Primary Immunodeficiency Diseases and Gastrointestinal Distress: Coping Strategies and Dietary Experiences to Relieve Symptoms.

In this article, we focus on adults with primary immunodeficiency disease (PID) and their experiences with gastrointestinal (GI) distress with the aim of exploring how they experience living with their condition and the actions they take to relieve GI distress. Twelve adults with PID and GI distress participated in semi-structured, in-depth interviews. The interviews were analyzed following the steps of thematic analysis (TA). The study revealed the complexity of the psychosocial aspects of living with PID and GI distress. Participants experienced GI distress to be highly challenging in daily life and felt they had to cope with the condition alone, without adequate help from the health care service. Participants used a wide and diverse range of coping strategies, and the search for normalcy was evident. Health care professionals should be more proactive in supporting individuals with PID in their struggle to find solutions to problems arising from GI distress.

Prevalence and factors associated with early initiation of breastfeeding among women in Moshi municipal, northern Tanzania.

BACKGROUND: Early initiation of breastfeeding (EIBF) is a predetermining factor for exclusive breastfeeding, and thus a foundation for optimal breastfeeding practices. Rates of EIBF are low globally (42%) and in Tanzania (51%), yet few studies have been done on this issue in Tanzania. This study aimed to determine the prevalence and factors associated with early initiation of breastfeeding among women in northern Tanzania. METHODOLOGY: This study extracted information from a cohort of 536 women who were followed from 3rd trimester period October 2013 to December 2015 in Moshi municipal, northern Tanzania. The data for this paper was collected by the use of questionnaires at enrolment, delivery and 7 days after delivery. The analysis is based on data from 413 women for whom complete information was obtained. Log binomial regression analysis was used to determine factors associated with early initiation of breastfeeding. RESULTS: The prevalence of EIBF was 83%. Overall, women had high knowledge on colostrum (94%), knowledge on exclusive breastfeeding (81%) and time of breastfeeding initiation (71%), but only 54% were counseled on breastfeeding during antenatal care. Knowledge on timely initiation of breastfeeding during pregnancy and vaginal delivery were associated with EIBF. CONCLUSION: Early initiation of breastfeeding is high (83%) in Moshi Municipal but still below the universal coverage recommended by WHO and UNICEF. There is missed opportunity by health facilities to counsel and support early initiation of breastfeeding given high antenatal and facility delivery in this setting. There is a need to evaluate health facility bottle necks to optimal support of early initiation of breastfeeding in Tanzania.

"We give water or porridge, but we don't really know what the child wants:" a qualitative study on women's perceptions and practises regarding exclusive breastfeeding in Kilimanjaro region, Tanzania.

BACKGROUND: World Health Organization (WHO) recommends exclusive breastfeeding (EBF) as the optimal way to feed infants below 6 months of age. The benefits of EBF are well documented. However, in Tanzania, EBF is still rarely practised. This study explored the knowledge, attitudes and practises of EBF among mothers in Kilimanjaro region of northern Tanzania. METHODS: This is a qualitative research study. The three districts in Kilimanjaro region namely Same, Moshi Municipal Council and Rombo districts were selected. In each district, three focus group discussions (FGDs) with mothers of infants aged 0-12 months were conducted. A total of 78 mothers participated in the focus group discussion. RESULTS: The main result is that most of the mothers had a theoretical knowledge of the benefits of EBF but were not able to practise this knowledge for a range of reasons. The reasons for not practising EBF in real life included poor maternal nutrition, the pressure for women to return to work, inadequate knowledge about expressing breast milk, and perceived insufficiency of milk supply. Additionally, mothers received conflicting advice from a range of sources including close relatives, community members and health care providers, and they often choose the advice of their elders. Mothers also offered suggestions on ways to improve EBF including educating the community on the benefits of EBF. CONCLUSION: The results show that the women need support from close relatives and employers to successfully practise EBF. This presents a need for involving close relatives in EBF interventions, as they are important sources of breastfeeding information in the community. Additionally, behavioural interventions that promote optimal breastfeeding practises might help to improve exclusive breastfeeding.

Women's work in farming, child feeding practices and nutritional status among under-five children in rural Rukwa, Tanzania.

