Perceived Food Insecurity, Dietary Quality, and Unfavorable Food Intake among Children and Adolescents from Economically Disadvantaged Households.

Few studies have investigated food security, dietary quality, or unfavorable food intake through self-reports among children and adolescents in Asia. This study assessed the association of perceived food insecurity with dietary quality and unfavorable food intake among 1111 children and 538 adolescents from economically disadvantaged families in Taiwan. Food security status was collected by a validated questionnaire. Dietary quality was examined using a dietary diversity score (DDS). Unfavorable food intake was defined as fried food, bread/cake/pastries, sugar-sweetened beverages, and biscuits/chips. Food-insecure participants had lower DDS, whole grains and protein-rich food intake than food-secure participants. Furthermore, food-insecure children had a higher frequency of unfavorable food consumption. The level of children's food insecurity was inversely associated with DDS (ß: -0.047, 95% CI: -0.085 to -0.009) but positively with bread/pastry (ß: 0.103, 95% CI: 0.022-0.184) and sugar-sweetened beverages (ß: 0.117, 95% CI: 0.018-0.215) intake. Adolescents who reported food insecurity and not enough money for household expenses had an odds ratio of 2.85 (95% CI: 1.15-7.10) for poor DDS relative to their food-secure and financially able counterparts. We recommended that health policy needs to include diversifying food and nutrition education for vulnerable children and adolescents to improve dietary quality.

Higher maternal autonomy is associated with reduced child stunting in Malawi.

Child undernutrition is a major health problem in Malawi. We assessed the association between maternal autonomy and child stunting in Malawi. We utilized nationally representative pooled cross-sectional data from the 2010 and 2015/16 Malawi Demographic and Health Surveys (MDHS), which included 7348 mother (28.1 ± 6.8 years, range 15-49 years)-child (27.6 ± 16.7 months, range 0-59 months) pairs. Maternal autonomy composite scores captured decision-making power, tolerance of domestic violence, and financial independence. The nutritional outcome measure was stunting (height-for-age z score < - 2). Logistic regression assessed associations between maternal autonomy and stunting, and dominance analysis evaluated the relative importance of the associated factors. From the two surveys combined, 39.2% were stunted. Stunting decreased from 45.0% in 2010 to 34.6% in 2015/16; concurrently, maternal autonomy improved and was evidently associated with stunting (aOR = 0.81, 95% CI = 0.71, 0.93; p = 0.002). However, this association was probably mediated by other factors associated with improved child nutrition, including maternal education and family wealth, which, along with child age, were associated with stunting in the dominance analysis. Concurrent interventional programs may also have contributed to the decrease in stunting between the surveys, thus moderating the effect of maternal autonomy.

After-school nutrition education programme improves eating behaviour in economically disadvantaged adolescents.

OBJECTIVE: To investigate whether an after-school nutrition education (ASNE) programme can improve the nutrition knowledge and healthy eating behaviour of adolescents from economically disadvantaged families. DESIGN: One-group pretest and posttest design. Nutrition knowledge and dietary intake were collected using a questionnaire, and anthropometric measurements were measured before and after the intervention. Nine components of healthy eating behaviour were assessed with reference to the Dietary Guideline of Taiwan. Pretest and posttest differences were analysed using generalised estimating equations. SETTING: Three after-school programmes in central and southern Taiwan. The ASNE programme comprised three monthly 1-h sessions (20-30-min lecture and 30-40-min interaction). PARTICIPANTS: A total of 153 adolescents aged 10-15 years from economically disadvantaged families (seventy-eight elementary students and seventy-five junior high school students). RESULTS: Elementary and junior high school students' nutrition knowledge scores (range 0-6) increased by 0·28 (+ 5·7 %, P = 0·02) and 0·30 points (+ 6·18 %, P = 0·02), respectively, but their fruit intake decreased by 0·36 serving/d (-22·9 %, P = 0·02) and 0·29 serving/d (-18·9 %, P = 0·03), respectively. Junior high school students' mean snacking frequency and fried food intake dropped to 0·75 d/week (-21·3 %, P = 0·008) and 0·10 serving/d (-28·8 %, P = 0·01), respectively. CONCLUSIONS: Short-term ASNE programmes can increase nutrition knowledge and reduce snacking frequency and fried food intake despite a decrease in fruit intake among adolescents from economically disadvantaged families.

Dietary exposure assessment of methylmercury and polyunsaturated fatty acids in saltwater fish and processed foods among Taiwanese women of child-bearing age and children: A novel core food-matching approach.

