World Nutrition

Introduction to the third issue of World Nutrition for 2024

Ted Greiner — 2024-09-30

Comments on the new WHO guidelines for the prevention and management of acute malnutrition in young children

Swati Jain — 2024-09-30

Association between sugar-sweetened beverage consumption and constructs of the Health Belief Model in young adult students at the University of Chester

Goodluck Chiemela Ndubuisi — 2024-09-30

Background
Young adults are reported as one of the major consumers of sugar-sweetened beverages (SSBs) globally and the consumption of SSBs is associated with long-term medical conditions. The Health Belief Model (HBM) has been applied to understand SSB consumption by children and adolescents through the use of its constructs. There is a gap in knowlege of HBM application to SSB consumption of young adults. Therefore, the present study was undertaken to fill this gap.
Objective
The primary objective of the study was to determine if an association existed between SSB consumption status and the constructs of the HBM: perceived susceptibility, perceived severity, perceived barriers, perceived benefits, self-efficacy, and cues in young adult students.
Methods
Design: Cross-sectional data were obtained using an online self-administered structured questionnaire. Descriptive statistics and Chi-squared (X2) test for association were used to analyse the data.
Setting: Participants were recruited via email and WhatsApp.
Participants: Seventy young adult students aged 18 to 30 years studying at the University of Chester, England.
Results
The mean age of the participants was 25.5 years (SD: 3.0). 53% consumed SSBs on a given day. Postgraduates (58%), Blacks (52%), and Asian students (70%) had the greater percentages of SSB consumers. There was a very strong significant association between SSB consumption status and level of perceived severity of diseases from a high intake of SSBs, X2 (1, N = 70) = 6.94, P = 0.01, Cramer’s V = 0.32. Also, a very strong association existed between SSB consumption status and self-efficacy level to control SSB intake, X2 (1, N = 70) = 8.83, P = 0.00, Cramer’s V = 0.36.
Conclusions
A high percentage of young adult students especially those from minority ethnic groups in the UK consumed SSBs which indicates that targeted initiatives at these groups are required to control their intake. Interventions to control SSB intake in young adult students should consider increasing their level of perceived severity of diseases from a high intake of SSBs and self-efficacy to control SSB intake. We recommend actions that can further increase their awareness of how serious diseases from a high intake of SSBs are. We also recommend measures intended to increase the confidence of young adultstudents in their ability to avoid SSBs when they are stressed, after writing exam, when they are eating, and when they engage in sedentary activities. In particular, modifying their environment to prevent the availability of SSBs at home and regulating the promotion and cost (via taxation) of SSBs in stores would help to increase their self- efficacy level. Further studies to determine why a greater percentage of postgraduate students are consuming SSBs despite their level of education is required. More comprehensive research on SSB consumption in young adults using the HBM is necessary.

Nutrition learning gaps in the undergraduate curricula of Nursing and Medicine degree and diploma programs in Tanzania Mainland

Elizabeth Lyimo — 2024-09-30

Background
Nutrition has been widely ignored in the curricula of many health professional training programs in Sub-Saharan African countries. The present review was conducted to explore the adequacy of medical and nursing curricula in training graduates to treat, educate effectively, and counsel patients/clients with nutritional disorders in Tanzania.
Methods
An assessment of accredited medical and paramedical curricula in mainland Tanzania. The assessment followed Stufflebeam's CIPP model (context, input, process, and product) to enhance methodological rigour and transparency.
Results
Of the twelve curricula studied, only one had a dedicated course for nutrition. In the undergraduate medicine degree curriculum, only 119 out of 6580 hours over five years were allocated for nutrition training, which is merely 1.7% of the total curriculum hours. Similarly, in the undergraduate nursing degree curriculum only 370 hours out of 5280 over four years were allocated for nutrition training, which is equivalent to 0.07% of the total hours. In the paramedical diploma programs of clinical medicine and nursing, nutrition content was scattered among various courses within the curriculum. Most curricula were teacher-centred with limited use of validated methods to assess trainee on skills such as Observed Structured Practical/ Clinical Examination.
Conclusions
Based on this assessment of accredited curricula, nutrition receives scant attention in medical and paramedical education in mainland Tanzania. Thus, it is imperative to support integrating stronger nutrition content into medical and paramedical schools focusing on skills and attitudes to enhance the efficient implementation of the nation’s nutrition policies and strategies.

Gender difference in nutritional knowledge, dietary pattern and nutritional status of undergraduates in Ado-Ekiti, Southwest Nigeria

