Examining the Prevalence, Nutritional Quality and Marketing of Foods with Voluntary Nutrient Additions in the Canadian Food Supply.

Foods with voluntary nutritional additions are a fast-growing sector of the global food industry. In Canada, while the addition of nutrients to foods has been regulated through fortification regulations, parallel policies which aim to encourage product innovation have also allowed for the voluntary addition of nutrients and other novel ingredients to 'supplemented' and 'functional' foods. Concerns have been raised that the consumption of these products may have negative repercussions on population health, such as high nutrient intakes inappropriate for certain population subgroups (e.g., children) and the shifting of dietary patterns to include more unhealthy foods. The aim of this study was to evaluate the prevalence, nutritional quality, and marketing characteristics of foods with added nutrients in the Canadian market. We found many nutritionally-enhanced foods contained high levels of nutrients beyond recommended intakes, despite these nutrients having no evidence of inadequacy in the Canadian population. Additionally, a large proportion of foods with added nutrients had poor nutrient profiles (were deemed 'less healthy' than their non-enhanced counterparts) and carried heavy marketing on their labels, regardless of their nutritional quality. Taken together these findings raise concerns about foods with voluntary nutrient additions and suggest the need to further investigate consumer attitudes and decision-making towards these foods.

A Food Insecurity Systematic Review: Experience from Malaysia.

Living free from hunger is a basic human right. However, some communities still experience household food insecurity. This systematic literature review explored different aspects of household food insecurity in Malaysia including vulnerable groups, prevalence, risk factors, coping strategies, and the consequences of food insecurity. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Thirty-three relevant articles were selected from scientific databases such as CINAHL, Pubmed and Google Scholar, scrutiny of reference lists, and personal communication with experts in the field. The prevalence of household food insecurity in Malaysia was unexpectedly reported as high, with affected groups including Orang Asli, low-income household/welfare-recipient households, university students, and the elderly. Demographic risk factors and socioeconomic characteristics included larger household, living in poverty, and low education. Coping strategies were practices to increase the accessibility of food in their households. Consequences of household food insecurity included psychological, dietary (macro- and micronutrient intakes), nutritional status, and health impacts. In conclusion, this review confirmed that household food insecurity in Malaysia continues to exist. Nevertheless, extensive and active investigations are encouraged to obtain a more holistic and comprehensive picture pertaining to household food security in Malaysia.

The Retail Food Environment, Store Foods, and Diet and Health among Indigenous Populations: a Scoping Review.

PURPOSE OF THE REVIEW: Describe the state of knowledge on how the retail food environment contributes to diet-related health and obesity among Indigenous populations, and assess how the literature incorporates Indigenous perspectives, methodologies and engagement throughout the research process. Outcomes included dietary behaviour (purchasing, intakes and diet quality) and diet-related health outcomes (weight-related outcomes, non-communicable diseases and holistic health or definitions of health as defined by Indigenous populations involved in the study). RECENT FINDINGS: Of fifty included articles (1996-2019), the largest proportions described Indigenous communities in Canada (20 studies, 40%), the USA (16, 32%) and Australia (9, 18%). Among articles that specified the Indigenous population of focus (42 studies, 84%), the largest proportion (11 studies, 26%) took place in Inuit communities, followed by Aboriginal and Torres Strait Islander communities (8 studies, 19%). The included literature encompassed four main study designs: type A, dietary intakes of store foods (14 studies, 28%), and type B, store food environments (16, 32%), comprised the greatest proportion of articles; the remainder were type C, store food environments and diet (7, 14%), and type D, store food environment interventions (13, 26%). Of the studies that assessed diet or health outcomes (36, 72%), 22 (61%) assessed dietary intakes; 16 (44%) sales/purchasing; and 8 (22%) weight-related outcomes. Store foods tended to contribute the greatest amount of dietary energy to the diets of Indigenous peoples and increased non-communicable disease risk as compared to traditional foods. Multi-pronged interventions appeared to have positive impacts on dietary behaviours, food purchasing and nutrition knowledge; promotion and nutrition education alone had more mixed effects. Of the nine studies which were found to have strong engagement with Indigenous populations, eight had moderate or high methodological quality. Eighteen studies (36%) did not mention any engagement with Indigenous populations. The literature confirmed the importance of store foods to the total energy intake of the contemporary diets of Indigenous people, the gaps in accessing both retail food environments and traditional foods and the potential for both new dietary assessment research and retail food environment intervention strategies to better align with and privilege Indigenous Ways of Knowing.

