Applying the food multimix concept for sustainable and nutritious diets.

Despite a rich and diverse ecosystem, and biodiversity, worldwide, more than 2 billion people suffer from micronutrient malnutrition or hidden hunger. Of major concern are a degradation of our ecosystems and agricultural systems which are thought to be unsustainable thereby posing a challenge for the future food and nutrition security. Despite these challenges, nutrition security and ensuring well balanced diets depend on sound knowledge and appropriate food choices in a complex world of plenty and want. We have previously reported on how the food multimix (FMM) concept, a food-based and dietary diversification approach can be applied to meet energy and micronutrient needs of vulnerable groups through an empirical process. Our objective in this paper is to examine how the concept can be applied to improve nutrition in a sustainable way in otherwise poor and hard-to-reach communities. We have reviewed over 100 FMM food recipes formulated from combinations of commonly consumed traditional candidate food ingredients; on average five per recipe, and packaged as per 100 g powders from different countries including Ghana, Kenya, Botswana, Zimbabawe and Southern Africa, India, Mexico, Malaysia and the UK; and for different age groups and conditions such as older infants and young children, pregnant women, HIV patients, diabetes and for nutrition rehabilitation. Candidate foods were examined for their nutrient strengths and nutrient content and nutrient density of recipes per 100 g were compared with reference nutrient intakes for the different population groups. We report on the nutrient profiles from our analysis of the pooled and age-matched data as well as sensory analysis and conclude that locally produced FMM foods can complement local diets and contribute significantly to meet nutrient needs among vulnerable groups in food-insecure environments.

Fruit and vegetables on prescription: a brief intervention in primary care.

BACKGROUND: Increasing fruit and vegetable consumption is a goal for the U.K. Therefore, the effectiveness of a fruit and vegetable voucher scheme coupled with key 'five-a-day' consumption messages as a brief intervention in primary care consultations was assessed in the present study. METHODS: One thousand one hundred and eighty-eight vouchers as a prescription for fruits and vegetables were routinely distributed to patients attending a primary healthcare centre in a deprived area, and 124 volunteer patients routinely attending the centre were included. Telephone-based questionnaires were used to examine changes in consumption over the short and medium term. Other key aspects assessed in the evaluation related to fruit and vegetable purchasing behaviour, knowledge relating to what constitutes a portion size, the relationship between food and health, and barriers to consumption. RESULTS: Although 76.2% of participants used the prescription vouchers when purchasing fruits and vegetables, a significant change in the consumption or purchasing behaviour was not observed (P > 0.05). Participants' level of knowledge relating to the number of portions recommended and the portion size of different fruits and vegetables showed a moderate increase from baseline over the short and medium term. The primary barriers to fruit and vegetable consumption were reported as 'the quality of fresh fruits and vegetables' and 'the money available to spend on food'. CONCLUSIONS: The use of 'the fruit and vegetable on prescription' scheme was an effective method of engaging participants in improving awareness of key diet-related health messages. However, further intervention is required to produce a significant impact on the actual behaviour change.

An investigation to determine the nutritional adequacy and individuals experience of a very low fat diet used to treat type V hypertriglyceridaemia.

BACKGROUND: The management of Type V hypertriglyceridaemia at some centres involves the use of a very low fat diet (15% energy as fat). There is no published research examining compliance with, or nutritional adequacy, of this treatment. This study assesses the nutritional adequacy of the diet and examines barriers and enablers to adherence. METHODS: Fifty-four eligible patients were invited to take part. Eight males and one female agreed to participate. One male later withdrew. The mean age of participants was 49.4 years (SD 12.9 years), their mean BMI was 30.4 kg m(-2) (SD 3.4 kg m(-2)) and their mean triglyceride level was 8.5 mmol L(-1) (SD 5.6 mmol L(-1)). To assess nutritional adequacy and compliance, 3-day dietary records and telephone based diet histories were used and analysed using CompEat. Patients' experience was investigated using semi-structured telephone based qualitative interviews. Qualitative data was recorded, transcribed and analysed using thematic analysis to allow elucidation of emerging themes. RESULTS: Fat accounted for 22.5% of dietary energy and compliance was considered difficult. Barriers included lack of accessible nutritional information, increased patient burden defined as inconvenience and the persistent awareness of potential or actual ill health, lack of appropriate food choices, other peoples' ignorance, lack of flavour and variety, a desire to broaden the palate, cost, social pressure and prior negative experiences with dietitians. Enablers to compliance included nutritional awareness, desire to maintain good health, building on their nutritional knowledge base, behaviour and lifestyle modification, developing a routine, the support of family and friends and supportive eating environments. CONCLUSION: Compliance could be improved through extensive education on labelling, eating during special occasions such as Christmas, birthdays and eating out.

Mainstreaming prevention: prescribing fruit and vegetables as a brief intervention in primary care.

This paper examines a brief preventive intervention as a model for embedding public health action in primary care. BACKGROUND: Low fruit and vegetable intake is a major risk factor for cancer, coronary heart disease and stroke. The recommended intake of five portions per day would reduce death rates from these causes by 20%. However, average daily consumption in the UK is under three portions, and it is significantly lower in men, young people and lower socio-economic groups. In order to tackle risk factors such as poor diet, the white paper Choosing Health promises action and funding to mainstream prevention and transform the NHS from a sickness service to a genuine health service. THE INTERVENTION: To promote increased fruit and vegetable consumption, primary care professionals working in a deprived area issue prescriptions which offer the patient discounts on fruit and vegetable purchases. Hand over of each prescription to the patient is linked explicitly to key five a day messages. This brief intervention takes 1-2 min to deploy. IMMEDIATE OUTCOMES: Evaluation is ongoing. However, early feedback suggests that the intervention of prescription plus key messages has a significant impact on patients in highlighting the connection between food and health. Clinicians express satisfaction at having a preventive intervention that can be deployed with confidence and consistency in routine primary care consultations. DISCUSSION: This brief intervention is presented as a potential model for embedding prevention in the day-to-day work of health professionals. Primary care is a natural setting for the promotion of health, but despite success in implementing some public health programmes, it has a patchy record in primary prevention. The reasons for this are examined, the impact of new contractual and commissioning levers is explored, and a general framework for mainstreaming public health action in primary care is proposed.