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Objective: Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the Nova classification system and WHO and World Cancer Research Fund dietary guidelines. Design: Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017–2018. Foods consumed were classified according to the Nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated. Setting: Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included. Participants: In total, 2521 participants (18–50 years) were included in the study. Results: Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall. Conclusions: Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF. [ABSTRACT FROM AUTHOR]

Objective: Using an adaption of the Photovoice method, this study explored how food insecurity affected parents' ability to provide food for their family, their strategies for managing household food insecurity and the impact of food insecurity on their well-being.Design: Parents submitted photos around their families' experiences with food insecurity. Afterwards, they completed in-depth, semi-structured interviews about their photos. The interviews were transcribed and analysed for thematic content using the constant comparative method.Setting: San Francisco Bay Area, California, USA.Participants: Seventeen parents (fourteen mothers and three fathers) were recruited from a broader qualitative study on understanding the experiences of food insecurity in low-income families.Results: Four themes were identified from the parents' photos and interviews. First, parents described multiple aspects of their food environment that promoted unhealthy eating behaviours. Second, parents shared strategies they employed to acquire food with limited resources. Third, parents expressed feelings of shame, guilt and distress resulting from their experience of food insecurity. And finally, parents described treating their children to special foods to cultivate a sense of normalcy.Conclusions: Parents highlighted the external contributors and internal struggles of their experiences of food insecurity. Additional research to understand the experiences of the food-insecure families may help to improve nutrition interventions targeting this structurally vulnerable population. [ABSTRACT FROM AUTHOR]

Objective: To compare the cost and affordability of two fortnightly diets (representing the national guidelines and current consumption) across areas containing Australia's major supermarkets.Design: The Healthy Diets Australian Standardised Affordability and Pricing protocol was used.Setting: Price data were collected online and via phone calls in fifty-one urban and inner regional locations across Australia.Participants: Not applicable.Results: Healthy diets were consistently less expensive than current (unhealthy) diets. Nonetheless, healthy diets would cost 25-26 % of the disposable income for low-income households and 30-31 % of the poverty line. Differences in gross incomes (the most available income metric which overrepresents disposable income) drove national variations in diet affordability (from 14 % of the median gross household incomes in the Australian Capital Territory and Northern Territory to 25 % of the median gross household income in Tasmania).Conclusions: In Australian cities and regional areas with major supermarkets, access to affordable diets remains problematic for families receiving low incomes. These findings are likely to be exacerbated in outer regional and remote areas (not included in this study). To make healthy diets economically appealing, policies that reduce the (absolute and relative) costs of healthy diets and increase the incomes of Australians living in poverty are required. [ABSTRACT FROM AUTHOR]

Objective: To understand low-income adults' expectations and experiences using an innovative smartphone and theory-based eLearning nutrition education programme, entitled Food eTalk.Design: Longitudinal mixed-methods single case study including a series of focus group and individual interviews, demographic and Internet habits surveys, and user-tracking data. Interviews were transcribed verbatim, analysed using the constant comparative method and digitalized using Atlas.ti. Descriptive statistics were analysed for demographics and user-tracking data.Setting: Community-based locations including libraries, public housing complexes, schools, safety-net clinics and food pantries.Subjects: Low-income Georgian adults aged ≥18 years (n 64), USA.Results: Participants found Food eTalk easy to navigate and better designed than expected. Primary themes were twofold: (i) motivation to engage in eLearning may be a formidable barrier to Food eTalk's success but improved programme content, format and external incentives could mitigate this barrier; and (ii) applying knowledge to change nutrition-related behaviour is challenging. To encourage engagement in eLearning nutrition education, programme format should highlight interactive games, videos, be short in length, and feature content that is relevant and important from the perspective of the priority audience. Examples of these topics include quick and easy recipes, chronic disease-specific diet information and tips to feed 'picky' children. Additionally, external incentives may help mitigate barriers to healthful eating behaviour and increase engagement in the programme.Conclusions: The findings suggest eLearning nutrition education programmes are best designed to match low-income adults' typical smartphone habits, include content considered particularly relevant by the intended audience and highlight solutions to barriers to healthful eating. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present study was to test the effectiveness of financial incentives and traffic-light labels to reduce purchases of sugar-sweetened beverages in a community supermarket. Design: In this randomized controlled trial, after a 2-month baseline period (February–March 2014), in-store traffic-light labels were posted to indicate healthy (green), less healthy (yellow) or unhealthy (red) beverages. During the subsequent five months (April–August 2014), participants in the intervention arm were eligible to earn a $US 25 in-store gift card each month they refrained from purchasing red-labelled beverages. Setting: Urban supermarket in Chelsea, MA, USA, a low-income Latino community. Subjects: Participants were customers of this supermarket who had at least one child living at home. A total of 148 customers (n 77 in the intervention group and n 71 in the control group) were included in the final analyses. Results: Outcomes were monthly in-store purchases tracked using a store loyalty card and self-reported consumption of red-labelled beverages. Compared with control participants, the proportion of intervention participants who purchased any red-labelled beverages decreased by 9 % more per month (P=0·002). More intervention than control participants reduced their consumption of red-labelled beverages (−23 % v. −2 % for consuming ≥1 red beverage/week, P=0·01). Conclusions: Overall, financial incentives paired with in-store traffic-light labels modestly reduced purchase and consumption of sugar-sweetened beverages by customers of a community supermarket. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between food insecurity and coping strategies (actions taken to manage economic stress) hypothesized to worsen glucose control in patients with diabetes.Design: Using a cross-sectional telephone survey and clinical data, we compared food-insecure and food-secure individuals in their use of coping strategies. Using logistic regression models, we then examined the association between poor glucose control (glycated Hb, HbA1c≥8·0 %), food insecurity and coping strategies.Setting: An urban medical centre, between June and December 2013.Subjects: Four hundred and seven adults likely to be low income (receiving Medicaid or uninsured and/or residing in a zip code with >30 % of the population below the federal poverty level) with type 2 diabetes.Results: Of respondents, 40·5 % were food insecure. A significantly higher percentage of the food-insecure group reported use of most examined coping strategies, including foregone medical care, participation in the Supplemental Nutrition Assistance Program (SNAP)) and use of emergency food programmes. Food insecurity was associated with poor glucose control (OR=2·23; 95 % CI 1·22, 4·10); coping strategies that were more common among the food insecure were not associated with poor glucose control. Among the food insecure, receipt of SNAP was associated with lower risk of poor glucose control (OR=0·27; 95 % CI 0·09, 0·80).Conclusions: While food insecurity was associated with poor glucose control, most examined coping strategies did not explain this relationship. However, receipt of SNAP among food-insecure individuals was associated with better diabetes control, suggesting that such programmes may play a role in improving health. [ABSTRACT FROM AUTHOR]