Dietary Diversity among Chinese Residents during the COVID-19 Outbreak and Its Associated Factors.

COVID-19, a Public Health Emergency of International Concern, has imposed enormous challenges on the health system, economy, and food supply and has substantially modified people's lifestyles. This study aimed to (1) explore the dietary diversity during the lockdown time in China and (2) examine factors associated with dietary diversity including socio-economic characteristics, sources for food and food purchases, and specific dietary behaviors responding to COVID-19 and isolation. A cross-sectional questionnaire-based survey was conducted online in March 2020. Multi-stage sampling was used to recruit participants living in Hubei Province and other parts of China. Dietary diversity was assessed using the Household Dietary Diversity Score (HDDS) and clustering analysis was used to categorize people with different propensities of methods for purchasing or obtaining foods. Logistic regression was used to model the associations among HDDS, participants' characteristics, approaches to purchase or obtain food, and behaviors adopted to cope with COVID-19. Results: A total of 1938 participants were included in the analysis. The overall mean HDDS was 9.7 ± 2.1, and the median (25th, 75th) was 10 (8, 12). There were relatively low consumptions of fish, legumes, and miscellaneous foods (e.g., processed food like snacks and beverages). After adjusting for age, family income, and geographic regions, people living in places where laboratory confirmed COVID-19 cases were above 500 (ORadjusted = 0.79, 95%CI 0.65, 0.96), or living in Hubei Province (ORadjusted = 0.60, 95%CI 0.39, 0.93) had a lower HDDS. During isolation time, the most common sources for food and food purchases were in-house storage and in person grocery shopping. More than half of the participants (55.9%) purchased food at least once via online ordering and delivery services. There was no significant difference in HDDS among people with distinct dependences on different ways to obtain or purchase food (i.e., dependence on in-person grocery shopping, dependence on both in-house storage and in-person grocery shopping, or dependence on online food purchasing). We also identified a total of 37.7% participants who consumed certain foods or nutritional supplements to cope with COVID-19, which included vitamin C, probiotics, other dietary supplements, alcohol, and vinegar. People who reported these specific dietary behaviors had a significantly higher HDDS (ORadjusted = 1.23, 95%CI 1.02, 1.45) than those who did not do so. This study revealed an overall good dietary diversity among the studied Chinese residents during the COVID-19 pandemic. However, we observed a lower dietary diversity among people living in areas with a high number of confirmed COVID-19 cases. Online ordering and delivery services were popular and could serve as a feasible method to obtain and purchase food, contributing to ensure diversified diets during the time of lockdown. Certain dietary behaviors associated with COVID-19 were also identified and had significant impacts on HDDS.

Are the nutrient and textural properties of Australian commercial infant and toddler foods consistent with infant feeding advice?

Infant feeding guidelines worldwide recommend first foods to be Fe rich with no added sugars and that nutrient-poor discretionary foods are to be avoided. Feeding guidelines also recommend exposing infants to a variety of foods and flavours with increasingly complex textures. Here, we compare nutritional and textural properties of commercial infant and toddler foods available in Australia with established infant feeding guidelines. Nutrition information and ingredient lists were obtained from food labels, manufacturer and/or retailer websites. In total, 414 foods were identified, comprising mostly mixed main dishes, fruit and vegetable first foods and snacks. Most products were poor sources of Fe, and 80 % of first foods were fruit-based. Half of all products were purées in squeeze pouches, and one-third of all products were discretionary foods. The nutritional content of many products was inconsistent with guidelines, being low in Fe, sweet, smooth in consistency or classified as discretionary. Reformulation of products is warranted to improve Fe content, particularly in mixed main dishes, expand the range of vegetable-only foods and textural variety. Greater regulatory oversight may be needed to better inform parents and caregivers. Frequent consumption of commercial baby foods low in Fe may increase the risk of Fe deficiency. Excessive consumption of purées via squeeze pouches may also have implications for overweight and obesity risk.

