Guardians' food literacy and breakfast skipping among Japanese school children.

Children and adolescents who regularly skip breakfast are at a greater risk of obesity than those who regularly eat breakfast. Guardian's food literacy, defined in this study as a collection of a guardian's knowledge, skill, and attitude towards healthy food practices, may directly influence their child's dietary habits. Thus, this study utilized a food literacy scale to assess the relationship between guardians' food literacy and breakfast skipping among school-attending Japanese children and adolescents and the most commonly reported reasons for skipping breakfast. This was a cross-sectional study using survey data collected from a nationally representative sample of households in Japan (n = 1520). Our results show that 13.0% of children self-reported skipping breakfast at least once a week. Children in households where guardians reported higher knowledge and attitude scores had significantly lower odds of skipping breakfast (odds ratios = 0.90 [95% confidence interval: 0.83-0.98] and 0.81 [0.74-0.90], respectively). These findings suggest that a guardian's attitude and knowledge towards healthy food practices influence the frequency at which their child eats breakfast. Moreover, lower parental attitude scores were associated with children skipping due to not having enough time for breakfast in the morning. Improving guardians' food literacy may provide an avenue by which to decrease the rate of breakfast skipping among children and adolescents, thereby decreasing the risk of obesity and other adverse health outcomes.

Successes and challenges to implementing the Fondo de Inclusión Social Energético LPG access Program in Peru: novel insights from front-end implementers.

Background: Household air pollution due to the burning of solid fuels is one of the leading risk factors for disease and mortality worldwide, resulting in an estimated three million deaths annually. Peru's national LPG access program, FISE, aims to reduce the use of biomass fuels and increase access to cleaner fuels for cooking in low-income Peruvian households through public-private partnerships. Perspectives from front-end program implementers are needed to better understand barriers and facilitators to program implementation and to identify strategies to strengthen program reach, uptake, and health impact. Methods: We conducted fourteen 30-60-minute, semi-structured interviews with FISE-authorized LPG vendors (also known as agents) in Puno, Peru from November to December of 2019. Questions focused on barriers and facilitators to program enrollment and participation as an LPG agent, and agents' motivations for participating in the program. Results: Overall, agents expressed satisfaction with the FISE program and a willingness to continue participating in the program. Distance from main cities and the homes of program participants, knowledge of FISE and LPG stoves among community members, cell service, and lack of communication with FISE authorities were cited as barriers to implementation and LPG distribution. Agents' previous experience selling LPG, as well as their social networks and understanding of the health impacts of household air pollution, aided agents in more effectively navigating the system of FISE rules and regulations and in better serving their clients. Many agents were motivated to participate in FISE because they saw it as a service to their community and were willing to find ways to prioritize the needs of beneficiaries. Conclusion: The FISE program provides an example of how a large-scale national program can successfully partner with local private enterprises for program implementation. Building upon the strengths of community-based LPG agents, educating community members on the use and benefits of LPG, incentivizing, and supporting delivery services, and improving communication will be key for increasing program utilization and exclusive use of LPG, and improving health outcomes among Peru's most vulnerable populations.

Retail Purchases of Red and Processed Meat by State in the United States.

The specific aim was to characterize retail purchases of red and processed meat and other major protein-rich foods in the U.S. and by state. Supermarket scanner data from grocery stores, supermarkets, and big box stores collected from 2017-2019 (NielsenIQ, New York, NY) was used to characterize retail purchases of red meat, processed meat, and other protein-rich foods in thirty-one states representative of US retail food sales. Red meat, processed meat, poultry, seafood, eggs, other meats, and non-meat foods (beans, nuts, seeds, meat alternatives) by weight accounted for 25.9%, 20.4%, 25.8%, 5.9%, 12.6%, 1.3%, and 10.1%, respectively of total sales in 2017-2019. Mean per capita purchases of red meat by weight was 30.1 g/d, ranging from 45.4 g/d in Mississippi to 21.9 g/d in New York. Mean per capita purchases of processed meat by weight was 23.8 g/d, ranging from 36.6 g/d in Mississippi to 15.2 g/d in California. We observed statistically significant correlations between red and processed meat purchases with cardiovascular mortality and colorectal cancer by state. Per capita retail purchases of red and processed meat appear to reflect a dietary pattern that is not consistent with current national and international dietary recommendations.

Relationship of cash transfers with risk of overweight and obesity in children and adults: a systematic review.

