and one with higher content) participants are asked to identify the food with the highest energy/sodium content. The NUTLY version with 79 combinations, obtained after experts/lay people evaluations, was applied to a sample representing different age, gender and education groups (n = 329). Dimensionality was evaluated through latent trait models. Combinations with negative or with positive small factor loadings were excluded after critical assessment. Internal consistency was measured using Cronbach's alpha and construct validity by comparing NUTLY scores with those obtained in the Medical Term Recognition Test and the Newest Vital Sign (NVS), and across education and training in nutrition/health groups. The cut-off to distinguish adequate/inadequate nutrition literacy was defined through ROC analysis using the Youden index criterion, after performing a Latent class analysis which identified a two-class model to have the best goodness of fit. Test-retest reliability was assessed after one month (n = 158). The final NUTLY scale was unidimensional and included 48 combinations (energy: 33; sodium: 15; α = 0.74). Mean scores (±standard deviation) were highest among nutritionists (39.9 ± 4.4), followed by health professionals (38.5 ± 4.1) and declined with decreasing education (p < 0.001). Those with adequate nutrition literacy according to NVS showed higher NUTLY scores (37.9 ± 4.3 vs. 33.9 ± 6.9, p < 0.001). Adequate nutrition literacy was defined as a NUTLY score≥35 (sensitivity: 89.3%; specificity: 93.7%). Test-retest reliability was high (ICC = 0.77). NUTLY is a valid and reliable nutrition literacy measurement tool.

Salt intake and gastric cancer: a pooled analysis within the Stomach cancer Pooling (StoP) Project.

PURPOSE: Previous studies show that consuming foods preserved by salting increases the risk of gastric cancer, while results on the association between total salt or added salt and gastric cancer are less consistent and vary with the exposure considered. This study aimed to quantify the association between dietary salt exposure and gastric cancer, using an individual participant data meta-analysis of studies participating in the Stomach cancer Pooling (StoP) Project. METHODS: Data from 25 studies (10,283 cases and 24,643 controls) from the StoP Project with information on salt taste preference (tasteless, normal, salty), use of table salt (never, sometimes, always), total sodium intake (tertiles of grams/day), and high-salt and salt-preserved foods intake (tertiles of grams/day) were used. A two-stage approach based on random-effects models was used to pool study-specific adjusted (sex, age, and gastric cancer risk factors) odds ratios (aORs), and the corresponding 95% confidence intervals (95% CI). RESULTS: Gastric cancer risk was higher for salty taste preference (aOR 1.59, 95% CI 1.25-2.03), always using table salt (aOR 1.33, 95% CI 1.16-1.54), and for the highest tertile of high-salt and salt-preserved foods intake (aOR 1.24, 95% CI 1.01-1.51) vs. the lowest tertile. No significant association was observed for the highest vs. the lowest tertile of total sodium intake (aOR 1.08, 95% CI 0.82-1.43). The results obtained were consistent across anatomic sites, strata of Helicobacter pylori infection, and sociodemographic, lifestyle and study characteristics. CONCLUSION: Salty taste preference, always using table salt, and a greater high-salt and salt-preserved foods intake increased the risk of gastric cancer, though the association was less robust with total sodium intake.

"True" Helicobacter pylori infection and non-cardia gastric cancer: A pooled analysis within the Stomach Cancer Pooling (StoP) Project.