Basic social resource needs screening in the gynecologic oncology clinic: a quality improvement initiative.

BACKGROUND: Social determinants of health are known to contribute to disparities in health outcomes. Routine screening for basic social needs is not a part of standard care; however, the association of those needs with increased healthcare utilization and poor compliance with guideline-directed care is well established. OBJECTIVE: In this study, we aimed to assess the prevalence of basic social resource needs identified through a quality improvement initiative in a gynecologic oncology outpatient clinic. In addition, we aimed to identify clinical and demographic factors associated with having basic social resource needs. STUDY DESIGN: We performed a prospective cohort study of women presenting to a gynecologic oncology clinic at an urban academic institution who were screened for basic social resource needs as part of a quality improvement initiative from July 2017 to May 2018. The following 8 domains of resource needs were assessed: food insecurity, housing insecurity, utility needs, financial strain, transportation, childcare, household items, and difficulty reading hospital materials. Women with needs were referred to resources to address those needs. Demographic and clinical information were collected for each patient. The prevalence of needs and successful follow-up interventions were calculated. Patient factors independently associated with having at least 1 basic social resource need were identified using multivariable Poisson regression. RESULTS: A total of 752 women were screened in the study period, of whom 274 (36%) reported 1 or more basic social resource need, with a median of 1 (range, 1-7) need. Financial strain was the most commonly reported need (171 of 752, 23%), followed by transportation (119 of 752, 16%), difficulty reading hospital materials (54 of 752, 7%), housing insecurity (31 of 752, 4%), food insecurity (28 of 752, 4%), household items (22 of 752, 3%), childcare (15 of 752, 2%), and utility needs (13 of 752, 2%). On multivariable analysis, independent factors associated with having at least 1 basic social resource need were being single, divorced or widowed, nonwhite race, current smoker, nonprivate insurance, and a history of anxiety or depression. A total of 36 of 274 (13%) women who screened positive requested assistance and were referred to resources to address those needs. Of the 36 women, 25 (69%) successfully accessed a resource or felt equipped to address their needs, 9 (25%) could not be reached despite repeated attempts, and 2 (6%) declined assistance. CONCLUSION: Basic social resource needs are prevalent in women presenting to an urban academic gynecologic oncology clinic and can be identified and addressed through routine screening. To help mitigate ongoing disparities in this population, screening for and addressing basic social resource needs should be incorporated into routine comprehensive care in gynecologic oncology clinics.

Nutritional adequacy and content of food bank parcels in Oxfordshire, UK: a comparative analysis of independent and organisational provision.

BACKGROUND: Food bank use has increased significantly in the UK. With the rise in demand, it is imperative that users are receiving food parcels that meet their requirements. The present study aimed to explore whether typical food parcels, supplied by The Trussell Trust and independent food banks, were meeting the daily nutrient and energy requirements of an adult user. METHODS: The Trussell Trust (n = 2) and independent food banks (n = 9) were surveyed in Oxfordshire, UK. Data were collected on food bank use, resources, donations and parcel content. The energy and nutrient contents of a representative parcel were compared with the average dietary reference values (DRVs) for an adult. Additional comparisons were made between The Trussell Trust and independent provision. RESULTS: Parcels provided energy, carbohydrate, sugar, protein and fibre contents that significantly exceeded the DRVs. In total, 62.2% of energy was provided as carbohydrate and 569% of the DRV was provided by sugars. The vitamin D and retinol content of the parcels was significantly lower than the DRVs, meeting 25% and 27% of users' needs respectively; provision of all other micronutrients exceeded the DRVs. The Trussell Trust's parcels provided significantly less vitamin D and copper than independent parcels. CONCLUSIONS: Food bank parcels distributed in Oxfordshire, UK, exceeded energy requirements and provided disproportionately high sugar and carbohydrate and inadequate vitamin A and vitamin D compared to the UK guidelines. Improved links with distributors and access to cold food storage facilities would help to address these issues, via increased fresh food provision.