BACKGROUND: Cash transfer (CT) programs are an important type of social protection meant to reduce poverty. Whether CT programs increase the risk of overweight and obesity is unclear. The objective was to characterize the relationship between CT programs and the risk of overweight and obesity in children and adults. METHODS: We searched articles in PubMed, Embase, Cochrane, EconLit, Global Health, CINAHL Plus, IBSS, Health & Medical Collection, Scopus, Web of Science, and WHO Global Index Medicus in August 2021. Studies involving CT as the intervention, a control group, body mass index, overweight, or obesity as an outcome, and sample size > 300 were included. The Newcastle-Ottawa Scale was used for quality assessment. RESULTS: Of 2355 articles identified, 20 met the inclusion criteria. Because of marked heterogeneity in methodology, a narrative synthesis was used to present results. Thirteen of the studies reported that CT programs were associated with a significantly lower risk of overweight and obesity, eight studies showed no significant association, and one study reported a significantly increased risk of obesity in women. Quality assessment showed that most studies lacked sample size and power calculations, validation of exposure, descriptions of non-respondents or those lost to follow-up, and blinded outcome assessment. CONCLUSIONS: Overall, the studies were suggestive that CT programs either have no impact or decrease the risk of overweight and/or obesity in children, adolescents, and adults, but no firm conclusions can be drawn from the available evidence. This review demonstrated limitations in the available studies of CT programs and overweight/obesity.

Convenience Food Options and Adequacy of Nutrient Intake among School Children during the COVID-19 Pandemic.

The COVID-19 pandemic has caused changes in the family food environment, resulting in more families relying on convenience food options. This study aimed to investigate diet quality by convenience food options (namely instant, frozen, and take-out foods) among Japanese school children during the COVID-19 pandemic. We examined the relationship between the frequency of consumption of convenience food options and nutritional status of the school children. The participants (671 children, 10-14 years old) were chosen to form a nationally representative sample of the Japanese population. Using questionnaires completed by the participants' guardians, information was collected on the frequency of instant, frozen, and take-out food consumption. Habitual food and nutrient intake were collected using a validated food frequency questionnaire, completed by the children with help from their guardian(s). "Frequent" consumption was defined as consumption of instant, frozen, and/or take-out foods on more than 5 days per week. Using 19 nutrients and their respective dietary reference intake (DRI) values, an index was created to label each child's nutrient intake as "Adequate", "Inadequate", "Excess", or "Deficient." Compared to children with non-frequent consumption, school children with frequent instant food consumption had significantly higher rates of inadequate nutrient intake (risk ratio (RR) = 3.0 [95% CI: 1.6-5.6]) and excess nutrient intake (RR = 2.3 [95% CI: 1.3-4.2]), while school children with frequent take-out food consumption had significantly higher rates of inadequate nutrient intake (RR = 2.1 [95% CI: 1.3-3.3]). There were no significant differences for children with frequent frozen-food intake. These associations did not change when adjusting for sociodemographic factors. Our results suggest that the frequent consumption of instant or take-out foods among school children results in non-adequate nutritional intake.

Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings.

INTRODUCTION: Despite the rising burden of chronic respiratory disease globally, and although many respiratory medications are included in the World Health Organization Essential Medications List (WHO-EML), there is limited information concerning the availability and affordability of treatment drugs for respiratory conditions in low- and middle-income countries (LMICs). METHODS: All public and private pharmacies in catchment areas of the Global Excellence in COPD outcomes (GECo) study sites in Bhaktapur, Nepal, Lima, Peru, and Nakaseke, Uganda, were approached in 2017-2019 to assess pricing and availability of medications for the management of asthma and COPD. RESULTS: We surveyed all 63 pharmacies in respective study areas in Nepal (95.2% private), 104 pharmacies in Peru (94.2% private) and 53 pharmacies in Uganda (98.1% private). The availability of any medication for respiratory disease was higher in private (93.3%) compared to public (73.3%) pharmacies. Salbutamol (WHO-EML) monotherapy in any formulation was the most commonly available respiratory medication among the three sites (93.7% Nepal, 86.5% Peru and 79.2% Uganda) while beclomethasone (WHO-EML) was only available in Peru (33.7%) and Nepal (22%). LABA-LAMA combination therapy was only available in Nepal (14.3% of pharmacies surveyed). The monthly treatment cost of respiratory medications was lowest in Nepal according to several cost metrics: the overall monthly cost, the median price ratio comparing medication costs to international reference prices at time of survey in dollars, and in terms of days' wages of the lowest-paid government worker. For the treatment of intermittent asthma, defined as 100 mcg Salbutamol/Albuterol inhaler, days' wages ranged from 0.47 days in Nepal and Peru to 3.33 days in Uganda. CONCLUSION: The availability and pricing of respiratory medications varied across LMIC settings, with medications for acute care of respiratory diseases being more widely available than those for long-term management.