Some progress has been achieved in reducing the prevalence of undernutrition among children under 5 years of age in Tanzania. In the Rukwa region (2010), the level of stunted and underweight children was 50·4 and 13·5 %, respectively. The aim of this study was to assess the nutritional status of children under 5 years of age, feeding practices and risk factors of undernutrition in a rural village in the Rukwa region, as well as to discuss the results in light of a similar study conducted in 1987/1988. This cross-sectional study was conducted in 152 households with children under 5 years of age. Data were obtained from the child's main caretaker and the household head, using a structured questionnaire and a 24 h dietary recall. Children's length/height and weight were measured. The prevalence of stunting and underweight was found to be 63·8 and 33·6 % (Z-score<-2 of WHO 2006 CGS), respectively. Sugar-water was given to 72·3 % of the children on the first day after birth. A thin gruel was introduced after a median of 2 months (25th-75th percentiles; 1-3). The time mothers spent farming was a significant risk factor for stunting (P=0·04). Illness, food shortage and dry-season cultivation were significant risk factors for underweight (P<0·01). Using the NCHS/WHO 1983 growth reference (<75 % of the median), the prevalence of underweight was 25·0 %, similar to that reported in 1987/1988 (26·4 %). In conclusion, the underweight prevalence was found to be at the same level in 2010 as was recorded in 1987/1988. Current child-feeding practices were not in line with WHO recommendations. Women working in farms, food shortage, dry-season cultivation and diseases partly explain the children's poor nutritional status.

Meal types as sources for intakes of fruits, vegetables, fish and whole grains among Norwegian adults.

OBJECTIVE: To study how different meals contribute to intakes of fruits, vegetables, fish and whole grains in a group of Norwegian adults and in subgroups of this population. Moreover, to investigate the consequences of skipping the meal contributing most to the intake of each food group (main contributing meal). DESIGN: Cross-sectional dietary survey in Norwegian adults. Dietary data were collected using two non-consecutive telephone-administered 24 h recalls. The recorded meal types were breakfast, lunch, dinner, supper/evening meal and snacks. SETTING: Nationwide, Norway (2010-2011). SUBJECTS: Adults aged 18-70 years (n 1787). RESULTS: Dinner was the main contributing meal for fish and vegetables, while snacks were the main contributing meal for fruit intake. For whole grains, breakfast was the main contributing meal. The main contributing meal did not change for any of the food groups when studying subgroups of the participants according to intake of each food group, educational level or age. A substantially lower intake of the food groups in question was found on days when the main contributing meal was skipped. CONCLUSIONS: Intakes of fruits, vegetables, fish and whole grains largely depend on one meal type. Inclusion of these foods in other meals in addition to the main contributing meal, preferably replacing energy-dense nutrient-poor foods, should be promoted.

The contribution of snacks to dietary intake and their association with eating location among Norwegian adults - results from a cross-sectional dietary survey.

BACKGROUND: Snack consumption has been reported to increase over recent decades. Little is known about possible associations between snack composition and snack eating location. In the present study, we aimed to describe the contribution of snacks to dietary intake in Norwegian adults and to investigate whether the composition of snacks differed according to where they were eaten. METHODS: Dietary data were collected in 2010 and 2011 using two telephone administered 24 h recalls about four weeks apart. In total, 1787 participants aged 18-70 years completed two recalls. The recorded eating locations were at home, other private household, work/school, restaurant/cafe/fast-food outlet and travel/meeting. RESULTS: Snacks contributed to 17% and 21% of the energy intake in men and women, respectively. Compared with main meals, snacks had a higher fiber density (g/MJ) and contained a higher percentage of energy from carbohydrates, added sugars and alcohol, while the percentages of energy from fat and protein were lower. The top five energy-contributing food groups from snacks were cakes, fruits, sugar/sweets, bread and alcoholic beverages. Snacks were mostly eaten at home (58% of all snacks) or at work/school (23% of all snacks). Snacks consumed at work/school contained less energy, had a higher percentage of energy from carbohydrates and had lower percentages of energy from added sugars, alcohol and fat than snacks consumed at home. Snacks consumed during visits to private households and at restaurants/cafe/fast-food outlets contained more energy, had a higher percentage of energy from fat and had a lower fiber density than snacks consumed at home. CONCLUSIONS: We conclude that snacks are an important part of the diet and involve the consumption of both favorable and less favorable foods. Snacks eaten at home or at work/school were generally healthier than snacks consumed during visits to other private households or at restaurants/cafe/fast-food outlets. Nutritional educators should recommend healthy snack options and raise awareness of the association between eating location and snack composition.