How the Smart Food Concept Can Lead to the Transformation of Food Systems and Combat Malnutrition: Different Approaches in Africa, Globally, and a Case Study from Myanmar with Lessons Learnt for Creating Behavior Change in Diets.

Some of the biggest global issues are poor diets, environmental concerns, and poverty. To tackle malnutrition, fast-growing lifestyle diseases such as diabetes, environmental concerns like climate change, land and water scarcity, and poverty, we need to incorporate dietary and on-farm diversity. These issues should be treated in unison, but also with more holistic solutions. Mainstreaming "traditional" Smart Foods back as staples across Africa and Asia is part of the "Smart Food" approach. Smart Foods are food items that fulfill the criteria of being good for you, the planet, and the farmer. Sorghum and millet were selected as the first Smart Foods and a participatory fun-filled approach was adopted to create awareness, to develop culturally acceptable products, and to bring about behavior change to improve adoption, dietary diversity, and nutritional status. Smart Food piloted these activities in Myanmar to understand its potential on the consumer market. Smart Food was promoted in different countries through social media competitions in Mali, cooking shows in Kenya and India, recipe development by popular chefs in Paris and London, as well as school feeding programs in Tanzania and India, and an international millet festival in Niger. As a case study in Myanmar, we compared two approaches to introduce Smart Food - one which directly introduces new products and one which takes a culturally sensitive participatory and inclusive approach. The later approach resulted in the development of 27 recipes, in contrast with the former approach, which accepted only 3 of the 13 products tested. The 27 products developed locally exhibited superior nutrient values compared to usual rice porridge. The Smart Food initiative is demonstrating the potential to make a difference in society and for the environment, thus contributing to a major impact on leading global issues such as dietary diversity, improved nutritional status, and adapting to climate change.

New Evaluation of Isoflavone Exposure in the French Population.

The study relates the present evaluation of exposure to estrogenic isoflavones of French consumers through two approaches: (1) identification of the isoflavone sources in the French food offering, (2) a consumption-survey on premenopausal women. For the foodstuff approach 150 food-items were analysed for genistein and daidzein. Additionally, 12,707 labels of processed-foods from French supermarket websites and a restaurant-supplier website were screened, and 1616 foodstuffs of interest were retained. The sources of phytoestrogens considered were soy, pea, broad bean and lupine. A price analysis was performed. A total of 270 premenopausal women from the French metropolitan territory were interviewed for their global diet habits and soy consumption and perception. In supermarkets, there were significantly less selected foodstuffs containing soy than in restaurant (11.76% vs. 25.71%, p < 0.01). There was significantly more soy in low price-foodstuff in supermarket (p < 0.01). Isoflavone levels ranged from 81 to 123,871 µg per portion of the analyzed soy containing foodstuff. Among the women inquired 46.3% claimed to have soy regularly. Isoflavone intake >45 mg/day is associated to vegan-diet (p < 0.01). In total, 11.9% of soy-consumers had a calculated isoflavone intake >50 mg/day. This dose can lengthen the menstrual cycles. The actual exposure to phytoestrogen is likely to have an effect in a part of the French population.

"We have a roof over our head, but we have to eat too:" Exploring shifting foodscapes from homelessness into Housing First in Kingston, Ontario.