BACKGROUND: Helicobacter pylori is the most important risk factor for non-cardia gastric cancer (NCGC); however, the magnitude of the association varies across epidemiological studies. This study aimed to quantify the association between H. pylori infection and NCGC, using different criteria to define infection status. METHODS: A pooled analysis of individual-level H. pylori serology data from eight international studies (1325 NCGC and 3121 controls) from the Stomach Cancer Pooling (StoP) Consortium was performed. Cases and controls with a negative H. pylori infection status were reclassified as positive considering the presence of anti-Cag A antibodies, gastric atrophy, or advanced stage at diagnosis, as available and applicable. A two-stage approach was used to pool study-specific adjusted odds ratios (OR), and 95% confidence intervals (95% CI). A meta-analysis of published prospective studies assessing H. pylori seropositivity in NCGCs was conducted. RESULTS: The OR for the association between serology-defined H. pylori and NCGC was 1.45 (95% CI: 0.87-2.42), which increased to 4.79 (95% CI: 2.39-9.60) following the reclassification of negative H. pylori infection. The results were consistent across strata of sociodemographic characteristics, clinical features and lifestyle factors, though significant differences were observed according to geographic region-a stronger association in Asian studies. The pooled risk estimates from the literature were 3.01 (95% CI: 2.22-4.07) for ELISA or EIA and 9.22 (95% CI: 3.12-27.21) for immunoblot or multiplex serology. CONCLUSION: The NCGC risk estimate from StoP based on the reclassification of H. pylori seronegative individuals is consistent with the risk estimates obtained from the literature. Our classification algorithm may be useful for future studies.

A method based on non-ionizing microwave radiation for ancillary diagnosis of osteoporosis: a pilot study.

BACKGROUND: Osteoporosis is a condition characterized by low bone mineral density, which typically leads to fractures and reduced quality of life. Currently, diagnostic devices used to assess this condition (e.g., dual-energy X-ray absorptiometry) are very costly, making it infeasible to meet the demand for testing in most countries. Therefore, we proposed a preclinical validation of a prototype called Osseus in an attempt to enhance osteoporosis screening tests and alleviate their costs. Osseus is a device developed to assist bone mineral density classification. It integrates a microcontroller into other peripheral devices to measure the attenuation at the middle phalanx of the middle finger, with two antennas operating at the 2.45 GHz frequency. RESULTS: We conducted tests with plaster, poultry, and porcine bones. A comparison of the measurements of the original and mechanically altered samples demonstrated that the device can handle the complexity of the tissues within the bone structure and characterize its microarchitecture. CONCLUSIONS: Osseus is a device that has been preliminarily validated. Ionising radiation needed for DXA tests is replaced by non-ionising microwave electromagnetic radiation. Osseus enables early detection of osteoporosis, reduces costs, and optimizes high-complexity testing referrals. There is a lack of validation studies with the reference/gold standard that are currently under development.

Stochastic Petri net model describing the relationship between reported maternal and congenital syphilis cases in Brazil.

INTRODUCTION: Syphilis is a sexually transmitted disease (STD) caused by Treponema pallidum subspecies pallidum. In 2016, it was declared an epidemic in Brazil due to its high morbidity and mortality rates, mainly in cases of maternal syphilis (MS) and congenital syphilis (CS) with unfavorable outcomes. This paper aimed to mathematically describe the relationship between MS and CS cases reported in Brazil over the interval from 2010 to 2020, considering the likelihood of diagnosis and effective and timely maternal treatment during prenatal care, thus supporting the decision-making and coordination of syphilis response efforts. METHODS: The model used in this paper was based on stochastic Petri net (SPN) theory. Three different regressions, including linear, polynomial, and logistic regression, were used to obtain the weights of an SPN model. To validate the model, we ran 100 independent simulations for each probability of an untreated MS case leading to CS case (PUMLC) and performed a statistical t-test to reinforce the results reported herein. RESULTS: According to our analysis, the model for predicting congenital syphilis cases consistently achieved an average accuracy of 93% or more for all tested probabilities of an untreated MS case leading to CS case. CONCLUSIONS: The SPN approach proved to be suitable for explaining the Notifiable Diseases Information System (SINAN) dataset using the range of 75-95% for the probability of an untreated MS case leading to a CS case (PUMLC). In addition, the model's predictive power can help plan actions to fight against the disease.

Assessment of the cytotoxic effects of aporphine prototypes on head and neck cancer cells.

