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1.
Obes Rev ; : e13824, 2024 Sep 03.
Article in English | MEDLINE | ID: mdl-39228092

ABSTRACT

BACKGROUND: The Mediterranean diet has been shown to be effective in improving health outcomes and for weight loss. Adherence and retention in dietary interventions are critical to ensure the benefits of the exposure. No studies to date have assessed the role of gender in understanding participants who remain engaged and adhere to Mediterranean diet interventions. AIMS: This study aimed to explore gender differences in recruitment, adherence, and retention for Mediterranean diet interventions and whether these were associated with differences in weight-loss outcomes. METHODS: A systematic search was completed in EMBASE, Medline, Cochrane, and clinicaltrials.gov from inception to March 2023. A meta-analysis of studies reporting retention by gender was completed using odds ratios comparing female to male dropout numbers. A second meta-analysis was completed for adherence comparing standardized mean difference of Mediterranean diet scores stratified by gender. Newcastle Ottawa score was used to assess risk of bias. RESULTS: A total of 70 articles were included in the systematic review with six articles included in the adherence meta-analysis and nine in the dropout meta-analysis. No statistically significant difference was shown for adherence or retention by gender. Weight-loss outcomes were inconsistent. CONCLUSIONS: The results of the study suggest a higher adherence and lower dropout for women although these results were not statistically significant. Future studies of Mediterranean diet interventions should include adherence, retention, and weight-loss data stratified by gender to allow further investigation of this relationship.

2.
Int J Obes (Lond) ; 48(8): 1065-1079, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38834795

ABSTRACT

BACKGROUND: Participants' recruitment and retention into community-based interventions can be challenging, especially in research involving ethnic minorities and migrants. Despite known challenges, there are limited reviews that probe recruitment and retention strategies involving ethnic minorities and migrants in the Organisation for Economic Cooperation and Development (OECD) countries. This systematic review aimed to measure recruitment and retention rates and identify the barriers and facilitators to effective recruitment and retention of ethnic minorities and migrants in community-based obesity prevention Randomised Control Trials (RCTs) in OECD countries. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases (CINAHL, Cochrane, Embase, Medline and PsychInfo) were searched from January 2000 to March 2022, in addition to Google and Google Scholar. Methodological quality and risk of bias were assessed, and pooled analysis and meta-ethnographic analysis were conducted on the included studies. RESULTS: Twenty-five studies were included in the review. The pooled analysis found a 64% rate of recruitment of ethnic minorities in RCTs, with a retention rate of 71%. Key facilitators identified were-use of multiple communication channels, incentives, recruiting community champions, participant convenience and employing culturally sensitive strategies. Key barriers to participation were limited access to study sites, time constraints, limited trust, perceived fear, and anxiety. CONCLUSION: Findings suggest the importance of undertaking culturally appropriate recruitment and retention strategies to minimise barriers and facilitate effective recruitment and retention of low-income ethnic minorities and migrants in community-based research.


Subject(s)
Ethnic and Racial Minorities , Obesity , Patient Selection , Randomized Controlled Trials as Topic , Transients and Migrants , Humans , Transients and Migrants/statistics & numerical data , Transients and Migrants/psychology , Obesity/prevention & control , Obesity/ethnology , Ethnic and Racial Minorities/statistics & numerical data , Minority Groups/statistics & numerical data , Minority Groups/psychology , Ethnicity/statistics & numerical data
3.
Eur J Nutr ; 63(5): 1771-1781, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38635026

