Association between work-related factors and health behaviour clusters among Finnish private-sector service workers.

PURPOSE: We examined how work-related factors associate with several health behaviours that appear together among the large, but less-studied, blue- and pink-collar worker group, which is characterized by low education and income levels. METHODS: In 2019, we conducted a cross-sectional survey among private sector service workers (n = 5256) in Finland. We applied two-step cluster analysis to identify groups on the basis of leisure-time physical activity, sleep adequacy, frequency of heavy drinking, smoking status, and frequency of fruit, vegetable and berry consumption. We examined the associations with work-related factors, using multinomial regression analyses and adjusting for confounding factors. RESULTS: We identified six clusters labelled as Moderately Healthy (28% of the participants), Healthy - Vigorous Exercise (19%), Sedentary Lifestyle (16%), Inadequate Sleep (15%), Mixed Health Behaviours (15%), and Multiple Risk Behaviours (8%). Those who perceived their work to be mentally or physically strenuous more commonly belonged to the Inadequate Sleep and Multiple Risk Behaviours clusters. Time pressure made belonging to the Inadequate Sleep, Mixed Health Behaviours, and Multiple Risk Behaviours clusters more likely. Those who were dissatisfied with their work more often belonged to the Healthy - Vigorous Exercise, Inadequate Sleep, and Multiple Risk Behaviours clusters. CONCLUSION: In addition of finding several considerably differing health behaviour clusters, we also found that adverse working conditions were associated with clusters characterized by multiple risk behaviours, especially inadequate sleep. Private-sector service workers' working conditions should be improved so that they support sufficient recovery, and occupational health services should better identify co-occurring multiple risk behaviours.

Challenges and opportunities when moving food production and consumption toward sustainable diets in the Nordics: a scoping review for Nordic Nutrition Recommendations 2023.

The terms 'Nordic countries' or 'The Nordics' include the five countries Denmark, Finland, Island, Norway, and Sweden. This review includes evaluation of the Nordic countries against Food and Agricultural Organisation (FAO)/World Health Organizations' (WHO) guiding principles for healthy, sustainable diets with respect to environmental impact (principles #9 - #13) and sociocultural aspects (principles #14 - #16). A food systems perspective is taken to summarize and discuss the most important challenges and opportunities for achieving sustainable diets. Food system, food security, self-sufficiency, and resilience perspectives are applied. The information can underpin decisions when developing and implementing Food Based Dietary Guidelines (FBDG) in the Nordics. None of the Nordic countries are on track to reach the 2030 UN climate and biodiversity goals. We describe how food production, processing, and consumption contribute to these and other environmental challenges, and what kinds of dietary changes/transitions consistent with these goals are required. A major challenge is the high production and consumption of meat and too low consumption of fish, vegetables, and fruits. Meat production is a major source of emissions and, together with farmed fish, heavily dependent on imported feed ingredients, leaving a large land-use and water footprint in exporting countries while domestic land resources are not used optimally. Dietary patterns have changed drastically over the past 50 years, and in large parts of the population, meat consumption has doubled since the 1970s, rendering historic food culture less useful as a basis for present-day recommendations. The Nordics have Europe's lowest use of antibiotics in animal and fish production and have made some progress in reducing food waste along the food chain. A major opportunity is better alignment of food production and consumption based on local or regional production potentials, in conjunction with better and more constructive integration with the global food system while integrating novel technologies to reduce emissions and resource use.

A tendency toward evening chronotype associates with less healthy diet among preschoolers: cross-sectional findings from the DAGIS study.

