The moderating effects of greenspace on the association between neighbourhood disadvantage and obesity among mid-to-older aged Australian adults.

This study examined whether the association between neighbourhood disadvantage and obesity was moderated by quantity and quality of greenspace. The sample included 2848 mid-to-older aged adults residing in 200 neighbourhoods in Brisbane, Australia from the HABITAT study. Self-reported height and weight were used to calculate body mass index (BMI), neighbourhood disadvantage was measured using a census-derived composite index and greenspace was measured geospatially. We found evidence of moderation by park quality: lower average BMI at higher levels of park quality was shown in the Q3 rather than the Q1 (least disadvantaged) neighbourhood disadvantage group. The findings suggest that, for reducing socioeconomic inequalities in obesity, the quality of greenspace is imperative.

Double Burden of Malnutrition: A Population Level Comparative Cross-Sectional Study across Three Sub-Saharan African Countries-Malawi, Namibia and Zimbabwe.

BACKGROUND: The double burden of malnutrition in sub-Saharan African countries at different levels of economic development was not extensively explored. This study investigated prevalence, trends, and correlates of undernutrition and overnutrition among children under 5 years and women aged 15-49 years in Malawi, Namibia, and Zimbabwe with differing socio- economic status. METHODS: Prevalence of underweight, overweight, and obesity were determined and compared across the countries using demographic and health surveys data. Multivariable logistic regression was used to ascertain any relationships between selected demographic and socio-economic variables and overnutrition and undernutrition. RESULTS: An increasing trend in overweight/obesity in children and women was observed across all countries. Zimbabwe had the highest prevalence of overweight/obesity among women (35.13%) and children (5.9%). A decreasing trend in undernutrition among children was observed across all countries, but the prevalence of stunting was still very high compared to the worldwide average level (22%). Malawi had the highest stunting rate (37.1%). Urban residence, maternal age, and household wealth status influenced maternal nutritional status. The likelihood of undernutrition in children was significantly higher with low wealth status, being a boy, and low level of maternal education. CONCLUSIONS: Economic development and urbanization can result in nutritional status shifts.

Triggering Weight Management Using Digital Avatars: Prospective Cohort Study.

BACKGROUND: There is evidence that showing motivated people with a less-than-ideal BMI (>25 kg/m2) digital and personalized images of their future selves with reduced body weight will likely trigger them to achieve that new body weight. OBJECTIVE: The purpose of this study is to assess whether digital avatars can trigger weight management action and identify some of the measurable factors that distinguish those who may be triggered. METHODS: A prospective cohort study followed participants for 12 weeks through 5 recorded interviews. Participants were screened for suitability for the study using the Cosmetic Procedure Screening Questionnaire as a measure of body dysmorphia. At interview 1, participants were shown 10 images from a "Food-pics" database and invited to estimate their calorie value. The intervention, the FutureMe app, delivered at interview 2, provided each participant an opportunity to see and take away a soft copy of an avatar of themselves as they might appear in the future depending on their calorie consumption and exercise regimen. Participants completed the readiness for change (S-Weight) survey based on Prochaska Stages of Change Model and the processes of change (P-Weight) survey. Any changes in diet, exercise, or weight were self-reported. RESULTS: A total of 87 participants were recruited, and 42 participants completed the study (48% of recruited participants). Body dysmorphia was a rare but possible risk to participation. The majority (88.5%) of the participants were female and older than 40 years. The average BMI was 34.1 (SD 4.8). Most people wanted to reduce to a BMI of 30 kg/m2 or lose on average 10.5 kg within 13 weeks (-0.8 kg per week). Most participants stated that they would achieve these results by limiting their calorie intake to 1500 calories per day and taking the equivalent of 1 hour of bicycling per day. At interview 1, more participants were in the preparation stage of behavior change than in subsequent interviews. By interview 5, most of the participants were at the maintenance stage. Participants who overestimated the recommended number of calories were more likely to be in the contemplation stage (P=.03). CONCLUSIONS: Volunteers who participated in the study were mainly women older than 40 years and beyond the contemplation stage of change for weight management, and those who took weight management action were demonstrated to have a more accurate idea of the calorie content of different foods. Most participants set ambitious targets for weight loss, but few, if any, achieve these goals. However, most people who completed this study were actively taking action to manage their weight. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001481167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378055&isReview=true.