Purpose Among alkaloids, abundant secondary metabolites in plants, aporphines constitute a class of compounds with interesting biological activities, including anticancer effects. The present study evaluated the anticancer activities of 14 substances, including four aporphine derivatives acquired through the biomonitoring of (±)-apomorphine hydrochloride total synthesis from 2-phenethylamine and 3,4-dimethoxybenzaldehyde against head and neck squamous cell carcinoma (HNSCC). Methods The cytotoxic effects of compounds against a panel of HNSCC cell lines were determined by PrestoBlue cell viability assay, while the genotoxicity of substances was evaluated by micronucleus test. Cell death was detected by flow cytometry (Annexin V/7AAD) and western blot analysis was used to detect the presence of cleaved Caspase-3 molecules. Results The aporphine and isoquinoline derivatives APO, C1, and A5 significantly reduced HNSCC cell viability and promoted DNA damages in these cells. Further, by activating the Caspase-3 pathway, these substances were able to induce apoptosis. Conclusion Our results revealed that APO, C1, and A5 exhibit cytotoxic effects in HNSCC cells. The mechanisms of action appear to be partly via the generation of DNA damages and apoptosis induction through Caspase-3 pathway activation. This study provides preclinical data that suggest a potential therapeutic role for APO, C1, and A5 against head and neck cancer cells.

Street food in Eastern Europe: a perspective from an urban environment in Moldova.

Street food is popular in Eastern Europe, but its diversity and nutritional value are unknown. This study aimed to characterise the street food environment in Chisinau, Moldova, including the vending sites and vendors, food availability and nutritional composition of foods and beverages. All street food vending sites (single point of sale) located in a 1-km buffer centred on the main public market were systematically selected (n 439; n 328 participants). Data on vending sites' characteristics (mobility, type of physical set-up and access to electricity), operating periods and food availability were collected. Samples of the most commonly available foods of unknown composition were collected (twenty-eight home-made and twenty-four industrial). Macronutrients, Na and K were quantified through chemical analysis. Fruits, beverages and food other than fruits were available in 2·5, 74·3 and 80·8 % of the vending sites, respectively. Among the latter, 66·4 % sold only industrial foods (e.g. pretzels, biscuits, wafers, chocolate and ice cream), 21·5 % only home-made (e.g. savoury and sweet pastries) and 12·1 % both. Home-made foods presented larger serving sizes and energy/serving (median kJ/serving: 1312·5 v. 670·3, P = 0·022); industrial foods were more energy-dense (median kJ/100 g: 1797·0 v. 1269·8, P = 0·002). High SFA, trans-fat and Na contents were found, reaching 10·9 g/serving, 1·4 g/serving and 773·7 mg/serving, respectively. Soft drinks and alcoholic beverages were available in 80·7 and 42·0 % of the vending sites selling beverages, respectively. Concluding, industrial snacks and home-made pastries high in Na and unhealthy fat were frequent in Chisinau. Prevention of diet-related diseases in Moldova may benefit from the improvement of the nutritional profile of street food.

Stunting and overweight among children in Northeast Brazil: prevalence, trends (1992-2005-2015) and associated risk factors from repeated cross-sectional surveys.

BACKGROUND: A study involving children from Alagoas (Northeast Brazil) revealed that, as a consequence of a drastic reduction in the prevalence of stunting between 1992 to 2005, (22.5 to 11.4%) combined with an increase in overweight prevalence (6.7 to 9.3%), the prevalence of these two conditions in 2005 was very close. If these trends were maintained, it is very likely that, at this time, the childhood overweight prevalence has already exceeded that of the stunting. However, no study is available to confirm this hypothesis. The identification of these changes is relevant to the planning and evaluation of public policies. This study aimed to investigate the prevalence, time trends and associated factors with stunting and overweight in children from Alagoas. METHODS: Independent cross-sectional household surveys were conducted in 1992 (n = 1231), 2005 (n = 1381) and 2015 (n = 988). Data were collected from probabilistic samples of children aged 0-60 months. Stunting was defined by stature-for-age < - 2 sd and overweight by weight-for-stature > 2 sd. RESULTS: Between 1992, 2005 and 2015, the stunting prevalence was 22.6, 11.2 and 3.2% (reduction of 85.8%), while the overweight prevalence was 6.9, 7.5 and 14.9% (increase of 115.9%), respectively. After multivariate analysis, the following positive associations with stunting were observed in 1992: age group > 24 months (28.3% vs 14.5%), mother with ≥2 children (28.8% vs 12.8%), low birth weight (28.3% vs 15.7%) and mother with low schooling (29.3% vs 7.2%). In 2015 there was a higher prevalence of stunting in males (4.2% vs 2.2%), in children < 24 months (4.6% vs 2.2%), with low birth weight (8.6% vs 3.0%) and in those who had mothers with low schooling (7.0% vs 2.6%). Regarding overweight, in 1992 there was higher prevalence for male (9.1% vs 4.7%) and in children whose mothers had ≤2 children (8.9% vs 5.8%), while in 2015 only birth weight >  4 kg was associated to overweight (27.3% vs 14.2%). CONCLUSIONS: During the analyzed period, there was a significant decrease in stunting prevalence. At the same time, a substantial increase was observed in the overweight prevalence. Currently, stunting is a problem of low magnitude, while overweight has become a worrying public health problem.

