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Barriers to healthy eating in Switzerland: A nationwide study
Abstract
Background & aims:
Several barriers can hinder healthy eating in the population. We aimed to assess the prevalence of self-reported barriers to healthy eating in Switzerland and examine their socioeconomic and demographic determinants.
Methods:
Using representative cross-sectional data from the Swiss Health Survey 2012, we assessed, separately by gender, the prevalence of ten barriers and their association with demographic and socioeconomic determinants; we used age- and multivariable-adjusted logistic regression and report the odds ratio for likelihood to identify each barrier according to each demographic and socioeconomic determinant.
Results:
The most prevalent barriers were "price" (43.2% in women, 35.8% in men), "daily habits, constraints" (39.8%, 37.5%), "fondness of good food" (38.8%, 51.0%), "time constraint" (34.8%, 29.0%) and "lack of willpower" (22.0%, 21.2%). Prevalence of most barriers decreased with age, increased for "fondness of good food" and remained constant for "price." After multivariable adjustment, obese participants were more likely to report "fondness of good food" [Odds ratio (95% confidence interval) for obese vs. normal weight women and men, respectively: 1.63 (1.38-1.91), 2.02 (1.72-2.38)]. Participants with lower education were more likely to report "fondness of good food" [mandatory vs. tertiary women and men, respectively: 1.93 (1.62-2.39), 1.51 (1.26-1.81)], but less likely to report "lack of willpower" [0.45 (0.38-0.55), 0.40 (0.33-0.49)] and "time constraint" [0.61 (0.51-0.73), 0.78 (0.63-0.96)]. Participants with lower income were more likely to report "price" [lowest vs. highest quartile for women and men, respectively, 1.65 (1.43-1.90), 1.47 (1.26-1.71)] but less likely to report "lack of willpower" [0.71 (0.61-0.82), 0.40 (0.33-0.49)]. Smoking, living situation, nationality and living area showed little or no association.
Conclusion:
Several barriers to healthy eating were highly prevalent regardless of gender; the most important determinants were age, obesity, education, and income, with different effects per barrier. This requires multifaceted interventions to tackle several barriers simultaneously.
... Generational analysis was conducted using [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] age groups in 1993. The [35][36][37][38][39][40][41][42][43][44] age group in 1993 corresponded to the [40][41][42][43][44][45][46][47][48][49] age group five years later (1998) and to the [45][46][47][48][49][50][51][52][53][54] age group in 2003. ...
... Generational analysis was conducted using [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] age groups in 1993. The [35][36][37][38][39][40][41][42][43][44] age group in 1993 corresponded to the [40][41][42][43][44][45][46][47][48][49] age group five years later (1998) and to the [45][46][47][48][49][50][51][52][53][54] age group in 2003. To assess 20year trends, only age groups [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] in 1993, corresponding to age groups [55-64] and [65-74] in 2013 and further on, were considered. ...
... Generational analysis was conducted using [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] age groups in 1993. The [35][36][37][38][39][40][41][42][43][44] age group in 1993 corresponded to the [40][41][42][43][44][45][46][47][48][49] age group five years later (1998) and to the [45][46][47][48][49][50][51][52][53][54] age group in 2003. To assess 20year trends, only age groups [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] in 1993, corresponding to age groups [55-64] and [65-74] in 2013 and further on, were considered. ...
Background and aims:
A healthy diet is the cornerstone of disease prevention, and dietary guidelines have been issued in most countries. We aimed to assess trends in compliance with dietary guidelines in the population of Geneva, Switzerland.
Methods:
Multiple cross-sectional, population-based surveys conducted between 1993 and 2016 in the canton of Geneva, Switzerland [20,310 participants (52.3% women, mean age 51.9 ± 10.7 years)]. Trends in compliance with the Swiss dietary guidelines regarding food intake were assessed using logistic regression (a) for each guideline and (b) for at least three guidelines. Compliance before and after the first and second issuing of the guidelines was assessed.
Results:
After multivariable adjustment, compliance with fruits increased overall [odds ratio and (95% confidence interval) for 1-year increase: 1.007 (1.003-1.012), p < 0.001], in men, participants aged over 45 and with low educational level. Compliance with vegetables increased overall [1.015 (1.008-1.022), p < 0.001], in both genders, age groups [45-54 and 55-64] and participants with low educational level. Compliance with meat increased in women [1.007 (1.001-1.013), p = 0.021] and participants with a university degree. Compliance with fresh fish increased in age group [55-64] [1.009 (1.000-1.018), p = 0.041]. Compliance with dairy products decreased overall [0.979 (0.972-0.986), p < 0.001] and in all groups studied, except for age group [65-74]. Compliance with at least three guidelines increased in age group [55-64] only [1.013 (1.002-1.024), p = 0.019]. No effect of the issuing of the guidelines was found.
Conclusion:
In the Geneva adult population, compliance with the Swiss dietary guidelines improved little. Issuing of dietary guidelines did not impact trends.
... This coincides with past research, where it was shown that feeling comfortable and feeling "at home" was essential to Indonesians decisions to dine out (Pratminingsih et al., 2018) and that "happiness" was an important goal to choosing to dine out (Arsil et al., 2021), thus, emphasizing that Indonesian dining out culture places a heavy importance on feelings of comfort and positive mood. Similarly, in Switzerland, food decisions were closely related to economic costs (Franziska, 2019;Mestral et al., 2016;Moschitz, 2017), hence, supporting the findings of this study. ...
... This could be because Swiss patrons already have a healthy lifestyle, and diet motivation, so they are not affected by the service quality of healthy food restaurants. This is supported by findings that price was the biggest barrier to healthy eating in Switzerland across various demographic groups, more so than motivation (Mestral et al., 2016). ...
Purpose: The focus of the research is on patrons' motivation for healthy dining, and influences on dining experience. Healthy dining in this study is operationalized as the perception of restaurant ambience and cognitive responses. The relationship between cognitive responses and restaurant ambience in Switzerland and Indonesia was tested. The relationship between healthy dining experience and patrons' satisfaction, and subsequently, its influence on repeated patronizing (repeat business) was also explored. Design/methodology/approach: The research uses mixed methods of qualitative and quantitative analysis, as the inquiries are exploratory in nature and rely on deductive logic. Findings: The study found support for several hypotheses. Apart from cognitive responses not affecting patrons' motivation to dine at healthy restaurants in Switzerland, all other variables were related in Switzerland and Indonesia. Research Limitation/Implication: This study addresses the scarcity of research in current literature on healthy dining and patron motivation to dine at, and revisit, health food restaurants.
... The socio-ecological model was used to describe the contributing factors of these behaviours at the individual, organisational, social, and policy levels (Kasteren et al., 2020). Some occupations, especially desk-based jobs require workers to spend long periods seated such as professional services, senior management roles, artistic work, and administration jobs (Lima et al., 2021;Mestral et al., 2016). These workers spend more time sitting than average workers and have double the risk of developing cardiovascular disease compared with those workers who have physically active jobs (Retamal, 2013). ...
... There has been very limited research carried out regarding the barriers and facilitators of healthy eating and physical activity in the workplace(Lima et al., 2021;Mestral et al., 2016;Nooijen et al., 2018;Tamrakar et al., 2020). In New Zealand, most of this research was based on different community samples such as older single men, male adolescent rugby players, primary school children, and university students (Bowden, 2008;Quintiliani et al., 2010;Stokes, 2017). ...
Healthy eating and regular physical activities are considered important factors to control obesity as well as non-communicable diseases such as type 2 diabetes, coronary heart disease, and several cancers. The obesity rate in New Zealand was 34.3% in 2021 and a sharp increase has been observed in 1977 (Ministry of
Health, 2021). This literature review is based on secondary sources to evaluate the existing facilitators and barriers of healthy eating and physical activity for office-based workers in the workplace in New Zealand. The Socio-ecological model is used as the conceptual framework to examine the implications. The
outcomes of this study can be used to develop suggestions and recommendations for health and wellness improvements for office-based workers. As an outcome, the work environment and culture have a significant influence on the healthy eating and physical activity of office-based workers in the workplace.
... Several studies concluded that individuals who identified a higher number of barriers for healthier eating habits correspond to those with worse habits [23,24]. The main factors identified by consumers as barriers for healthy eating were lack of time, poor cooking skills, food price, or the lack of healthy choices at food service units [23][24][25][26]. ...
... Only a small proportion of respondents perceived barriers for adoption of a healthy diet. Other authors observed similar results [25,26,62]. Healthier environments should be promoted to facilitate healthy eating and fighting chronic diseases such as obesity [63]. ...
Background:
A wide variety of social, cultural and economic factors may influence dietary patterns. This work aims to identify the main determinants of food consumption and barriers for healthy eating at the workplace, in a university setting.
Methods:
A cross-sectional observational study was conducted with 533 participants. Data were obtained through the application of a self-administered questionnaire that included socio-demographic information, food consumption determinants and the main perceived barriers for healthy eating at the workplace.