Saltwater fish is rich in health-promoting polyunsaturated fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Excessive fish intake may also cause health hazards due to methylmercury (MeHg). A novel dose estimation method was proposed in this study to improve the quality of food matching by considering the usage ratio of cooking and processing methods in sampling design. In total, 39 table-ready samples were specified according to 2-3 common cooking methods, and MeHg and total mercury (THg) were analyzed. The results showed that mercury was detected in 20 samples (LOD = 0.01 µg/g). High MeHg samples included fried-Spanish mackerel (1.23 µg/g), non-cooked shredded swordfish (0.325 µg/g), pan-fried Spanish mackerel (0.248 µg/g), and non-cooked shredded salmon (0.208 µg/g). Consumption data (n = 166,911) were obtained from 24-h recalls in the 2005-2008 Nutrition and Health Surveys in Taiwan (NAHSIT). The average whole-group estimated daily intake (EDI_WG) was 0.018 (7.9% tolerable daily intake, TDI) for women of child-bearing age and 0.031 µg/day per kg body weight (13.6% TDI) for children. However, 95th percentile values (P95) of 90.4% TDI and 185% TDI were estimated for the two consumer-only populations, which have raised public health concerns. The ratio of % TDI to % daily reference intake (% DRI) was used as a risk-benefit (R/B) indicator. The top 4 R/B foods were: tuna sashimi (0.089 and 0.14), non-cooked shredded swordfish (0.033 and 0.052), fried-Spanish mackerel (0.027 and 0.043) and deep-fried fish balls (0.022 and 0.035) in the two perspective populations.

What natural and social scientists need from each other for effective marine environmental assessment: Insights from collaborative research on the Tomakomai CCS Demonstration Project.

We propose actions to guide collaboration between 'natural' and 'social' science disciplines in marine environmental issues. Despite enthusiasm for interdisciplinarity on environmental issues, institutional and disciplinary barriers remain for interdisciplinary working in practice. This paper explores what natural and social scientists need from each other for more effective impact assessment in the marine environment. We reflect on collaboration between natural- (especially marine biology) and social scientists (especially environmental sociology) researching the Tomakomai CCS Demonstration Project in Japan; including subsequent expansion of the research team and wider evaluation of project outcomes. We identify two areas of mutual support: community and stakeholder engagement on marine monitoring; and identification of points in regulatory/policy processes where qualitative findings may gain traction alongside quantitative results. We suggest interdisciplinary collaboration for marine environmental research could be helped by making time to learn from each other within projects; and by working together more closely in the field.

Secular trend towards ultra-processed food consumption and expenditure compromises dietary quality among Taiwanese adolescents.

OBJECTIVE: To compare two Nutrition and Health Surveys in Taiwan (NAHSITs) 15-18 years apart to evaluate secular changes in ultra-processed food (UPF) consumption and expenditure among Taiwanese adolescents aged 16-18 years and the influences of such changes on dietary quality. DESIGN: This cross-sectional study was based on two representative surveys (NAHSIT 1993-1996, n = 788; NAHSIT 2011, n = 1,274) of senior high school students. Dietary information and food expenditure were based on 24-h dietary recall. All food items were classified into original foods, processed culinary ingredients, processed foods, and UPFs based on NOVA criteria. Dietary quality was categorized as poor or good based on the mean of the Youth Healthy Eating Index-Taiwan Revised. RESULTS: Compared to 1993-1996, adolescents consumed less energy from original foods (55 vs. 39%) but more from processed foods (12 vs. 18%) and UPFs (21 vs. 25%) in 2011, with no apparent gender differences. Those who consumed more UPFs had the lowest proportions of protein energy intake in both surveys (13.7 and 13.1%). Those who consumed more UPFs had higher levels of saturated fat and lower levels of monounsaturated and polyunsaturated fat, dietary fiber, and micronutrient intakes. The participants who consumed more UPFs and fewer original foods exhibited poorer dietary quality. Boys and girls exhibited equal UPF expenditure in both surveys despite an increase in UPF energy consumption. The adjusted odds ratios (95% confidence interval) were 1.33 (1.16-1.52) and 1.36 (1.10-1.69) for the risk of poor dietary quality with 10% increases in UPF energy intake and expenditure, respectively, in 2011. CONCLUSIONS: UPF energy consumption among Taiwanese adolescents increased between 1993-1996 and 2011. Observed trends in expenditure suggest that lower UPF costs influenced food choices during this period. Increasing UPF intake and expenditure was associated with poor dietary quality.

Medical costs of a low skeletal muscle mass are modulated by dietary diversity and physical activity in community-dwelling older Taiwanese: a longitudinal study.

