Household-level dietary quality indicator for countries in nutritional transition: application to vulnerable communities in El Salvador.

OBJECTIVE: To develop a household-level diet quality indicator (HDQI) using the Salvadorian dietary guidelines to assess the dietary quality of households in vulnerable communities in El Salvador. DESIGN: The Salvadorian dietary guidelines were reviewed and eighteen HDQI components were identified (nine foods and nine nutrients). The components were evaluated using a proportional scoring system from 0 to 1, penalizing over- and under-consumption, where appropriate. The HDQI was validated in consultations with experts in El Salvador and by statistical analyses of the study sample data. Dietary variety and energy, nutrient and food intakes were compared among households above and below the median HDQI score using Student's t test. SETTING: Vulnerable, border communities in El Salvador. SUBJECTS: Households (n 140) provided food consumption information using an FFQ and sociodemographic data. RESULTS: The mean HDQI score was 63·5, ranging from 43·6 to 90·0. The indicator showed a positive, significant association with the dietary variety components. The statistical associations of the indicator with the energy and nutrient components were as expected. CONCLUSIONS: Based on the indicator's demonstrated face validity and the results of the expert consultations, the indicator is suggested as a good measure of diet quality for households in El Salvador.

Cultural Influences on the Regulation of Energy Intake and Obesity: A Qualitative Study Comparing Food Customs and Attitudes to Eating in Adults from France and the United States.

(1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews (n = 10) or focus groups (n = 15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were: (1) influence of commensality, social interactions, and pleasure from eating on eating behavior, (2) having a balanced and holistic approach to nutrition, (3) the role of environmental concerns in food consumption, (4) relationship with "natural" products (idealized) and food processing (demonized), (5) perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the U.S., while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered "natural" where idealized and juxtaposed against processed and "industrial" products, whereas this was not a salient aspect in the U.S. (4) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations.

Different and Unequal: A Qualitative Evaluation of Salient Factors Influencing Energy Intake in Adults with Overweight and Obesity.

Environmental factors such as food availability and variety can function as cues for overeating in individuals susceptible to overweight or obesity, but relatively little is known about other types of environmental factors that may also be important. This qualitative study compared and contrasted categories of internal and external cues through focus groups and key informant interviews with 24 adults (26 to 77 years old) in the United States who had a body mass index within the healthy range (21.6 ± 2.5 kg/m2) or had overweight or obesity (29.1 ± 3.6 kg/m2). Five domains of external factors influencing food intake were identified: (a) Environmental cues including food availability and variety; (b) normative expectations for dietary intake; (c) food palatability; (d) overt social pressures to overeat; and (e) perceived social expectations around eating. All external domains were noted by participants with overweight or obesity to be challenging, and solutions to avoid overeating were lacking; however, overt social pressures and perceived social expectations appeared to be especially problematic. By explicitly defining different domains of external factors that challenge healthy weight regulation, this study identifies specific targets to address in interventions for healthy weight management.

Talking to patients about food insecurity.

Food insecurity is highly prevalent in the United States. Even in the best of times, some 10% of the U.S. population self-reports food insecurity in the U.S. annual census instrument, and some 23.3 million Americans use the community-based emergency food system. Unemployed or underemployed individuals, the elderly, single parents, substance abusers, and uninsured or underinsured individuals with medical illnesses are at increased risk for food insecurity. This article discusses clinical approaches to food-insecure individuals. Measurement tools developed to define and document the extent of hunger and food insecurity in the U.S. population are presented as templates for discussion between doctor or dietitian and patient. Information is provided to help clinicians guide patients with food insecurity to appropriate resources.

Dietary intake changes associated with post-cyclone food aid in Western Samoa.

This study examines dietary intake responses to a food aid program in Western Samoa, which consisted primarily of rice and flour supplements. Using a semi-quantitative food frequency questionnaire, intake estimates were made for 147 Samoans (72 men, 75 women), 5 months before and 8 months after a tropical cyclone. Study participants were from urban Apia (n = 34) and three rural, more traditional villages (n = 113). For the total sample, consumption of rice and pancakes more than doubled, and the contribution of these foods to total carbohydrate and kilocalorie intake increased approximately three-fold (p < 0.0001, for paired t-tests). Significant decreases were noted for the nutrient contribution from breadfruit and coconut products. These dietary changes were significantly less in the urban sub-sample. These results indicate the food aid may have accelerated an existing modernizing trend in the diet of Samoans. The nutritional and economic implications are discussed within the context of Western Samoa.

Perceived access and actual intake of healthy diets among households in vulnerable Salvadoran communities.