Study Objectives: Evidence suggests that adolescents and adults with a later chronotype have poorer sleep habits and are more susceptible to unhealthy behaviors, but little is known about these associations in younger children. The objective of the study was to (1) identify and compare individual chronotype tendencies among preschool-aged children and (2) investigate associations of sleep dimensions and chronotype with diet. Methods: Participants were 636 3-6 years old (mean ±â€…SD age: 4.74 ±â€…0.89 years, 49% girls) preschoolers from the cross-sectional Increased Health and Well-Being in Preschoolers (DAGIS) study in Finland. Sleep duration, sleep variability (in duration and midpoint), social jetlag, and midsleep on weekends adjusted for sleep debt (MSWEadj) were measured with 7-day actigraphy. Morning, intermediate, and evening chronotype tendencies were defined based on the lowest and highest 10th percentile cutoffs of MSWEadj. Food, energy, and macronutrient intake were assessed from 3-day records. Associations between sleep dimensions and diet were assessed with regression models. Results: MSWEadj was 1:13 ±â€…14 minutes for morning (n = 64), 2:25 ±â€…28 minutes for intermediate (n = 560), and 3:38 ±â€…15 minutes for evening (n = 64) chronotype tendency. Children with an evening chronotype tendency had greater social jetlag and sleep variability. Having an evening chronotype tendency was associated with higher added sugar, higher sugary food consumption, and lower vegetable consumption compared to intermediate tendency types. A later chronotype (MSWEadj) was associated with higher sugary food consumption, as well as lower vegetable and fiber intake. Sleep duration, social jetlag, and sleep variability were not associated with diet. Conclusions: Several less healthy sleep and diet behaviors were observed among children with later chronotypes. Future public health interventions aimed towards children would benefit from taking into account chronotype.

Building nutritionally meaningful classification for grocery product groups: the LoCard Food Classification process.

Analysing customer loyalty card data is a novel method for assessing nutritional quality and changes in a population's food consumption. However, prior to its use, the thousands of grocery products available in stores must be reclassified from the retailer's original hierarchical structure into a structure that is suitable for the use of nutrition and health research. We created LoCard Food Classification (LCFC) and examined how it reflects the nutritional quality of the grocery product groups. Nutritional quality was considered the main criterion guiding the reclassification of the 3574 grocery product groups. Information on the main ingredient of the product group, purpose of use and carbon footprint was also used at the more granular levels of LCFC. The main challenge in the reclassification was a lack of detailed information on the type of products included in each group, and some of the groups included products that have opposite health effects. The final LCFC has four hierarchical levels, and it is openly available online. After reclassification, the product groups were linked with the Finnish food composition database, and the nutrient profile was assessed by calculating the Nutrient-Rich Food Index (NRFI) for each product group. sd in NRFI decreased from 0·21 of the least granular level to 0·08 of the most granular level of LCFC indicating that the most granular level of LCFC has more homogeneous nutritional quality. Studies that apply LCFC to examine loyalty card data with health and environmental outcomes are needed to further demonstrate its validity.

How energy balance-related behaviours, temperament, stress and overweight associate: a cross-sectional study of Finnish preschoolers.

OBJECTIVE: This study aimed to (1) examine the clustering of energy balance-related behaviours (EBRB) and (2) investigate whether EBRB clusters, temperament and hair cortisol concentration (HCC) associate with overweight. DESIGN: We assessed food consumption using food records, screen time (ST) using sedentary behaviour diaries, sleep consistency and temperament (negative affectivity, surgency, effortful control) using questionnaires and HCC using hair samples. Accelerometers were used to assess physical activity (PA) intensities, sleep duration and sleep efficiency. Researchers measured each child's weight and height. We used finite mixture models to identify EBRB clusters and multilevel logistic regression models to examine the associations between EBRB clusters, temperament, HCC and overweight. SETTING: The cross-sectional DAGIS survey, data collected in 2015-2016. PARTICIPANTS: Finnish 3-6-year-olds (n 864) recruited through preschools. RESULTS: One-third of the participants were categorised into the cluster labelled 'Unhealthy diet, excessive screen time', characterised by unhealthy dietary choices (e.g. greater consumption of high-fat, high-sugar dairy products) and longer ST. Two-thirds were categorised into the second cluster, labelled 'Healthy diet, moderate screen time'. PA and sleep were irrelevant for clustering. Higher negative affectivity and lower effortful control associated with the 'Unhealthy diet, excessive screen time' cluster. EBRB clusters and HCC did not associate with overweight, but surgency was positively associated with overweight (OR = 1·63, 95 % CI 1·17, 2·25). CONCLUSIONS: Of the EBRB, food consumption and ST seem to associate. As temperament associates with EBRB clusters and overweight, tailored support acknowledging the child's temperament could be profitable in maintaining a healthy weight.

The dynamics in food selection stemming from price awareness and perceived income adequacy: a cross-sectional study using 1-year loyalty card data.