Patterns of Legume Purchases and Consumption in the United States.

Background: Legumes are an inexpensive, healthy source of protein, fiber, and micronutrients, have low greenhouse gas and water footprints, and enrich soil through nitrogen fixation. Although higher legume consumption is recommended under US dietary guidelines, legumes currently comprise only a minor part of the US diet. Objectives: To characterize the types of legumes most commonly purchased by US consumers and patterns of legume purchases by state and region, seasonality of legume purchases, and to characterize adults that have a higher intake of legumes. Methods: We examined grocery market, chain supermarket, big box and club stores, Walmart, military commissary, and dollar store retail scanner data from Nielsen collected 2017-2019 and dietary intake from the National Health and Nutrition Examination Survey (NHANES), 2017-2018. Results: The five leading types of legumes purchased in the US were pinto bean, black bean, kidney bean, lima bean, and chickpea. The mean annual per capita expenditure on legumes based on grocery purchases was $4.76 during 2017-2019. The annual per capita expenditure on legumes varied greatly by state with highest expenditure in Louisiana, South Carolina, Florida, Alabama, Mississippi, and lowest expenditure in Washington, New York, and Wisconsin. There were large regional differences in the most commonly purchased legumes. Of 4,741 adults who participated in the 24-h dietary recall in NHANES, 2017-2018, 20.5% reported eating any legumes in the previous 24 h. Those who consumed legumes were more likely to be Hispanic, with a higher education level, with a larger household size (all P < 0.05), but were not different by age, gender, or income level compared to those who did not consume legumes. Conclusion: Although legumes are inexpensive, healthy, and a sustainable source of protein, per capita legume intake remains low in the US and below US dietary guidelines. Further insight is needed into barriers to legume consumption in the US.

Effectiveness of low-dose theophylline for the management of biomass-associated COPD (LODOT-BCOPD): study protocol for a randomized controlled trial.

BACKGROUND: COPD is a leading cause of death globally, with the majority of morbidity and mortality occurring in low- and middle-income country (LMIC) settings. While tobacco-smoke exposure is the most important risk factor for COPD in high-income settings, household air pollution from biomass smoke combustion is a leading risk factor for COPD in LMICs. Despite the high burden of biomass smoke-related COPD, few studies have evaluated the efficacy of pharmacotherapy in this context. Currently recommended inhaler-based therapy for COPD is neither available nor affordable in most resource-limited settings. Low-dose theophylline is an oral, once-a-day therapy, long used in high-income countries (HICs), which has been proposed for the management of COPD in LMICs in the absence of inhaled steroids and/or bronchodilators. The Low-dose Theophylline for the Management of Biomass-Associated COPD (LODOT-BCOPD) trial investigates the clinical efficacy and cost-effectiveness of low-dose theophylline for the management of biomass-related COPD in a low-income setting. METHODS: LODOT-BCOPD is a randomized, double-blind, placebo-controlled trial to test the efficacy of low-dose theophylline in improving respiratory symptoms in 110 participants with moderate to severe COPD in Central Uganda. The inclusion criteria are as follows: (1) age 40 to 80 years, (2) full-time resident of the study area, (3) daily biomass exposure, (4) post-bronchodilator FEV1/FVC below the 5th percentile of the Global Lung Initiative mixed ethnic reference population, and (5) GOLD Grade B-D COPD. Participants will be randomly assigned to receive once daily low-dose theophylline (200 mg ER, Unicontin-E) or placebo for 52 weeks. All participants will receive education about self-management of COPD and rescue salbutamol inhalers. We will measure health status using the St. George's Respiratory Questionnaire (SGRQ) and quality of life using the EuroQol-5D (EQ-5D) at baseline and every 6 months. In addition, we will assess household air pollution levels, serum inflammatory biomarkers (fibrinogen, hs-CRP), and theophylline levels at baseline, 1 month, and 6 months. The primary outcome is change in SGRQ score at 12 months. Lastly, we will assess the cost-effectiveness of the intervention by calculating quality-adjusted life years (QALYs) from the EQ-5D. TRIAL REGISTRATION: ClinicalTrials.gov  NCT03984188 . Registered on June 12, 2019 TRIAL ACRONYM: Low-dose Theophylline for the Management of Biomass-Associated COPD (LODOT-BCOPD).