Adult food choices in association with the local retail food environment and food access in resource-poor communities: a scoping review.

BACKGROUND: There is a growing body of research on local retail food environments globally in both urban and rural settings. Despite this, little research has been conducted on adult food choices, local retail environments, and healthy food access in resource-poor communities. The purpose of this study is therefore to provide an overview of the evidence on adult food choices (measured as dietary intake) in association with the local retail food environment and food access in resource-poor communities (defined as low-income communities and/or households). METHODS: We searched nine databases for studies published from July 2005 to March 2022 and identified 2426 records in the primary and updated search. Observational studies, empirical and theoretical studies, focused on adults ≤ 65 years, published in English peer-reviewed journals, examining local retail food environments and food access, were included. Two independent reviewers screened identified articles using the selection criteria and data extraction form. Study characteristics and findings were summarized for all studies and relevant themes summarized for qualitative and mixed methods studies. RESULTS: A total of 47 studies were included in this review. Most studies were cross sectional (93.6%) and conducted in the United States of America (70%). Nineteen (40.4%) studies assessed the association between food choice outcomes and local retail food environment exposures, and evidence on these associations are inconclusive. Associations of certain food choice outcomes with healthy food retail environments were positive for healthy foods (in 11 studies) and unhealthy foods (in 3 studies). Associations of certain food choice outcomes with unhealthy retail food environment exposures were positive for unhealthy foods in 1 study and negative for healthy foods in 3 studies. In 9 studies, some of the food choice outcomes were not associated with retail food environment exposures. A healthy food store type and lower food prices were found to be major facilitators for healthy food access in resource-poor communities, while cost and transportation were the main barriers. CONCLUSIONS: More research is needed on the local retail food environment in communities in low- and middle-income countries to develop better interventions to improve food choices and access to healthy foods in resource-poor communities.

Nutrient density and cost of commonly consumed foods: a South African perspective.

Food-based dietary guidelines promote consumption of a variety of nutritious foods for optimal health and prevention of chronic disease. However, adherence to these guidelines is challenging because of high food costs. The present study aimed to determine the nutrient density of foods relative to cost in South Africa, with the aim to identify foods within food groups with the best nutritional value per cost. A checklist of 116 food items was developed to record the type, unit, brand and cost of foods. Food prices were obtained from the websites of three national supermarkets and the average cost per 100 g edible portion was used to calculate cost per 100 kcal (418 kJ) for each food item. Nutrient content of the food items was obtained from the South African Food Composition Tables. Nutrient density was calculated using the Nutrient Rich Food (NRF9.3) Index. Nutrient density relative to cost was calculated as NRF9.3/price per 100 kcal. Vegetables and fruits had the highest NRF9.3 score and cost per 100 kcal. Overall, pulses had the highest nutritional value per cost. Fortified maizemeal porridge and bread had the best nutritional value per cost within the starchy food group. Foods with the least nutritional value per cost were fats, oils, foods high in fat and sugar, and foods and drinks high in sugar. Analysis of nutrient density and cost of foods can be used to develop tools to guide low-income consumers to make healthier food choices by identifying foods with the best nutritional value per cost.

Retail Cost and Energy Adjusted Cost Are Associated with Dietary Diversity and Nutrient Adequacy for Diets of 6-24 Months Children.

Poor nutrition during the first two years of life has long term consequences, but resource-poor households often do not have the means to access nutrient-dense and diverse diets. Pooled data of 24-h dietary recalls (n = 3336) and 2019 retail food prices were analyzed to determine associations of retail cost and energy cost (per 100 kcal) with diet quality indicators for diets of 6-24-month-old South African children who were breastfed (BF-diet) and not breastfed (NBF-diet) during the 24-h recall period. Compared to the BF-diet, retail cost for the NBF-diet was three times higher for age 6-11 months, and double for age 12-17 months. Higher retail cost and energy cost were both associated with higher mean adequacy ratios and dietary diversity scores for BF and NBF diets, except energy cost for the NBF-diet for age 6-11 months. Overall, inclusion of flesh foods, vitamin A-rich fruits and vegetables, and other fruit and vegetables increased from the lowest to the highest retail cost tertile. The higher cost of more nutritious diets highlights the importance of the affordability of diets in interventions aimed at improving diet quality. Possible strategies include: identifying the most-affordable foods within each food group, focusing on foods that provide multiple key micronutrients, and the inclusion of locally available indigenous foods.

Dietary Diversity and its Association with Nutritional Status, Cardiometabolic Risk Factors and Food Choices of Adults at Risk for Type 2 Diabetes Mellitus in Cape Town, South Africa.