ABSTRACT

PURPOSE: Recent evidence suggests that plant-based diets may reduce the risk of breast cancer (BC). However, the macronutrient composition of plant-based diets and its potential impact on BC risk has not been well explored. This analysis investigated the association of macronutrient composition with BC risk across a spectrum of plant-based diet indexes using a multidimensional approach. DESIGN: This study followed 64,655 participants from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (E3N) cohort from 1993 to 2014. Diets were evaluated using validated 208-item diet history questionnaires at baseline (1993) and follow-up (2005), to calculate adherence to the overall plant-based diet (PDI), healthful plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). The association of macronutrient composition with BC risk was assessed via generalized additive time-dependent Cox models across different levels of these indexes. Response surfaces were generated to visualize compositional associations at the 25th, 50th, and 75th percentile of each index (low, moderate, and high). RESULTS: A total of 3,932 incident BC cases were identified during the 21-year follow-up. There was a significant association between macronutrient composition and BC risk for hPDI, uPDI, and PDI (all P < 0.001). Akaike information criterion favored the hPDI model for characterizing the association between macronutrients and BC. BC risk was highest for individuals with a lower hPDI score who also consumed a diet containing lower protein (10%), lower carbohydrate (35%), and higher fat (55%). The lowest risk of BC was observed in those with higher hPDI scores with the lowest intake of protein (10%). At higher PDI and uPDI, diets containing higher protein (30%) and fat (45%) had the highest BC risk. CONCLUSION: These results demonstrate a complex relationship between macronutrient composition, plant-based diet quality, and BC risk. Further research is needed to examine specific foods that may be driving these associations. REGISTRY: The protocol is registered at clinicaltrials.gov as NCT03285230.


Subject(s)
Breast Neoplasms , Diet, Plant-Based , Nutrients , Female , Humans , Breast Neoplasms/epidemiology , Breast Neoplasms/etiology , Breast Neoplasms/prevention & control , Cohort Studies , Diet, Plant-Based/methods , Diet, Plant-Based/statistics & numerical data , Follow-Up Studies , Nutrients/administration & dosage , Nutrients/analysis , Prospective Studies , Risk Factors , Surveys and Questionnaires
4.
Adv Biol (Weinh) ; 8(4): e2300619, 2024 04.
Article in English | MEDLINE | ID: mdl-38229191

ABSTRACT

The role of dietary macronutrients and energy intake in the aging process has been well-established. However, previous research has mainly focused on the association between leukocyte telomere length (LTL) and individual macronutrients, while the effects of macronutrient composition on LTL remain unclear. This cross-sectional analysis involved 4130 US adults (44.8 ± 17.0 years; 51% female) from the National Health and Nutrition Examination Survey during 1999-2002. A single 24-h dietary recall is used to collect dietary data. The relationship between dietary macronutrient composition and LTL is examined using three-dimensional generalized additive models. After adjustment for age, sex, ethnicity, education, physical activity, BMI, and dietary quality, a three-dimensional association of macronutrient composition with LTL (P = 0.02) is revealed. Diets lower in protein (5-10%), higher in carbohydrates (75%), and lower in fat (15-20%) are associated with the longest LTL corresponding to 7.7 years of slower biological aging. Diets lowest in protein (5%) and carbohydrate (40%), while highest in dietary fat (55%) are associated with the shortest LTL, corresponding to accelerated biological aging of 4.4 years. The associations appeared magnified with higher energy intake. These findings support a complex relationship between dietary macronutrients and biological aging independent of diet quality.


Subject(s)
Diet , Nutrients , Adult , Humans , Female , Male , Nutrition Surveys , Cross-Sectional Studies , Telomere/genetics
5.
Nutrients ; 15(6)2023 Mar 15.
Article in English | MEDLINE | ID: mdl-36986142