Eating location is associated with the nutritional quality of the diet in Norwegian adults.

OBJECTIVE: To study the association between dinner eating location and the nutritional quality of the specific dinner meal and the whole-day dietary intake and to compare the diets of those consuming ≥25% of energy out of home and at school/work (SOH; substantial out-of-home eaters) with those consuming <25% of energy out (NSOH; non-substantial out-of-home eaters). DESIGN: Cross-sectional dietary survey using two non-consecutive 24 h recalls. Recorded eating locations were at home, other private households, work/school, restaurant/cafeteria/fast-food outlet and travel/meeting. SETTING: Nationwide, Norway (2010-2011). SUBJECTS: Adults aged 18-70 years (n 1746). RESULTS: Dinners at restaurants and other private households were higher in energy than home dinners (P < 0.01). Restaurant dinners contained less fibre (g/MJ; P < 0.01) and had a higher percentage of alcohol consumers (P < 0.05), while dinners at other private households had a higher percentage of energy from sugar (P < 0.001) and a higher percentage of consumers of sugar-sweetened beverages (P < 0.05) than home dinners. Most differences between dinners consumed at different eating locations were also observed in dietary intakes for the whole day. SOH-eaters had a higher energy intake (P < 0.01), a higher percentage of energy from sugar (P < 0.01) and a lower fibre intake (P < 0.01) than NSOH-eaters. The percentages of consumers of alcohol and sugar-sweetened beverages were higher (P < 0.01) among SOH-eaters. CONCLUSIONS: Dinner eating location was significantly associated with the nutritional quality of the diet, both for the specific dinner meal and for whole-day intake. Our data generally point to healthier dinners being consumed at home. SOH-eaters had a less favourable dietary intake than NSOH-eaters.

Abscess infections and malnutrition--a cross-sectional study of polydrug addicts in Oslo, Norway.

BACKGROUND: Injection drug use and malnutrition are widespread among polydrug addicts in Oslo, Norway, but little is known about the frequency of abscess infections and possible relations to malnutrition. OBJECTIVES: To assess the prevalence of abscess infections, and differences in nutritional status between drug addicts with or without abscess infections. DESIGN: A cross-sectional study of 195 polydrug addicts encompassing interview of demographics, dietary recall, anthropometric measurements and biochemical analyses. All respondents were under the influence of illicit drugs and were not participating in any drug treatment or rehabilitation program at the time of investigation. RESULTS: Abscess infections were reported by 25% of the respondents, 19% of the men and 33% of the women (p = 0.025). Underweight (BMI < 18.5 kg/m(2)) was significantly more prevalent in the abscess infected than in the non-abscess-infected group (p = 0.001). The abscess-infected addicts reported fewer meals, lower intakes of fruits and vegetables, lower energy percentage (E%) from protein and higher E% from sugar. They also had lower total intakes of vitamins D, B1, B6, B12, folic acid and vitamin C than the non-abscess-infected group. The two groups differed significantly with respect to S-C-peptide (p = 0.042) and B-HbA1c (p = 0.012), and the prevalence of hyperhomocysteinemia (P-tHCY > 15 µmol/L) was 73% in the abscess-infected group and 41% in the non-abscess-infected group (p = 0.001). The concentrations of S-25-hydroxy-vitamin D3 was very low. CONCLUSION: The prevalence of abscess infections was 25% among the examined polydrug addicts. Dietary, anthropometric and biochemical assessment indicated a relation between abscess infections and malnutrition.

The InnvaDiab-DE-PLAN study: a randomised controlled trial with a culturally adapted education programme improved the risk profile for type 2 diabetes in Pakistani immigrant women.