In South Africa, the nutrition transition has led to unhealthy diets lacking variety, contributing to the rise in overweight, obesity and diet-related noncommunicable diseases. Using baseline screening data of the South African Diabetes Prevention Programme (SA-DPP) study, this study aims to determine the relationship of dietary diversity (DD) with nutritional status, cardiometabolic risk factors and food choices of adults at risk of type 2 diabetes in resource-poor communities around Cape Town. Data of 693 adults, 25−65 years old were analysed. This included socio-demographic information, anthropometric measurements, biochemical assessments, food groups consumed the previous day and consumption frequency of certain foods to reflect food choices. The Minimum Dietary Diversity for Women (MDD-W) indicator was calculated; 70.4% of participants had low DD (<5 food groups). Low DD was associated with elevated serum triglycerides [AOR: 1.49, 95% CI (1.03, 2.15) p = 0.036]. The DD score was positively correlated (although weak) with the unhealthy food score (r = 0.191, p = 0.050) and sugary food score (r = 0.139, p < 0.01). Study participants at risk of diabetes consumed a diet low in DD; however, DD was not associated with nutritional status or cardiometabolic risk factors except for serum triglycerides.

Adult food choices in association with the local retail food environment and food access in resource-poor communities: a scoping review protocol.

INTRODUCTION: The local retail food environment influences dietary patterns and food choices, as suggested in the literature. The lack of access to healthy food within this environment may result in unhealthy food choices which may lead to obesity and the development of non-communicable diseases. Evidence suggests that resource-poor communities may have unhealthy food environments, therefore, preventing residents from making healthy food choices. A systematic scoping review will be conducted to provide an overview of the evidence on adult food choices in association with the local retail food environment and food access in resource-poor communities. METHODS AND ANALYSIS: This protocol for the scoping review was developed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the framework process by Arksey and O'Malley. Observational studies, published from July 2005 to January 2021, will be searched and screened. Keywords and medical subject headings (MeSH) terms will be used to search several multidisciplinary databases. Two independent reviewers will screen identified articles using the selection criteria and extract data using the PRISMA-ScR checklist. Descriptive numerical and thematic analysis will be performed to evaluate and categorise quantitative and qualitative data. ETHICS AND DISSEMINATION: Ethical approval will not be required for the review, as data from published studies will be used. The results of this scoping review will form part of a PhD thesis that will be submitted to the University of the Western Cape, South Africa. The review findings will also be presented at conferences and published in a peer-reviewed journal. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER: https://osf.io/shf93.

Household Consumption of Orange-Fleshed Sweet Potato and its Associated Factors in Chipata District, Eastern Province Zambia.

BACKGROUND: The Integrating Orange Project promotes production and consumption of orange-fleshed sweet potato (OFSP) to address vitamin A deficiency among rural populations of Zambia since 2011. OBJECTIVE: This study assessed household production and consumption of OFSP and identified factors associated with consumption thereof in Integrating Orange Project areas in Chipata district, Zambia. METHODS: Respondents of 295 randomly selected households were interviewed using a structured questionnaire during the sweet potato harvest season. Associations between OFSP consumption and household factors were assessed using χ2 tests. RESULTS: Frequency of OFSP consumption was categorized as ≥4 days during the last 7 days (30.2%), 1 to 3 days during the last 7 days (49.5%), eats OFSP but not during the last 7 days (7.1%), and never (13.2%). In total, 60.3% of households planted OFSP, and 40.0% bought OFSP, mostly from farmers within the community. Orange-fleshed sweet potato consumption was associated with the presence of children aged less than 5 years in the household ( P = .018), production of OFSP ( P < .001), purchasing of OFSP ( P < .001), and respondent having knowledge on health benefits of OFSP ( P = .014). Age and sex of the household head and household size had no association with OFSP consumption ( P > .05). CONCLUSION: A high percentage of households consumed OFSP during the harvesting season in Integrating Orange Project areas. Programs promoting OFSP consumption should thus focus on OFSP production and sensitizing households on nutritional benefits of OFSP and target households with children aged less than 5 years as entry point.

Dietary fat intake and red blood cell fatty acid composition of children and women from three different geographical areas in South Africa.