Results:
The respondents identified "price" (22.5%), "meal quality" (20.7%), and "location/distance" (16.5%). For women, the determinant "availability of healthy food options" was more important than for men (p < 0.001). The food consumption determinants at the workplace most referred to by respondents were related to the nutritional value. Smell, taste, appearance and texture, and good value for money, were also considered important for choosing food at the workplace. Respondents referred to work commitments and lack of time as the main barriers for healthy eating at the workplace.
Conclusions:
Identification of determinants involved in food consumption, and the barriers for healthy eating, may contribute to a better definition of health promotion initiatives at the workplace aiming to improve nutritional intake.
... Results found that 80 % of barriers and facilitators fell into six of the TDF domains, with the main barriers reported as environmental context and resources, belief about capabilities, knowledge, memory, attention and decision-making, behaviour regulation and physical skills, and the main facilitators reported as belief about consequences, belief about capabilities, environmental context and resources, social influences, skills and emotion. Results confirmed earlier findings regarding common barriers and facilitators to adopting or adherence to dietary change, including budget (40) , time and taste preference (41) , and convenience and cooking skills (42) . ...
... Participants reported convenience to be a factor associated with their ability to adopt the MIND diet. Previous research also found convenience to be a barrier to healthy food choices (41) and that fast food and unhealthy snacks were more convenient (59) . ...
Objective
The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40–55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life.
Design
This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet.
Setting
Northern Ireland.
Participants
Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face.
Results
Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food.
Conclusions
This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.
... For instance, individuals consistently report time constraints, taste preferences, high cost of foods, and low availability of healthy foods as important barriers to healthy eating [14]. We previously reported that between 20% and 50% of the Swiss adult population perceived time constraints, taste preference, high cost of healthy foods and daily habits as the main barriers to healthy eating over a 15-year period [15], and that reporting of these barriers was demographically and socioeconomically patterned [16]. However, only few reports have explored whether perceived barriers to healthy eating are in fact associated with an unhealthy dietary behavior [17,18], and findings have been inconsistent. ...
... The SHS is a cross-sectional, nationwide, population-based study with a sample considered representative of the Swiss adult population. Details of the SHS methodology have been described elsewhere [16]. ...
Background:
People report many barriers that prevent them from achieving a healthy diet. Whether perceived barriers are associated with dietary behavior remains unclear.
Objective:
To assess the association between barriers to healthy eating and adherence to the Swiss dietary guidelines.
Methods:
Cross-sectional data from the Swiss Health Survey 2012 (N = 15,450; 53% women). Barriers included price, daily habits, taste, gluttony, lack of time, lack of willpower, limited options in restaurants, in supermarkets, no social support, and social opposition. The associations between barriers and adherence to Swiss dietary guidelines were assessed using multivariable logistic regression.
Results:
Daily habits (odds ratio; 95% confidence interval: 0.91; 0.85-0.98) and taste (0.85; 0.79-0.91) were associated with lower adherence to the guidelines for fruits, while price (1.13; 1.06-1.21) and limited options in restaurants (1.33; 1.23-1.45) and in supermarkets (1.18; 1.03-1.35) were associated with higher adherence. Taste was associated with lower adherence to the guidelines for vegetables (0.72; 0.66-0.78), while price (1.20; 1.11-1.30), gluttony (1.17; 1.04-1.31), social group opposition (1.48; 1.18-1.85) and limited options in restaurants (1.56; 1.42-1.72) and in supermarkets (1.25; 1.07-1.47) were associated with higher adherence. Daily habits (0.82; 0.75-0.90), time (0.86; 0.78-0.94), lack of willpower (0.78; 0.70-0.87), and gluttony (0.86; 0.76-0.98) were associated with lower adherence to the guidelines for fish, whereas price (1.09; 1.01-1.19), and limited options in restaurants (1.26; 1.14-1.39) and supermarkets (1.40; 1.20-1.63) were associated with higher adherence. Daily habits (0.89; 0.82-0.97), taste (0.66; 0.61-0.72), lack of willpower (0.84; 0.76-0.92) and gluttony (0.66; 0.58-0.75) were associated with lower adherence to the guidelines for meat. Time (0.88; 0.78-0.99) was associated with lower adherence to the guidelines for dairy, while gluttony (1.26; 1.09-1.46) was associated with higher adherence. Daily habits was associated with lower adherence (0.91; 0.85-0.97) to the guidelines for liquids, while limited options in restaurants was associated with higher adherence (1.12; 1.03-1.22).
Conclusion:
In the Swiss adult population, several self-reported barriers to healthy eating appear to hinder adherence to the dietary guidelines, while other commonly reported barriers are linked to higher adherence.
... In Malaysia cancer is one of the major health problems [4]. It is undeniably one of the most important non-communicable diseases in Malaysia and contributed to 13.56% of all deaths occurred in the Ministry of Health Hospitals in 2015 [5]. Nutrition and related factors such as physical activity, obesity believed to contribute crucially to cancer occurrence [6]. ...
... A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer [12]. Furthermore, high price of healthy foods has been one of the main deterrents for healthy eating among the lower income group [13][14][15]. The encouragement toward healthy, balanced, affordable and palatable diet among the low-income group may improve their overall health status and eventually reduce the prevalence of chronic diseases in Malaysia including cancer. ...
Background
Poor dietary habits have been identified as one of the cancer risks factors in various epidemiological studies. Consumption of healthy and balance diet is crucial to reduce cancer risk. Cancer prevention food plan should consist of all the right amounts of macronutrients and micronutrients. Although dietary habits could be changed, affordability of healthy foods has been a major concern, as the price of healthy foods are more expensive the unhealthy counterparts.
Methods
Therefore, using linear programming, this study is aimed to develop a healthy and balanced menu with minimal cost in accordance to individual needs that could in return help to prevent cancer. A cross sectional study involving 100 adults from a local university in Kuala Lumpur was conducted in 3 phases. The first phase is the data collection for the subjects, which includes their socio demographic, anthropometry and diet recall. The second phase was the creation of a balanced diet model at a minimum cost. The third and final phase was the finalization of the cancer prevention menu. Optimal and balanced menus were produced based on respective guidelines of WCRF/AICR (World Cancer Research Fund/ American Institute for Cancer Research) 2007, MDG (Malaysian Dietary Guidelines) 2010 and RNI (Recommended Nutrient Intake) 2017, with minimum cost.
Results
Based on the diet recall, most of subjects did not achieve the recommended micronutrient intake for fiber, calcium, potassium, iron, B12, folate, vitamin A, vitamin E, vitamin K, and beta-carotene. While, the intake of sugar (51 ± 19.8 g), (13% ± 2%) and sodium (2585 ± 544 g) was more than recommended. From the optimization model, three menus, which met the dietary guidelines for cancer prevention by WCRF/AICR 2007, MDG 2010 and RNI 2017, with minimum cost of RM7.8, RM9.2 and RM9.7 per day were created.
Conclusion
Linear programming can be used to translate nutritional requirements based on selected Dietary Guidelines to achieve a healthy, well-balanced menu for cancer prevention at minimal cost. Furthermore, the models could help to shape consumer food choice decision to prevent cancer especially for those in low income group where high cost for health food has been the main deterrent for healthy eating.
... Older adults are often found to have healthier diets than younger adults. Many of the barriers to healthy eating in young adults point to the food environment, social norms and pressures, and lack of skill and motivation to prepare healthy foods [33,37,38]. Self-reported prevalence of some of these barriers are lower in older age groups [37,38]. ...
... Many of the barriers to healthy eating in young adults point to the food environment, social norms and pressures, and lack of skill and motivation to prepare healthy foods [33,37,38]. Self-reported prevalence of some of these barriers are lower in older age groups [37,38]. ...
Background/objectives
Little is known about time trends in diet quality and associated inequalities in the United Kingdom (UK). This study aimed to examine trends in adherence to four UK dietary recommendations, overall, and among sociodemographic subgroups, from 1986 to 2012.
Subjects/methods
We conducted a repeated cross-sectional analysis using data from three UK diet surveys: Dietary and Nutritional Survey of British Adults 1986-87 (n=2018), National Diet and Nutrition Survey (NDNS) 2000-01 (n=1683), and NDNS Rolling Programme 2008-12 (n=1632). We measured adherence to dietary recommendations for fruit and vegetables, salt, oily fish, and red and processed meat, estimated using food diary record data. We compared adherence across surveys and by four sociodemographic characteristics: sex, age, socioeconomic position, and ethnicity.
Results
Overall, population adherence to dietary recommendations was low to moderate, but improved over time. There were inequalities in adherence to all recommendations at all timepoints according to one or more sociodemographic characteristic. When inequalities were present, women, older adults, those with non-manual occupations, and non-whites were more likely to adhere to dietary recommendations. Whilst some dietary inequalities declined, most persisted across the three surveys.
Conclusions
The persistence of most inequalities highlights the need for further interventions to reduce dietary inequalities, as well as improve overall population diet. The greatest simultaneous improvement in population adherence and reduction of inequalities was observed for salt, which may reflect the success of the UK Salt Reduction Programme. Similarly comprehensive programmes should be encouraged for other dietary components.