The objective of the present study was to explore whether a culturally adapted lifestyle education programme would improve the risk factor profile for type 2 diabetes (T2D) and the metabolic syndrome (MetS) among Pakistani immigrant women in Oslo, Norway. The randomised controlled trial (the InnvaDiab study), lasting 7 ± 1 months, comprised six educational sessions about blood glucose, physical activity and diet. Participants (age 25-62 years) were randomised into either a control (n 97) or an intervention (n 101) group. Primary outcome variables were fasting and 2 h blood glucose, and secondary outcome variables were fasting levels of insulin, C-peptide, lipids, glycated Hb, BMI, waist circumference and blood pressure, measured 1-3 weeks before and after the intervention. During the intervention period, the mean fasting blood glucose decreased by 0·16 (95 % CI -0·27, -0·05) mmol/l in the intervention group, and remained unchanged in the control group (difference between the groups, P=0·022). Glucose concentration 2 h after the oral glucose tolerance test decreased by 0·53 (95 % CI -0·84, -0·21) mmol/l in the intervention group, but not significantly more than in the control group. A larger reduction in fasting insulin was observed in the intervention group than in the control group (between-group difference, P= 0·036). Among the individuals who attended four or more of the educational sessions (n 59), we found a more pronounced decrease in serum TAG (-0·1 (95 % CI -0·24, 0·07) mmol/l) and BMI (-0·48 (95 % CI -0·78, -0·18) kg/m²) compared with the control group. During the intervention period, there was a significant increase in participants having the MetS in the control group (from 41 to 57 %), which was not seen in the intervention group (from 44 to 42 %). Participation in a culturally adapted education programme may improve risk factors for T2D and prevent the development of the MetS in Pakistani immigrant women.

Maintenance of changes in food intake and motivation for healthy eating among Norwegian-Pakistani women participating in a culturally adapted intervention.

OBJECTIVE: To investigate maintenance of changes in food intake and motivation for healthy eating at follow-up 2 data collection after a lifestyle intervention among Pakistani immigrant women. DESIGN: A culturally adapted lifestyle intervention, aiming at reducing the risk of type 2 diabetes mellitus. Data collection including FFQ and questions on intentions to change dietary behaviour was completed at baseline, right after the 7 ± 1 month intervention (follow-up 1) and 2-3 years after baseline (follow-up 2). SETTING: Oslo, Norway. SUBJECTS: Pakistani women (n =198), aged 25-60 years, randomized into control and intervention groups. RESULTS: From follow-up 1 to follow-up 2 there was a shift from action to maintenance stages for intention to reduce fat intake (P < 0.001), change type of fat (P = 0.001), increase vegetable intake (P < 0.001) and reduce sugar intake (P = 0.003) in the intervention group. The reduction in intakes of soft drinks with sugar, fruit drinks with sugar and red meats, and the increase in intakes of vegetables and fish from baseline to follow-up 1 were maintained (significant change from baseline) at follow-up 2 in the intervention group. The intake of vegetables was higher (P = 0.019) and the intake of fruit drinks with sugar lower (P = 0.023) in the intervention group compared with the control group at follow-up 2. CONCLUSIONS: The culturally adapted intervention had the potential of affecting intentions to change food behaviour among Pakistani immigrant women long after completion of the intervention and also of leading to long-term maintenance of beneficial changes in diet.

Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs): a qualitative systematic review using the Consolidated Framework for Implementation Research (CFIR).

BACKGROUND: Low- and middle-income countries (LMICs) are particularly vulnerable to the double burden of malnutrition: co-existence of underweight, overweight, obesity, and/or diet-related non-communicable diseases. Nutrition-related double-duty actions in school settings have been identified as one of the ways to address this challenge. However, to be able to take full advantage of the potential impact, it is important to understand their implementation as well. The aim of this paper is to systematically review qualitative research on barriers and facilitators to the implementation of nutrition-related actions in the school settings in LMICs. METHODS: The following databases were searched: EMBASE, ERIC, MEDLINE, Global Health and PsycInfo (all on Ovid), Scopus (Elsevier), the Web of Science Social Sciences Citation Index, and Global Index Medicus from the World Health Organization. Of the 4253 identified records, 4030 were excluded after the abstract and title screen, leaving 223 for the full-text screen. A final 36 papers were included in this review. The consolidated framework for implementation research (CFIR) was used in the analysis. RESULTS: We identified barriers and facilitators to implementation linked to the following CFIR constructs/sub-constructs: design quality and packaging, cost (intervention characteristics); target group needs and resources, cosmopolitanism, external policy and incentives (outer setting); structural characteristics, readiness for implementation (inner setting); knowledge and beliefs (characteristics of individuals) and engaging, executing (process). All identified constructs apart from target group needs and resources, knowledge and beliefs, and engaging were predominantly barriers. Available resources were the most prevalent barriers across studies. CONCLUSION: This review identified barriers and facilitators to the implementation of nutrition-related actions based on qualitative articles in the school setting in LMICs, using the CFIR. Schools face continuous challenges in regard to funding and the government sector may have a role to play not only by offering financial assistance, but also through policy-making that would support healthy eating practices on school grounds. REGISTRATION: PROSPERO ID: CRD42022296159.