ABSTRACT

The gut microbiome has been shown to play a role in the relationship between diet and cardiometabolic health. We sought to examine the degree to which key microbial lignan metabolites are involved in the relationship between diet quality and cardiometabolic health using a multidimensional framework. This analysis was undertaken using cross-sectional data from 4685 US adults (age 43.6 ± 16.5 years; 50.4% female) participating in the National Health and Nutrition Examination Survey for 1999-2010. Dietary data were collected from one to two separate 24-hour dietary recalls and diet quality was characterized using the 2015 Healthy Eating Index. Cardiometabolic health markers included blood lipid profile, glycemic control, adiposity, and blood pressure. Microbial lignan metabolites considered were urinary concentrations of enterolignans, including enterolactone and enterodiol, with higher levels indicating a healthier gut microbial environment. Models were visually examined using a multidimensional approach and statistically analyzed using three-dimensional generalized additive models. There was a significant interactive association between diet quality and microbial lignan metabolites for triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, insulin, oral glucose tolerance, adiposity, systolic blood pressure, and diastolic blood pressure (all p < 0.05). Each of these cardiometabolic health markers displayed an association such that optimal cardiometabolic health was only observed in individuals with both high diet quality and elevated urinary enterolignans. When comparing effect sizes on the multidimensional response surfaces and model selection criteria, the strongest support for a potential moderating relationship of the gut microbiome was observed for fasting triglycerides and oral glucose tolerance. In this study, we revealed interactive associations of diet quality and microbial lignan metabolites with cardiometabolic health markers. These findings suggest that the overall association of diet quality on cardiometabolic health may be affected by the gut microbiome.


Subject(s)
Cardiovascular Diseases , Lignans , Humans , Adult , Female , Middle Aged , Male , Risk Factors , Nutrition Surveys , Cross-Sectional Studies , Cardiovascular Diseases/epidemiology , Diet/methods , Obesity , Triglycerides , Cholesterol, HDL , Lignans/metabolism
6.
BMC Public Health ; 22(1): 1215, 2022 06 18.
Article in English | MEDLINE | ID: mdl-35717146

ABSTRACT

BACKGROUND: Obesity is an increasing health concern in Australia among adult and child populations alike and is often associated with other serious comorbidities. While the rise in the prevalence of childhood obesity has plateaued in high-income countries, it continues to increase among children from disadvantaged and culturally diverse backgrounds. The family environment of disadvantaged populations may increase the risk of childhood obesity through unhealthy eating and lifestyle practices. The Strong Families Trial aims to assess the effectiveness of a mixed behavioural and lifestyle intervention for parents and carers of at-risk populations, i.e. families from culturally diverse and disadvantaged backgrounds, in preventing unhealthy weight gain among children aged 5 to 11 years. METHODS: Eight hundred families from low socio-economic areas in Greater Western Sydney, NSW, and Melbourne, VIC, will be recruited and randomised into a lifestyle intervention or control group. The intervention comprises 90-minute weekly sessions for 6 weeks (plus two-booster sessions) of an integrated, evidence-based, parenting and lifestyle program that accounts for the influences of family functioning. Primary (anthropometric data) and secondary (family functioning, feeding related parenting, physical activity, consumption of healthy foods, health literacy, family and household costs) outcome measures will be assessed at baseline, immediately following the intervention, and 12 months post-intervention. DISCUSSION: This study will elucidate methods for engaging socially disadvantaged and culturally diverse groups in parenting programs concerned with child weight status. TRIAL REGISTRATION: This study is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12619001019190 ). Registered 16 July 2019.


Subject(s)
Pediatric Obesity , Adult , Australia/epidemiology , Child , Child, Preschool , Humans , Parenting , Parents , Pediatric Obesity/prevention & control , Randomized Controlled Trials as Topic , Weight Gain
7.
Nutr Diabetes ; 10(1): 39, 2020 12 05.
Article in English | MEDLINE | ID: mdl-33279939

