Carl Lachat

Eating out of home and its association with dietary intake: a systematic review of the evidence

During the last decades, eating out of home (OH) has gained importance in the diets worldwide. We document the nutritional characteristics of eating OH and its associations with energy intake, dietary quality and socioeconomic status. We carried out a systematic review of peer‐reviewed studies in eight databases up to 10 March 2011. Of the 7,319 studies retrieved, 29 met the inclusion criteria and were analysed in this review. The quality of the data was assessed and a sensitivity analysis was conducted by isolating nationally representative or large cohort data from 6 and 11 countries, respectively. OH foods were important sources of energy in all age groups and their energy contribution increased in adolescents and young adults. Eating OH was associated with a higher total energy intake, energy contribution from fat in the daily diet and higher socioeconomic status. Two large studies showed how eating OH was also associated with a lower intake of micronutrients, particularly vitamin C, Ca and Fe. Although the studies were cross‐sectional and heterogeneous in the way they classified eating OH, we conclude that eating OH is a risk factor for higher energy and fat intake and lower micronutrient intake.

Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review

BACKGROUND The prevalence of childhood obesity is increasing rapidly in low- and middle-income countries, and informed policies to tackle the problem must be defined. OBJECTIVE We systematically reviewed the evidence on the effectiveness of school-based interventions targeting dietary behavior and/or physical activity for the primary prevention of obesity in children and adolescents aged 6-18 y in low- and middle-income countries. DESIGN We searched the MEDLINE, EMBASE, Web of Science, CENTRAL, ERIC, Cochrane Library, and Centre for Reviews and Dissemination databases for peer-reviewed controlled studies published in English, Spanish, French, German, or Dutch between January 1990 and July 2011. The quality of the included studies was appraised independently by 2 authors who used the Effective Public Health Practice Project tool. RESULTS From a total of 7218 unique references, we retained 22 studies. Most of the interventions (82%) had a positive effect on dietary behavior and physical activity behavior (effect size ranged from -0.48 to 1.61). BMI decreased in 8 studies (effect size ranged from -0.7 to 0.0). Effective interventions targeted both diet and physical activity, involved multiple stakeholders, and integrated educational activities into the school curriculum. CONCLUSIONS School-based interventions have the potential to improve dietary and physical activity behavior and to prevent unhealthy body weights in low- and middle-income countries. To reach their full potential, interventions should conduct process evaluations to document program implementation. The effect and the pathways through which interventions have this effect need to be better documented through rigorous evaluation studies.

Fumonisin exposure through maize in complementary foods is inversely associated with linear growth of infants in Tanzania

Infants consuming maize-based foods are at a high risk of exposure to fumonisins. This study explored the association between exposure of fumonisins from maize and growth retardation among infants in Tanzania. Mothers of 215 infants consented for their children to participate in this study. We estimated maize intake for each child by twice conducting a 24 h dietary recall and fumonisins level in the maize, using HPLC. Fumonisins exposure for each child was estimated by combining his/her maize intake and the fumonisins level in the maize. Of the infants, 191 consumed maize. The maize consumed by 131 infants contained fumonisins at levels varying from 21 to 3201 μg/kg. Fumonisins exposure in 26 infants exceeded the provisional maximum tolerable daily intake of 2 μg/kg body weight. At 12 months of age, infants exposed to fumonisins intakes above the provisional maximum tolerable daily intake of 2 μg/kg bodyweight were significantly shorter by 1.3 cm and 328 g lighter. It appears that the exposure to fumonisins is associated with growth retardation. This is the first study to report an association between fumonisins exposures and growth retardation.

Eating out of home in Belgium: current situation and policy implications

The aim of the study was to characterise substantial out-of-home (SOH) eaters, describe the nutritional quality of their diet, compare SOH eaters and non-SOH eaters for a set of nutritional indicators and evaluate the quality of meals consumed at home and at different places outside the home. Information on food intake was collected with two 24 h recalls. Habitual food intake was estimated by the Nusser method. Non-dietary variables were obtained using a face-to-face questionnaire. SOH eaters were defined as individuals who consume at least 25% of their daily energy out of home. A representative sample (n 3245) of the Belgian population aged 15 years and older was randomly selected from the National Register using a multi-stage stratified procedure. Of the Belgian population, 35.2% were defined as SOH eaters. Energy intake, energy density of the total diet and daily consumption of most food groups, except for fruits and vegetables, were substantially higher among SOH eaters compared with non-SOH eaters. Out-of-home eating was more common among men than women and decreased with increasing age. There were considerable differences in portion sizes, consumption frequency of different foods and diversity of meals according to different places of consumption. Out-of-home eating is a significant nutritional issue in Belgium and is associated with a more adverse dietary profile. Out-of-home eating, places of consumption, and specific population groups, eating substantially out of home, should consequently be taken into account when designing and evaluating nutrition policies.