Frequent use of staff canteens is associated with unhealthy dietary habits and obesity in a Norwegian adult population.

OBJECTIVE: To explore socio-economic differences in use of staff canteens and whether frequent use of staff canteens is associated with different food patterns and obesity. DESIGN: Cross-sectional study using three self-administered questionnaires, two of them including food frequency questions. Factor analysis was used to explore food patterns. SETTING: Oslo, Norway, 2000-2001. SUBJECTS: In total 8943 adult, working Oslo citizens. RESULTS: Frequent (≥3 times/week) use of staff canteens was most likely among men, younger workers and those in the highest education and income groups. However, after adjustment for demographic, socio-economic and lifestyle factors, those with highest education were least likely to use staff canteens frequently. Frequent eating in staff canteens was positively associated with a Western food pattern (based on fat-rich food, fast food and red meat) and inversely associated with a traditional food pattern (based on boiled potatoes and gravy, and less rice, pasta and oil) in multivariate analyses. Unadjusted, frequent eating in staff canteens was also inversely associated with a prudent food pattern (based on fruit, vegetables, fish, legumes and oil). The likelihood of being obese (BMI ≥ 30 kg/m2) increased significantly with frequent eating in staff canteens, also when adjusted for demographic and socio-economic variables. Adjustment for the food patterns attenuated this relationship, but it was still significant. CONCLUSIONS: Frequent eating in staff canteens was negatively related to socio-economic position and positively associated with unhealthy dietary habits. This partly explained higher odds for obesity among frequent users of staff canteens. Future research should assess the availability and food options of staff canteens.

Body weight, weight perceptions and food intake patterns. A cross-sectional study among male recruits in the Norwegian National Guard.

BACKGROUND: Young men tend to have a low intake of vegetables and fruit. Unfortunately, this group is difficult to reach with health information. Furthermore, knowledge about weight perceptions and the relationship to food behaviour among young men is scant. The purpose of this study was to explore the relationship between BMI, health and weight perceptions and food intake patterns among young men in the military. METHODS: Data were collected with a 4-day food diary among 578 male recruits (age 18-26, mean 19.7) in the Norwegian National Guard (response rate 78%), in addition to a questionnaire, including questions about health and weight perceptions, and food frequency when still living at home. Weight and height were objectively measured. Food patterns were explored with principal component analysis, based on the diary data. A multivariate linear regression analysis determined the association between BMI and food patterns, and attitudes to health and slenderness, adjusting for smoking, physical activity and phase of data collection. RESULTS: Twenty eight percent of the recruits were overweight/obese (BMI > 25 kg/m(2)). Two-thirds meant that it is important for them to be slender, and these recruits reported more of both light (p = 0.025) and hard (p = 0.016) physical activity than the others. It was a positive association between the recruits' food frequency at home, and the amount of intake in the military camp for several food items. A principal component analysis identified three distinct food patterns, loading on 1) plant foods, 2) fast food/soft drinks, 3) milk/cereals. Those who stated that it is important for them to be slender, or to have good health, did not have significantly different food intake patterns than the others. BMI was inversely related to scores on the plant food pattern, and positive attitudes to slenderness. CONCLUSION: The majority of the recruits find it important to be slender. This orientation had a bearing on their physical activity pattern, but less on the food intake pattern. The data also indicate that subjects with high intakes of plant foods were less likely to have a high BMI than others. It is important to raise awareness of healthy eating in young men.

Perceptions of risk factors for diabetes among Norwegian-Pakistani women participating in a culturally adapted intervention.

OBJECTIVE: To explore perceptions of diabetes risk factors among Pakistani immigrant women, as part of their explanatory model of the disease, and the changes in these perceptions after a culturally adapted intervention. DESIGN: Intervention study, carried out in Oslo, Norway, comprising 198 women. RESULTS: At baseline, about 75% of the women perceived sugar to be a risk factor for diabetes, about 30% mentioned physical inactivity and stress and close to 20% mentioned overweight. Twelve per cent could not identify any risk factors. When asked about foods to include in a diet to prevent diabetes, vegetables were mentioned by 45%, while 33% did not know any foods to include. Among those attending ≥60% of the educational sessions, the proportions mentioning little physical activity (p<0.001), overweight (p=0.001) and family history (p=0.007) as risk factors increased. Furthermore, the proportions mentioning legumes (p=0.001), fish (p<0.001), fibre (p=0.035) or vegetables (p=0.015) as important in a diet to prevent diabetes increased, and the proportion not knowing any food to include was reduced to 10% (p=0.004). Except for little physical activity, similar changes in responses were not registered in the control group. CONCLUSIONS: There is a need for improved knowledge about diabetes prevention among Pakistani immigrant women, and a culturally adapted intervention may contribute to this.

