Characteristics of food environments that influence food acquisition and diets of women in low- and middle-income countries: a scoping review protocol.

OBJECTIVE: This scoping review aims to identify and map characteristics of food environments that influence food acquisition practices and dietary intake of women of reproductive age in low- and middle-income countries. INTRODUCTION: Due to the disproportionate burden of malnutrition on women of reproductive age in low- and middle-income countries, accelerated progress in improving women's nutrition is required to achieve Sustainable Development Goal 2 "Zero hunger" by 2030. Food environments are increasingly recognized as the key interface between consumers and food systems; however, little is known about the characteristics that influence women's food acquisition and diets in low- and middle-income countries, especially during physiological stages of heightened nutritional requirement, such as pre-conception, pregnancy, and breastfeeding. INCLUSION CRITERIA: This review will consider quantitative, qualitative, mixed methods, or review studies that report on the influence of food environment characteristics on food acquisition practices and dietary intake of women aged 15 to 49 years in any low- or middle-income country, as defined by the World Bank in 2021. METHODS: Twenty-one databases across EBSCO, Web of Science Core Collection, and PubMed platforms will be searched. Screening, selection, and data extraction will be performed in duplicate by 2 members of the team, with any discrepancies resolved by group discussion. The patterns of food acquisition and dietary intake in relation to food environment characteristics will be charted, mapped, and summarized in tabular and graphical formats. Findings will inform the refinement of effective food environment conceptual frameworks for this nutritionally vulnerable group.

Fish and Fish-Based Products for Nutrition and Health in the First 1000 Days: A Systematic Review of the Evidence from Low and Middle-Income Countries.

Fish provide essential nutrients for the critical window of growth and development in the first 1000 d of life and are thus an attractive option for inclusion in nutrition-sensitive and nutrition-specific programming. We conducted a systematic review of the evidence for fish and fish-based products for nutrition and health outcomes during the first 1000 d of life in low- and middle-income countries, searching the peer-reviewed and gray literature from 1999 to 2020. Databases included PubMed, Web of Science, Embase, ProQuest, and the Clinical Trials repository. Our search returned 1135 articles, 39 of which met the inclusion criteria. All studies were dual evaluated for risk of bias. Of the included studies, 18 measured maternal health and nutrition outcomes and 24 measured infant/child outcomes (3 measured both). Our search uncovered 10 impact evaluations, all of which measured consumption of fish or fish-based complementary food products in children aged 6-24 mo. We did not find strong evidence for fish consumption in children improving child growth from the impact evaluations; however, the studies were highly heterogeneous in their design and likely underpowered to detect an effect. Results from observational studies were mixed but provided evidence that adding fish to maternal and child diets is associated with improved nutrition outcomes, such as reducing the risk of anemia and improving vitamin D status. Given the nutrient richness of fish and the fact that production is often more environmentally friendly as compared with other animal source foods, more robust evidence is needed on the role of fish consumption in nutrition interventions to inform policy and programming recommendations in low- and middle-income countries.

Consumer experiences of food environments during the Covid-19 pandemic: Global insights from a rapid online survey of individuals from 119 countries.

This study investigates consumer experiences of food environments and food acquisition practices during the Covid-19 pandemic. Our rapid assessment online survey featured a convenience sample of 2015 individuals from 119 countries, spanning Western Europe, North America, Latin America, Asia-Pacific, and Africa. Data collection took place in April 2020 during the second month of the pandemic. Participants were recruited via existing networks of the United Nations System Standing Committee on Nutrition, through social media, and by snowballing. The majority of participants were female (71.9%), from low- and middle-income countries (51.0%), and working in nutrition or healthcare (39.3%). Qualitative thematic analysis and descriptive statistics reveal a series of common global experiences related to food availability and accessibility, food prices and affordability, food acquisition practices, and food preparation and consumption. The importance of community food participation, food sharing, and resource allocation are highlighted, along with increasing awareness of healthy diets and food waste. We identify ten synergistic policy entry points to: 1) build resilient and equitable food environments resistant to stresses and shocks; 2) harness positive dietary-related behaviors manifested during the pandemic; and, 3) mitigate the projected nutrition crisis and promote sustainable healthy diets for all.

Predictors of Dietary Diversity of Indigenous Food-Producing Households in Rural Fiji.

Fiji, like other Pacific Islands, are undergoing economic and nutrition transitions that increase the risk of noncommunicable diseases (NCDs) due to changes of the food supply and dietary intake. This study aimed to examine dietary diversity (DD) in indigenous food-producing households in rural Fiji. Surveys were conducted with households from the Nadroga-Navosa, Namosi and Ba Provinces of Western Fiji in August 2018. Participants reported on foods consumed in the previous 24 h per the Household Dietary Diversity Score. Data was analysed using multinomial logistic regression. Of the 161 households, most exhibited medium DD (66%; M = 7.8 ± 1.5). Commonly consumed foods included sweets (98%), refined grains (97%) and roots/tubers (94%). The least consumed foods were orange-fleshed fruits (23%) and vegetables (35%), eggs (25%), legumes (32%) and dairy (32%). Households with medium DD were more likely to be unemployed (OR 3.2, p = 0.017) but less likely to have ≥6 occupants (OR = 0.4, p = 0.024) or purchase food ≥2 times/week (OR = 0.2, p = 0.023). Households with low DD were more likely to have low farm diversity (OR = 5.1, p = 0.017) or be unemployed (OR = 3.7, p = 0.047) but less likely to have ≥6 occupants (OR = 0.1, p = 0.001). During nutrition transitions, there is a need for public health initiatives to promote traditional diets high in vegetables, fruits and lean protein and agricultural initiatives to promote farm diversity.

Low Health Literacy Is Associated With Risk of Developing Type 2 Diabetes in a Nonclinical Population.

PURPOSE: The purpose of this study was to examine associations among risk of type 2 diabetes (T2D), health literacy levels, and sociodemographic characteristics in a nonclinical adult population to assist in the development of effective T2D prevention programs. METHODS: The Health Literacy Questionnaire and Australian Type 2 Diabetes Risk Assessment Tool were included in an online survey. Participants were a random sample of adults residing in each Australian state and territory. Data were analyzed with descriptive statistics and multinomial logistic regression. RESULTS: A total of 1279 Australian adults participated (52% female; mean ± SD age, 61 ± 12 years). Most were at medium (42.4%) or high (46.9%) risk of developing T2D. The lowest health literacy scores were found for the domains "critical appraisal of health information" and "navigating the health care system." After controlling for covariates, participants at the highest risk of developing T2D were significantly more likely to be unemployed, have ≥1 chronic conditions, or have a mental health condition. Furthermore, they were significantly more likely to develop T2D if they scored low in 1 of the following health literacy domains: critical appraisal of health information, navigating the health care system, actively managing health, social support, and health care provider support. CONCLUSIONS: Health literacy was associated with increased risk for developing T2D and should therefore be part of diabetes prevention initiatives. Specifically, new health promotion initiatives need to help people develop skills required to critically appraise health information and navigate the health care system. Health practitioners and educators should ensure that health information developed for consumers is uncomplicated and easily understood.