BACKGROUND: People facing extended periods of homelessness exhibit a remarkable degree of agency and resilience in procuring food. The literature on foodscapes considers the sociospatial contexts of food procurement, finding that what happens within and along the way to sites of food acquisition and consumption are important considerations in fully understanding and realizing food security. PURPOSE: This study explores the shift in foodscapes of people who are transitioning from homelessness into scattered-site independent housing via a municipal Housing First program and considers implications for health and wellbeing. METHODS: Our mixed-method approach included observational research at 11 local food providers and drop-in centres that provided context for semi-structured interviews with 10 Housing First clients in Kingston, Ontario between November 2016 and March 2017. RESULTS: The findings confirm that the provision of stable housing makes it possible for people to store, prepare, and consume food at home. An increased ability to have control over when, where, and what is eaten had a positive impact on people's sense of health and wellbeing. However, other effective markers of wellbeing were enacted along people's everyday routines and activities that had negative impacts. Interviewees remained heavily dependent on charitable food programs, including increased use of foodbanks. Others reported increasing detachment and social isolation from previously established food routines. Finally, the structured transition perpetuated a circuit of dependence and marginalization that fell short of contributing to improved food security as well as health and wellbeing. IMPLICATIONS: Understanding the relational geography of foodscape transitions is critical to the design of effective Housing First programs. Addressing the root causes of homelessness and poverty requires investments in comprehensive housing strategies including adequate social assistance and community supports that take a sociospatially holistic approach to wellbeing.

Influence of Food Security Status and Anemia-Related Knowledge on Perceptions About 2 Nutritious Underutilized Foods Among Ghanaian Caregivers.

BACKGROUND: Nutritious underutilized foods (NUFs) significantly contribute to sustainable dietary diversity but are often unused for many reasons. OBJECTIVE: We assessed the influence of food security status (FSS) and anemia-related knowledge (ARK) on perceptions about Solanum torvum (turkey berry) and Rhynchophorus phoenicis Fabricius (palm weevil larvae) among Ghanaian caregivers. METHODS: A cross-sectional survey was conducted among 891 caregivers (aged 20-49 years), who have children 6 to 59 months old, from Upper Manya Krobo district (Eastern region), Kumasi metropolitan (Ashanti region), Ho municipality (Volta region), La-Nkwantanang-Madina, and Ga West municipality (Greater-Accra region), Ghana. Food security status, ARK, and perceptions about the 2 NUFs were obtained using pretested semi-structured questionnaire. Logistic regression models were used to determine effect of FSS and ARK on perception outcomes. RESULTS: Thirty-six percent of caregivers were food secure, while 13.9%, 28.4%, and 21.7%, respectively, were mildly, moderately, and severely food insecure. Most caregivers (62.0%) scored above 70% on ARK. High favorable perception was significantly lower for palm weevil larvae than that for turkey berry. Food secure caregivers were 4.5 times more likely to have poor favorable perceptions about palm weevil larvae than food insecure caregivers (P = .03). However, food secure caregivers were 2.9 times more likely to have high favorable perceptions about turkey berry than food insecure caregivers (P < .001). Caregivers' knowledge about anemia was associated with high favorable perception about turkey berry by 3.3-fold (95% confidence interval: 2-5.5, P = .001). CONCLUSIONS: Nutrition education about turkey berry and palm weevil larvae is needed to encourage their use for promoting nutrient density of complementary and household foods.

A cross-disciplinary mixed-method approach to understand how food retail environment transformations influence food choice and intake among the urban poor: Experiences from Vietnam.

Nutrition insecurity among urban poor in modernizing Asian metropolises is a critical issue. It is well recognized that in urban Asia the poor are food insecure. Across Asia the food retail environment is transforming rapidly, in which supermarkets increasingly replace traditional food vending, like markets and street vendors that the urban poor depend upon. The question is, how these transformations impact the diets of the urban poor? What drives their food choice? What are their daily shopping practices and how does that affect their dietary intake? To investigate this, we developed a cross-disciplinary nutrition and social practices study with a sequential quantitative-qualitative mixed-method design. Building on empirical evidence from Hanoi, Vietnam, the study links (i) food choice and measured dietary intake, with (ii) food retail environment, through (iii) food shopping practices and preferences of 400 women of reproductive age within the context of (iv) their transformative urban lifestyles. Methods included are a retail census with GPS coordinates to map the food retail environment, a household survey, a 24-h diet recall, multi-generation household interviews and shopping trips. We demonstrate that integrated sociological and nutritional perspectives are productive in rapidly generating evidence to comprehend the complex trade-offs between food safety and nutrition in everyday food consumption practices. We describe and reflect on our theoretical mix of dietary intake and social practices research, and our holistic mixed method approach which besides combining quantitative and qualitative methods, also voices the urban poor first hand.