BACKGROUND: Age-related loss of skeletal muscle mass (SMM) and function (sarcopenia) are associated with poor health outcomes and an economic burden on health care services. An appropriate diet and physical activity have been proposed for prevention and treatment of sarcopenia. Nevertheless, the effects on medical service utilization and costs remain unclear. This study determined the effects of SMM in conjunction with diet quality and physical activity on medical service utilization and expenditure in community-dwelling older Taiwanese. METHODS: In total, 1337 participants from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were enrolled. An SMM index [SMMI, calculated by dividing SMM (kg) by height (m2)] was used as the marker of sarcopenia. Participants with the lowest SMMI quartiles (<11.4 kg/m2 for men and 8.50 kg/m2 for women) comprised the high-risk group, and the remainder comprised the low-risk group. Dietary information (dietary diversity: low and high) and physical activity (low and moderate) were obtained at baseline. Annual medical service utilization and expenditure were calculated from National Health Insurance claims until December 31, 2006. Generalized linear models were used to determine the association between the SMMI and annual medical service utilization and costs in conjunction with dietary diversity or physical activity. RESULTS: After 8 follow-up years, regardless of gender, participants in the high-risk group reported significantly more hospitalization (days and expenditure) and total medical expenditure. Participants in the high-risk group who had low dietary diversity made fewer annual outpatient (14%), preventive care (19%), and dental (40%) visits, but exhibited longer hospitalization (102%) than did those who had a low SMMI and high dietary diversity. Similar patterns were observed in the corresponding medical expenditures. The findings were similar when considering physical activity. Being in the low-risk group in conjunction with having high dietary diversity or more physical activity was associated with the lowest annual adjusted mean hospitalization days with expenditure, and also total expenditure. CONCLUSIONS: A lower SMMI was associated with more hospitalization days and costs. However, high dietary diversity and more physical activity can attenuate the effects of lower SMMI on medical service utilization and expenditure.

Elderly Taiwanese who spend more on fruits and vegetables and less on animal-derived foods use less medical services and incur lower medical costs.

A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated with lower risks of all-cause-, cancer- and CVD-related mortalities. However, the association between consumption patterns and medical costs remains unclear. The effects of various food group costs on medical service utilisation and costs were investigated. The study cohort was recruited through the Elderly Nutrition and Health Survey in Taiwan between 1999 and 2000 and followed-up for 8 years until 2006. It comprised free-living elderly participants who provided a 24-h dietary recall. Daily energy-adjusted food group costs were estimated. Annual medical service utilisation and costs for 1445 participants aged 65-79 years were calculated from the National Health Insurance claim data. Generalised linear models were used to appraise the associations between the food group costs and medical service utilisation and costs. Older adults with the highest F&V cost tertile had significantly fewer hospital days (30%) and total medical costs (19%), whereas those in the highest animal-derived group had a higher number of hospital days (28%) and costs (83%) as well as total medical costs (38%). Participants in the high F&V and low animal-derived cost groups had the shortest annual hospitalisation stays (5·78 d) and lowest costs (NT$38,600) as well as the lowest total medical costs (NT$75,800), a mean annual saving of NT$45 200/person. Older adults who spend more on F&V and less on animal-derived foods have a reduced medical-care system burden. This provides opportunities for nutritionally related healthcare system investment strategies.

Internal consistency of the traditional Chinese character version of the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N).

BACKGROUND: This study investigated the internal consistency of the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) translated version in traditional Chinese characters (TChi). The FACT-H&N quality of life instrument is composed of the FACT-General (FACT-G) assessing four primary areas of well-being (physical, social/family, emotional, and functional) and 11 additional items specific to H&N cancer patients. METHODS: Two hundred and three patients with H&N cancer were recruited at a medical center in northwestern Taiwan. All completed the TChi FACT-H&N along with demographic and clinical questionnaires written in traditional Chinese characters. Several psychometric properties of the TChi FACT-H&N were examined, including Cronbach's alpha coefficients. RESULTS: Most of the 203 enrolled patients were men (78%). The median age was 52.5 years (range 23-81 years) and the median number of years of education was 9. All patients had a Karnofsky score of 70 or higher. The results showed that the TChi FACT-H&N scales demonstrated acceptable internal consistency. Translation of the physical and functional concepts was most straightforward. Translation of emotional items, however, posed some difficulties. The social/family well-being subscale was problematic, as expected, based upon observations of cultural differences in social values and functioning. We also noted that concerns about hearing were different between patients with nasopharyngeal carcinoma (NPC) and those with other H&N cancers. CONCLUSION: The TChi FACT-H&N is reliable. Items related to problems with hearing should be added to better evaluate the quality of life in patients with NPC.

The opportunities and challenges of evidence-based nutrition (EBN) in the Asia Pacific region: clinical practice and policy-setting.

Evidence-based nutrition (EBN) has gained currency as part of the growing role of evidence-based medicine (EBM) to increase the validity, utility and cost-effectiveness of both clinical practice and, increasingly, public health endeavours. Nutritionally-related disorders and diseases (NRD) account for a relatively large proportion of the burden of ill-health, disease and mortality, especially as the nexus between them and both infectious disease and so-called chronic disease is understood. As resource allocation is increasingly dependent on the evidence for preventive or therapeutic effect, the case for nutrition interventions also needs to be underpinned by evidence. However, feeding studies are not as amenable to the designs familiar to clinical trialists and dietary interventions in public health may be complex in their conduct and interpretation, making other approaches like cohort studies more attractive even if costly and long in the execution. With a number of food system changes in rapid progress or imminent, especially in the populous Asia Pacific region, along with changing demographics, changing disease patterns and concern about present and future food security, a stock-take and scenario analysis of EBN was undertaken by a panel of nutrition scientists, population scientists, agriculturalists, clinicians and policy makers together with consumer and indigenous stake-holders in Taiwan in 2007. They found that clinical practice guidelines and proposals for health and nutrition policies required greater emphasis and expertise in EBN.