Israel Olanrele Dada — 2024-09-30

Background
Poor nutritional knowledge at an early stage of life suggests developing poor dietary habits that later lead to obesity and attendant complications of non-communicable diseases.
Objective
This study examined gender differences in nutritional knowledge, dietary pattern and the prevalence of overweight/obesity among students of a private tertiary institution in Ado-Ekiti, Ekiti State, Nigeria.
Methods
A total of 214 students were recruited to this study from the six colleges of the university. A semi-structured questionnaire was used to collect information on personal and lifestyle characteristics, dietary patterns and physical activity. Weight and height measures were used to calculate Body Mass Index (BMI). Data were analyzed using descriptive statistics and chi square test at 5% level of significance.
Results
The mean age of the students was 19±1.89years. Monthly allowance of ≥₦50, 000.00 ($70) was received by 64%; 80% and 78% of them had fathers and mothers respectively with university degrees. Physical exercise was not done by 40%, 69% took < 3meals/day and 60% skipped breakfast; 71% and 21% had medium and high dietary diversity scores respectively. The mean BMI was 24.6±3.70; 36% had a BMI ≥25. Regarding their nutritional knowledge, 16% were high. There were no gender differences in BMI, nutritional knowledge or dietary diversity.
Conclusions
The study revealed less than ideal nutritional knowledge and dietary diversity and prevalence of overweight/obesity. Great emphasis needs to be given to nutrition education and promotion among university students.

Validating a portable device for groundwater iron measurement in Bangladesh

Sneha Sarwar — 2024-09-30

The mineral iron is essential for health at an optimum level. In Bangladesh iron is obtained from the drinking source groundwater, attributing largely to the good iron status in population. This groundwater iron poses two scenarios—predominantly high in many areas and predominantly low in other areas. Despite good iron status, burden of anemia in population is high. To control anemia, iron supplementation programs are operational against the backdrop of high iron status. This often leads to iron-associated side effects, plausibly due to excess iron, especially among the individuals exposed to high amount of iron from the drinking water. This geological phenomenon warrants the supplementation program to deliver different doses depending on the groundwater iron level. To enable that, the country needs an area-representative “mapping” of groundwater iron. However, such a mapping using the gold standard laboratory methods is expensive and logistically intensive. The aim of the study is to validate Handheld Colorimeter (HI721 Checker® HC), a portable device (“spot kit” device) to measure iron concentration in the drinking groundwater. The study was carried out in the rural Belkuchi upazila of the Sirajganj district in the Rajshahi division. In the study 25 tubewells were selected and categorized into five groups. Among them, four were categorized based on their iron concentration, low iron conc. (0-<1 mg/L), medium iron conc. (1-2 mg/L), high iron conc. (2-10 mg/L), very high iron conc. (>10 mg/L). One additional group was included for tubewell water that was used after filtering. The study compared the iron estimates measured in groundwater samples of the selected tube wells by the spot kit device and the same samples measured by atomic absorption spectrophotometry (AAS). There was a high agreement between the estimates by the spot kit and AAS (Kappa coefficient= 0.72, p <0.001; Lin’s concordance = 0.829, p < 0.001). Pitman's test of difference in variance exhibited that the two methods produced equally precise results (r=0.227, p=0.275). The study concluded that the Handheld Colorimeter (HI721 Checker® HC) was valid to measure the iron concentration of groundwater under field conditions. This device can facilitate testing processes, particularly in remote or resource-constrained areas where sophisticated testing methods (i.e: AAS) are unavailable and thus may help the re-design of the anemia control program in settings like Bangladesh with high and variable level of iron in the drinking groundwater.

Demographic and food frequency survey of a marginalized community in Almora, Uttarakhand, India

Smita Rana — 2024-09-30

The demography and eating behaviour of the marginalized communities residing in the Almora district of Uttarakhand, India, was investigated. It was observed that agriculture was the main income source along with other work such as labourer, black-smith, etc. Food consumption was mainly dependent upon either the Government Public Distribution System or on traditional coarse grains which were being produced only for their own consumption. Traditional food crops were being neglected in the Himalayan region due to the deterioration of local food systems, changing food habits, and lack of awareness of the uses and nutritional value of traditional crops.

Understanding infant and young child feeding (IYCF) practices among Muslim mothers/caregivers: A qualitative study in the Bangsamoro Autonomous Region in Muslim Mindanao, Philippines

Divine Grace C. Domingo — 2024-09-30

Background
The study focused on understanding infant and young child feeding practices (IYCF) among Muslim mothers in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), Philippines.
Objective
Recognizing the cultural and religious sensitivities associated with these practices, the research aimed to identify influencing factors and assess the influence of advertisements on maternal decisions regarding infants' and children's diets.
Methods
A total of 74 Muslim mothers with infants 6-23 months old were recruited and participated in the focus group discussions (FGD). Ten FGD sessions were conducted in Maguindanao Province, Philippines from July to August 2021. Verbatim transcriptions of audio-recorded discussions were transcribed into Microsoft Word files and QSR NVivo version 12 was used in the coding and analysis of the transcripts.
Results
Mothers exhibited limited awareness of such important complementary feeding issues as preferring fruits and vegetables while avoiding junk food as chips. IYCF information came primarily from health workers and other mothers - their own mothers, mothers-in-law, and midwives. Television commercials were identified as particularly influential in shaping maternal feeding decisions.
Conclusions
There was a diversity of breastfeeding practices and limited knowledge, especially of complementary feeding among these Muslim mothers. Both traditional beliefs and marketing were said to influence feeding choices. This underscores the need for culturally-sensitive interventions and targeted educational initiatives to enhance maternal knowledge and advocate for optimal infant feeding practices within Muslim communities, as well as regulation of the marketing of commercial infant foods.