BACKGROUND: Higher cost of healthy foods may explain unhealthy dietary patterns in lower-income households. Unfortunately, combining food selection and nutrient intake data to price and expenditure is challenging. Food retailer's customer loyalty card data, linked to nutrient composition database, is a novel method for simultaneous exploration of food purchases, price, and nutrition. OBJECTIVES: We studied the associations between perceived income adequacy (PIA) as a grouping variable with price (per kilogram or megajoule) and the volume of purchases (percentage of expenditure or energy) simultaneously as outcome variables for 17 most purchased food groups. METHODS: We used 1-year (2018) loyalty card data from the largest grocery chain in Finland. Participants were 28,783 loyalty cardholders who made ≥41% of food purchases from the retailer and answered an online questionnaire at the midpoint of data collection. The 5-level PIA described the perceived financial situation in the household. Energy and nutrient content of foods purchased were from the Finnish Food Composition Database Fineli. We calculated the Nutrient Rich Food Index per 100 g food using 11 nutrients. Trends in prices and expenditures between PIA levels were analyzed using 2-sided Jonckheere-Terpstra tests, with false discovery rate control (Benjamini-Hochberg method) and confounder adjustments (inverse probability weighting). RESULTS: Lower PIA participants selected cheaper foods per kilogram and megajoule within most food groups. They also favored unhealthy food groups cheap in energy [<1 € (USD 1.18)/MJ]. Despite lower purchase price, the expenditure (%) among lower PIA was higher on alcohol, snacks, sugar-sweetened beverages, and sweets and chocolates. CONCLUSIONS: Participants with lower PIA showed stronger price awareness. It is crucial to consider the pricing of competing alternative food groups, when steering toward environmentally sustainable and healthier food purchases. Package labeling might also direct the selection of healthier choices among the less expensive items within a food group.

Comparison of actigraphy-measured and parent-reported sleep in association with weight status among preschool children.

This study compared weekday and weekend actigraphy-measured and parent-reported sleep in relation to weight status among preschool-aged children. Participants were 3-6 years old preschoolers from the cross-sectional DAGIS-study with sleep data for ≥2 weekday and ≥2 weekend nights. Parents-reported sleep onset and wake-up times were gathered alongside 24 h hip-worn actigraphy. An unsupervised Hidden-Markov Model algorithm provided actigraphy-measured night time sleep without the guidance of reported sleep times. Waist-to-height ratio and age-and-sex-specific body mass index characterised weight status. Comparison of methods were assessed with consistency in quintile divisions and Spearman correlations. Associations between sleep and weight status were assessed with adjusted regression models. Participants included 638 children (49% girls) with a mean ± SD age of 4.76 ± 0.89. On weekdays, 98%-99% of actigraphy-measured and parent-reported sleep estimates were classified in the same or adjacent quintile and were strongly correlated (rs = 0.79-0.85, p < 0.001). On weekends, 84%-98% of actigraphy-measured and parent-reported sleep estimates were respectively classified and correlations were moderate to strong (rs = 0.62-0.86, p < 0.001). Compared with actigraphy-measured sleep, parent-reported sleep had consistently earlier onset, later wake-up, and greater duration. Earlier actigraphy-measured weekday sleep onset and midpoint were associated with a higher body mass index (respective ß-estimates: -0.63, p < 0.01 and -0.75, p < 0.01) and waist-to-height ratio (-0.004, p = 0.03 and -0.01, p = 0.02). Though the sleep estimation methods were consistent and correlated, actigraphy measures should be favoured as they are more objective and sensitive to identifying associations between sleep timing and weight status compared with parent reports.

Food consumption and nutrient intake of Finnish preschool children according to parental educational level.

We examined the association between parental educational level (PEL) and children's food consumption and nutrient intake in a sample of Finnish 3- to 6-year-old preschoolers (n 811). The data were obtained from the cross-sectional DAGIS project, conducted in eight municipalities in Finland during 2015-2016. The food consumption and nutrient intake were assessed using food records. The highest educational level of the family was used as the indicator of socio-economic status. Differences in diet by PEL were analysed using a hierarchical linear model adjusted for energy intake. Compared with high PEL, low PEL was associated with a child's lower consumption of fresh vegetables and salads, vegetarian dishes, berries, white bread, blended spread, skimmed milk and ice cream but higher consumption of milk with 1-1·5 % fat content, dairy-based desserts and sugar-sweetened soft drinks. Food consumption was also examined after disaggregating dishes into their ingredients. Low PEL was associated with lower consumption of vegetables, nuts and seeds, berries and fish but higher consumption of red meat. Children in the low PEL, compared with the high PEL group, had a lower intake of protein, fibre, EPA, DHA, vitamin D, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, potassium, phosphorous, Ca, Mg, Zn and iodine but a higher intake of fat and saturated, trans and MUFA. The observed diet-related disparities highlight the need for policy actions and interventions supporting healthy eating patterns such as high consumption of vegetables, nuts and berries in childhood, paying special attention to those with low PEL.