... However, compliance to the Swiss dietary guidelines has remained low in the population (14), showing no improvements over time (15). A previous nationwide study showed that barriers to healthy eating were highly prevalent ($20%) and demographically and socioeconomically patterned in the Swiss population (16). Still, whether the prevalence of barriers to healthy eating remains constant or evolves over time has never been assessed. ...
... Still, they remained in the upper range of participation rates of national surveys conducted in Europe in the same period (41). Third, 29% of participants were excluded, and they were more likely to be of lower SES, which is associated with higher prevalence of barriers to healthy eating (16). Thus, our estimates might be conservative, and the true prevalence of the barriers to healthy eating might be even higher. ...
Background: Despite increasing levels of education and income in the Swiss population over time and greater food diversity due to globalization, adherence to dietary guidelines has remained persistently low. This may be because of barriers to healthy eating hampering adherence, but whether these barriers have evolved in prevalence over time has never been assessed, to our knowledge.
Objective: We assessed 15-y trends in the prevalence of self-reported barriers to healthy eating in Switzerland overall and according to sex, age, education, and income.
Design: We used data from 4 national Swiss Health Surveys conducted between 1997 and 2012 (52,238 participants aged ≥18 y, 55% women), applying multivariable-adjusted logistic regression models to assess trends in prevalence of 6 barriers to healthy eating (taste, price, daily habits, time, lack of willpower, and limited options).
Results: The prevalence of 3 barriers exhibited an increasing trend until 2007, followed by a decrease in 2012 (from 44% in 1997 to 50% in 2007 and then to 44% in 2012 for taste, from 40% to 52% and then to 39% for price, and from 29% to 34% and then to 32% for time; quadratic P-trend < 0.0001). Limited options decreased slightly until 2007 (35–33%) and then sharply by 2012 (18%) (linear P-trend < 0.0001). Daily habits remained relatively stable across time from 42% in 1997 to 38% in 2012 (linear P-trend < 0.0001). Conversely, lack of willpower decreased steadily over time from 26% in 1997 to 21% in 2012 (linear P-trend < 0.0001). Trends were similar for all barriers irrespective of sex, age, education, and income.
Conclusion: Between 1997 and 2012, barriers to healthy eating remained highly prevalent (≥20%) in the Swiss population and evolved similarly irrespective of age, sex, education, and income.
... Taste appeared to be an important consideration that supported the consumption of some anthocyanin-rich foods, and this finding is supported by other research on the influence of taste on food choices in people across the lifespan [47]. Taste preferences and 'an appetite' for fruit and vegetables, has been reported to be among the top factors impacting older adults ability to achieve dietary recommendations for these foods [48]. ...
... Taste appeared to be an important consideration that supported the consumption of some anthocyanin-rich foods, and this finding is supported by other research on the influence of taste on food choices in people across the lifespan [47]. Taste preferences and 'an appetite' for fruit and vegetables, has been reported to be among the top factors impacting older adults ability to achieve dietary recommendations for these foods [48]. ...
Despite the positive relationship between anthocyanin-rich foods and cognitive health, a dietary deficit exists in older adults. Effective interventions require an understanding of people’s dietary behaviors situated in social and cultural contexts. Therefore, the aim of this study was to explore older adults’ perceptions about increasing their consumption of anthocyanin-rich foods for cognitive health. Following an educational session and the provision of a recipe and information book, an online survey and focus groups with Australian adults aged 65 years or older (n = 20) explored the barriers and enablers towards eating more anthocyanin-rich foods and potential strategies to achieve dietary change. An iterative, qualitative analysis identified the themes and classified the barriers, enablers and strategies onto the Social-Ecological model levels of influence (individual, interpersonal, community, society). Enabling factors included a desire to eat healthily, taste preference and familiarity of anthocyanin-rich foods (individual), social support (community), and the availability of some anthocyanin-rich foods (society). The barriers included budget, dietary preferences and motivation (individual), household influences (interpersonal), limited availability and access to some anthocyanin-rich foods (community) and the cost and the seasonal variability (society). The strategies included increasing individual-level knowledge, skills, and confidence in utilizing anthocyanin-rich foods, educational initiatives about the potential cognitive benefits, and advocating to increase access to anthocyanin-rich foods in the food supply. This study provides for the first time, insight into the various levels of influence impacting older adults’ ability to consume an anthocyanin-rich diet for cognitive health. Future interventions should be tailored to reflect the barriers and enablers and to provide targeted education about anthocyanin-rich foods.
... The high price of food was iterated by both FGD and IDI participants as a major influence on dietary preference. These findings were consistent with other studies [35][36][37]. This study reveals that the choice of food goes beyond personal preferences of taste and satiety but is also strongly influenced by the economic environments that determine what food is available and at what cost. ...
Introduction
Non-communicable diseases have risen markedly over the last decade. A phenomenon that was mainly endemic in high-income countries has now visibly encroached on low and middle-income settings. A major contributor to this is a shift towards unhealthy dietary behavior. This study aimed to examine the complex interplay between people’s characteristics and the environment to understand how these influenced food choices and practices in Western Kenya.
Methods
This study used semi-structured guides to conduct in-depth interviews and focus group discussions with both male and female members of the community, across various socioeconomic groups, from Kisumu and Homa Bay Counties to further understand their perspectives on the influences of dietary behavior. Voice data was captured using digital voice recorders, transcribed verbatim, and translated to English. Data analysis adopted an exploratory and inductive analysis approach. Coded responses were analyzed using NVIVO 12 PRO software.
Results
Intrapersonal levels of influence included: Age, the nutritional value of food, occupation, perceived satiety of some foods as opposed to others, religion, and medical reasons. The majority of the participants mentioned location as the main source of influence at the community level reflected by the regional staple foodscape. Others include seasonality of produce, social pressure, and availability of food in the market. Pricing of food and distance to food markets was mentioned as the major macro-level influence. This was followed by an increase in population and road infrastructure.
Conclusion
This study demonstrated that understanding dietary preferences are complex. Future interventions should not only consider intrapersonal and interpersonal influences when aiming to promote healthy eating among communities but also need to target the community and macro environments. This means that nutrition promotion strategies should focus on multiple levels of influence that broaden options for interventions. However, government interventions in addressing food access, affordability, and marketing remain essential to any significant change.
... [44] In contrast, a nationwide study in Switzerland reported price as the most prevalent barrier to a healthy diet among 43.2% and 35.8% women and men. [45] Another study in Europe showed a lack of willpower, time constraints, and taste preferences as the three main barriers. [46] the evidence suggests that exercise is just as effective as medical treatment in special situations. ...
Background:
The rate of chronic diseases is increasing due to the global pandemic of inactivity and an unhealthy diet.
Objective:
We aimed to determine the dietary habits, physical activities of the participants, and challenges facing them to adapt to a healthy lifestyle.
Methodology:
The researchers conducted a cross-sectional study on chronic disease patients attending primary health care centers in Riyadh from January to March 2018. The estimated sample size was 250 patients. The participants completed a self-administered questionnaire.
Result:
The mean age of the 250 participants was 35.3 years old. The Overweight and obese participants accounted for 67.2% of the sample (mean BMI = 28.0). Two-thirds of the participants depend mainly on rice or pasta for their diet, and 48.4-52.0% eat fruits and vegetables less than three times a week. About 50% of the participants perceived a lack of information, skills, motivation, and family or friends support as a barrier to a healthy diet. Also, (56.4%) of males and (67.8%) of females are physically inactive. Accessibility, cost, and the hot climate were physical activity obstacles in more than 60% of the respondents. Optimal BMI showed a significant association with increased physical activity P = 0.04.
Conclusion:
Physical inactivity and consuming a non-balanced diet are common. So awareness campaigns of the benefit of a healthy lifestyle besides increasing physical exercise facilities, installing environmental changes, and subsidizing sports gyms would encourage people to be more physically active.
... This fact makes it necessary to intervene in this group through public policies. Previous studies have shown that this socioeconomic group also presents barriers to a healthy diet, which are represented by the low income it perceives, the need to satisfy hunger, the low level of schooling, and obesity [47,48]. ...
Nutritional Warning Labels (NWLs) inform consumers about processed foods that exceed critical nutrient levels activating the risk perception in consumers. However, this information is limited. The objective was to identify the dimensions of risk perception and to study their associations with avoidance of buying processed foods with warning labels. A survey was applied to 807 decision-makers who choose what to eat at home. The four dimensions of risk perception (performance, financial, physical, and psychological) were identified through exploratory factor analysis. Through a multiple regression model, we determined the dimensions of risk perception and sociodemographic variables that affect the intention to avoid buying processed foods with NWLs. The results show that the performance risk, physical risk, and psychological risk positively affect the intention of avoiding processed foods with NWLs. In addition, the female gender considers NWLs to purchase foods. Nevertheless, the high frequency of consumption and belonging to a lower-income socioeconomic group are barriers to the use of NWLs. In conclusion, NWLs help people to choose processed food that does not impact negatively their food expectations, as well as their mental and physical health. However, health authorities must invest in nutrition education. Specifically, in groups who pay less attention to NWLs. Such groups include people with high daily consumption of processed foods, males, and low-income socioeconomic groups.