ABSTRACT

BACKGROUND: Rapid simultaneous increases in ultra-processed food sales and obesity prevalence have been observed worldwide, including in Australia. Consumption of ultra-processed foods by the Australian population was previously shown to be systematically associated with increased risk of intakes of nutrients outside levels recommended for the prevention of obesity. This study aims to explore the association between ultra-processed food consumption and obesity among the Australian adult population and stratifying by age group, sex and physical activity level. METHODS: A cross-sectional analysis of anthropometric and dietary data from 7411 Australians aged ≥20 years from the National Nutrition and Physical Activity Survey 2011-2012 was performed. Food consumption was evaluated through 24-h recall. The NOVA system was used to identify ultra-processed foods, i.e. industrial formulations manufactured from substances derived from foods and typically added of flavours, colours and other cosmetic additives, such as soft drinks, confectionery, sweet or savoury packaged snacks, microwaveable frozen meals and fast food dishes. Measured weight, height and waist circumference (WC) data were used to calculate the body mass index (BMI) and diagnosis of obesity and abdominal obesity. Regression models were used to evaluate the association of dietary share of ultra-processed foods (quintiles) and obesity indicators, adjusting for socio-demographic variables, physical activity and smoking. RESULTS: Significant (P-trend ≤ 0.001) direct dose-response associations between the dietary share of ultra-processed foods and indicators of obesity were found after adjustment. In the multivariable regression analysis, those in the highest quintile of ultra-processed food consumption had significantly higher BMI (0.97 kg/m2; 95% CI 0.42, 1.51) and WC (1.92 cm; 95% CI 0.57, 3.27) and higher odds of having obesity (OR = 1.61; 95% CI 1.27, 2.04) and abdominal obesity (OR = 1.38; 95% CI 1.10, 1.72) compared with those in the lowest quintile of consumption. Subgroup analyses showed that the trend towards positive associations for all obesity indicators remained in all age groups, sex and physical activity level. CONCLUSION: The findings add to the growing evidence that ultra-processed food consumption is associated with obesity and support the potential role of ultra-processed foods in contributing to obesity in Australia.


Subject(s)
Diet/statistics & numerical data , Fast Foods/adverse effects , Food Handling , Obesity/epidemiology , Adult , Aged , Australia/epidemiology , Body Mass Index , Cross-Sectional Studies , Diet/adverse effects , Energy Intake , Exercise , Feeding Behavior , Female , Humans , Male , Middle Aged , Nutrition Surveys , Nutritive Value , Obesity, Abdominal/epidemiology , Risk Factors , Waist Circumference , Young Adult
9.
Eur J Nutr ; 59(6): 2783-2792, 2020 Sep.
Article in English | MEDLINE | ID: mdl-31676952

ABSTRACT

OBJECTIVE: To analyze the contribution of ultra-processed foods to the intake of free sugars among different age groups in Australia. METHODS: Dietary intakes of 12,153 participants from the National Nutrition and Physical Activity Survey (2011-12) aged 2+ years were evaluated. Food items collected through two 24-h recalls were classified according to the NOVA system. The contribution of each NOVA food group and their subgroups to total energy intake was determined by age group. Mean free sugar content in diet fractions made up exclusively of ultra-processed foods, or of processed foods, or of a combination of un/minimally processed foods and culinary ingredients (which includes table sugar and honey) were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of free sugars, as well as in the prevalence of excessive free sugar intake (≥ 10% of total energy) were examined. RESULTS: Ultra-processed foods had the highest energy contribution among children, adolescents and adults in Australia, with older children and adolescents the highest consumers (53.1% and 54.3% of total energy, respectively). The diet fraction restricted to ultra-processed items contained significantly more free sugars than the two other diet fractions. Among all age groups, a positive and statistically significant linear association was found between quintiles of ultra-processed food consumption and both the average intake of free sugars and the prevalence of excessive free sugar intake. CONCLUSION: Ultra-processed food consumption drives excessive free sugar intake among all age groups in Australia.