Food behaviours and eating habits among Sub-Saharan African migrant mothers of school-aged children in South Australia.

Overweight, obesity and chronic conditions like diabetes, stroke and heart disease represent a significant burden to public health. Traditional foods and healthy dietary habits can reduce the risk of these conditions. Therefore, this study aimed to explore traditional food patterns and eating habits among Sub-Saharan African migrant mothers of school-aged children in South Australia. The study was a qualitative inquiry that used face-to-face interviews with 15 mothers of school-aged children in South Australia. Snowballing was used to sample participants, and data were audio-recorded, transcribed verbatim, coded, and analysed thematically. Four broad themes described participants' food behaviours and eating habits, including maintaining traditional food patterns, changes in traditional food patterns and eating habits, concerns with food environments in Australia, and challenges with traditional food availability and access in Australia. This study found that although mothers were committed to maintaining their traditional foods, they found it increasingly difficult to continue such habits. Participants reported challenges as their children are increasingly demanding westernised foods. While some parents pushed back against such demands from their children, others felt helpless and relented. Some views showed that food environments, food systems, access, and scarcity of traditional foods in Australia influenced the participants' food patterns and eating habits. Appropriately tailored healthy eating health promotion actions targeting school-aged children and mothers in this population need to consider their food contexts. Promoting the use of traditional foods, their preparation practices, and processing might be helpful in this community when developing healthy eating programs.

Removal of sugar sweetened beverages from sale in a hospital setting-Consumer opinion and influence on purchasing behavior.

ISSUE ADDRESSED: This study investigated the impact of removing sugar sweetened beverages (SSBs) from sale in a regional health service. Drink purchasing patterns were measured by product ordering data. Consumer opinion regarding the intervention, self-reported packaged drink purchase and consumption were also explored. METHODS: Packaged drinks were classified into two categories, SSB or non-SSB and drink types. Drink sales were determined by the collection of product ordering data for all packaged drink types sold, six months prior to and twelve months after the removal of SSBs. A consumer survey was undertaken six months after SSB removal to assess consumer opinion regarding SSB removal, self-reported SSB consumption and purchase. Descriptive and Wilcoxon rank-sum tests analyses assessed differences in packaged drinks purchase, self-reported SSB consumption and purchase. Open-ended survey responses were thematically analysed. RESULTS: The median monthly number of juices, and diet drinks ordered increased significantly (P = .05). 59% of the survey respondents regularly consumed SSBs and 58% agreed or strongly agreed with removing SSBs from sale. However, some consumers felt it was a removal of their freedom of choice. CONCLUSIONS: Removing SSBs from sale can result in consumers making healthier purchases. There was support for the initiative as it is seen as the responsibility of the health service to role model healthy eating behaviours. SO WHAT?: This study indicates removal of SSBs from sale is a promising health promotion intervention that can contribute to positive behaviour change, and potentially influence longer-term health and wellbeing.

Socioeconomic Inequalities and HIV Testing During Antenatal Care in High- Medium- and Low-Conflict Intensity Countries in Sub-Saharan Africa.

Understanding HIV testing determinants in different settings is vital to reducing new infections. This study assessed HIV testing rates during antenatal care (ANC) in seven sub-Saharan African countries designated as high, medium, low or no conflict intensity settings. We ranked and plotted concentration curves for HIV testing by socioeconomic inequality and determined their concentration indices (CCI). Testing for HIV during ANC was highest in Zimbabwe (95.7%) and lowest in Sudan (3.6%). Countries with medium and high conflict intensity experienced higher HIV testing inequality (CCI = 0.38) than countries with low or no conflict (CCI = 0.15). Low HIV testing rates were associated with no education, rural areas, poorest wealth index quintiles and home birth, which demonstrate that determinants of HIV testing during ANC in conflict-affected areas are complex and context-based. Programme implementation and policymakers must acknowledge these complexities and local contexts in their program designs and planning.

Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: A systematic review and meta-analysis.