Under nutrition, maternal anemia and household food insecurity are risk factors of anemia among preschool aged children in Menz Gera Midir district, Eastern Amhara, Ethiopia: a community based cross-sectional study.

BACKGROUND: In Ethiopian, the prevalence of anemia among preschool aged children widely varied across regions. Since anemia adversely affects the cognitive and physical development of the children, it is important to determine its burden for implementing appropriate measurements. Therefore, this study was aimed at determining the anemia prevalence and associated factors among preschool aged children. METHOD: A community based cross-sectional study was conducted on a total of 432 preschool children in Menz Gera Midir district from January to May, 2017. A multi stage sampling procedure was applied to select the target groups. Hemocue analyzer for Haemoglobin determination; anthropometric measurements for assessment nutritional status, structured questionnaires for socio-demographic and economic variables were used for data collection. The morphological appearance of red blood cell was assessed microscopically to determine type of anemia. Descriptive statistics were employed to summarize the data and binary logistic regression was used for inferential statistics. A p value less than 0.05 was considered as statistically significant. RESULT: The overall prevalence of anemia was 123 (28.5%); of which 38 (30.9%) and 85 (69.1%) were moderate and mild, respectively. Morphologically about 50.4, 37.4 and 12.2% were microcytic hypochromic, normocytic normochromic and macrocytic anemias, respectively. Child age 6-11 months (COR: 5.67, 95% CI: 2.2, 14.86), child age 12-23 months (COR: 5.8, 95% CI: 2.3, 14.7), wasting (COR: 3.5, 95% CI: 1.2, 9.8), stunting (COR: 3.8, 95% CI: 1.92, 7.77), underweight (COR: 2.12, 95% CI: 1.07, 4.38), MUAC measurement below 13 cm (COR: 5.6, 95% CI: 2.83, 11.15), household headed by female (COR: 3.24, 95% CI: 1.1, 9.63), maternal anemia (COR: 4, 95% CI: 2.2, 7.23) and household food insecurity (COR: 2.12, 95% CI: 1.09, 4.12) were significantly associated with anemia. CONCLUSION: The prevalence of anemia among the children was found to be high and associated with child age group, child nutritional status, house hold headed by female, maternal anemia and household food insecurity. Further studies on nutritional anemia, community based nutritional education, iron supplementation to children at risk should be promoted.

Perceptions of agrodiversity and seed-saving practices in the northern Andes of Ecuador.

BACKGROUND: As concerns about agrodiversity loss and its impact on food security increase, interest in seed-saving practices and motivations has risen, especially in regions characterized by ancestral farming. Agroecology practitioners in the northern Andes of Ecuador (n = 65) participated in this study to describe (1) the dynamics of intergenerational agrodiversity, (2) perceptions of relevance of the crops they grow, (3) criteria for characterizing the differences between conventional and non-conventional seeds, and (4) their seed-saving practices. METHODS: This exploratory study incorporated a community-based participatory research approach using mixed methods. We conducted (1) a timeline mapping for exploring the dynamics of intergenerational agrodiversity and (2) structured interviews to explore the perception of relevance of crops grown to identify criteria for characterizing conventional and non-conventional seeds and for identifying seed-saving practices. We computed ranks and frequencies from free listing data derived from the interviews to detect the most salient patterns for crop diversity and seed-saving practices. A principal component analysis was performed to illustrate crops distribution within the study area. RESULTS AND DISCUSSION: Based on the timeline-mapping tool, we found that participants perceive an intergenerational loss of agrodiversity. Data derived from free listing determined that salient crops differ in each location of the study area, mostly due to geographic (altitude, climate), market factors, and crop management limitations. Responses from open-ended interview questions revealed that farmers discriminate conventional from non-conventional seeds using yield, adaptation to local conditions, pest tolerance, taste, and crop management as criteria. Analysis of free listing data determined that the most salient reported practices related to seed saving were soil fertility management, seed selection, safe seed storage, tilling and rowing, and weeding. CONCLUSIONS: This study contributes to raising awareness of intergenerational agrodiversity loss and replacement with modern crops. We found the relevance of crops and practices is subject to cultural and environmental context, and few agricultural practices are exclusively used for seed saving. Further, farmers clearly discriminate conventional from non-conventional seeds based on advantages and disadvantages, cultural motivation, and produce destination. The community-based participatory approach resulted in positive engagement from participants and promoted commitment from farmers to preserve agrodiversity and support practices at the community level.