Subject(s)
Fast Foods , Food Handling , Adolescent , Adult , Australia , Child , Diet , Dietary Sucrose , Energy Intake , Humans , Nutrition Surveys
10.
BMC Public Health ; 19(1): 1681, 2019 Dec 16.
Article in English | MEDLINE | ID: mdl-31842820

ABSTRACT

BACKGROUND: Understanding the knowledge and beliefs of key stakeholders is crucial in developing effective public health interventions. Knowledge and beliefs about obesity and eating disorders (EDs) have rarely been considered, despite increasing awareness of the need for integrated health promotion programs. We investigated key aspects of knowledge and beliefs about obesity and EDs among key stakeholders in Australia. METHODS: Using a semi-structured question guide, eight focus groups and seven individual interviews were conducted with 62 participants including health professionals, personal trainers, teachers and consumer group representatives. An inductive thematic approach was used for data analysis. RESULTS: The findings suggest that, relative to obesity, EDs are poorly understood among teachers, personal trainers, and certain health professionals. Areas of commonality and distinction between the two conditions were identified. Integrated health promotion efforts that focus on shared risk (e.g., low self-esteem, body dissatisfaction) and protective (e.g., healthy eating, regular exercise) factors were supported. Suggested target groups for such efforts included young children, adolescents and parents. CONCLUSIONS: The findings indicate areas where the EDs and obesity fields have common ground and can work together in developing integrated health promotion programs.


Subject(s)
Feeding and Eating Disorders , Health Knowledge, Attitudes, Practice , Health Promotion/organization & administration , Obesity , Stakeholder Participation/psychology , Adolescent , Adult , Australia , Feeding and Eating Disorders/prevention & control , Female , Focus Groups , Humans , Male , Middle Aged , Obesity/prevention & control , Young Adult
12.
Public Health Nutr ; 22(16): 2921-2930, 2019 11.
Article in English | MEDLINE | ID: mdl-31340874

ABSTRACT

OBJECTIVE: There is an urgent need to identify and develop cross-sectoral policies which promote and support a healthy, safe and sustainable food system. To help shape the political agenda, a critical first step is a shared definition of such a system among policy makers across relevant sectors. The aim of the present study was to determine how Australian policy actors define, and contribute to, a healthy, safe and sustainable food system. DESIGN: A Delphi survey, consisting of two rounds, was conducted. Participants were asked how they define, and contribute to, a healthy, safe and sustainable food system (Round 1) and indicate their level of agreement with summary statements (Round 2). SETTING: This was an online Delphi survey conducted in Australia. PARTICIPANTS: Twenty-nine and fourteen multisectoral and multilevel policy makers completed Round 1 and Round 2, respectively. RESULTS: The definition included food processing regulation, environmentally friendly food production and access to nutritious food. All agreed that it was important for them to improve access and supply of healthy food and ensure healthy planning principles are applied. CONCLUSIONS: There were cross-sectoral differences in definitions and contributions; however, critical consensus was achieved. The study contributes to the definition of key elements of a cross-sectoral food and nutrition policy to meet today's environmental, health, social and economic challenges; however, further research using a more representative multisectoral sample is warranted.


Subject(s)
Diet Surveys , Diet, Healthy , Food Supply , Nutrition Policy , Australia , Delphi Technique , Humans
13.
Asia Pac J Public Health ; 31(2): 167-172, 2019 03.
Article in English | MEDLINE | ID: mdl-30897934

ABSTRACT

The aim of this study was to investigate trends of body mass index (BMI) with age in westernizing Macau and to make comparisons with Australian data. A representative random sample (n = 1406, 18-93 years, 55% female) from Macau was recruited in 2012. The Australian sample was extracted from the Australian Health Survey 2011-2012 (n = 7958, 18 to ≥85 years, 52% female). BMI in Australians was greater than Macanese, mean difference 4.4 kg/m2 ( P < .001). While BMI increases steadily with ageing in each population, the plateau for Macau subjects appears 5 to 10 years earlier than Australians. Prevalence of overweight/obesity in young Macanese adults (18-40 years) was 25% (men) and 22% (women), with the greatest increase in BMI from age 25 to 39 years and 24 to 45 years in men and women, respectively. BMI shifts in younger Macanese men and women, which may reflect emerging lifestyle and nutrition transitions, are a future population health concern in Macau.