The relative importance of socioeconomic indicators in explaining differences in BMI and waist:hip ratio, and the mediating effect of work control, dietary patterns and physical activity.

Socioeconomic differences in overweight are well documented, but most studies have only used one or two indicators of socioeconomic position (SEP). The aim of the present study was to explore the relative importance of indicators of SEP (occupation, education and income) in explaining variation in BMI and waist:hip ratio (WHR), and the mediating effect of work control and lifestyle factors (dietary patterns, smoking and physical activity). The Oslo Health Study, a cross-sectional study, was carried out in 2000-1, Oslo, Norway. Our sample included 9235 adult working Oslo citizens, who attended a health examination and filled in two complementary FFQ with < 20% missing responses to food items. Four dietary patterns were identified through factor analysis, and were named 'modern', 'Western', 'traditional' and 'sweet'. In multivariate models, BMI and WHR were inversely associated with education (P < 0.001/P < 0.001) and occupation (P = 0.002/P < 0.001), whereas there were no significant associations with income or the work control. The 'modern' (P < 0.001) and the 'sweet' (P < 0.001) dietary patterns and physical activity level (P < 0.001) were inversely associated, while the 'Western' dietary pattern (P < 0.001) was positively associated with both BMI and WHR. These lifestyle factors could not fully explain the socioeconomic differences in BMI or WHR. However, together with socioeconomic factors, they explained more of the variation in WHR among men (21%) than among women (7%).

Overweight and weight dissatisfaction related to socio-economic position, integration and dietary indicators among south Asian immigrants in Oslo.

OBJECTIVE: To investigate how socio-economic position, demographic factors, degree of integration and dietary indicators are related to BMI/waist:hip ratio (WHR) and to weight dissatisfaction and slimming among South Asians in Oslo, Norway. DESIGN: Cross-sectional study consisting of a health check including anthropometric measures and two self-administered questionnaires. SETTING: Oslo, Norway. SUBJECTS: Pakistanis and Sri Lankans (n 629), aged 30-60 years, residing in Oslo. RESULTS: BMI was positively associated with female gender (P = 0.004) and Pakistani origin (P < 0.001), and inversely associated with years of education (P = 0.011) and eating more hot meals (P = 0.016). WHR was positively associated with male gender (P < 0.001), age (P < 0.001) and a dietary pattern with high-fat foods (P = 0.005), and inversely associated with degree of integration (measured by a composite index, independent of duration of residence; P = 0.017). One-third of those with normal weight and most of those obese were dissatisfied with their weight. Among these, about 40 % had attempted to slim during the past year. Dissatisfaction with weight was positively associated with education in women (P = 0.006) and with integration in men (P = 0.026), and inversely associated with physical activity (P = 0.044) in men. Women who had made slimming attempts had breakfast and other meals less frequently than others (P < 0.05). CONCLUSIONS: Weight dissatisfaction exists among South Asian immigrants. More research is needed regarding bodily dissatisfaction and the relationship between perception of weight and weight-change attempts among immigrants in Norway, in order to prevent and treat both obesity and eating disorders.

Changes in food habits and motivation for healthy eating among Pakistani women living in Norway: results from the InnvaDiab-DEPLAN study.

OBJECTIVE: Pakistani women in Oslo have high risk of overweight and type 2 diabetes. The objective is to present the effect of an intervention study on Pakistani women's intentions to change dietary behaviour and changes made in dietary intake. DESIGN: The intervention group received culturally adapted lifestyle education, including diet and physical activity. The questionnaire, applied before and after the 7-month intervention, included FFQ and questions on intentions to change. SETTING: Oslo, Norway. SUBJECTS: A total of 198 Pakistani women, aged 25-63 years, randomised into control and intervention groups. RESULTS: There was a shift in distribution of intentions to change the intake of selected foods in the intervention group after the intervention, resulting in significant differences between the groups. The daily intake of vegetables, fruits and fruit juice had increased (P = 0.043), and the intake of red meats (P = 0.001), full fat milk/yoghurt (P = 0.027) and sugar-rich drinks (P

Barriers to healthy eating among Norwegian-Pakistani women participating in a culturally adapted intervention.