Association of the timing of evening eating with BMI Z-score and waist-to-height ratio among preschool-aged children in Finland.

Later timing of eating has been associated with higher adiposity among adults and children in several studies, but not all. Moreover, studies in younger children are scarce. Hence, this study investigated the associations of the timing of evening eating with BMI Z-score and waist-to-height ratio (WHtR), and whether these associations were moderated by chronotype among 627 preschoolers (3-6-year-olds) from the cross-sectional DAGIS survey in Finland. Food intake was measured with 3-d food records, and sleep was measured with hip-worn actigraphy. Three variables were formed to describe the timing of evening eating: (1) clock time of the last eating occasion (EO); (2) time between the last EO and sleep onset; and (3) percentage of total daily energy intake (%TDEI) consumed 2 h before sleep onset or later. Chronotype was assessed as a sleep debt-corrected midpoint of sleep on the weekend (actigraphy data). The data were analysed with adjusted linear mixed effects models. After adjusting for several confounders, the last EO occurring closer to sleep onset (estimate = -0·006, 95 % CI (-0·010, -0·001)) and higher %TDEI consumed before sleep onset (estimate = 0·0004, 95 % CI (0·00003, 0·0007)) were associated with higher WHtR. No associations with BMI Z-score were found after adjustments. Clock time of the last EO was not significantly associated with the outcomes, and no interactions with chronotype emerged. The results highlight the importance of studying the timing of eating relative to sleep timing instead of only as clock time.

Tensorial Principal Component Analysis in Detecting Temporal Trajectories of Purchase Patterns in Loyalty Card Data: Retrospective Cohort Study.

BACKGROUND: Loyalty card data automatically collected by retailers provide an excellent source for evaluating health-related purchase behavior of customers. The data comprise information on every grocery purchase, including expenditures on product groups and the time of purchase for each customer. Such data where customers have an expenditure value for every product group for each time can be formulated as 3D tensorial data. OBJECTIVE: This study aimed to use the modern tensorial principal component analysis (PCA) method to uncover the characteristics of health-related purchase patterns from loyalty card data. Another aim was to identify card holders with distinct purchase patterns. We also considered the interpretation, advantages, and challenges of tensorial PCA compared with standard PCA. METHODS: Loyalty card program members from the largest retailer in Finland were invited to participate in this study. Our LoCard data consist of the purchases of 7251 card holders who consented to the use of their data from the year 2016. The purchases were reclassified into 55 product groups and aggregated across 52 weeks. The data were then analyzed using tensorial PCA, allowing us to effectively reduce the time and product group-wise dimensions simultaneously. The augmentation method was used for selecting the suitable number of principal components for the analysis. RESULTS: Using tensorial PCA, we were able to systematically search for typical food purchasing patterns across time and product groups as well as detect different purchasing behaviors across groups of card holders. For example, we identified customers who purchased large amounts of meat products and separated them further into groups based on time profiles, that is, customers whose purchases of meat remained stable, increased, or decreased throughout the year or varied between seasons of the year. CONCLUSIONS: Using tensorial PCA, we can effectively examine customers' purchasing behavior in more detail than with traditional methods because it can handle time and product group dimensions simultaneously. When interpreting the results, both time and product dimensions must be considered. In further analyses, these time and product groups can be directly associated with additional consumer characteristics such as socioeconomic and demographic predictors of dietary patterns. In addition, they can be linked to external factors that impact grocery purchases such as inflation and unexpected pandemics. This enables us to identify what types of people have specific purchasing patterns, which can help in the development of ways in which consumers can be steered toward making healthier food choices.

Associations of dietary patterns with common infections and antibiotic use among Finnish preschoolers.