... These results are consistent with other studies among refugees, which have shown that low income and limited language proficiency are linked to food insecurity [42,43]. In comparison, in the Swiss population, barriers to healthy eating include daily routines, time constraints and personal preferences while the price is also the major obstacle [44]. ...
Refugees face various nutritional challenges during and after migration. This cross-sectional, mixed-methods study seeks to investigate the prevalence of undernutrition and obesity among refugees in Geneva, and to identify barriers to healthy eating. Anthropometric measurements of 354 adult refugees were collected between 2017 and 2019 by trained nurses and dietitians. Seven focus group discussions totaling 51 participants, refugees and social workers, investigated conceptions and needs regarding diet. The mean Body Mass Index is 24.6 ± 4.8 kg/m2. Women are disproportionately affected by obesity compared to men (p < 0.001). Weight gain post-migration is correlated positively with length of stay in Geneva (p < 0.001). Major obstacles to healthy eating are economic and linguistic. For participants, cooking workshops and free physical activities are highly needed interventions. Post-migration lifestyle interventions should be implemented to prevent weight gain in this population. Such interventions must be multi-level, to overcome structural, social and behavioral barriers to healthy eating.
... food preferences, capacity to buy or process foods) as well as the local cultures and traditions [41]. People trying to shift to a healthier diet face a series of barriers that might prevent them from successfully achieving the desired changes [42,43]. Hence, identification those barriers and support to overcome them could be envisaged. ...
Objective:
Assess the dietary recommendations provided to patients hospitalized for a coronary heart disease (CHD) event.
Design:
Cross-sectional, multicentre observational study (ESC EORP Euroaspire V).
Methods:
8261 participants (25.8% women, 9.3% aged<50 years) from 27 countries, 6 to 24 months after hospitalization for a CHD event were included. Participants were asked if they had been advised to reduce salt, fat or sugar intake, change type of fat consumed, and increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish. Self-reported changes were recorded.
Results:
Advice to reduce energy intake, salt, fat and sugar was provided to 64.5% [range: 9.2-90.5], 73.2% [38.6-95.2], 77.3% [42.3-95.6] and 67.0% [39.4-93.3] of patients, respectively. Advice to change fat type, increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish was provided to 68.3% [33.7-92.3], 36.7% [0.6-75.2], 73.2% [39.2-93.6], 66.5% [8.0-90.8] and 53.5% [3.7-83.3] of patients, respectively. Advices were more frequently provided to patients aged 50 to 69, with a high educational level, or obesity. One-eighth [0-55.0] of patients reported having consulted a dietician. Reductions in energy intake, salt, fat and sugar were reported by 57.7% [4.9-81.0], 69.9% [32.1-85.9], 71.8% [40.4-88.4] and 61.2% [29.0-84.0] of patients, respectively. Changes in fat type and increased consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish were reported by 60.9% [4.9-81.0], 25.8% [0.6-54.1], 69.2% [27.7-88.4], 54.8% [4.0-80.1] and 40.4% [2.0-66.8] of patients, respectively.
Conclusion:
Dietary advice is not systematically provided to patients with CHD, and considerable differences exist between European countries.
... Consumer behavior toward healthy eating and adherence to the dietary recommendations have been widely explored [10][11][12]. However, a more holistic view of sustainable healthy eating behavior has received less attention, albeit more consumer research is emerging in this area [4,13,14]. ...
Sustainable and healthy food-related behavior is high on the public policy and research agenda due to its potential to cope with negative environmental and health outcomes. There are several measures related to sustainability in food choices but there have not been many attempts to integrate sustainable and healthy eating (SHE) behaviors into one measurement instrument so far. Therefore, the main aim of this study was to identify how young adults interpret the SHE concept and to develop an instrument that measures a self-reported consumer’s SHE behavior. The process of scale development involved an exploratory qualitative study and two quantitative studies. As a result of 20 individual in depth interviews with Polish young adults, 50 items were generated reflecting their perspective on principles of SHE (Study 1). Two samples were used in the scale validation process: n = 217 (Study 2) and n = 220 (Study 3). Via principal component analysis, reliability analysis, and confirmatory factor analysis, the final form of the scale was derived. The proposed 34-item scale offers insights into the most relevant aspects of SHE behaviors, grouped in eight factors: “healthy and balanced diet”, “certification and quality labels”, “meat reduction”, “selection of local food”, “choice of low fat food products”, “avoidance of food waste” and purchase and consumption of food products that are respecting “animal welfare” and finally choice of “seasonal food”. Although the developed scale can benefit from further refinement and validity testing in different cultural and social background, it is clear that the scale, as developed, can be a useful tool for researchers who are interested in the study of SHE behaviors.
... Still, for the "chocolate and sweets" pattern, no significant decrease was found in the 45-to 54-y age group cohort. Possible explanations are that aging is associated with a fondness for savory foods (40) or to an unwillingness to change dietary habits (41). ...
Background: Dietary patterns provide a summary of dietary intake, but to our knowledge, few studies have assessed trends in dietary patterns in the population.
Objective: The aim was to assess 20-y trends in dietary patterns in a representative sample of the Geneva, Switzerland, population with the consideration of age, sex, education, and generation.
Design: Repeated, independent cross-sectional studies were conducted between 1993 and 2014. Dietary intake was assessed by using a validated food-frequency questionnaire. Dietary patterns were assessed by using principal components analyses.
Results: Among 18,763 adults, 1 healthy (“fish and vegetables”) and 2 unhealthy (“meat and chips” and “chocolate and sweets”) patterns were identified. Scores for the “fish and vegetables” pattern increased, whereas the “meat and chips” and “chocolate and sweets” pattern scores decreased in both sexes and across all age groups. The stronger increase in the “fish and vegetables” pattern score among the less well-educated participants led to a narrowing of educational differences (mean ± SD scores in 1993: −0.56 ± 1.39 compared with −0.05 ± 1.58 in low- compared with highly educated groups, respectively; P < 0.001; scores in 2014: 0.28 ± 1.64 compared with 0.24 ± 1.83, respectively; P = 0.772). Generational analysis showed that older age groups tended to show smaller changes than younger age groups: the yearly score change in “chocolate and sweets” was −0.021 (95% CI: −0.027, −0.014; P < 0.001) for the 35- to 44-y cohort compared with −0.002 (95% CI: −0.009, 0.005; P = 0.546) for the 45- to 54-y cohort.
Conclusions: Three dietary patterns were identified; scores for the “fish and vegetables” pattern increased, whereas the “meat and chips” and the “chocolate and sweets” pattern scores decreased. The stronger increases in the “fish and vegetables” pattern score among the less well-educated participants led to a smaller difference in dietary intake across the different educational levels.
Background
India has seen rise in consumption of foods high in fat, sugar and salt that increases risk of diet related non-communicable diseases. Information of the drivers that determine food choices among adults will provide insights for policy makers to promote healthier food selection.
Objective
This study assessed the determinants of food choices among adults in India
Methods
A cross-sectional study with non-probability purposive sampling technique where adults were selected from residential colonies belonging to the four geographical zones of the city. Data was collected using a mixed methods approach on a total of 589 adults (20-40 years) belonging to upper middle-income and high-income group. Data was analyzed by principle component analysis, chi square test and logistic regression with a level of significance set at p<0.05.
Results
Most influential factors of food choices were brand (30%), nutritive value (22%) and taste (20%). The three factors that emerged from principle component analysis which determine food choices among adults were ‘individual’, ‘social’ and ‘food quality/wholesomeness’. Focus group discussions also showed that majority of participants were influenced by ‘brand’, ‘nutritive value’ and ‘taste’ of the food product while making food choices. Food choices were influenced by the company the person was eating food with, family members and friends. Cost of the food product was also an important driver of food choices among younger adults.
Conclusion
Public health policy should utilize the determinants of food choices to bring about changes in the food environment by increasing the availability of healthier yet tasty food keeping the cost in mind.