Human exposure to mycotoxins and their masked forms through cereal-based foods in Belgium

In the present study, a quantitative dietary exposure assessment of mycotoxins and their masked forms was conducted on a national representative sample of the Belgian population using the contamination data of cereal-based foods. Cereal-based food products (n=174) were analysed for the occurrence of deoxynivalenol, 3-acetyldeoxynivalenol, 15-acetyldeoxynivalenol, zearalenone, α-zearalenol, β-zearalenol, T-2-toxin, HT-2-toxin, and their respective masked forms, including, deoxynivalenol-3-glucoside, zearalenone-4-glucoside, α-zearalenol-4-glucoside, β-zearalenol-4-glucoside and zearalenone-4-sulfate. Fibre-enriched bread, bran-enriched bread, breakfast cereals, popcorn and oatmeal were collected in Belgian supermarkets according to a structured sampling plan and analysed during the period from April 2010 to October 2011. The habitual intake of these food groups was estimated from a national representative food intake survey. According to a probabilistic exposure analysis, the mean (and P95) mycotoxin intake for the sum of the deoxynivalenol-equivalents, zearalenone-equivalents, and the sum of HT-2-and T-2-toxin for all cereal-based foods was 0.1162 (0.4047, P95), 0.0447 (0.1568, P95) and 0.0258 (0.0924, P95) μg kg(-1)body weight day(-1), respectively. These values were below the tolerable daily intake (TDI) levels for deoxynivalenol, zearalenone and the sum of T-2 and HT-2 toxin (1.0, 0.25 and 0.1 μg kg(-1)body weight day(-1), respectively). The absolute level exceeding the TDI for all cereal-based foods was calculated, and recorded 0.85%, 2.75% and 4.11% of the Belgian population, respectively.

A concise overview of national nutrition action plans in the European Union Member States

OBJECTIVE This study presents an overview of national nutrition action plans in the member states of the European Union (EU), before its enlargement in 2004. In addition, their compliance with key recommendations of the World Health Organization, as documented in the First Action Plan for Food and Nutrition Policy and the Global Strategy on Diet, Physical Activity and Health, has tentatively been evaluated on the basis of the policy documents published. DESIGN Literature review of publicly available policy national plans on nutrition and physical activity. SETTING Member states of the EU before enlargement in May 2004. RESULTS The development of national nutrition action plans is gaining momentum. Six of the 15 EU member states - namely, Sweden, Finland, Denmark, France, The Netherlands and the UK - have an operational nutrition policy and four of them have published an elaborated description of their nutrition policy in English. By the end of 2004, another four countries are expected to have their plan finalised. The available nutrition action plans generally seem to comply with international recommendations, although large variations are observed between the member states in terms of terminology, nutritional recommendations, institutional framework, nutritional scope, social groups targeted and monitoring and evaluation structures. CONCLUSIONS Although the importance of nutritional surveillance, a comprehensive approach to nutritional problems and stakeholder involvement is recognised by the action plans, the justification for it is vaguely described. This paper advocates for proper evaluation and documentation of interventions in public health nutrition and nutrition policies.

Validity of two physical activity questionnaires (IPAQ and PAQA) for Vietnamese adolescents in rural and urban areas

BackgroundAlthough physical activity is recognised to be an important determinant of health and nutritional status, few instruments have been developed to assess physical activity in developing countries. The aim of this study was to compare the validity of the short form of the International Physical Activity Questionnaire (IPAQ) and a locally adapted version of the Physical Activity Questionnaire for Adolescents (PAQA) for use in school going adolescents in rural and urban areas in Vietnam.MethodsSixteen year old adolescents from rural areas (n = 137) and urban areas (n = 90) completed the questionnaires in 2006. Test-retest reliability was assessed by comparing registrations after 2 weeks. Criterion validity was assessed by comparison with 7 days continuous accelerometer logging. Validity of the two methods was assessed using Spearman correlation coefficient, intra class correlation coefficients (ICC) and Kappa statistics.ResultsReliability of both questionnaires was poor for both the IPAQ (ICC = 0.37) and the PAQA (ICC = 0.40). Criterion validity of both questionnaires was acceptable and similar for the IPAQ (ρ = 0.21) and the PAQA (ρ = 0.27) but a significantly lower validity was observed in rural areas. Both forms poorly estimated time spent on light, moderate and vigorous physical activity. Agreement of both questionnaires to classify individuals was also low but the IPAQ performed better than the PAQA.ConclusionBoth questionnaires have a similar and overall poor validity to be used as a population instrument in Vietnam. Low reliability and classification properties in rural areas call for further research for specific use in such settings.