OBJECTIVE: This study aimed to examine the dietary intake of Salvadoran households according to perceived access to healthy meals (PAHD), and to identify household characteristics associated with diet quality and PAHD. METHODS: Secondary data analysis with a sample of 139 Salvadoran households from resource-poor communities in El Salvador. Chi-square tests and ANOVA were used to assess differences in dietary intake across households classified according to PAHD. RESULTS: High-PAHD households had higher women's education, household food security levels, overall diet quality, and variety, and higher intakes of animal products, fats, cholesterol, vitamin C, and sodium (P < .05). Diet quality was not associated with the household characteristics studied. CONCLUSIONS AND IMPLICATIONS: Overall diet quality was associated with higher levels of PAHD, but some differences in intakes were not as expected, such as higher intakes in foods and nutrients associated with low-quality diets, among high PAHD households.

An observer study for a computer-aided reading protocol (CARP) in the screening environment for digital mammography.

RATIONALE AND OBJECTIVES: The aims of this study were to investigate improving work flow efficiency by shortening the reading time of digital mammograms using a computer-aided reading protocol (CARP) in the screening environment and to increase detection sensitivity using CARP, compared to the current protocol, commonly referred to as the quadrant view (QV). MATERIALS AND METHODS: A total of 200 cases were selected for a receiver-operating characteristic (ROC) study to evaluate two image display work flows, CARP and QV, in the screening environment. A Web-based tool was developed for scoring, reporting, and statistical analysis. Cases were scored for and stratified by difficulty. A total of six radiologists of differing levels of training ranging from dedicated mammographers to senior radiology residents participated. Each was timed while interpreting the 200 cases in groups of 50, first using QV and then, after a washout period, using CARP. The data were analyzed using ROC and κ analysis. Interpretation times were also assessed. RESULTS: Using QV, readers' average area under the ROC curve was 0.68 (range, 0.54-0.73). Using CARP, readers' average area under the ROC curve was 0.71 (range, 0.66-0.75). There was no statistically significant difference in reader performance using either work flow. However, there was a statistically significant reduction in the average interpretation time of negative cases from 64.7 seconds using QV to 58.8 seconds using CARP. CONCLUSIONS: CARP determines the display order of regions of interest depending on computer-aided detection findings. This is a variation of traditional computer-aided detection for digital mammography that has the potential to reduce interpretation times of studies with negative findings without significantly affecting sensitivity, thus allowing improved work flow efficiency in the screening environment, in which, in most settings, the majority of cases are negative.

¿Se considera la alimentación saludable parte de la seguridad alimentaria y nutricional?: perspectivas desde comunidades pobres de El Salvador / Is healthy eating part of food and nutrition security?: Perspectives from poor communities in El Salvador

Antecedentes: la definición de la seguridad alimentaria y nutricional (SAN) incluye la importancia de la calidad nutricional de los alimentos además de la suficiencia. Sin embargo, aún existe un énfasis en el aspecto de la suficiencia, incluso en contextos con crecientes problemas relacionados con sobrealimentación. Objetivos: describir estrategias locales para el manejo de la alimentación en la escasez de recursos; documentar perspectivas sobre la SAN en comunidades vulnerables; evaluar enlaces conceptuales entre la SAN y la alimentación saludable en estas comunidades, y comparar las definiciones locales acerca de la SAN con la política nacional sobre la SAN. Materiales y métodos: investigación cualitativa utilizando grupos focales, entrevistas informales y observaciones no estructuradas, seguida por codificación y análisis. Resultados y conclusiones: los participantes definieron la SAN como ''asegurar'' los alimentos (disponibilidad e inocuidad, incluyendo modo de producción y procesamiento de alimentos). Hubo desacuerdo entre los participantes sobre la conexión entre la SAN y la alimentación saludable. Se encontraron áreas de concordancia y desacuerdo entre la percepción local sobre la SAN y la política nacional. Es necesario entender cómo las concepciones locales evolucionan dado cambios en los alimentos disponibles localmente y la capacidad adquisitiva de poblaciones vulnerables.

Background: the definition of food and nutrition security (FNS) includes the importance of the nutritional quality of foods other than sufficiency. However, there is still an emphasis on sufficiency, even in settings with increasing problems relating to overeating. Objectives: (1) describe local coping strategies in times of resource scarcity; (2) document perspectives related to FNS in vulnerable communities; (3) evaluate the conceptual links between FNS and healthy eating in these communities and (4) compare local FNS definitions to the national discourse found in the FNS national policy. Materials and methods: qualitative research using focus groups, informal interviews and unstructured observations, followed by analytic coding. Results and conclusions: participants defined FNS as ''securing'' the food (availability and food safety, including concerns over food production and processing methods). There was disagreement among the participants regarding the connection between FNS and healthy eating. Areas of agreement and disagreement between the local discourse on national politics and SAN were found. More information is needed on how local conceptions evolve in the light of changes in the types of food available and accessible locally for vulnerable populations.