An Acceptability of locally produced Ready-to-Use Therapeutic Food (RUTF) among children aged 2-4 years in Sri Lanka

Renuka Jayatissa — 2024-09-30

Although child wasting is preventable, it is a significant public health problem in Sri Lanka. Imported ready-to-use therapeutic food (RUTF), called BP-100, is part of the locally used treatment of severe acute wasting. However, Sri Lanka has faced economic barriers in providing this product. Two RUTF bars were developed in our laboratory based on global nutrient and other specifications (RUTF-1 and RUTF-2). Nutrient and microbiological analyses were within acceptable limits and shelf life was determined. This observational study was conducted to test the acceptability of locally produced RUTFs among children aged 2-4 years old, a first step in its possible use in place of imported versions. 56 children aged 2-4 years old in two preschools located in poor urban settings were included. These two RUTF bars and BP-100 were given to the children for a total period of three weeks (3 days of each product), with 3 to 4 days of interval in between. At the beginning, weight and height of the children were measured. A five-response hedonic scale was used to test acceptability. Mean daily intakes, and any apparent adverse effects were recorded. A taste test on the acceptability of RUTF and BP-100 among mothers or guardians was carried out on the last day of the trial. The colour, taste, smell, and texture of both RUTF bars were compared to BP-100. Overall acceptability of RUTF-1 (p=0.000) and RUTF-2 (p=0.02) was observed compared to BP-100 among both children and mothers. No adverse effects were reported. Further analysis indicated that there was no significant difference between locally produced RUTFs and BP-100 on acceptability in relation to sex, age, wasting, or stunting; however, a difference was noted related to ethnicity (p=0.000). In conclusion, locally produced RUTFs are as acceptable as BP-100. There is a need to assess the effectiveness of RUTFs while building partnerships with the food industry for sustainable production.

Unpacking front-of-pack nutrition labelling research: when the food industry produces ‘science’ as part of its lobbying strategies

Amandine Garde — 2024-09-30

The lobbying strategies of the food industry, which seek to undermine the development of regulatory measures intended to improve public health, are increasingly well documented and associated with slow progress in addressing diet-related diseases at national, regional and global levels. These strategies include the creation and dissemination of biased research findings in order to skew evidence in the favour of the industry, and to cast doubt about the harms stemming from its products and practices. Front-of-pack nutrition labelling (FoPNL) provides fertile ground for industry opposition, which we discuss in this commentary.

Food culture, lifestyle & traditional food festivals: a narrative on the public health relevance of the traditional yam recipes in the Afikpo New Yam Festival

Henry Chukwuemeka Uro-Chukwu — 2024-09-30

Food culture has over the years remained the centre for socio-cultural linkages among people in a community, with generational transmission giving birth to cultural affinity and cultural heritage. Besides its primary aim of nourishment, enhancement of growth and body functions, it also defines religious and traditional belief systems. Several communities, tribes and nation states such as China, Italy, Japan, India, Europe and Americas, have been associated with unique food cultures. In North and West African countries like Tunisia and Nigeria respectively, food cultures abound. In South-East Nigeria, the Igbo tribe conduct yam rituals as food cultural festivals. Afikpo, a community in the Igbo-speaking part of Nigeria, celebrates an annual yam ritual called Ikeji Festival, part of which, as the new yam is harvested, is preparation of traditional yam recipes. This article reviews the nutritional content of the various traditional yam recipes consumed in such ceremonies and the associated drinks. A literature search revealed that yam, an energy-giving food with a carbohydrate content of 15 – 40.6%, could be prepared with vegetables, legumes, fish, meat, melon seeds, red palm oil, African black beans, pumpkin fruit pulp, eggplants, African oil bean, piper guineese, plantain, solanum americanum, vitex donians, pterocarpus santalinoids, which are sources of minerals, vitamins, antioxidants, dietary fibres and polyunsaturated fatty acids, all of which have been documented as beneficial in the management of chronic diseases. Alcoholic and various soft drinks are consumed with the yam recipes during the ceremony and there are possibilities that if awareness is not created, overindulgence could constitute to abuse.

Nutritional Status of Children in Bangladesh: Changes and Challenges for Development

Md Idris Ali — 2024-09-30

Despite suffering from widespread poverty, Bangladesh has made remarkable improvements in the nutritional status of children over the past three decades. This paper describes the trends in the nutritional status of children in Bangladesh by age groups, explores factors associated with these trends, and concludes with a description of future challenges for development in Bangladesh. The national-level survey (BDHS), national plan and policy paper, and literature were used for the study. It is remarkable for Bangladesh that stunting, underweight, and wasting among children under five years old has improved gradually. Children 12- 23 months of age are the most vulnerable. Living in a rural vs urban area, wealth status and maternal education are the main determinants linked to the nutritional status of children. Poverty reduction, improved water and sanitation, strengthened maternal and child health care, education and other policies linked to food and dietary practices and many other policies and programs could continue to improve nutritional levels in children in Bangladesh. Attention is also needed to under five mortality and the double burden of malnutrition. Addressing gaps in policies and programs to achieve the goals of national plans and SDG targets will pay health dividends for the entire population.