Polyphenols, bitter and astringent compounds present in many healthy foods, induce varied sensory responses across individuals. These differences in liking and flavor intensity may be attributable, in part, to differences in saliva. In the current study, we tested the effect of repeated consumption of a bitter polyphenol (epigallocatechin gallate, EGCG) solution on perceived bitterness intensity and salivary protein composition. We hypothesized exposure to EGCG would cause an increase in concentrations of salivary proteins that inhibit bitterness of polyphenols. We also hypothesized that participants with higher habitual polyphenol, specifically the flavanols, intake would experience less bitterness from EGCG solutions than those with low habitual intake, and that the high flavanol consumers would be more resistant to salivary alterations. We also tested whether bovine milk casein, a food analog for salivary proteins that may suppress bitterness, would decrease bitterness intensity of the EGCG solution and mitigate effects of the intervention. Participants (N=37) in our crossover intervention adhered to two-week periods of daily bitter (EGCG) or control (water) solution consumption. Bitterness intensity ratings and citric acid-stimulated saliva were collected at baseline and after each exposure period. Results indicate that bitterness intensity of the EGCG solution decreased after polyphenol (bitter EGCG) exposure compared to control (water) exposure. Casein addition also decreased bitterness intensity of the EGCG solution. While there was not a significant overall main effect of baseline flavanol intake on solution bitterness, there was an interaction between intervention week and baseline flavanol intake. Surprisingly, the higher flavanol intake group rated EGCG solutions as more bitter than the low and medium intake groups. Of proteins relevant to taste perception, several cystatins changed in saliva in response to the intervention. Interestingly, most of these protein alterations occurred more robustly after the control (water) exposure rather than the bitter (EGCG) exposure, suggesting that additional factors not quantified in this work may influence salivary proteins. Thus, we confirm in this study that exposure to bitterness suppresses ratings of bitterness over time, but more work needs to establish the causal factors of how diet influences salivary proteins.
Background
The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40–55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life.
Methods
This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years.
Results
Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only.
Conclusions
Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.
Policies incentivizing store entry or store improvements are aimed at increasing access to healthy foods; however, findings about their effectiveness to improve diets are mixed. Similarly, little is known about whether food stores' presence affects consumers' perceived barriers to purchasing healthy foods, which reflect the subjective hardships experienced by shoppers to purchase and consume healthier foods. In this study, we assess the relationship between the two most widely studied perceived barriers to purchasing healthy foods (price and availability) and the local retail food environment using individual‐level survey data collected across the northeastern US and census data on the numbers of grocery stores and warehouse clubs and supercenters. Our results indicate that unobserved heterogeneity plays an important role in determining the sign and magnitude of the relationship between store presence and perceptions. The likelihood that an individual cites price or availability as a perceived barrier depends upon the barrier considered, whether respondents live in the zip code where they shop, and the method of controlling for unobserved heterogeneity. Thus, policies focusing on improving access to a given store type may only mitigate some of the negative perceptions associated with one's food environment.
Hypercholesterolemia is an important risk factor for cardiovascular disease. Lifestyle modification including dietary changes is the first step for the treatment. Low adherence to dietary recommendations has reported earlier. This study purposed to identify barriers to the American Heart Association dietary recommendations in hypercholesterolemic patients. A 30-item structured questionnaire was designed and the reliability and validity of the questionnaire were evaluated. The exploratory factor analysis was performed on 160 hypercholesterolemic patients and extracted seven interpretable underlying factors of diet non-adherence (52.35% of total variance). These factors included “situational barriers and gathering,” “takeaways and eating out,” “psychological factors,” “false beliefs and food habits,” “lack of motivation,” “enjoy eating and difficulty resisting the temptation” and “satisfaction with previous food habits”. From the practical point of view, considering these perceived barriers, patient’s culture, traditions, and dietary preferences can be beneficial in improving dietary adherence among hypercholesterolemic patients.
Objective
The purpose of this study was to evaluate the psychometric properties of the 22‐item Barriers to Healthy Eating (BHE) scale in four independent weight loss studies conducted over 13 years.
Methods
Principal axis factoring with promax rotation was performed to reveal the underlying factor structure. Internal consistency was assessed using Cronbach α, and convergent validity was assessed by correlating the baseline BHE with the Weight Efficacy Lifestyle questionnaire total and subscale scores. Predictive validity was examined by the association of BHE change with weight loss over 6 months.
Results
The four studies had similar gender (82.9%‐89.9% female) and race (70.5%‐81.4% white) distributions. Factor analyses suggested removal of two items and a three‐factor structure: self‐control and motivation (10 items), daily mechanics (7 items), and social support (3 items). The Cronbach α for the 20‐item BHE ranged from 0.849 to 0.881 across the four studies. The BHE and Weight Efficacy Lifestyle questionnaire total and subscale scores were all negatively correlated with each other, showing good convergent validity (r = 0.120‐0.544, P < 0.05). BHE change was associated with weight loss from 0 to 6 months (r = 0.282‐0.450, P < 0.05).
Conclusions
The BHE scale showed very good psychometric properties over time, supporting its use in measuring barriers to one's ability to adopt or maintain a healthy eating plan.
This study used hermeneutic phenomenology to explore the meaning that seven Canadian midlife women give to the experience of their changing bodies in relation to food, body function, and leisure. Findings emerge from in-depth, semi-structured research conversations and reveal these women have a contentious relationship with eating that arises from an awareness that what they choose to eat today will impact how they will feel tomorrow. The women in this study experience fatigue as a consequence of their food decisions, which then negatively impacts their leisure participation. The current study underscores the impact of food and body function not only on physical activity for midlife women but also on other leisure pursuits such as socializing with friends. These findings highlight the complex relationship between food, body function, and leisure in the context of daily life for these midlife women.
Objective:
Many adults struggle with eating healthfully. To address this problem, dietitians and a physician at a worksite wellness center designed and implemented a healthy eating program to identify and reduce barriers and to improve nutrition knowledge, confidence, and eating habits.
Methods:
A single cohort study design of members of a worksite wellness center who attended the program.
Results:
Eight-six participants demonstrated significant improvement in reducing perceived barriers (p < 0.001), improving nutritional knowledge (p = 0.001), increasing confidence (p < 0.001), and increasing the frequency of preparing healthy meals (p < 0.001) and intake of fruits and vegetables (p < 0.001). These improvements were maintained at the six month follow-up.
Conclusion:
These results suggest that participation in a 6 week nutrition education program at a worksite wellness center decreases barriers to healthy eating and improves dietary intake.
Background: With an ageing population, there is an increasing societal impact of ill health in later life. People who adopt healthy behaviours are more likely to age successfully. To engage people in health promotion initiatives in mid-life, a good understanding is needed of why people do not undertake healthy behaviours or engage in unhealthy ones.
Methods: Searches were conducted to identify systematic reviews and qualitative or longitudinal cohort studies that reported mid-life barriers and facilitators to health behaviour. Mid-life ranged from 40 to 64 years, but younger adults in disadvantaged or minority groups were also eligible to reflect potential earlier disease onset.
Two reviewers independently conducted reference screening and study inclusion. Included studies were assessed for quality. Barriers and facilitators were identified and synthesised into broader themes to allow comparisons across behavioural risks.
Findings: From 16,426 titles reviewed, 28 qualitative studies, 11 longitudinal cohort studies and 46 systematic reviews were included. Evidence was found relating to uptake and maintenance of physical activity, diet and eating behaviours, smoking, alcohol, eye care, and other health promoting behaviours and grouped into six themes: health and quality of life, sociocultural factors, the physical environment, access, psychological factors, evidence relating to health inequalities. Most of the available evidence was from developed countries.
Barriers that recur across different health behaviours include lack of time (due to family, household and occupational responsibilities), access issues (to transport, facilities and resources), financial costs, entrenched attitudes and behaviours, restrictions in the physical environment, low socioeconomic status, lack of knowledge. Facilitators include a focus on enjoyment, health benefits including healthy ageing, social support, clear messages, and integration of behaviours into lifestyle. Specific issues relating to population and culture were identified relating to health inequalities.
Conclusions: The barriers and facilitators identified can inform the design of tailored interventions for people in mid-life.
Healthiness, price, and convenience are typically indicated as important motives for food choices; however, it is largely unknown to what extent older adults from high and low socioeconomic groups differ in these underlying motives. A discrete choice experiment (DCE) is an innovative way to elicit implicit motives for food choices.
The aim was to investigate differences in food motives between socioeconomic groups by means of a DCE.
A DCE was carried out during a face-to-face interview among older adults as part of the Health and Living Conditions in Eindhoven and surrounding cities (GLOBE) cohort study, The Netherlands. Participants (n = 399; mean age: 63.3 y) were offered a series of choice sets about a usual dinner at home and were asked to choose in each choice set between 2 meals and an opt-out choice, with different combinations of attribute levels. We included 5 meal attributes (taste, healthiness, preparation time, travel time to shops, and price) and 3 or 4 levels for each attribute. Data were analyzed by multinomial logit models.
Healthiness, taste, price, and travel time to the grocery store proved to significantly influence older adults' meal decisions; preparation time was not significant. Healthiness was the most important attribute for all of the participants. More highly educated participants rated a healthy and less expensive meal to be more important than did less educated participants. Those with a high income rated a meal that was healthy and very tasteful to be more important than did those with a lower income.
Healthiness, taste, price, and travel time to grocery shops influenced older adults' meal decisions. Higher socioeconomic groups valued health more than did lower socioeconomic groups. DCEs represent a promising method to gain insight into the relative importance of motives for food choices. This trial was registered at www.isrctn.com as ISRCTN60293770.
© 2015 American Society for Nutrition.
Cited By (since 1996):687, Export Date: 18 October 2014
To examine the extent to which the gendered division of labour persists within households in the USA in regard to meal planning/preparation and food shopping activities.
