Obesity increased the risk of SARS-CoV-2 positivity in children.

AIM: To determine the effects of obesity in childhood on SARS-CoV-2 infection. METHODS: A population-based, cross-sectional study combining the Israeli Growth Survey and COVID-19 data for children with at least one SARS-CoV-2 test from 16 February 2020 to 20 December 2021. Overweight and obesity status were based on body mass index and the Center for Disease Control criteria. Multivariate logistics regression was performed to validate reliability for weight categories at the age of approximately 6 years compared with weights at approximately 12 years. RESULTS: A total of 444 868 records for children with an overall positivity rate of 22% were studied. The mean age was 9.5 years. The odds ratios of children with obesity or overweight after controlling for sex at 6 years to test positive were 1.07-1.12 and 1.06-1.08 (depending on the model), respectively, compared to those with healthy range body mass index. CONCLUSION: Excess weight appears to increase the risk of SARS-CoV-2 infection. This finding should be considered for public health planning. For example, children with overweight and obesity should be prioritised for vaccination. Excess weight in childhood can be harmful at a young age and not only for long-term health.

The demographic and morbidity characteristics of a population receiving food support in Israel.

BACKGROUND: Food supply to poor populations is a big challenge, particularly in periods of economic stress and in an era of chronic diseases epidemics. In Israel more than 4000 poor families are currently receiving food support. Many of the food support products given to the family have low nutrient values, therefore not appropriately ensuring food security of the population. The aim of the current study was to examine for the first time the demographic, nutritional and chronic diseases profiles of food support beneficiaries, so as to aid in planning future food support components in Israel. In addition, the study examined associations between levels of food insecurity status and selected morbidities among food support recipients. METHODS: In 2016, 3000 families (classified as very poor) in 24 municipalities received food support in Israel from the "National Food Security Project" (NFSP), under the guidance of the National Food Security Council. The 400 new families who joined the program in 2016 were requested to complete a questionnaire regarding the demographic and health characteristics of their families. Three hundred sixty-two of them completed the questionnaire for a response rate of 90%. The current study includes these families only. RESULTS: The disposable income per capita of the surveyed families was very low - less than NIS 1100 a month ($280). About half the families were working families and 40% of them were in debt. Of the 362 responding families, about 82% of them were food insecure, with more than half severely food-insecure; this, despite receiving food support. About one-third of the families had at least one member with anemia, and a quarter of the families had a member with hyperlipidemia. Hypertension is present in about 22% of the families, diabetes in 17%, and there is a 12% incidence of at least one family member with heart disease. These rates are markedly higher than those in the general population. Higher levels of food insecurity were associated with higher levels of hyperlipidemia, heart disease and hypertension. DISCUSSION AND CONCLUSIONS: The nutrition and medical status of the population receiving food support is much worse than in the general population. There is a need to improve the nutritional value of food support; this could include greater emphasis on whole grains, fruits and vegetables. There is also a need for a nationwide education program to focus on healthy nutrition and to subsidize healthy foods. Many health and nutrition promotion models show that in order to effect changes in dietary habits and behaviors related to improving nutrition, there is a need for nutrition education (Kamp et al., J Nutr Educ Behav 42:72-82, 2010).

Texture-modified foods and thickened fluids used in dysphagia: Israeli standardised terminology and definitions.

BACKGROUND: Texture-modified foods and thickened fluids are used as a strategy that aims to compensate for dysphagia and improve the safety and efficiency of swallowing. Currently, in Israel, there are no standardised terminologies and definitions for texture-modified diets. The inconsistent terminology adversely affects patient safety and the efficiency of communication between staff members both within and between health institutions. This present study describes a project of the Israeli Ministry of Health in which the labels and definitions of prevalent foods and fluids used in health institutions are mapped to develop a consensus on national standards. METHODS: A multidisciplinary committee of speech-language pathologists (SLPs) and registered dietitians (RDs) was appointed. A questionnaire was developed to identify the labels of texture-modified foods and fluids used in the Israeli healthcare system. The questionnaire included questions on knowledge, attitudes and barriers related to the need for a consistent national terminology for texture-modified diets. Questionnaires were sent to 120 institutions. The project was conducted between September 2016 and December 2017. RESULTS: Twenty-six SLPs and 42 RDs responded. The answers revealed that there were 50 labels in use for texture-modified foods. When asked to describe the texture of a particular food item, up to 17 different labels were used. There was broad support for a standardised terminology. CONCLUSIONS: The results of the present study confirm the lack of national standards in clinical practice and the need for a consistent terminology. A consensus was achieved between the committee members and the committee adopted the International Dysphagia Diet Standardization Initiative (IDDSI) recommendations and adapted the terminology to Hebrew.