Social and economic barriers to adherence among patients at Livingstone General Hospital in Zambia.

BACKGROUND:  Zambia is one of the countries hardest hit by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic with a national HIV prevalence estimated at 14% among those aged 15-49 years in 2012. Antiretroviral therapy (ART) has been available in public health facilities in Zambia since 2003. By early 2016, 65% of the 1.2 million Zambians living with HIV were accessing ART. While access to ART has improved the lives of people living with HIV globally, the lack of adherence to ART is a major challenge to treatment success globally. AIM:  This article reports on social and economic barriers to ART adherence among HIV patients being attended to at Livingstone General Hospital in Zambia. SETTING:  Livingstone General Hospital is located in the Southern province of Zambia, and had over 7000 patients enrolled for HIV care of whom 3880 patients were on ART. METHODS:  An explorative, qualitative study was conducted with 42 patients on ART where data were collected through six focus group discussions (3 male and 3 female groups) and seven in-depth interviews. Data were audio-recorded and transcribed verbatim and subjected to thematic content analysis. RESULTS:  Economic factors such as poverty and unemployment and the lack of food were reported as major barriers to adherence. Furthermore, social factors such as traditional medicine, religion, lack of family and partner support, and disclosure were also reported as critical barriers to adherence to ART. CONCLUSION:  Interventions to improve adherence among ART patients should aim to redress the socio-economic challenges at community and individual levels.

Inter-brand competition in the convenience store industry, store density and healthcare utilization.

We investigate the impact of access to convenience stores and competition between convenience store chains on the use of medical care in Taiwan. Using insurance claims from 0.85 million individuals and administrative data on store sales, we find that greater store density and more inter-brand competition reduced expenditures on outpatient medical services and prescription drugs. In support of these findings, we demonstrate that convenience store competition was associated with greater consumption of healthy foods and lower obesity rates. Our estimates suggest that the rise in convenience store competition from 2002 to 2012 reduced outpatient expenditures in Taiwan by 0.44 percent and prescription drug expenditures by 0.85 percent.

Anaemia among adolescent girls in three districts in Ethiopia.

BACKGROUND: Adolescence is characterized by rapid growth and development with a significantly increased need for macro and micronutrients. However, there is little empirical evidence on the burden of anaemia among adolescent girls in developing countries such as Ethiopia. This study aims to address this gap by evaluating the magnitude of anaemia with an aim to guide design of intervention modalities to address anaemia among adolescent girls. METHODS: The study employed a community based cross sectional design. The study was conducted on weekends to capture both in school and out of school adolescent girls. Data was collected from a total 1323 adolescent girls. From each district, we randomly selected villages and ensured that the sampled households had a range geographical spread (lowlands, highlands) within the larger category of rural and urban. We performed anaemia testing using HemoCue B-Haemoglobin analyser. We applied a complex survey data analysis method to estimate the level of anaemia. The hemoglobin level was adjusted for altitude and smoking status. We ran a logistic regression model to evaluate predictors of anaemia. RESULTS: The overall anaemia prevalence ranged from 24 to 38%, with an average rate of 29%. Less than half of the girls heard the term anaemia, and about one third knew the relationship between anaemia and the intake of iron rich foods. The risk of anaemia is higher among adolescent girls in their early adolescence period (10-14 years) (Adjusted Odds Ratio (AOR); 1.98; 95% CI; 1.03, 3.82] and among adolescent girls who lived in moderately food insecure households (AOR 1.48; 95% CI; 1.05-2.09). However, knowing the term "anaemia" was found to be protective against the risk of anaemia. CONCLUSIONS: The risk of anaemia was particularly high among adolescent girls in their early age and among those living in food insecure households. The prevalence of anaemia among adolescent girls is a moderate public health problem. According to the WHO set criteria, the districts could be candidates for intermittent iron and Folic acid supplementation program.