Street food in Dushanbe, Tajikistan: availability and nutritional value.

Street food is part of the culture in central Asia. Although nourishing food can be found, unhealthier options are becoming increasingly popular - a marker of nutrition transition. The nutritional composition of street food in urban settings is, however, unknown. The objective of the present study was, thus, to characterise the street food availability in Dushanbe, Tajikistan. A total of 800 street food vending sites in public markets were selected through random and systematic procedures. Trained interviewers collected data on vending sites' characteristics, location and food available. Samples of the most commonly available food were collected (ninety-nine homemade and thirty-five industrial). Macronutrients were quantified through proximate analysis. Fruit, drinks and food other than fruits were available, respectively, in 4·5, 40·5 and 87·4 %, of the vending sites. Among the latter, 63·6 % sold only homemade (e.g. bread, traditional dishes, snacks, pastries, sandwiches and cakes), 19·3 % only industrial (e.g. bread, snacks, pastries and cookies) and 17·1 % both types of food. Homemade food presented higher energy per serving compared with industrial food (median 452 v. 276 kcal/serving (1891 v. 1155 kJ/serving); P < 0·001). A high content of SFA (soup: 10·9 g/serving) and trans-fatty acids (cakes: 1·8 g/serving) was also found in homemade food. However, industrial wafers showed the highest content of these fatty acids (12·9 g/serving and 2·5 g/serving, respectively). Soft drinks were available in 68·5 % of the vending sites selling beverages. Homemade and industrial street food, with heterogeneous nutritional value, were widely available in Dushanbe. Hence, policies promoting the availability of healthy food should be encouraged.

Appetite-Related Eating Behaviours: An Overview of Assessment Methods, Determinants and Effects on Children's Weight.

Identifying the underlying child-eating behaviours that contribute to weight differences across growth has been a constant challenge. This report reviews the various literature approaches for assessing appetite regulation. In doing so, it attempts to understand how appetite control develops and determines the eating habits in early childhood, and its effects on children's weight status. The interaction between homeostatic and hedonic mechanisms largely explains the appetite regulation process. Homeostatic mechanisms are mediated by the biological need to maintain the body's energy reserves, increasing the motivation to eat. On the contrary, the hedonic mechanisms are mediated by food reward, increasing the craving for high-palatable foods and triggering the release of dopamine and serotonin. There are many biological methods (plasma measurements of hormones, like leptin, ghrelin and insulin) and behavioural evaluation methods of appetite. The Children's Eating Behaviour Questionnaire is most commonly used, due to its adequate psychometric properties tested in several population settings. The development of eating behaviours begins in utero, and several determinants may contribute to a decrease in the ability to self-regulate dietary intake. Examples include genetic predisposition, the first taste experiences and the family environment, a key determinant in this process. Several eating behaviours contribute most to childhood obesity. Among them, are the external eating (eating by external stimuli, such as the mere presence of the food or its smell), food restriction (which may potentiate the uninhibited increased intake of the restricted foods) and emotional eating (intake due to emotional variations, especially negative feelings). These eating behaviours have been linked to childhood obesity.

Early Life Characteristics Associated with Appetite-Related Eating Behaviors in 7-Year-Old Children.