Secondary analysis of cross-sectional data.
2007-2008 US National Health and Nutrition Examination Survey.
Sub-sample of 3195 adults at least 20 years old who had a spouse or partner.
Analyses revealed that the majority of women and men reported they shared in both meal planning/preparing and food shopping activities (meal planning/preparation: women 54 % and men 56 %; food shopping: women 60 % and men 57 %). Results from multinomial logistic regression analyses indicated that, compared with men, women were more likely to take primary responsibility than to share this responsibility and less likely to report having no responsibility for these tasks. Gender differences were observed for age/cohort, education and household size.
This study may have implications for public health nutritional initiatives and the well-being of families in the USA.
Importance: Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy.
Objectives: To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries.
Design: We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages.
Results: US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th.
Conclusions and Relevance: From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.
Background:
Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD.
Design and methods:
Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol).
Results:
Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life.
Conclusion:
Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structural strategies at international, national, and regional levels that in combination can substantially reduce CVD.
Background & aims:
To assess the adherence to the national dietary recommendations and to identify factors contributing to dietary compliance in Switzerland.
Methods:
Population-based cross-sectional study in Lausanne, Switzerland (CoLaus study), 2009-2012. Dietary intake was assessed using a validated food frequency questionnaire. Participants were dichotomized according to whether they followed the national recommendations for fruits, vegetables, meat, fish and dairy products.
Results:
Data from 4371 participants (54% women, mean age ± SD: 57.6 ± 10.5 years) were analyzed. Compliance with the recommendations was low: only 39.4%, 7.1%, 61.3%, 66.4%, and 8.4% complied with the Swiss recommendations for fruit (≥2/day), vegetables (≥3/day), meat (≤5/week), fish (≥1/week) and dairy products (≥3/day), respectively. In multivariate analyses, gender, age, smoking status, Swiss-born status, education, being on a diet and body mass index were associated with dietary compliance, while no difference was found between women before and after menopause. Factors specifically associated with fruits, vegetables, meat, fish or dairy products recommendations were identified.
Conclusion:
The low degree of compliance with dietary recommendations calls for a continued effort to increase the population awareness of the importance of a healthy and balanced diet, especially for vegetables and dairy products. This study identified determinants that should guide this effort.
Background:
Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD.
Design and methods:
Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol).
Results:
Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life.
Conclusion:
Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structural strategies at international, national, and regional levels that in combination can substantially reduce CVD.
To describe the proportion of women reporting time is a barrier to healthy eating and physical activity, the characteristics of these women and the perceived causes of time pressure, and to examine associations between perceptions of time as a barrier and consumption of fruit, vegetables and fast food, and physical activity.
A cross-sectional survey of food intake, physical activity and perceived causes of time pressure.
A randomly selected community sample.
A sample of 1580 women self-reported their food intake and their perceptions of the causes of time pressure in relation to healthy eating. An additional 1521 women self-reported their leisure-time physical activity and their perceptions of the causes of time pressure in relation to physical activity.
Time pressure was reported as a barrier to healthy eating by 41% of the women and as a barrier to physical activity by 73%. Those who reported time pressure as a barrier to healthy eating were significantly less likely to meet fruit, vegetable and physical activity recommendations, and more likely to eat fast food more frequently.
Women reporting time pressure as a barrier to healthy eating and physical activity are less likely to meet recommendations than are women who do not see time pressure as a barrier. Further research is required to understand the perception of time pressure issues among women and devise strategies to improve women's food and physical activity behaviours.
Excess bodyweight is a major public health concern. However, few worldwide comparative analyses of long-term trends of body-mass index (BMI) have been done, and none have used recent national health examination surveys. We estimated worldwide trends in population mean BMI.
We estimated trends and their uncertainties of mean BMI for adults 20 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9·1 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean BMI by age, country, and year, accounting for whether a study was nationally representative.
Between 1980 and 2008, mean BMI worldwide increased by 0·4 kg/m(2) per decade (95% uncertainty interval 0·2-0·6, posterior probability of being a true increase >0·999) for men and 0·5 kg/m(2) per decade (0·3-0·7, posterior probability >0·999) for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2·0 kg/m(2) per decade (posterior probabilities >0·99) in nine countries in Oceania. Male BMI increased in all but eight countries, by more than 2 kg/m(2) per decade in Nauru and Cook Islands (posterior probabilities >0·999). Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33·9 kg/m(2) (32·8-35·0) for men and 35·0 kg/m(2) (33·6-36·3) for women in Nauru. Female BMI was lowest in Bangladesh (20·5 kg/m(2), 19·8-21·3) and male BMI in Democratic Republic of the Congo 19·9 kg/m(2) (18·2-21·5), with BMI less than 21·5 kg/m(2) for both sexes in a few countries in sub-Saharan Africa, and east, south, and southeast Asia. The USA had the highest BMI of high-income countries. In 2008, an estimated 1·46 billion adults (1·41-1·51 billion) worldwide had BMI of 25 kg/m(2) or greater, of these 205 million men (193-217 million) and 297 million women (280-315 million) were obese.
Globally, mean BMI has increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially between nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries.
Bill & Melinda Gates Foundation and WHO.
Although the DASH (Dietary Approaches to Stop Hypertension) diet has been shown to lower blood pressure (BP) in short-term feeding studies, it has not been shown to lower BP among free-living individuals, nor has it been shown to alter cardiovascular biomarkers of risk.
To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension (systolic BP, 130-159 mm Hg; or diastolic BP, 85-99 mm Hg).
Randomized, controlled trial in a tertiary care medical center with assessments at baseline and 4 months. Enrollment began October 29, 2003, and ended July 28, 2008.
Overweight or obese, unmedicated outpatients with high BP (N = 144).
Usual diet controls, DASH diet alone, and DASH diet plus weight management.
The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring. Secondary outcomes included pulse wave velocity, flow-mediated dilation of the brachial artery, baroreflex sensitivity, and left ventricular mass.
Clinic-measured BP was reduced by 16.1/9.9 mm Hg (DASH plus weight management); 11.2/7.5 mm (DASH alone); and 3.4/3.8 mm (usual diet controls) (P < .001). A similar pattern was observed for ambulatory BP (P < .05). Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity, baroreflex sensitivity, and left ventricular mass (all P < .05).
For overweight or obese persons with above-normal BP, the addition of exercise and weight loss to the DASH diet resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.
clinicaltrials.gov Identifier: NCT00571844.
In order to promote healthful nutrition, insight is needed into the determinants of nutrition behaviours. Behavioural determinant research and behavioural nutrition interventions have focused mostly on individual-level motivational factors. It has been argued that the individual's socio-cultural and physical environments may be the main determinants of nutrition behaviours. However, the theoretical basis and empirical evidence for environmental determinants of nutrition behaviours are not strong. The present paper is a narrative review informed by a series of systematic reviews and recent original studies on associations between environmental factors and nutrition behaviours to provide an overview and discussion of the evidence for environmental correlates and predictors of nutrition behaviour. Although the number of studies on potential environmental determinants of nutrition behaviours has increased steeply over the last decades, they include only a few well-designed studies with validated measures and guided by sound theoretical frameworks. The preliminary evidence from the available systematic reviews indicates that socio-cultural environmental factors defining what is socially acceptable, desirable and appropriate to eat may be more important for healthful eating than physical environments that define the availability and accessibility of foods. It is concluded that there is a lack of well-designed studies on environmental determinants of healthful eating behaviours. Preliminary evidence indicates that social environmental factors may be more important than physical environmental factors for healthful eating. Better-designed studies are needed to further build evidence-based theory on environmental determinants to guide the development of interventions to promote healthful eating.
A prominent hypothesis regarding social inequalities in mortality is that the elevated risk among the socioeconomically disadvantaged is largely due to the higher prevalence of health risk behaviors among those with lower levels of education and income.
To investigate the degree to which 4 behavioral risk factors (cigarette smoking, alcohol drinking, sedentary lifestyle, and relative body weight) explain the observed association between socioeconomic characteristics and all-cause mortality.
Longitudinal survey study investigating the impact of education, income, and health behaviors on the risk of dying within the next 7.5 years.
A nationally representative sample of 3617 adult women and men participating in the Americans' Changing Lives survey.
All-cause mortality verified through the National Death Index and death certificate reviews.
Educational differences in mortality were explained in full by the strong association between education and income. Controlling for age, sex, race, urbanicity, and education, the hazard rate ratio of mortality was 3.22 (95% confidence interval [CI], 2.01-5.16) for those in the lowest-income group and 2.34 (95% CI, 1.49-3.67) for those in the middle-income group. When health risk behaviors were considered, the risk of dying was still significantly elevated for the lowest-income group (hazard rate ratio, 2.77; 95% CI, 1.74-4.42) and the middle-income group (hazard rate ratio, 2.14; 95% CI, 1.38-3.25).
Although reducing the prevalence of health risk behaviors in low-income populations is an important public health goal, socioeconomic differences in mortality are due to a wider array of factors and, therefore, would persist even with improved health behaviors among the disadvantaged.
