Patient and Professional Perspectives on Nutrition in Chronic Respiratory Disease Self-Management: Reflections on Nutrition and Food Literacies.

BACKGROUND: Nutrition literacy (NL) and food literacy (FL) have emerged as distinct forms of the multifaceted concept of health literacy (HL). Despite convincing evidence that changes in dietary behavior can improve health, the role of nutrition in supporting self-management in patients with chronic respiratory disease tends to be overlooked. OBJECTIVE: This study examined patient and key informant (health care professionals, researchers, and policymakers) perspectives on nutrition in the context of self-management practices in asthma and chronic obstructive pulmonary disease with implications for NL and FL. METHODS: Data were collected during 16 focus groups with 93 English- and French-speaking patients in the Canadian Provinces of British Columbia, Ontario, and Quebec, and in-depth interviews with 45 key informants mainly from Canada. Participants' comments, including dietary perception keywords, were extracted and classified using NVivo software. Thematic analysis was applied. KEY RESULTS: Patients' perspectives on nutrition reflected three broad themes: (1) importance of nutrition knowledge in self-management, (2) applying nutrition knowledge in self-management, and (3) challenges in applying nutrition knowledge in self-management. Embedded within the third theme were six sub-themes: Limitations in "accessing nutrition information," "understanding nutrition information," "basic literacy skills," and "ability to act on nutrition information," along with "lack of supports to act on nutrition information," and "competing daily demands in mealtime and medication management." Although less than 10% of key informants provided nutrition-relevant comments, their comments reinforced patients' concerns about barriers to accessing, understanding, and using nutrition information in self-management. CONCLUSIONS: Our findings suggest that more attention be directed to nutrition in the self-management of chronic respiratory disease and warrant further research on the roles of NL and FL in this health practice context. Such research could also contribute to the broader agenda of understanding NL and FL and applying them as subconcepts of HL in chronic disease self-management interventions. [ HLRP: Health Literacy Research and Practice. 2018;2(3):e166-e174.]. PLAIN LANGUAGE SUMMARY: Growing evidence supporting the role of diet in chronic disease calls for more attention to nutrition literacy. This study explored patient and key informant viewpoints on engaging with nutrition information in self-management of chronic lung disease. Findings suggest patients encounter many challenges in accessing, understanding, and acting on relevant nutrition information.

Cooking methods and esophageal squamous cell carcinoma in high-risk areas of Iran.

Cooking methods have been implicated in the etiology of gastrointestinal cancers, reflecting exposure to potential carcinogens as results of cooking. We used a validated food frequency questionnaire and a pretested cooking method questionnaire in 3 groups: 40 esophageal squamous cell carcinoma (ESCC) cases from a high-risk area in northeast of Iran, 40 healthy subjects from the same high-risk area, and 40 healthy subjects from a low-risk area in Southern Iran. We compared the frequency of boiling, grilling, and frying, and the frying score among these 3 groups. We also calculated "frying index" by multiplying the frequency of each fried food item by its frying score. Mean frying to boiling ratios were 18.2:1, 12.8:1, and 2.6:1 for cases, high-risk controls, and low-risk controls, respectively (P < 0.01). Reuse of cooking oil for frying was reported in 37.5% of the ESCC cases, 25% of high-risk controls, and 7.5% of low-risk controls (P < 0.001). Frying index was higher in the high-risk than in the low-risk controls (P < 0.001) and in cases than in the high-risk controls (P < 0.05) after adjusting for smoking, opium use, rural residence, education, and ethnicity. High-temperature cooking and frying may be associated with increased risk of ESCC in high-risk areas.

Dietary intake of benzo(a)pyrene and risk of esophageal cancer in north of Iran.

One etiologic factor for high incidence of esophageal squamous cell carcinoma (ESCC) in Golestan (Northeastern Iran) might be exposure to polycyclic aromatic hydrocarbons. We examined whether food and water are major sources of benzo(a)pyrene (BaP) exposure in this population. We used a dietary questionnaire to assess the daily intake of staple food (rice and bread) and water in 3 groups: 40 ESCC Golestan cases, 40 healthy subjects from the same area, and 40 healthy subjects from a low-risk area in Southern Iran. We measured, by high-performance liquid chromatography combined with fluorescence detection, the BaP concentration of bread, rice, and water in samples obtained from these 3 groups and calculated the daily intake of BaP. Mean BaP concentration of staple foods and water was similar and within standard levels in both areas, but the daily intake of BaP was higher in controls from the high-risk area than in controls from the low-risk area (91.4 vs. 70.6 ng/day, P < 0.01). In the multivariate regression analysis, having ESCC had no independent effect on BaP, whereas residence in the low-risk area was associated with a significant decrease in total BaP intake. Polycyclic aromatic hydrocarbons might, along with other risk factors, contribute to the high risk of ESCC in Golestan.