OBJECTIVE: To assess early life characteristics associated with appetite-related eating behaviors in 7-year-old children. STUDY DESIGN: The participants are children from the population-based birth cohort Generation XXI. Data on sociodemographics, health, and lifestyles and anthropometrics were collected at birth, and 4- and 7-year-old evaluations. A Portuguese version of the Children's Eating Behavior Questionnaire was completed by mothers (n = 3562 children) with children aged 7 years old. A 2-factor solution was identified: factor 1-appetite restraint and factor 2-appetite disinhibition. Associations were estimated through generalized linear models adjusted for maternal age, education, body mass index (BMI) before birth, family structure, number of siblings, and child's sex (ß regression coefficients and 95% CIs). RESULTS: Higher appetite restraint at 7 years old was associated with higher maternal age and educational level, families with both parents (1- vs 2-parent: ß = -0.074, 95% CI -0.140, -0.007) and no siblings (≥2 vs 0: ß = -0.152, 95% CI -0.224, -0.081), and more sedentary lifestyles at 4 years old. It was also associated with lower child and maternal BMI and waist circumference at 4 years old. In contrast, higher appetite disinhibition was associated with lower maternal educational background, having a 1-parent family, more sedentary behaviors (≥120 vs <120 min/d of media: ß = 0.055, 95% CI 0.018, 0.093), and higher BMI and waist circumference at 4 years old. CONCLUSIONS: Higher maternal age and education, and a family with both parents at 4 years old seem to influence higher appetite restraint, but less appetite disinhibition at 7 years old. More sedentary lifestyles at 4 years old were associated with higher appetite restraint and appetite disinhibition scores later in childhood. These results can be useful for the development of prevention guidelines and educational strategies aimed at improving healthy eating behaviors.

Selective regulation of hepatic lipid metabolism by the AMP-activated protein kinase pathway in late-pregnant rats.

The liver plays an essential role in maternal metabolic adaptation during late pregnancy. With regard to lipid metabolism, increased secretion of very low-density lipoprotein (VLDL) is characteristic of late pregnancy. Despite this well-described metabolic plasticity, the molecular changes underlying the hepatic adaptation to pregnancy remain unclear. As AMPK is a key intracellular energy sensor, we investigated whether this protein assumes a causal role in the hepatic adaptation to pregnancy. Pregnant Wistar rats were treated with vehicle or AICAR (5-aminoimidazole-4-carboxamide ribonucleotide) for 5 days starting at gestational day 14. At the end of treatment, the rats were subjected to an intraperitoneal pyruvate tolerance test and in situ liver perfusion with pyruvate. The livers were processed for Western blot analysis, quantitative PCR, thin-layer chromatography, enzymatic activity, and glycogen content measurements. Blood biochemical profiles were also assessed. We found that AMPK and ACC phosphorylation were reduced in the livers of pregnant rats in parallel with a reduced level of hepatic gluconeogenesis of pyruvate. This effect was accompanied by both a reduction in the levels of hepatic triglycerides (TG) and an increase in circulating levels of TG. Treatment with AICAR restored hepatic levels of TG to those observed in nonpregnant rats. Additionally, AMPK activation reduced the upregulation of genes related to VLDL synthesis and secretion observed in the livers of pregnant rats. We conclude that the increased secretion of hepatic TG in late pregnancy is concurrent with a transcriptional profile that favors VLDL production. This transcriptional profile results from the reduction in hepatic AMPK activity.

Advances on chalcogenide quantum dots-based sensors for environmental pollutants monitoring.

Water contamination represents a significant ecological impact with global consequences, contributing to water scarcity worldwide. The presence of several pollutants, including heavy metals, pharmaceuticals, pesticides, and pathogens, in water resources underscores a pressing global concern, prompting the European Union (EU) to establish a Water Watch List to monitor the level of these substances. Nowadays, the standard methods used to detect and quantify these contaminants are mainly liquid or gas chromatography coupled with mass spectrometry (LC/GC-MS). While these methodologies offer precision and accuracy, they require expensive equipment and experienced technicians, and cannot be used on the field. In this context, chalcogenide quantum dots (QDs)-based sensors have emerged as promising, user-friendly, practical, and portable tools for environmental monitoring. QDs are semiconductor nanocrystals that possess excellent properties, and have demonstrated versatility across various sensor types, such as fluorescent, electrochemical, plasmonic, and colorimetric ones. This review summarizes recent advances (2019-2023) in the use of chalcogenide QDs for environmental sensing, highlighting the development of sensors capable of detect efficiently heavy metals, anions, pharmaceuticals, pesticides, endocrine disrupting compounds, organic dyes, toxic gases, nitroaromatics, and pathogens.