ObjectiveAnalysing dietary data to capture how individuals typically consume foods is dependent on the coding variables used. Individual foods consumed simultaneously, like coffee with milk, are given codes to identify these combinations. Our literature review revealed a lack of discussion about using combination codes in analysis. The present study identified foods consumed at mealtimes and by race when combination codes were or were not utilized.DesignDuplicate analysis methods were performed on separate data sets. The original data set consisted of all foods reported; each food was coded as if it was consumed individually. The revised data set was derived from the original data set by first isolating coded foods consumed as individual items from those foods consumed simultaneously and assigning a code to designate a combination. Foods assigned a combination code, like pancakes with syrup, were aggregated and associated with a food group, defined by the major food component (i.e. pancakes), and then appended to the isolated coded foods.SettingHealthy Aging in Neighborhoods of Diversity across the Life Span study.SubjectsAfrican-American and White adults with two dietary recalls (n 2177).ResultsDifferences existed in lists of foods most frequently consumed by mealtime and race when comparing results based on original and revised data sets. African Americans reported consumption of sausage/luncheon meat and poultry, while ready-to-eat cereals and cakes/doughnuts/pastries were reported by Whites on recalls.ConclusionsUse of combination codes provided more accurate representation of how foods were consumed by populations. This information is beneficial when creating interventions and exploring diet–health relationships. [ABSTRACT FROM PUBLISHER]

ObjectiveCorner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment.DesignEvaluation staff used 9238 intercept surveys to directly examine food and beverage purchases.SettingIntercepts were collected at 192 corner stores in Philadelphia, PA, USA.SubjectsParticipants were adult, adolescent and child corner store shoppers.ResultsAmong the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2·2 (sd 2·1) items (1·3 (sd 2·0) foods and 0·9 (sd 0·9) beverages) that cost $US 2·74 (sd $US 3·52) and contained 2786·5 (sd 4454·2) kJ (666·0 (sd 1064·6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65·9 % of intercepts and accounted for 39·2 % of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66·2 g of sugar, 921·1 mg of sodium and 2·5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy.ConclusionsUrban corner store shoppers spent almost $US 3·00 for over 2700 kJ (650 kcal) per store visit. Obesity prevention efforts may benefit from including interventions aimed at changing corner store food environments in low-income, urban areas. [ABSTRACT FROM AUTHOR]

ObjectiveTo report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households.DesignA four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week.SettingA large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA.SubjectsFifty-eight households, with at least one child living in the home.ResultsDuring the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited.ConclusionsAt baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations. [ABSTRACT FROM AUTHOR]