Background: Preschoolers suffer frequently from infections. Although nutrition plays a key role in immune function, very little is known about the impact of overall diet on preschoolers' infections. Objective: To assess the associations between dietary patterns, common infections and antibiotic use among Finnish preschoolers. Design: The study included 721 3-6-year-old preschoolers participating in the cross-sectional DAGIS survey. Parents retrospectively reported the number of common colds, gastroenteritis episodes and antibiotic courses their children had acquired during the past year. Food consumption outside preschool hours was recorded using a food frequency questionnaire. Dietary patterns were derived from the consumption frequencies using principal component analysis. Associations between the thirds of the dietary pattern scores and the outcomes were analysed using logistic and negative binomial regression models. Results: Prevalence of common colds was lower in moderate and high adherence to the sweets-and-treats pattern than in low adherence (prevalence ratio [PR]: 0.89, 95% confidence interval [CI]: 0.80-1.00, and PR: 0.88, 95% CI: 0.79-0.99, respectively) and higher in high adherence to the health-conscious pattern than in low adherence (PR: 1.13, 95% CI: 1.01-1.27) after adjusting for age, sex, number of children living in the same household, frequency of preschool attendance, family's highest education and probiotic use. The risk of ≥1 gastroenteritis episode and the prevalence of antibiotic courses were lower in moderate adherence to the sweets-and-treats pattern than in low adherence (odds ratio [OR]: 0.63, 95% CI: 0.44-0.92 and PR: 0.77, 95% CI: 0.59-1.00, respectively). Conclusions: The results were unexpected. Parents who were most health-conscious of their children's diet might also have been more aware of their children's illness.

Child temperament is associated with energy intake and its day-to-day variability among preschoolers-Results from a cross-sectional DAGIS study.

BACKGROUND: Although research has linked children's temperament with weight outcomes, the associations between temperament and dietary outcomes, particularly energy intake, remain understudied. Furthermore, little is known about how temperament is associated with diet in the early childhood education and care (ECEC) context, which is an important environment for many children. OBJECTIVES: This study examined whether temperament is associated with mean energy intake and its day-to-day variability. In addition, the associations were examined separately in the contexts of home and ECEC. METHODS: The study used data from 505 Finnish children from a cross-sectional DAGIS study conducted in 2015-2016. Parents reported their child's temperament with a questionnaire and food consumption with a food record for two weekdays (outside daycare hours) and one weekend day. Early educators at an ECEC centre reported the child's food consumption during the daycare hours on the same weekdays as the parents kept food records at home. Associations were examined with linear regression models. RESULTS: Children with higher surgency had a higher mean daily energy intake. When examined separately at home and in the ECEC centre, the association was found only in the ECEC centre. Children with higher negative affectivity had greater day-to-day variability in energy intake. This association, however, was not observed when examined separately at home and at the ECEC centre. CONCLUSIONS: The results indicate that temperament may shape children's energy intake. Moreover, the role of the ECEC context in children's eating may be different depending on a child's temperamental dispositions, which warrants further research.

Associations between socioeconomic status, home food availability, parental role-modeling, and children's fruit and vegetable consumption: a mediation analysis.

BACKGROUND: Recent literature has suggested that associations and interactions between family socioeconomic status (SES) and home food environment influence children's diet, but little is known about the mediation roles of parental role-modeling and food availability in the socioeconomic inequalities of children's diet. This study aimed to determine the associations between family SES and children's fruit and vegetable (FV) consumption and to assess the mediation roles of parental role-modeling and food availability in the above associations. METHODS: Cross-sectional data of 574 Finnish children (aged 3 to 6) were analyzed. Parents completed an FFQ assessing their children's FV consumption frequency and a questionnaire assessing SES and home food environment. Two exposure variables: parental educational level ("low", "middle", and "high") and the relative family income tertiles of the family were used. The frequencies of parental role-modeling of FV and sugary food and drink (SFD) consumption, and the availability of FV and SFD at home were calculated. Single- and multiple-mediator models were created using IBM SPSS 27.0. RESULTS: The positive association between high parental educational level and children's FV consumption (direct effect coefficient: 2.76, 95% CI: 0.51-4.86) was partially mediated by more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.89, 95% CI: 0.10-1.76), higher availability of FV (indirect effect coefficient: 1.00, 95% CI: 0.35-1.77), and lower availability of SFD (indirect effect coefficient: -0.30, 95% CI: -0.72 - -0.01). The relative family income was not directly associated with the outcome. However, the higher relative family income level indirectly predicted the Children's FV consumption (full mediation) through more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.91, 95% CI: 0.06-1.83) and higher availability of FV (indirect effect coefficient: 0.98, 95% CI: 0.40-1.67). Parental role-modeling on SFD consumption did not mediate any of the above associations. CONCLUSIONS: Parental educational level showed more associations with children's FV consumption than relative family income. Our findings suggest that reducing the availability of SFD is as important as increasing the availability of FV to enhance children's FV consumption. Future interventions to improve children's dietary behaviors should pay greater attention to the lower SES segments of society. Longitudinal studies and intervention studies supporting these findings are needed for making meaningful recommendations for health promotion.