Subject(s)
Aging , Body Mass Index , Obesity/epidemiology , Overweight/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Australia/epidemiology , Female , Health Surveys , Humans , Macau/epidemiology , Male , Middle Aged , Prevalence , Risk Factors , Young Adult
14.
Clin Obes ; 9(3): e12301, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30761766

ABSTRACT

We aimed to develop an expert consensus on standardizing data collections in specialist obesity management clinics in Australia. A panel of 16 experts participated in a structured consensus-driven Delphi process to reach agreement on a minimum set of baseline patient data collections for consideration in specialist obesity services. The panel included surgeons, clinicians, allied health professionals (dietician, exercise physiologist, psychologist), a bariatric nurse and obesity researchers. We produced a recommended list of core and useful data items that should comprise the baseline patient data set. Consensus was achieved for recommended measures of demographic, anthropometric, biochemical, weight-loss history, medication, medical history and comorbidity data items using a 70% agreement threshold. In this iterative process, there was also consideration of specific data items for patients referred for bariatric surgery. We present the first expert panel consensus on recommendations for a minimum and standard set of baseline patient data collections in obesity management services in Australia. These may be relevant to other countries with similar obesity management service models. Implementation of these recommendations should facilitate data pooling for clinical audits and research collaborations across clinics seeking to improve the quality of specialist obesity care.


Subject(s)
Data Collection/standards , Obesity Management/standards , Obesity/therapy , Adult , Anthropometry/methods , Australia , Consensus , Data Collection/methods , Delphi Technique , Female , Humans , Male , Obesity Management/methods , Specialization/standards
15.
Online J Public Health Inform ; 10(2): e213, 2018.
Article in English | MEDLINE | ID: mdl-30349631

ABSTRACT

OBJECTIVES: Consumers routinely seek health and nutrition-related information from online sources, including social media platforms. This study identified popular online nutrition content to examine the advice and assess alignment with the Australian Guideline to Healthy Eating (AGHE). METHODS: We used Facebook page "likes" as an indicator of popularity to identify online nutrition and diet content. Websites and blogs associated with pages that had more than 100,000 Australian likes on 7th September 2017 were included. The dietary advice promoted was collected and compared with the AGHE across nine categories (Vegetables, Fruits, Legumes, Grains, Lean Meat, Dairy/Alternative, Fat, Sugar, Salt). RESULTS: Nine Facebook pages met the inclusion criteria. The four most-liked pages were hosted by celebrities. Only two pages and their associated websites had advice consistent with AGHE recommendations across all nine categories reviewed. The concept of "real food" was a popular theme online. While most sources advocated increasing vegetable consumption and reducing processed food, other advice was not evidence-based and frequently deviated from the AGHE. DISCUSSION: Health information seekers are exposed to a variety of online dietary information and lifestyle advice. While few public health goals are promoted, there are many contradictions, as well as deviations from the AGHE, which can create confusion among health information seekers. Public health organisations promoting AGHE on Facebook are few and not as popular. CONCLUSION: Public health organisations need to be more engaged on popular internet platforms such as Facebook. The prevailing popular nutrition advice online may increase consumer confusion, scepticism and even avoidance of dietary advice. Proactive efforts are needed by public health organisations, in partnership social marketing experts, to create and share engaging and accurate nutrition content. Partnership with celebrities should be explored to improve reach and impact of evidence-based diet recommendations online.