Diabetes prevention program in a Mediterranean environment: individual or group therapy? An effectiveness evaluation.

INTRODUCTION: Diabetes as a multifactorial disorder requires prevention measures based upon the modification of several risk factors simultaneously; otherwise, there is insufficient potential for prevention. Following the success of the American Diabetes Prevention Program (DPP), we implemented an intervention program in a large Israeli healthcare organization with an emphasize on Mediterranean Diet (MedDiet) and physical activity. The objective was to evaluate the effectiveness of two types of intervention, individual and group therapies, in reducing risk factors and in preventing or delaying the development of type 2 diabetes. METHODS: Out of 180 primary care physicians, 85 who agreed to participate, were randomly assigned, between the years 2005 and 2006, into two groups: those who would refer pre-diabetes adult patients for individual therapy and those who would refer for group therapy. The two groups of patients consisted of 111 and 112 in each group. The intervention lasted for 6 months and discussed: the benefits of MedDiet, planning nutritional behavior and mindful eating, and the importance of physical activity. All patients were invited to participate in walking groups. Follow up lasted for 24 months and logistic, mixed models, and Cox regressions were employed. RESULTS: No statistically significant differences were detected between the two intervention groups in age; gender and clinical measurements at recruitment. Thirty nine percent of both groups developed diabetes (entered the DR by 2012), including 38.7% from the individual therapy and 39.3% from the group therapy (P=0.933). The mean time from 2005 until entry to the Diabetes Registry (DR) was 2.9 and 2.5 years for the individual and group therapy respectively (P=0.542). CONCLUSION: Both interventions were equally effective in achieving the desired outcomes and time until entry to the DR. For large health organizations with a high number of pre-diabetes patients and scarce resources, group therapy, where 12 people are reached out by one team member are preferable and more costly effective, than a one on one therapy.

Factors associated with dropout in a group weight-loss programme: a longitudinal investigation.

BACKGROUND: Attrition is a major limitation of most weight management intervention programmes. The present study aimed to conduct an extensive investigation of personal, sociodemographic and treatment-related factors associated with attrition at different stages of a 10-week group weight-loss programme. METHODS: The present study is part of a longitudinal, clinical intervention study comparing three conditions in a 10-week group programme: Control, Behavioural Intentions and Implementation Intentions. The study included 587 participants with a mean (SD) age of 46 (11) years (range 18-78 years) and a mean (SD) body mass index (BMI) of 31.9 (5.5) kg m(-2), with 90% being female. To characterise dropout in each week separately, as well as overall dropout (dropout until week 9, the median time of dropout), we tested several logistic regression models, including multiple imputations to cope with missing data. RESULTS: The results of the different dropout models consistently showed that a smaller reduction in BMI in the first 2 weeks of the programme was the strongest predictor of dropout. Dropout in the tenth and last week differed from the earlier weeks both in the relatively high dropout rate (56% of total dropout) and in that, in contrast to earlier weeks, the week 10 model included the reduction in BMI during the last 2 weeks before dropout but did not include the reduction in BMI at the initiation of the intervention. CONCLUSIONS: Weight-loss in the beginning of the programme is a crucial independent determinant of dropout in each week except the last one. This finding is important because it suggests a simple assessment for a major dropout risk factor in adult weight-loss intervention programmes.

Nutrition labelling and the choices logo in Israel: positions and perceptions of leading health policy makers.