Computational methods applied to syphilis: where are we, and where are we going?

Syphilis is an infectious disease that can be diagnosed and treated cheaply. Despite being a curable condition, the syphilis rate is increasing worldwide. In this sense, computational methods can analyze data and assist managers in formulating new public policies for preventing and controlling sexually transmitted infections (STIs). Computational techniques can integrate knowledge from experiences and, through an inference mechanism, apply conditions to a database that seeks to explain data behavior. This systematic review analyzed studies that use computational methods to establish or improve syphilis-related aspects. Our review shows the usefulness of computational tools to promote the overall understanding of syphilis, a global problem, to guide public policy and practice, to target better public health interventions such as surveillance and prevention, health service delivery, and the optimal use of diagnostic tools. The review was conducted according to PRISMA 2020 Statement and used several quality criteria to include studies. The publications chosen to compose this review were gathered from Science Direct, Web of Science, Springer, Scopus, ACM Digital Library, and PubMed databases. Then, studies published between 2015 and 2022 were selected. The review identified 1,991 studies. After applying inclusion, exclusion, and study quality assessment criteria, 26 primary studies were included in the final analysis. The results show different computational approaches, including countless Machine Learning algorithmic models, and three sub-areas of application in the context of syphilis: surveillance (61.54%), diagnosis (34.62%), and health policy evaluation (3.85%). These computational approaches are promising and capable of being tools to support syphilis control and surveillance actions.

Osteoporosis screening using machine learning and electromagnetic waves.

Osteoporosis is a disease characterized by impairment of bone microarchitecture that causes high socioeconomic impacts in the world because of fractures and hospitalizations. Although dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing the disease, access to DXA in developing countries is still limited due to its high cost, being present only in specialized hospitals. In this paper, we analyze the performance of Osseus, a low-cost portable device based on electromagnetic waves that measures the attenuation of the signal that crosses the medial phalanx of a patient's middle finger and was developed for osteoporosis screening. The analysis is carried out by predicting changes in bone mineral density using Osseus measurements and additional common risk factors used as input features to a set of supervised classification models, while the results from DXA are taken as target (real) values during the training of the machine learning algorithms. The dataset consisted of 505 patients who underwent osteoporosis screening with both devices (DXA and Osseus), of whom 21.8% were healthy and 78.2% had low bone mineral density or osteoporosis. A cross-validation with k-fold = 5 was considered in model training, while 20% of the whole dataset was used for testing. The obtained performance of the best model (Random Forest) presented a sensitivity of 0.853, a specificity of 0.879, and an F1 of 0.859. Since the Random Forest (RF) algorithm allows some interpretability of its results (through the impurity check), we were able to identify the most important variables in the classification of osteoporosis. The results showed that the most important variables were age, body mass index, and the signal attenuation provided by Osseus. The RF model, when used together with Osseus measurements, is effective in screening patients and facilitates the early diagnosis of osteoporosis. The main advantages of such early screening are the reduction of costs associated with exams, surgeries, treatments, and hospitalizations, as well as improved quality of life for patients.

Nutritional Characterization of Street Food in Urban Turkmenistan, Central Asia.