Posting point-of-purchase nutrition information in university canteens does not influence meal choice and nutrient intake

BACKGROUND Growing concern over the relation between out-of-home eating and overweight has triggered the use of point-of-purchase (POP) nutrition information when eating out of the home. In canteens that offer various unhealthy choices, the posting of POP nutrition information has the potential to improve meal choices and dietary intakes. OBJECTIVE The objective of this study was to increase the proportion of consumed meals that comply with recommendations for energy, saturated fat, sodium, and vegetable content by 5%. DESIGN A one-group pretest-posttest design was used. A total of 224 customers of 2 university canteens completed a questionnaire used for consumer profiling and 3-d food records to assess their meal choices and nutrient intakes. The 12 best meal combinations received star ratings and descriptors for nutrients or food groups that did not comply. RESULTS Reported meal choices in canteens and nutrient intakes did not improve after the intervention (P > 0.05). The nutritional profile of the meal choice, obtained from a qualitative and quantitative nutritional assessment of meals, mirrored the nutritional profile of all meals offered (P > 0.05) and not that of the recommended meals offered (P < 0.001). Meal choices were not compensated for later in the day (P > 0.05). The healthiest choices were made by participants with greater objective nutrition knowledge, stronger health and weight-control motives, and a greater openness to change meal choices at baseline (P < 0.05). CONCLUSIONS The posting of nutrition information in university canteens did not effectively change meal choices and nutrient intakes. Despite the intervention, meal choices were largely determined by meals offered. Therefore, nutrition-information interventions in canteens may be more effective with a healthier meal supply. This trial was registered at clinicaltrials.gov as NCT01249508.

Association of out-of-home eating with anthropometric changes : a systematic review of prospective studies

In the present review, the association of out-of-home eating with anthropometric changes was examined. Peer-reviewed studies in eight databases were searched, and 15 prospective studies were included in the review. The quality of the data was assessed by considering risks of bias in sample selection, data collection methods, and the appropriateness of statistical tests. From this, seven studies, which used relatively large samples or had a follow-up period longer than 10 years, were retained for further analysis. It was concluded that eating out-of-home frequently, in the broad sense, is positively associated with the risk of becoming overweight or obese and weight change. With regard to specific out-of-home sources, the review shows that eating at fast-food outlets is associated with a greater increase in body weight and waist circumference over time than eating at restaurants and takeaway foods positively predict BMI change in women. More research is needed on out-of-home foods other than fast-foods and restaurant foods, such as street, canteen, and school foods.

Food insecurity, school absenteeism and educational attainment of adolescents in Jimma Zone Southwest Ethiopia: a longitudinal study

BackgroundFood insecurity not only affects physical growth and health of children but also their intellectual development, school attendance and academic performance. However, most evidences are based on studies in high income countries. Although food insecurity is common in Ethiopia, to what extent it affects school attendance and educational attainment of adolescents is not explored. We hypothesized that food insecure adolescents would be more likely to be absent from school and have lower grades attained after 1 year compared to their food secure peers.MethodsWe used data from 2009 adolescents in the age group of 13-17 years from two consecutive surveys of a five year longitudinal family study in Southwest Ethiopia. A stratified random sampling was used to select participants. Regression analyses were used to compare school absenteeism and the highest grade attained after 1 year of follow-up in food secure and insecure adolescents. The analysis was adjusted for demographic factors, reported illness and workload.ResultsSignificantly more (33.0%) food insecure adolescents were absent from school compared with their food secure peers (17.8%, P < 0.001). Multivariable logistic regression analyses showed that after adjusting for gender, place of residence and gender of the household head, adolescent food insecurity [OR 1.77 (1.34-2.33)], severe household food insecurity [OR 1.62 (1.27-2.06)], illness during the past one month before the survey [OR 2.26 (1.68-3.06)], the highest grade aspired to be completed by the adolescent [OR 0.92 (0.88-0.96)], and the number of days that the adolescent had to work per week [OR 1.16 (1.07-1.26)] were independent predictors of school absenteeism. Similarly after controlling for household income and gender of the household head, adolescent food insecurity(P < 0.001), severe household food insecurity(P < 0.001), illness during the last month(P < 0.001) and rural residence(P < 0.001) were inversely associated with highest grade attained, while age of the adolescent(P < 0.001), the highest grade intended to be completed(P < 0.001) and residence in semi urban area(P < 0.001) were positively associated with the highest grade attained.ConclusionsAdolescent and household food insecurity are positively associated with school absenteeism and a lower educational attainment. Programs aiming to achieve universal access to primary education in food insecure environments should integrate interventions to ensure food security of adolescents.