The role of parental congruence in pre-school children's screen time, moderated by parental education.

AIM: This study investigated whether parental congruency regarding screen time (ST) is associated with ST in pre-school children. In addition, we investigated whether parental education levels moderated this relationship. METHODS: A cross-sectional study was conducted in 2015-2016 in Finland (N = 688). Parents completed a questionnaire reporting their children's sedentary behaviour, their parental congruency regarding ST rules, and their educational level. Associations were examined using linear regression. RESULTS: Children of parents with higher congruence regarding ST rules engaged in less ST, this was moderated by parental education levels. Children whose parents had a high level of education and parents' who strongly agree or somewhat agree on ST rules was negatively associated with ST. Furthermore, children whose parents had a medium level of education and parents' who strongly agree on ST rules was negatively associated with ST. CONCLUSION: Children of parents who agree on ST rules engaged in less ST compared with children of parents who do not agree on ST rules. Providing advice to parents regarding parental congruency could be the focus of future interventions.

Wealth and Sedentary Time Are Associated With Dietary Patterns Among Preadolescents in Nairobi City, Kenya.

OBJECTIVE: The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya. DESIGN: Cross-sectional. PARTICIPANTS: Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi. VARIABLES MEASURED: Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer. ANALYSIS: Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression. RESULTS: Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted.

Wealth and obesity in pre-adolescents and their guardians: A first step in explaining non-communicable disease-related behaviour in two areas of Nairobi City County.

The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (ß = 0.01; SE 0.0; p = 0.003) and income (ß = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes.

Who buys non-alcoholic beer in Finland? Sociodemographic characteristics and associations with regular beer purchases.

BACKGROUND: The consumption of non-alcoholic beer and other non-alcoholic and low-alcohol beverages has grown significantly in recent years. Due to a lack of suitable datasets, there have been few studies conducted on the forerunners of the non-alcoholic beer consumption trend. This study examined the associations of sociodemographic characteristics with non-alcoholic beer purchase, and of non-alcoholic beer purchases with regular beer purchases. METHODS: The data consisted of longitudinal individual purchases of non-alcoholic and regular beer from grocery stores in 2017 and 2018. The study participants were loyalty cardholders from the largest food retailer in Finland (n = 47,066). The level of education, household income and occupational status were analyzed as determinants of non-alcoholic beer purchase using logistic regression models. The changes in the regular and non-alcoholic beer purchases from 2017 to 2018 and the distributions of non-alcoholic beer purchase by regular beer purchase, by gender and by age were described. RESULTS: Between 2017 and 2018, the total volume of non-alcoholic beer purchases increased from 2.3% to 3.7% of the total volume of all beer purchases. Men and older people purchased non-alcoholic beer more often than women and younger people did. Non-alcoholic beer purchases were most common among the highly educated and high-income consumers. Non-alcoholic beer purchases were most prevalent in the groups with the highest volumes of regular beer purchase. CONCLUSIONS: Educated and affluent consumers have been the forerunners of non-alcoholic beer consumption in Finland. In order to promote the substitution of regular beer with non-alcoholic beer the shift towards lower-strength beverages should be facilitated across social strata.

Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation.

BACKGROUND: Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators. METHODS: The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms. RESULTS: Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09,  -0.09). CONCLUSIONS: Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior. TRIAL REGISTRATION: ISRCTN57165350 (8 January, 2015).