Dietary fat intake, particularly the type of fat, is reflected in the red blood cell (RBC) fatty acid (FA) profile and is vital in growth, development and health maintenance. The FA profile (%wt/wt) of RBC membrane phospholipids (as determined by gas chromatography) and dietary intake (as determined by 24h recall) was assessed in 2-6y old South African children and their caregivers randomly selected from three communities, i.e. an urban Northern Cape community (urban-NC; n=104), an urban coastal Western Cape community (urban-WC; n=93) and a rural Limpopo Province community (rural-LP; n=102). Mean RBC FA values across groups were compared using ANOVA and Bonferroni post-hoc test while controlling for age and gender (children); median dietary intake values were compared using a Kruskal-Wallis test. Dietary intakes for total fat, saturated FAs and polyunsaturated FAs were higher in the two urban areas compared to the rural area. Total fat intake in rural-LP, and omega-3 FA dietary intake in all three areas were lower than the South African adopted guidelines. Dietary SFA intake in both urban areas was higher than recommended by South African guidelines; this was reflected in the RBC membrane FA profile. Rural-LP children had the lowest intake of omega-3 and omega-6 FAs yet presented with the highest RBC docosahexaenoic acid (DHA) profile and highest arachidonic acid percentage. Although differences observed in dietary fat intake between the two urban and the rural area were reflected in the RBC membrane total phospholipid FA profile, the lowest total fat and α-linolenic acid (ALA) intake by rural children that presented with the highest RBC DHA profile warrants further investigation.

Correlates of prevalent sexually transmitted infections among participants screened for an HIV incidence cohort study in Kisumu, Kenya.

We determined the prevalence of four sexually transmitted infections and the demographic and behavioural correlates associated with having one or more sexually transmitted infections among participants in an HIV incidence cohort study in Kisumu, western Kenya. Participants were enrolled from a convenience sample and underwent aetiologic sexually transmitted infection investigation. Demographic and behavioural information were collected and basic clinical evaluation performed. Multiple regression analysis was done to determine variables associated with having one or more sexually transmitted infections. We screened 846, 18- to 34-year-olds. One-third had at least one sexually transmitted infection with specific prevalence being: syphilis, 1.6%; gonorrhoea, 2.4%; herpes simplex virus type-2, 29.1%; chlamydia, 2.8%; and HIV, 14.8%. Odds of having any sexually transmitted infection were higher among participants who were women, were aged 20-24 or 30-34 years compared to 18-19 years, had secondary or lower education compared to tertiary education, were divorced, widowed or separated compared to singles, reported having unprotected sex compared to those who did not, reported previous sexually transmitted infection treatment, and tested HIV-positive. Multiple strategies are needed to address the overall high prevalence of sexually transmitted infections as well as the gender disparity found in this Kenyan population. Structural interventions may be beneficial in addressing educational and socio-economic barriers, and increasing the uptake of health-promoting practices.

The association between the body mass index of first-year female university students and their weight-related perceptions and practices, psychological health, physical activity and other physical health indicators.

OBJECTIVE: To investigate the association between the weight status of first-year female students (FYFS) and various weight management-related characteristics to identify possible components of a weight management programme for students. DESIGN: Cross-sectional study. SETTING: Female residences at a South African university. SUBJECTS: A total of 360 FYFS. RESULTS: Mean (+/-standard deviation (SD)) body mass index (BMI) of the FYFS was 21.8 +/- 2.6 kg m(-2), with 7.2% being underweight, 81.9% normal-weight, 10.0% overweight and 0.8% obese. Underweight, normal-weight and overweight students differed with regard to their perception of their weight (P < 0.001), weight goals (P < 0.001) and previous weight-loss practices (P < 0.001). Mean+/-SD score on the 26-item Eating Attitudes Test (EAT-26) was 8.5 +/- 9.0 with 8.4% classified as high scorers. Mean+/-SD score on the 34-item Body Shape Questionnaire (BSQ) was 87.7 +/- 32.2, with 76.1% classified as low, 11.9% as medium and 11.9% as high scorers. The self-concept questionnaire indicated that 36.7% had a high, 43.9% a medium and 19.4% a low self-concept. Higher BMI correlated with a higher BSQ score (P < 0.001), a lower self-concept (P = 0.029) and a higher EAT-26 score (P < 0.001). Smoking was prevalent amongst 13.1% of students, and 51.2% used vitamin and/or mineral supplements. Students who quitted smoking had higher (P = 0.006) BMI (22.7 +/- 2.9 kg m(-2)) than those who never smoked before (21.6 +/- 2.5 kg m(-2)). Normal-weight students were more physically active than underweight or overweight students (P = 0.038). CONCLUSIONS: The specific weight management-related needs of FYFS include information about supplement use, smoking, realistic weight goals, safe and sound weight-loss methods, weight cycling, body-shape perceptions, eating attitudes and behaviours, self-concept and physical activity. Interventions aimed at correcting these problems should target all students, regardless of their BMI.