BACKGROUND: People from racial minority groups in western countries experience disproportionate socioeconomic and structural determinants of health disadvantages. These disadvantages have led to inequalities and inequities in health care access and poorer health outcomes. We report disproportionate disparities in prevalence, hospitalisation, and deaths from COVID-19 by racial minority populations. METHODS: We conducted a systematic literature search of relevant databases to identify studies reporting on prevalence, hospitalisations, and deaths from COVID-19 by race groups between 01 January 2020 - 15 April 2021. We grouped race categories into Blacks, Hispanics, Whites and Others. Random effects model using the method of DerSimonian and Laird were fitted, and forest plot with respective ratio estimates and 95% confidence interval (CI) for each race category, and subgroup meta-regression analyses and the overall pooled ratio estimates for prevalence, hospitalisation and mortality rate were presented. RESULTS: Blacks experienced significantly higher burden of COVID-19: prevalence ratio 1.79 (95% confidence interval (CI) = 1.59-1.99), hospitalisation ratio 1.87 (95% CI = 1.69-2.04), mortality ratio 1.68 (95% CI = 1.52-1.83), compared to Whites: prevalence ratio 0.70 (95% CI = 0.0.64-0.77), hospitalisation ratio 0.74 (95% CI = 0.65-0.82), mortality ratio 0.82 (95% CI = 0.78-0.87). Also, Hispanics experienced a higher burden: prevalence ratio 1.78 (95% CI = 1.63-1.94), hospitalisation ratio 1.32 (95% CI = 1.08-1.55), mortality ratio 0.94 (95% CI = 0.84-1.04) compared to Whites. A higher burden was also observed for Other race groups: prevalence ratio 1.43 (95% CI = 1.19-1.67), hospitalisation ratio 1.12 (95% CI = 0.89-1.35), mortality ratio 1.06 (95% CI = 0.89-1.23) compared to Whites. The disproportionate burden among Blacks and Hispanics remained following correction for publication bias. CONCLUSIONS: Blacks and Hispanics have been disproportionately affected by COVID-19. This is deeply concerning and highlights the systemically entrenched disadvantages (social, economic, and political) experienced by racial minorities in western countries; and this study underscores the need to address inequities in these communities to improve overall health outcomes.

HIV/AIDS knowledge and attitudes assessment among women of child-bearing age in South Sudan: Findings from a Household Survey.

This study assessed the determinants that shape HIV knowledge and attitudes among South Sudanese women by analysing a Multiple Indicator Cluster Survey collected from 9,061 women in 9,369 households. Generalised linear mixed model regression was performed. Fifty percent of respondents were aware of HIV/AIDS, with 21% and 22% exhibiting good knowledge and positive attitudes towards people with HIV/AIDS, respectively. When controlled for individual and community-level variables, younger women (AOR = 1.28, 95% CI: 1.01-162), women with primary (AOR = 2.19; 95% CI: 1.86-2.58) and secondary (AOR = 4.48; 95% CI: 3.38-5.93) education, and those living in urban areas (AOR = 1.40; 95% CI: 1.12-1.76) had significantly good knowledge. Women in the richer (AOR = 1.60; 95% CI: 1.08-2.36) and the richest (AOR = 2.02; 95% CI: 1.35-3.02) wealth quintiles had significant positive attitudes towards people with HIV/AIDS. Well-designed social and behavioural campaigns targeting uneducated women and those living in rural and remote settings will enhance knowledge of perceived risk, awareness, and ability to carry out preventive behaviours.

Blackcurrant anthocyanins modulate CCL11 secretion and suppress allergic airway inflammation.

CCL11, a chemokine, is linked to the early development of airways eosinophilia in allergic asthma. Therefore, CCL11 production is a target for abrogating eosinophilic-driven airway inflammation. Blackcurrants are high in compounds that regulate inflammation, particularly anthocyanins. In this study, we investigated the effect of oral blackcurrant supplementation on allergen-induced eosinophilia and CCL11 production; we also profiled key compounds in blackcurrants that were linked to this effect. Ten milligram per kilogram (total anthocyanins) of a commercially available, anthocyanin-rich New Zealand "Ben Ard" blackcurrant extract ("Currantex 30") attenuated ovalbumin-induced inflammation, eosinophilia (by 52.45 ± 38.50%), and CCL11 production (by 48.55 ± 28.56%) in a mouse model of acute allergic lung inflammation. Ten blackcurrant polyphenolic extracts were also found to suppress CCL11 secretion by stimulated human lung epithelial cells in vitro. Correlation analysis identified potential blackcurrant polyphenolic anthocyanin constituents specifically delphinidins and cyanidins, involved in CCL11 suppression. Our findings show oral supplementation with New Zealand blackcurrant is effective in reducing lung inflammation, and highlight the potential benefit of developing cultivars with specific polyphenolic profiles for the creation of functional foods with desirable biological activity.