ObjectiveThe present study aimed to assess complementary feeding practices and identify the potential risk factors associated with inappropriate complementary feeding in Indonesia for a nationally representative sample of births from 2004 to 2007.DesignThe data source for the analysis was the 2007 Indonesia Demographic and Health Survey. Multiple logistic regression was performed to analyse the factors associated with complementary feeding, using individual-, household- and community-level determinants.SettingIndonesia.SubjectsChildren (n 4604) aged 6–23 months.ResultsMultivariate analysis revealed that infants from poor households were significantly less likely to be introduced to complementary feeding (adjusted odds ratio, AOR = 4·32; 95 % CI 1·46, 12·80) and meet the minimum dietary diversity (AOR = 1·76; 95 % CI 1·16, 2·68). Mother's education (AOR for no education in dietary diversity = 1·92; 95 % CI 1·09, 3·38; AOR for no education in meal frequency = 2·03; 95 % CI 1·13, 3·64; AOR for no education in acceptable diet = 3·84; 95 % CI 2·07, 7·12), residence and decreased age of the infant were negatively associated with minimum dietary diversity, minimum meal frequency and an acceptable diet. Infants aged 6–11 months were also significantly less likely to meet minimum dietary diversity (AOR = 6·36; 95 % CI 4·73, 8·56), minimum meal frequency (AOR = 2·30; 95 % CI 1·79, 2·96) and minimum acceptable diet (AOR = 2·27; 95 % CI 1·67, 3·09). All geographical regions compared with Sumatra were more likely to give the recommended meal frequency and an acceptable diet to breast-fed children.ConclusionsPublic health interventions to improve complementary feeding should address individual-, household- and community-level factors which significantly influence the introduction of complementary feeding. Complementary feeding intervention programmes in Indonesia should ensure that restraints on families with low socio-economic status are addressed. Infants aged 6–11 months and mothers with low education levels may also need special focus. Promotion strategies should also target the health-care delivery system and the media. [ABSTRACT FROM PUBLISHER]

ObjectiveTo explore associations between household food security and home gardening, use of soya and pressure cooker ownership in low-income households affected by HIV/AIDS in Aurangabad, India.DesignCross-sectional pilot study which assessed household food security using the validated US Department of Agriculture's food security core-module questionnaire. Questions were added to explore household environment, education, occupation, home gardening, use of soya and pressure cooker ownership. Households with very low v. low food security were compared using logistic regression analysis, controlling for confounding by socio-economic status.SettingAurangabad is an urban setting situated in a primarily agricultural dependent area. The study was carried out in 2008, at the peak of the global food crisis.SubjectsAdult caregivers of children affiliated with the Network of People Living with HIV/AIDS in Aurangabad.ResultsAll except for one of 133 households were identified as food insecure (99·2 %). Of these households, 35·6 % had to cut size or skip a meal in the past 30 d. Households that cut meal size due to cooking fuel shortages were more likely to have very low food security (OR = 4·67; 95 % CI 1·62, 13·44) compared with households having no cooking fuel shortages. Owning a pressure cooker was shown to be protective against very low food security after controlling for confounding by socio-economic status (OR = 0·27; 95 % CI 0·11, 0·64).ConclusionsOnly pressure cooker ownership showed a protective association with low household food security. Pressure cookers save household fuel costs. Therefore, future interventions should explore pressure cookers as a sustainable means of improving household food security. [ABSTRACT FROM PUBLISHER]

ObjectiveThe present study aimed to highlight the similarities and differences between perceived and objective measures of the food store environment among low-income women and the association with diet and weight.DesignCross-sectional analysis of food store environment. Store level was characterized by: (i) the availability of healthy foods in stores where participants shop, using food store audits (objective); and (ii) summary scores of self-reported perception of availability of healthy foods in stores (perceived). Neighbourhood level was characterized by: (i) the number and type of food stores within the census tract (objective); and (2) summary scores of self-reported perception of availability of healthy foods (perceived).SettingSix counties in North Carolina.SubjectsOne hundred and eighty-six low-income women.ResultsIndividuals who lived in census tracts with a convenience store and a supercentre had higher odds of perceiving their neighbourhood high in availability of healthy foods (OR = 6·87 (95 % CI 2·61, 18·01)) than individuals with no store. Overall, as the number of healthy foods available in the store decreased, the probability of perceiving that store high in availability of healthy foods increased. Individuals with a supercentre in their census tract weighed more (2·40 (95 % CI 0·66, 4·15) kg/m2) than individuals without one. At the same time, those who lived in a census tract with a supercentre and a convenience store consumed fewer servings of fruits and vegetables (−1·22 (95 % CI −2·40, −0·04)).ConclusionsThe study contributes to a growing body of research aiming to understand how the food store environment is associated with weight and diet. [ABSTRACT FROM PUBLISHER]