Objective: Describing the availability and nutritional composition of the most commonly available street foods in Ashgabat, Turkmenistan. Methods: One hundred sixty-one street food vending sites (six public markets) were assessed, through a collection of data on vending sites' characteristics and food availability, and samples of commonly available foods (21 homemade; 11 industrial), for chemical analysis. Results: Fruit, beverages, and food other than fruit were available in 6.8, 29.2, and 91.9% of all vending sites, respectively. Regarding the latter, 52.7% of the vending sites sold only homemade products (main dishes, snacks, cakes, biscuits and pastries, bread, ice-cream chocolate and confectionery, savory pastries and sandwiches), 37.2% only industrial (ice-cream, chocolate and confectionery, cakes, biscuits and pastries, snacks, bread and savory pastries) and 10.1% both. Homemade foods presented significantly higher total fat [homemade 11.6 g (range 6.6-19.4 g); industrial 6.2 g (range 4.0-8.6 g), p = 0.001], monounsaturated, polyunsaturated and trans-fat, and sodium and potassium content per serving. Industrial wafers presented the highest mean saturated (11.8 g/serving) and trans-fat (2.32 g/serving) content. Homemade hamburgers presented the highest mean sodium content (1889 mg/serving). Conclusions: Strategies to encourage the production and sales of healthier street foods, especially homemade, are needed to promote healthier urban food environments in urban Turkmenistan.

Availability and Nutritional Composition of Street Food in Urban Central Asia: Findings From Almaty, Kazakhstan.

Objective: To describe the availability and nutritional composition of commonly available street foods in Almaty, Kazakhstan. Methods: 384 street food vending sites (in 10 public markets) were assessed; information on vending sites' characteristics and food availability and samples of the most commonly available street foods (81 homemade; 40 industrial) were collected for chemical analysis. Results: Fruit, beverages and food other than fruit were available in 1.0%, 47.4% and 92.7% of all vending sites. Homemade food other than fruit (e.g., bread, main dishes, snacks, pastries, sandwiches, and cakes) were available in 63.4% of stationary vending sites, while industrial (e.g., snacks, chocolate, cakes, and cookies) in 45.6% of them. Industrial foods were the most energy-dense [median kcal/100 g: 438.8 vs. 267.2, p < 0.001 (homemade)]. Traditional homemade dishes were high in sodium, reaching 2,248 mg/serving (lagman) and major contributors of protein and fat to energy content (shashlik: 22.8% from protein, 68.3% from fat). Industrial chocolate and homemade cake presented the highest saturated (14.6 g/serving) and trans-fat (3.20 g/serving) contents. Conclusion: These findings advocate for the implementation of health promotion strategies targeted at vendors, consumers and other stakeholders.

Patterns of Street Food Purchase in Cities From Central Asia.

Street food makes a significant contribution to the diet of many dwellers in low- and middle-income countries and its trade is a well-developed activity in the central Asian region. However, data on its purchase and nutritional value is still scarce. This study aimed to describe street food purchasing patterns in central Asia, according to time and place of purchase. A multicentre cross-sectional study was conducted in 2016/2017 in the main urban areas of four central Asian countries: Dushanbe (Tajikistan), Bishkek (Kyrgyzstan), Ashgabat (Turkmenistan) and Almaty (Kazakhstan). Street food markets (n = 34) and vending sites (n = 390) were selected by random and systematic sampling procedures. Data on the purchased foods and beverages were collected by direct observation. Time and geographic location of the purchases was registered, and their nutritional composition was estimated. A total of 714 customers, who bought 852 foods, were observed. Customers' influx, buying rate and purchase of industrial food were higher in city centers compared to the outskirts (median: 4.0 vs. 2.0 customers/10 min, p < 0.001; 5.0 vs. 2.0 food items/10 min, p < 0.001; 36.2 vs. 28.7%, p = 0.004). Tea, coffee, bread and savory pastries were most frequently purchased in the early morning, bread, main dishes and savory pastries during lunchtime, and industrial products in the mid-morning and mid-afternoon periods. Energy and macronutrient density was highest at 11:00-12:00 and lowest at 09:00-10:00. Purchases were smaller but more energy-dense in city centers, and higher in saturated and trans-fat in the peripheries. This work provides an overview of the street food buying habits in these cities, which in turn reflect local food culture. These findings from the main urban areas of four low- and middle-income countries which are currently under nutrition transition can be useful when designing public health interventions customized to the specificities of these food environments and their customers.