Blackcurrant cultivar polyphenolic extracts suppress CCL26 secretion from alveolar epithelial cells.

Eosinophil recruitment to the airways is a characteristic feature of allergic asthma. Eotaxins are potent chemokines that regulate the recruitment of eosinophils to sites of inflammation. Of these, CCL26 is linked to persistent eosinophil recruitment in the later phase of an allergic response. We evaluated the effectiveness of 10 different blackcurrant cultivar polyphenolic extracts in suppressing CCL26 secretion in stimulated human alveolar epithelial cells. Correlation analysis to identify the potential blackcurrant composition constituent(s) involved in CCL26 suppression and the effects of the four major anthocyanins present in blackcurrants to validate results was conducted. All blackcurrant polyphenolic extracts suppressed CCL26 secretion by lung alveolar cells; however, differential efficacy was observed, which was attributed to their cultivar-specific polyphenolic composition profiles. We identified that the ratio of concentrations of delphinidin glycosides to cyanidin glycosides in the blackcurrant cultivars was an important determinant in influencing CCL26 suppression in lung cells. Our findings support the potential use of blackcurrants or blackcurrant-derived foods/ingredients in managing lung inflammation and the development of specific cultivars as functional foods/ingredients with beneficial biological activities.

Plant-derived foods for the attenuation of allergic airway inflammation.

Asthma is an allergy-mediated inflammatory disease characterised by infiltration of the airway with mast cells, lymphocytes, and eosinophils. The disease is induced by co-ordination of T-helper cell type 2 (Th2) cytokines and inflammatory signal molecules. Fruits and vegetables are a rich source of polyphenolic bioactive compounds, which have been observed to have health-promoting properties when consumed by humans. In particular, fruit-derived proanthocyanins and anthocyanins have been found to attenuate lung inflammation. Epidemiological studies have revealed correlations between fruit consumption and a lower prevalence of respiratory symptoms and lower incidence of non-specific lung diseases. In this review we summarise the current understanding of the pathophysiologic mechanism(s) involved in the development of allergic airway disease. We also review evidence of the beneficial effects of plant-derived foods, their components and metabolites in allergic airway inflammation arising from in vitro and rodent studies, epidemiological studies and human intervention trials. The mechanism, biological relevance and functional benefits, such as immune modulation (e.g. reduction in cytokine and eotaxin production), antioxidant ability, tissue remodelling and tight junction function are also discussed.

Effects of potato fiber and potato-resistant starch on biomarkers of colonic health in rats fed diets containing red meat.

UNLABELLED: The effects of red meat consumption with and without fermentable carbohydrates on indices of large bowel health in rats were examined. Sprague-Dawley rats were fed cellulose, potato fiber, or potato-resistant starch diets containing 12% casein for 2 wk, then similar diets containing 25% cooked beef for 6 wk. After week 8, cecal and colonic microbiota composition, fermentation end-products, colon structure, and colonocyte DNA damage were analyzed. Rats fed potato fiber had lower Bacteroides-Prevotella-Porphyromonas group compared to other diet groups. Colonic Bifidobacterium spp. and/or Lactobacillus spp. were higher in potato fiber and potato-resistant starch diets than in the cellulose diet. Beneficial changes were observed in short-chain fatty acid concentrations (acetic, butyric, and propionic acids) in rats fed potato fiber compared with rats fed cellulose. Phenol and p-cresol concentrations were lower in the cecum and colon of rats fed potato fiber. An increase in goblet cells per crypt and longer crypts were found in the colon of rats fed potato fiber and potato-resistant starch diets. Fermentable carbohydrates had no effect on colonic DNA damage. Dietary combinations of red meat with potato fiber or potato-resistant starch have distinctive effects in the large bowel. Future studies are essential to examine the efficacy of different types of nondigestible carbohydrates in maintaining colonic health during long-term consumption of high-protein diets. PRACTICAL APPLICATION: Improved understanding of interactions between the food consumed and gut microbiota provides knowledge needed to make healthier food choices for large bowel health. The impact of red meat on large bowel health may be ameliorated by consuming with fermentable dietary fiber, a colonic energy source that produces less harmful by-products than the microbial breakdown of colonic protein for energy. Developing functional red meat products with fermentable dietary fiber could be one way to promote a healthy and balanced macronutrient diet.