ObjectiveThe nutritional intake of schoolchildren is affected not only by what is consumed at school but also by what is available in food outlets near schools. The present study surveys the range of food outlets around schools and examines how the availability of healthy food in the food stores encountered varies by income status of the school and by store participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food assistance programme.DesignNetwork buffer zones were created to reflect a quarter-mile (400 m) walk from elementary schools with lower- and higher-income student populations in Oakland, CA, USA. All food outlets within these zones were categorised by type, and audits were conducted within food stores using a checklist to assess for the presence or absence of twenty-eight healthy items (in five domains).SettingMid-sized city in the USA.SubjectsFood outlets near public elementary schools.ResultsThere were considerably more food outlets around lower-income schools. Food stores near higher-income schools had higher scores in two of the five domains (healthy beverages/low-fat dairy and healthy snacks). However, there were more food stores near lower-income schools that accepted WIC vouchers. Stratification showed that WIC stores scored higher than non-WIC stores on four of the five domains.ConclusionsAlthough higher-income students have more access to healthy food in the environment surrounding their school, this disparity appears to be mitigated by stores that accept WIC and offer more healthy snacking options. Federal programmes such as this may be particularly valuable for children in lower-income areas. [ABSTRACT FROM PUBLISHER]

AbstractObjectivesTo assess the potential nutritional contribution of meals provided in a sample of community programmes for homeless individuals, to determine the effect of food donations on meal quality and to develop food-based guidance for meals that would meet adults? total nutrient needs.SettingToronto, Canada.DesignAn analysis of weighed meal records from eighteen programmes. The energy and nutrient contents of meals were compared to requirement estimates to assess contribution to total needs, given that homeless people have limited access to nutritious foods. Mixed linear modelling was applied to determine the relationship between the use of food donations and meal quality. The composition of meals that would meet adults? nutrient requirements was determined by constructing simulated meals, drawing on the selection of foods available to programmes.SampleIn all, seventy meals, sampled from eighteen programmes serving homeless individuals.ResultsOn average, the meals contained 2?6 servings of grain products, 1?7 servings of meat and alternatives, 4?1 servings of vegetables and fruits and 0?4 servings of milk products. The energy and nutrient contents of most meals were below adults? average daily requirements. Most meals included both purchased and donated foods; the vitamin C content of meals was positively associated with the percentage of energy from donations. Increasing portion sizes improved the nutrient contribution of meals, but the provision of more milk products and fruits and vegetables was required to meet adults? nutrient requirements.ConclusionsThe meals assessed were inadequate to meet adults? nutrient requirements. Improving the nutritional quality of meals requires additional resources. [ABSTRACT FROM AUTHOR]

Aims: To investigate the prevalence of vitamin A deficiency among lactating women in a poor urban population of Bangladesh, and to examine the relationship between various factors and vitamin A status. Design: Cross-sectional study. Setting: Maternal and child health clinic in Dhaka City, Bangladesh. Subjects and methods: A total of 120 lactating women aged 17-37 years were randomly selected from women who attended a local maternal and child health clinic in Dhaka City for immunisation of their children. Various socio-economic, personal characteristics, dietary intakes of vitamin A and anthropometric data were collected. Serum retinol (vitamin A) concentration was determined as a measure of vitamin A status. Results: Of the subjects, 37% had low serum vitamin A levels (<30 μg dl-1), with 13.3% having sub-clinical vitamin A deficiency (<20 μg dl-1). Eighty-seven per cent had vitamin A intakes below the recommended dietary allowance. The lactating women who were either illiterate or received only informal education had significantly (P=0.002) lower serum vitamin A levels compared with those who received formal education. The women whose husbands received formal education had significantly (P=0.05) higher serum vitamin A levels than those whose husbands were either illiterate or received only informal education. The serum vitamin A levels of women in households with poor sanitation/latrine practice were significantly (P=0.03) lower than those of women in households with good sanitation/latrine practice. The women with one child had significantly (P=0.015) lower serum vitamin A levels than those with two or more children. Women with a lactation period of 6 months or more had significantly (P=0.034) lower serum vitamin A levels than women with a lactation period of less than 6 months. The women who consumed less than the median vitamin A intake (274.8 μg day-1) had significantly (P=0.01) lower serum vitamin A levels than those who consumed more than the median vitamin A intake. By multiple regression analysis, education level of the women, number of living children, duration of lactation and dietary intake of vitamin A were found to have significant independent relationships with serum vitamin A. The overall F-ratio (6.8) was highly significant (P=0.000), the adjusted R2 was 0.16 (multiple R=0.44). Conclusion: A significant proportion of poor, urban, lactating women in Bangladesh have vitamin A deficiency. Among the various factors, education level of the women, number of living children, duration of lactation and dietary intake of vitamin A appear to be important in influencing the vitamin A status of these women. [ABSTRACT FROM AUTHOR]

Farmer P (Sen A, foreword). Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley and Los Angeles, CA: University of California Press, 2003. U$27.50, hardcover, 402 pp. ISBN 0-520-23550-9 [ABSTRACT FROM AUTHOR]