AIMS: To explore barriers to healthy dietary changes experienced by Pakistani immigrant women participating in a culturally adapted intervention, and whether these barriers were associated with intentions to change dietary behaviours. METHODS: Participants were randomly assigned to control and intervention group. The 7-month intervention consisted of six educational group sessions on diet and physical activity, based on knowledge about Pakistani lifestyle and focusing on blood glucose control. Data on barriers for and intentions to healthy dietary changes were collected through an interview with help of a questionnaire. The article is based on data from follow-up assessments in the intervention group, comprising 82 women, aged 28-62 years, without a history of type 2 diabetes. RESULTS: The most important barriers to healthy dietary changes were preferences of children and other family members and perceived expectations during social gatherings. The perceived pressure from other family members was especially strong when the women were trying to change to more vegetables, lentils, and fish and to use less oil in food preparation. The barriers were inversely related to intentions to change. CONCLUSIONS: The women encountered various types of barriers when trying to change to healthier food habits, the most prominent being those related to the social dimensions of food consumption, as well as to awareness of the amount of oil used for cooking.

Body size perceptions among Pakistani women in Norway participating in a controlled trial to prevent deterioration of glucose tolerance.

South Asians are prone to diabetes type 2 and cardiovascular diseases, which can be prevented by a diet leading to weight reduction. Body size perceptions may influence compliance to dietary advice. The objective was to study body size perceptions among Pakistani immigrant women in Norway, enrolled in a controlled trial to prevent deterioration of glucose tolerance by focussing on diet and physical activity. Participants (n=198) were 25-62 years of age, 79.8% had BMI > 25 and mean BMI was 29.6. Data were collected by questionnaire interviews with Punjabi/Urdu speaking interviewers, and body weight and height were measured. This article is based on baseline data. Stunkard's Figure Rating Scale was used. The scale consists of nine figures, representing women with different body shapes, from very thin (1-2) to very obese (6-9). The women were asked which body size they thought would connote health and wealth. A significantly smaller body size was related to health (mean 2.9) than to wealth (mean 3.3), p<0.01, and both were smaller than their self-rated own body size (mean 5.7), p<0.01. The women perceived that Pakistanis in Norway prefer women to have a smaller body size (mean 3.4) than people in Pakistan (mean 4.5), but larger than Norwegians (mean 2.5). A discrepancy score was calculated between self-rated own body size and perceived body size preference among Pakistanis in Norway. BMI was positively associated, and level of education negatively associated, with the discrepancy score. The women related body size numbers to BMI similarly to what has been described for US women. In conclusion, body size preferences among Pakistani women in this study were within the range of normal weight. However, there was a large discrepancy between own self-rated body size and the perceived ideal for Pakistanis in Norway.

Association between folate intake from different food sources in Norway and homocysteine status in a dietary intervention among young male adults.

The aim of the present investigation was to study the effect of a dietary intervention which combined nutrition information with increased availability of vegetables, fruits and wholegrain bread. The effect of the intervention was determined by changes in the intake of vegetables, fruits, wholegrain bread and estimated nutrients. Furthermore, the study investigated whether changes in relative contribution from different food sources of folate were related to changes in the concentration of plasma total homocysteine (p-tHcy). The 5-month intervention study included 376 male recruits from the Norwegian National Guard, Vaernes (intervention group) and 105 male recruits from the Norwegian National Guard, Heggelia (control group). The study resulted in an increase in the total consumption of vegetables, fruits, berries and juice (P < 0.001) and of wholegrain bread (P < 0.001). The participants in the intervention group showed a higher increase in the intake of dietary fibre (P < 0.001) and folate (P < 0.001) compared with the control group. The relative contribution of folate intake from fruits, vegetables and wholegrain bread was higher in the intervention group compared with the control group (P < 0.001 for all). The increased intake of folate from wholegrain bread was inversely associated with a reduced concentration of p-tHcy (P = 0.017). In summary, the dietary intervention resulted in an increased intake of vegetables, fruits and wholegrain bread and a subsequent increase in folate intake from these food components. Reduction in the concentration of p-tHcy was significantly related to an increased folate intake due to an increased consumption of wholegrain bread.