16.
Diabetes Res Clin Pract ; 139: 239-252, 2018 May.
Article in English | MEDLINE | ID: mdl-29522789

ABSTRACT

Nutrition therapy is considered a key component of diabetes management, yet evidence around the ideal macronutrient composition of the diet remains inconclusive. A systematic review and meta-analysis was performed to assess the effects of carbohydrate-restricted diets (≤45% of total energy) compared to high carbohydrate diets (>45% of total energy) on glycemic control in adults with diabetes mellitus. Six databases were searched for articles published between January 1980 and August 2016. Primary outcome was between-group difference in HbA1c change. Individual effect sizes were standardized, and a meta-analysis performed to calculate pooled effect size using random effects. 25 RCTs involving 2412 participants were included. Carbohydrate-restricted diets, in particular those that restrict carbohydrate to <26% of total energy, produced greater reductions in HbA1c at 3 months (WMD -0.47%, 95% CI: -0.71, -0.23) and 6 months (WMD -0.36%, 95% CI: -0.62, -0.09), with no significant difference at 12 or 24 months. There was no difference between moderately restricted (26-45% of total energy) and high carbohydrate diets at any time point. Although there are issues with the quality of the evidence, this review suggests that carbohydrate-restricted diets could be offered to people living with diabetes as part of an individualised management plan.


Subject(s)
Blood Glucose/metabolism , Diabetes Mellitus, Type 2/diet therapy , Diet, Carbohydrate-Restricted/methods , Dietary Carbohydrates/adverse effects , Aged , Diabetes Mellitus, Type 2/pathology , Female , Humans , Male , Middle Aged
17.
Sci Rep ; 7(1): 17392, 2017 12 12.
Article in English | MEDLINE | ID: mdl-29234031

ABSTRACT

Food reformulation has been suggested to be one of the strategies to reduce population added sugar (AS) intake. This study aims to investigate the untested assumption that a reduction in AS through reformulation will result in a reduction in population intakes of AS and energy. Plausible dietary data from 4,140 respondents of an Australian national nutrition survey were used. Dietary modelling was performed at AS reductions of 10%, 15%, and 25% using four strategies: simple removal of AS or replacement with non-nutritive sweeteners (NNS), and replacement of AS with NNS and either: polyols, 50% fibres or 50% maltodextrin. Paired t-tests were conducted to compare the intake of energy, fat, and AS pre- and post-reformulation. The chosen reformulation strategies resulted in a projected reduction in AS and energy, with the greatest reduction found in 25% reformulation which was the highest level modelled. The overall projected mean (SD) reduction in energy and AS after 25% reformulation was 114 (92) kJ/day and 11.73 (7.52) g/day, p < 0.001. To conclude, product reformulation may be a potentially useful strategy for reducing AS intake. Although the magnitude of projected reduction was small at the individual level, the impact may be meaningful at a population level.

18.
Matern Child Health J ; 21(12): 2256-2266, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28779369

ABSTRACT

Objectives Globally, one-fifth of the world's children are stunted, however this statistic may be an underestimate as many countries lack comprehensive monitoring of height-for-age. Until a recent national health survey, Negara Brunei Darussalam has lacked the data to offer a comprehensive assessment of height-for-age among children. The aim of this study is to determine the prevalence of and factors associated with stunting among children aged 0-24 months in Negara Brunei Darussalam (Brunei). Methods A cross-sectional analyses of 396 children aged <24 months. Demographic, dietary and anthropometric measurements were recorded. Multivariate logistic regression was used to analyse factors associated with moderate stunting. Results Almost one-quarter of infants (24%) were stunted. Male children and children who were preterm (<37 weeks gestation) were more than twice as likely to be stunted as their counterparts, respectively (OR 2.48; 95% CI 1.49-4.12; OR 2.14; 95% CI 1.06-4.33, respectively). Those who were born low birth weight (<2.5 kg) were three times more likely to be stunted than those born normal birth weight (OR 2.99; 95% CI 1.44-6.17). Conclusions for Practice This study presents data on prevalence of stunting in Brunei based upon the World Health Organization's growth charts. In addition it is also the first time that the factors associated with stunting among infants aged <24 months have been examined in Brunei. The stunting prevalence in Brunei is of concern due to the reported short and long-term negative impact on health later in life. The authors recommend close monitoring of pregnant women who are at risk of delivering low birth weight infants and frequent monitoring of low birth weight infants in line with World Health Organization nutrition goals. Existing height-for-age data should be integrated into global databases.