BACKGROUND: Based on the Social Marketing approach and Diffusion of Innovations Theory that indicates the importance of opinion leaders with respect to the spreading of new ideas, concepts or practices within a community, the present study aimed to examine positions and perceptions of Israeli leading dietitians and health officials regarding nutrition labelling and the Choices logo, before it was launched in Israel in February 2011, as well as how they would communicate it to the public as agents of influence. METHODS: The study involved in-depth face-to-face and telephone interviews with 15 senior dietitians and Health Ministry officials using semi-structured protocols including questions about nutrition labelling and the Choices logo. RESULTS: The respondents considered that the nutrition facts panels usually found on the backs of packages are too complicated for the average consumer. Simiularly, fronts of packages are cluttered with advertisements and health claims, causing confusion. The study participants would like to see an integrative label on the front of the package to facilitate consumers' decisions. However, the Choices logo raises ethical and social questions about the conflict between corporate interests and public health: (i) the label's relativity versus objectivity; (ii) the consumer's responsibility to create a balanced diet; (iii) the label's credibility; and (iv) bias against companies, products and audiences. CONCLUSIONS: The results of the present study highlight the importance of a need for an integrated programme of nutrition promotion, including the use of social marketing based on a cooperative effort between the food industry, regulators and professionals, to recommend changes and adjustments in nutritional front of package labelling with the aim of promoting healthier nutrition consumption.

Intensive dietary intervention by a dietitian as a case manager among community dwelling older adults: the EDIT study.

BACKGROUND: Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce. OBJECTIVE: To determine the impact of an intensive nutritional intervention program led by a dietitian on the health and nutritional status of malnourished community dwelling older adults. METHODS: Sixty-eight eligible participants (age<75) were randomly assigned to a Dietetic Intervention Treatment (DIT), an intensive nutritional intervention led by a dietitian, or a Medical Treatment (MT), a physician-led standard care group, with an educational booklet regarding dietary requirements and recommendations for older adults. An additional 59 eligible participants who were unable to participate in the randomization were included as a non-randomized "untreated nutrition" group (UNG). RESULTS: Over the 6-month follow-up, the DIT group showed significant improvement in cognitive function (from 25.8±4.5 to 26.8±4, p=0.04), and depression score (from 7.3±3.9 to 5.4±3.9, p=0.04) compared with the change in the other 2 groups. The DIT group showed a significant improvement in intake of carbohydrates (+15% vs. +1% in the MT and +3% in the UNG), protein (+8% vs. +2% in the MT and -3% in the UNG), vitamin B6 (+20% vs. +7% in the MT and +8% in the UNG), and vitamin B1 (+22% vs. +11% in the MT and 0% in the UNG). The DIT group had a significantly lower cost of physician visits than the other 2 groups ($172.1±232.0 vs. $417.2±368.0 in the MT and $428.1±382.3 in the UNG, p=0.005). CONCLUSION: Intensive dietary intervention was moderately effective in lowering cost of services used and improving medical and nutritional status among community dwelling older adults.

Nurses knowledge and attitudes regarding nutrition in the elderly.

BACKGROUND/AIMS: Nurses in the community are in contact with the elderly at different levels of care. The aim of this study was to assess nurses' knowledge and attitudes regarding nutritional-care for the elderly, and the impact of their attitude on the quality of assessment-care they provide to this growing population in need of nutritional-care. METHODS: A structured questionnaire was distributed by mail to 600 nurses working in Maccabi-Health-Care-Services (MHS). The questionnaire assessed different aspects of elderly nutrition. RESULTS: The vast majority (91%) of the participants reported treating elderly in their practice. Religious nurses and the nurses with an individual orientation specialty reported more positive attitudes about nutritional-care for the elderly than others did (p=0.05). Nurses with a bachelor's degree had better attitudes than registered nurses about the importance of nutrition for the elderly (p < 0.01). Younger nurses were found to be more knowledgeable than older ones (p < 0.04). The nurses perceived nutrition as influencing different health conditions, and 85% pointed to the importance of feeding at the end of life. CONCLUSIONS: Nurses working in the community recognize the impact of proper nutrition on elderly patients' health, but need more training in screening for nutritional problems in the elderly.