Information on the perceived difficulties in trying to eat a healthier diet is important in assisting those in nutrition education devise more effective programmes. The objective of this study was to determine the main perceived barriers that people have in trying to eat a healthy diet in the 15 member states of the European Union (EU). A cross-sectional study in which quota-controlled nationally representative samples of approximately 1000 adults (15 years upwards) from each member state completed a face-to-face interview-assisted questionnaire. The most frequently mentioned perceived barriers to healthy eating concerned time and taste factors. Time-related factors were more important for younger respondents and those with a higher level of education, who appear to regard taste as being compromised by healthy eating. Variation exists both between member states and between demographic groups in the frequency of barriers mentioned. A lack of knowledge about healthy eating was not selected by many as an important barrier. A major obstacle to nutrition education is the fact that 70% of EU subjects believe their diets are already healthy. It may be that nutrition educators should concentrate on showing consumers how to evaluate their own diet appropriately in terms of fat, fibre, and fruit and vegetables. Food-based guidelines may be useful in this endeavour.
This study compared responses of US and Geneva residents to items on analogous questionnaires concerning knowledge and attitudes about diet and health.
Comparable data were available from 2 population-based sample surveys: the Cancer Control Supplement of the 1987 National Health Interview Survey and the 1994 Bus Santé 2000 in Geneva, Switzerland. Samples included 10,366 US respondents and 698 Geneva respondents, aged 35 to 74 years. The analysis involved descriptive statistics, contingency tables, and linear regression models.
In both the United States and Geneva, health consciousness was greater among women and more highly educated persons than among other groups. Compared with Americans, Genevans assigned more importance to avoiding salt, sugar, and overweight (odds ratio = 1.6, 2.9, and 5.9, respectively) and less importance to lowering cholesterol (odds ratio = 0.6). Genevans were more likely to recognize the relatively high fiber content of lettuce, carrots, and apples. Recognition of low-fat foods was slightly better in the United States.
Knowledge and attitudes differed despite high general diet and health awareness in both populations. Identifying why generally similar dietary guidance messages are embraced to different extents across cultures may facilitate global implementation.
Socio-economic factors may affect diet quality, perhaps differentially across gender and ethnicity. The mechanism of this association is still largely unknown.
We examined the independent effects of socio-economic status (SES), perceived barrier of food price (PBFP) and perceived benefit of diet quality (PBDQ) on diet quality indicators and indices (DQI(j,k)), across gender and ethnicity. Additionally, we estimated the mediation proportion of the effect of SES on DQI(j,k) through PBFP and PBDQ.
Data from two cross-sectional surveys, the Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS) 1994-96 were used. Our sample consisted of 4356 US adults aged 20-65 years. With principal components analysis, SES (an index) was measured using household income per capita and education, and PBDQ was measured using an 11-item scale. PBFP was defined as the ratio of importance of food price score relative to nutrition. DQI(j,k) were assessed by a set of indicators and two indices including the Healthy Eating Index.
The associations between SES, PBFP, PBDQ and DQI(j,k) varied significantly across gender and ethnic groups. PBFP acted as a mediator in the association between SES and selected DQI(j) indicators, namely energy, fat intake, sodium and simple sugar consumption (mediation proportion >10%), but not PBDQ.
SES, PBFP and PBDQ all affect dietary intake, and vary by ethnicity and gender. Positive effect of SES on DQI(j,k) may be mediated by PBFP but not PBDQ which is an independent protective factor. Nutrition education is important to promote healthy eating.
The determinants of a healthy diet have not been studied in Switzerland. This study aimed at assessing the individual and behavioural factors associated with a healthy diet in a Swiss city.
Cross-sectional, population-based study conducted between 2009 and 2013 (n = 4,439, 2,383 women, mean age 57.5 ± 10.3 years) in Lausanne. Food consumption was assessed using a validated food frequency questionnaire. Two Mediterranean diet scores (classic score and specific for Switzerland) and the Harvard School of Public Health alternate healthy eating index were computed.
For all three dietary scores considered, living in couple or having a high education were associated with a healthier diet. An unhealthy lifestyle (smoking, sedentary behaviour) or a high body mass index were associated with an unhealthier diet. Participants born in Italy, Portugal and Spain had healthier diets than participants born in France or Switzerland. Women and elderly participants had healthier diets than men and young participants according to 2 scores, while no differences were found for the Swiss-specific Mediterranean score.
In Switzerland, healthy eating is associated with high education, a healthy lifestyle, marital status and country of origin. The associations with gender and age depend on the dietary score considered.
© 2015 S. Karger AG, Basel.
Importance:
Many changes in the economy, policies related to nutrition, and food processing have occurred within the United States since 2000, and the net effect on dietary quality is not clear. These changes may have affected various socioeconomic groups differentially.
Objective:
To investigate trends in dietary quality from 1999 to 2010 in the US adult population and within socioeconomic subgroups.
Design, setting, and participants:
Nationally representative sample of 29 124 adults aged 20 to 85 years from the US 1999 to 2010 National Health and Nutrition Examination Survey.
Main outcomes and measures:
The Alternate Healthy Eating Index 2010 (AHEI-2010), an 11-dimension score (range, 0-10 for each component score and 0-110 for the total score), was used to measure dietary quality. A higher AHEI-2010 score indicated a more healthful diet.
Results:
The energy-adjusted mean of the AHEI-2010 increased from 39.9 in 1999 to 2000 to 46.8 in 2009 to 2010 (linear trend P < .001). Reduction in trans fat intake accounted for more than half of this improvement. The AHEI-2010 component score increased by 0.9 points for sugar-sweetened beverages and fruit juice (reflecting decreased consumption), 0.7 points for whole fruit, 0.5 points for whole grains, 0.5 points for polyunsaturated fatty acids, and 0.4 points for nuts and legumes over the 12-year period (all linear trend P < .001). Family income and education level were positively associated with total AHEI-2010, and the gap between low and high socioeconomic status widened over time, from 3.9 points in 1999 to 2000 to 7.8 points in 2009 to 2010 (interaction P = .01).
Conclusions and relevance:
Although a steady improvement in AHEI-2010 was observed across the 12-year period, the overall dietary quality remains poor. Better dietary quality was associated with higher socioeconomic status, and the gap widened with time. Future efforts to improve nutrition should address these disparities.
Objective:
We aimed to identify barriers for meeting the fruit, vegetable and fish guidelines in older Dutch adults and to investigate socio-economic status (SES) differences in these barriers. Furthermore, we examined the mediating role of these barriers in the association between SES and adherence to these guidelines.
Design:
Cross-sectional.
Setting:
Longitudinal Aging Study Amsterdam (LASA), the Netherlands.
Subjects:
We used data from 1057 community-dwelling adults, aged 55-85 years. SES was measured by level of education and household income. An FFQ was used to assess dietary intake and barriers were measured with a self-reported lifestyle questionnaire.
Results:
Overall, 48.9 % of the respondents perceived a barrier to adhere to the fruit guideline, 40.0 % for the vegetable and 51.1 % for the fish guideline. The most frequently perceived barriers to meet the guidelines were the high price of fruit and fish and a poor appetite for vegetables. Lower-SES groups met the guidelines less often and perceived more barriers. The association between income and adherence to the fruit guideline was mediated by 'perceiving any barrier to meet the fruit guideline' and the barrier 'dislike fruit'. The association between income and adherence to the fish guideline was mediated by 'perceiving any barrier to meet the fish guideline' and the barrier 'fish is expensive'.
Conclusions:
Perceived barriers for meeting the dietary guidelines are common in older adults, especially in lower-SES groups. These barriers and in particular disliking and cost concerns explained the lower adherence to the guidelines for fruit and fish in lower-income groups in older adults.
The majority of the US population does not meet recommendations for consumption of milk, whole grains, fruit, and vegetables. The goal of our study was to understand barriers and facilitators to adherence to the Dietary Guidelines for Americans for four nutrient-rich food groups in fifth-grade children and unrelated adult caregivers across six sites in a multistate study. A total of 281 unrelated adult caregivers (32% African American, 33% European American, and 35% Hispanic American) and 321 children (33% African American, 33% European American, and 34% Hispanic American) participated in 97 Nominal Group Technique sessions. Nominal Group Technique is a qualitative method of data collection that enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. The core barriers specific to unrelated adult caregivers were lack of meal preparation skills or recipes (whole grains, fruit, vegetables); difficulty in changing eating habits (whole grains, fruit, vegetables), cost (milk, whole grains, fruit, vegetables), lack of knowledge of recommendation/portion/health benefits (milk, vegetables), and taste (milk, whole grains, vegetables). Specific to children, the core barriers were competing foods (ie, soda, junk foods, sugary foods [whole grains, milk, fruit, vegetables]), health concerns (ie, milk allergy/upset stomach [milk]), taste/flavor/smell (milk, whole grains, fruit, vegetables), forget to eat them (vegetables, fruit), and hard to consume or figure out the recommended amount (milk, fruit). For both unrelated adult caregivers and children, reported facilitators closely coincided with the barriers, highlighting modifiable conditions that could help individuals to meet the Dietary Guidelines for Americans.