Subject(s)
Child Nutrition Disorders/epidemiology , Growth Disorders/epidemiology , Malnutrition/complications , Body Height , Brunei/epidemiology , Child , Growth Disorders/etiology , Health Surveys , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Logistic Models , Male , Malnutrition/epidemiology , Nutritional Status , Prevalence , Risk Assessment , Risk Factors , Severity of Illness Index
19.
Soc Sci Med ; 177: 141-149, 2017 03.
Article in English | MEDLINE | ID: mdl-28161671

ABSTRACT

Effective obesity prevention requires a synergistic mix of population-level interventions including a strong role for government and the regulation of the marketing, labelling, content and pricing of energy-dense foods and beverages. In this paper we adopt the agenda of the Australian Federal Government (AFG) as a case study to understand the factors generating or hindering political priority for such 'regulatory interventions' between 1990 and 2011. Using a theoretically-guided process tracing method we undertook documentary analysis and conducted 27 interviews with a diversity of actors involved in obesity politics. The analysis was structured by a theoretical framework comprising four dimensions: the power of actors involved; the ideas the actors deploy to interpret and portray the issue; the institutional and political context; and issue characteristics. Despite two periods of sustained political attention, political priority for regulatory interventions did not emerge and was hindered by factors from all four dimensions. Within the public health community, limited cohesion among experts and advocacy groups hampered technical responses and collective action efforts. An initial focus on children (child obesity), framing the determinants of obesity as 'obesogenic environments', and the deployment of 'protecting kids', 'industry demonization' and 'economic costs' frames generated political attention. Institutional norms within government effectively selected out regulatory interventions from consideration. The 'productive power' and activities of the food and advertising industries presented formidable barriers, buttressed by a libertarian/neolibertarian rhetoric emphasizing individual responsibility, a negative view of freedom (as free from 'nanny-state' intervention) and the idea that regulation imposes an unacceptable cost on business. Issue complexity, the absence of a supportive evidence base and a strict 'evidence-based' policy-making approach were used as rationales to defer political priority. Overcoming these challenges may be important to future collective action efforts attempting to generate and sustain political priority for regulatory interventions targeting obesity.


Subject(s)
Health Policy/legislation & jurisprudence , Obesity/prevention & control , Policy Making , Politics , Australia , Health Policy/trends , Humans , Nutrition Policy/legislation & jurisprudence , Nutrition Policy/trends , Public Health/legislation & jurisprudence , Public Health/methods , Qualitative Research
20.
Am J Pharm Educ ; 80(4): 69, 2016 May 25.
Article in English | MEDLINE | ID: mdl-27293236

ABSTRACT

Objective. To develop, implement, and evaluate a competency-based weight management skills workshop for undergraduate pharmacy students in an Australian university. Design. A 3-hour workshop titled "Weight Management in Pharmacy" was implemented with a cohort of fourth-year undergraduate pharmacy students (n=180). Learning activities used included case-based learning, hands-on experience, role-play, and group discussion. Assessment. A 22-item attitudinal survey instrument and the validated Obesity Risk Knowledge (ORK-10) scale were administered at baseline and postworkshop to evaluate the impact of this educational workshop. There was significant improvement in the students' ORK scores and students' perceived level of self-confidence in performing weight management skills. Conclusion. An educational workshop designed to enhance professional competencies in weight management ensured graduates were "service-ready" and had the appropriate knowledge, skills, and attributes to deliver patient-centered pharmacy-based weight management services.


Subject(s)
Clinical Competence , Curriculum , Education, Pharmacy/methods , Education/methods , Students, Pharmacy , Weight Loss , Australia , Cohort Studies , Female , Humans , Male , Surveys and Questionnaires , Young Adult
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