Hospitals lead by poor example: An assessment of snacks, soda, and junk food availability in Veterans Affairs hospitals.

OBJECTIVE: The Veterans Health Administration is the largest integrated health care system fully funded through the US government; however, compliance with government dietary recommendations within Veterans Affairs (VA) hospitals is not well known. The aim of this study was to determine which foods are available at VA hospitals and whether these foods comply with government recommendations. METHODS: Process verification for a Freedom of Information Act request was used to assess government-run inpatient and outpatient VA hospital facilities by accessing the location, quantity, and contents of vending machines. These foods and beverages were then quantified and compared with the US Department of Agriculture Dietary Guidelines for Americans 2015-2020 (eighth edition). RESULTS: Of the beverages supplied, 49% contained >55 g of sugar, supplying >10% of daily calories in added sugar in a single serving. Of all beverages, 50% contained >50 g of added sugar (range 17-77 g per bottle/can). The 65 available food items were comprised of 28% candy, 14% potato chips/puffed corn snacks, 11% pastries/frosted baked goods, 11% crackles/pretzels, and 8% nuts/trail mix, and the remainder consisted of jerky, pork rinds, gum, and popcorn. Nuts/trail mix and granola-items meeting nutritional guidelines-comprised five and three options in total, respectfully. CONCLUSIONS: All VA Hospitals contain vending machines providing a majority of soda, candy, and junk foods that directly conflict with healthy food choice recommendations from US governing health bodies. Few sources meeting US dietary guidelines are available in vending machines at these government-run facilities, which serve as poor examples for patients who are attempting to follow a healthy diet.

Caribou (Rangifer tarandus) and Inuit Nutrition Security in Canada.

Caribou (Rangifer tarandus) has been fundamental to the diet and culture of Arctic Indigenous Peoples for thousands of years. Although caribou populations observe natural cycles of abundance and scarcity, several caribou herds across the Circumpolar North have experienced dramatic declines in recent decades due to a range of interrelated factors. Broadly, the objectives of this study are to examine food and nutrition security in relation to wildlife population and management status across Inuit Nunangat (the Inuit homeland, consisting of four regions across the Canadian Arctic). Specifically, we: (1) characterize the contribution of caribou to Inuit nutrition across northern Canada and (2) evaluate the population and management status of caribou herds/populations harvested by Inuit. Dietary data were derived from the 2007-2008 Inuit Health Survey, which included dietary information for Inuit adults (n = 2097) residing in thirty-six communities, spanning three regions (the Inuvialuit Settlement Region, Nunavut, and Nunatsiavut) of the Canadian North. Published information regarding the range, abundance, status, and management status of caribou herds/populations was collected through document analysis and was validated through consultation with northern wildlife experts (territorial governments, co-management, and/or Inuit organizations). While caribou contributed modestly to total diet energy (3-11% of intake) across the regions, it was the primary source of iron (14-37%), zinc (18-41%), copper (12-39%), riboflavin (15-39%), and vitamin B12 (27-52%), as well as a top source of protein (13-35%). Restrictions on Inuit subsistence harvest (harvest quotas or bans) are currently enacted on at least six northern caribou herds/populations with potential consequences for country food access for over twenty-five Inuit communities across Canada. A holistic multi-sectorial approach is needed to ensure the sustainability of wildlife populations, while supporting Inuit food and nutrition security in the interim.