Background: Studies have shown that socioeconomic groups differ in their dietary behaviours, and it has been suggested that these differences partly account for health inequalities between social groups. To-date, however, we have a limited understanding of why socioeconomic groups differ in their dietary behaviours. This paper addresses this issue by examining the relationship between socioeconomic status, food preference (likes and dislikes) and the purchase of `healthy' food (i.e. food consistent with dietary guideline recommendations).Methods: This study was based on a dual-sample, dual-method research design. One sample was systematically selected from the Australian Commonwealth electoral roll and the data collected using a mail-survey methodology (81% response rate, n=403). The second consisted of a convenience sample of economically disadvantaged people recruited via welfare agencies (response rate unknown, n=70). A mail survey methodology was deemed inappropriate for this sample, so the data were collected by personally delivering the questionnaire to each respondent.Results: Socioeconomic groups differed significantly in their food purchasing choices and preferences. The food choices of respondents in the welfare sample were the least consistent with dietary guideline recommendations, and they reported liking fewer healthy foods (all results were independent of age and sex). Notably, socioeconomic differences in preference explained approximately 10% of the socioeconomic variability in healthy food purchasing behaviour.Conclusion: Whilst it is not clear why socioeconomic groups differ in their food preferences, possible reasons include: reporting bias, differential exposure to healthy food as a consequence of the variable impact of health promotion campaigns, structural and economic barriers to the procurement of these foods, and subculturally specific beliefs, values, meanings, etc.
Background:
Excess bodyweight is a major public health concern. However, few worldwide comparative analyses of long-term trends of body-mass index (BMI) have been done, and none have used recent national health examination surveys. We estimated worldwide trends in population mean BMI.
Methods:
We estimated trends and their uncertainties of mean BMI for adults 20 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9·1 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean BMI by age, country, and year, accounting for whether a study was nationally representative.
Findings:
Between 1980 and 2008, mean BMI worldwide increased by 0·4 kg/m(2) per decade (95% uncertainty interval 0·2-0·6, posterior probability of being a true increase >0·999) for men and 0·5 kg/m(2) per decade (0·3-0·7, posterior probability >0·999) for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2·0 kg/m(2) per decade (posterior probabilities >0·99) in nine countries in Oceania. Male BMI increased in all but eight countries, by more than 2 kg/m(2) per decade in Nauru and Cook Islands (posterior probabilities >0·999). Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33·9 kg/m(2) (32·8-35·0) for men and 35·0 kg/m(2) (33·6-36·3) for women in Nauru. Female BMI was lowest in Bangladesh (20·5 kg/m(2), 19·8-21·3) and male BMI in Democratic Republic of the Congo 19·9 kg/m(2) (18·2-21·5), with BMI less than 21·5 kg/m(2) for both sexes in a few countries in sub-Saharan Africa, and east, south, and southeast Asia. The USA had the highest BMI of high-income countries. In 2008, an estimated 1·46 billion adults (1·41-1·51 billion) worldwide had BMI of 25 kg/m(2) or greater, of these 205 million men (193-217 million) and 297 million women (280-315 million) were obese.
Interpretation:
Globally, mean BMI has increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially between nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries.
Funding:
Bill & Melinda Gates Foundation and WHO.
Large nutritional epidemiology studies, with long-term follow-up to assess major clinical end points, coupled with advances in basic science and clinical trials, have led to important improvements in our understanding of nutrition in primary prevention of chronic disease. Although much work remains, sufficient evidence has accrued to provide solid advice on healthy eating. Good data now support the benefits of diets that are rich in plant sources of fats and protein, fish, nuts, whole grains, and fruits and vegetables; that avoid partially hydrogenated fats; and that limit red meat and refined carbohydrates. The simplistic advice to reduce all fat, or all carbohydrates, has not stood the test of science; strong evidence supports the need to consider fat and carbohydrate quality and different protein sources. This article briefly summarizes major findings from recent years bearing on these issues. Expected final online publication date for the Annual Review of Public Health Volume 34 is March 17, 2013. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
For more than fifty years, low protein diets have been proposed to patients with kidney failure. However, the effects of these diets in preventing severe kidney failure and the need for maintenance dialysis have not been resolved.
To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis.
Cochrane Renal Group studies register, the Cochrane Central Register of Controlled studies, MEDLINE, and EMBASE. Congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987). Direct contacts with investigators.
Randomised studies comparing two different levels of protein intake in adult patients suffering from moderate to severe kidney failure, followed for at least one year.
Two authors independently selected studies and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). Collection of the number of "renal deaths" defined as the need for starting dialysis, the death of a patient or a kidney transplant during the study.
Ten studies were identified from over 40 studies. A total of 2000 patients were analysed, 1002 had received reduced protein intake and 998 a higher protein intake. There were 281 renal deaths recorded, 113 in the low protein diet and 168 in the higher protein diet group (RR 0.68, 95% CI 0.55 to 0.84, P = 0.0002). To avoid one renal death, 2 to 56 patients need to be treated with a low protein diet during one year.
Reducing protein intake in patients with chronic kidney disease reduces the occurrence of renal death by 32% as compared with higher or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.
The Commission on Social Determinants of Health, created to marshal the evidence on what can be done to promote health equity and to foster a global movement to achieve it, is a global collaboration of policy makers, researchers, and civil society, led by commissioners with a unique blend of political, academic, and advocacy experience. The focus of attention is on countries at all levels of income and development. The commission launched its final report on August 28, 2008. This paper summarises the key findings and recommendations; the full list is in the final report.
In developed countries, persons of low socioeconomic status (SES) are generally less likely to consume diets consistent with dietary guidelines. Little is known about the mechanisms that underlie SES differences in eating behaviours. Since women are often responsible for dietary choices within households, this qualitative study investigated factors that may contribute to socioeconomic inequalities in dietary behaviour among women. Semi-structured interviews were conducted with 19 high-, 19 mid- and 18 low- SES women, recruited from Melbourne, Australia, using an area-level indicator of SES. An ecological framework, in which individual, social and environmental level influences on diet were considered, was used to guide the development of interview questions and interpretation of the data. Thematic analysis was undertaken to identify the main themes emerging from the data. Several key influences varied by SES. These included food-related values such as health consciousness, and a lack of time due to family commitments (more salient among higher SES women), as well as perceived high cost of healthy eating and lack of time due to work commitments (more important for low SES women). Reported availability of and access to good quality healthy foods did not differ strikingly across SES groups. Public health strategies aimed at reducing SES inequalities in diet might focus on promoting healthy diets that are low cost, as well as promoting time-efficient food preparation strategies for all women.
For more than fifty years, low protein diets have been proposed to patients with kidney failure. However, the effects of these diets in preventing severe renal failure and the need for maintenance dialysis have not been resolved.
To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis.
Cochrane Renal Group trials register, the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987). Direct contacts with investigators. Date of most recent search: December 2004.
Randomised trials comparing two different levels of protein intake in adult patients suffering from moderate to severe renal failure, followed for at least one year.
Two reviewers independently selected studies and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI). Collection of the number of "renal deaths" defined as the need for starting dialysis, the death of a patient or a kidney transplant during the trial.
Eight trials were identified from over 40 studies. A total of 1524 patients were analysed, 763 had received reduced protein intake and 761 a higher protein intake. Two hundred and fifty one renal deaths were recorded, 103 in the low protein diet and 148 in the higher protein diet group (RR 0.69, 95% CI 0.56 to 0.86, P = 0.0007). To avoid one renal death, 2 to 56 patients need to be treated with a low protein diet during one year.
Reducing protein intake in patients with chronic kidney disease reduces the occurrence of renal death by 31% as compared with higher or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.
Due to the increasing proportion of the elderly in the European Union knowledge of health and nutritional status has to be complemented by studies focused on food preferences and health behavior. A comprehensive literature review has been conducted. The state of the art documents a gap in understanding why differences exist between food knowledge, attitudes and practices. Inadequate attention has been given to cultural factors. Research into the reasons for nutrition behavior and food choice is of key importance for the future.
A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.
Research Institute of Organic Agriculture (FiBL), Frick, and IFOAM e Organics International
- Helga Willer
- Lernoud Julia
Helga Willer, Lernoud Julia, editors. The world of organic agriculture -statistics & emerging trends 2015. Bonn: Research Institute of Organic Agriculture (FiBL), Frick, and IFOAM e Organics International; 2015.
Results are expressed as number of participants (percentage) for qualitative data or as average ± standard deviation for quantitative data. Bivariate analyses were conducted using chi-square test for qualitative variables and student's t-test for quantitative variables
- Bmi Chf
- Swiss Franc
BMI, body mass index; CHF, Swiss Franc. Results are expressed as number of participants (percentage) for qualitative data or as average ± standard deviation for quantitative
data. Bivariate analyses were conducted using chi-square test for qualitative variables and student's t-test for quantitative variables.