Laura Terragni

Socioeconomic Indicators Are Independently Associated with Nutrient Intake in French Adults: A DEDIPAC Study

Studies have suggested differential associations of specific indicators of socioeconomic position (SEP) with nutrient intake and a cumulative effect of these indicators on diet. We investigated the independent association of SEP indicators (education, income, occupation) with nutrient intake and their effect modification. This cross-sectional analysis included 91,900 French adults from the NutriNet-Santé cohort. Nutrient intake was estimated using three 24-h records. We investigated associations between the three SEP factors and nutrient intake using sex-stratified analysis of covariance, adjusted for age and energy intake, and associations between income and nutrient intake stratified by education and occupation. Low educated participants had higher protein and cholesterol intakes and lower fibre, vitamin C and beta-carotene intakes. Low income individuals had higher complex carbohydrate intakes, and lower magnesium, potassium, folate and vitamin C intakes. Intakes of vitamin D and alcohol were lower in low occupation individuals. Higher income was associated with higher intakes of fibre, protein, magnesium, potassium, beta-carotene, and folate among low educated persons only, highlighting effect modification. Lower SEP, particularly low education, was associated with lower intakes of nutrients required for a healthy diet. Each SEP indicator was associated with specific differences in nutrient intake suggesting that they underpin different social processes.

Systematic mapping review of the factors influencing dietary behaviour in ethnic minority groups living in Europe: a DEDIPAC study.

BackgroundEurope has a growing population of ethnic minority groups whose dietary behaviours are potentially of public health concern. To promote healthier diets, the factors driving dietary behaviours need to be understood. This review mapped the broad range of factors influencing dietary behaviour among ethnic minority groups living in Europe, in order to identify research gaps in the literature to guide future research.MethodsA systematic mapping review was conducted (protocol registered with PROSPERO 2014: CRD42014013549). Nine databases were searched for quantitative and qualitative primary research published between 1999 and 2014. Ethnic minority groups were defined as immigrants/populations of immigrant background from low and middle income countries, population groups from former Eastern Bloc countries and minority indigenous populations. In synthesizing the findings, all factors were sorted and structured into emerging clusters according to how they were seen to relate to each other.ResultsThirty-seven of 2965 studies met the inclusion criteria (n = 18 quantitative; n = 19 qualitative). Most studies were conducted in Northern Europe and were limited to specific European countries, and focused on a selected number of ethnic minority groups, predominantly among populations of South Asian origin. The 63 factors influencing dietary behaviour that emerged were sorted into seven clusters: social and cultural environment (16 factors), food beliefs and perceptions (11 factors), psychosocial (9 factors), social and material resources (5 factors), accessibility of food (10 factors), migration context (7 factors), and the body (5 factors).ConclusionThis review identified a broad range of factors and clusters influencing dietary behaviour among ethnic minority groups. Gaps in the literature identified a need for researchers to explore the underlying mechanisms that shape dietary behaviours, which can be gleaned from more holistic, systems-based studies exploring relationships between factors and clusters. The dominance of studies exploring ‘differences’ between ethnic minority groups and the majority population in terms of the socio-cultural environment and food beliefs suggests a need for research exploring ‘similarities’. The evidence from this review will feed into developing a framework for the study of factors influencing dietary behaviours in ethnic minority groups in Europe.

Empowerment and Bariatric Surgery Negotiations of Credibility and Control

Today obesity is understood as a chronic illness. Programs developed to deal with obesity often build on an explicit aim to “empower” patients to take increased responsibility for their health, in line with contemporary neoliberal discourses. There is little empirically based knowledge about this so-called empowering process. In this article we focus on how an empowering program for patients diagnosed as morbidly obese worked on individuals’ identity. The program encompassed a course in lifestyle change, bariatric surgery, and aftercare. We conducted qualitative interviews with 9 individuals at different stages of their treatment process and applied discourse analysis to interpret their constructions and negotiations as they progressed through the program. We found that dimensions of control and credibility framed the respondents’ identity work. Based on the findings we suggest that contemporary discourses of empowerment as practice might leave the participants “trapped” within the ambivalence of freedom and control.

Ultra-processed food purchases in Norway: a quantitative study on a representative sample of food retailers

OBJECTIVE To identify the use of ultra-processed foods - vectors of salt, sugar and fats - in the Norwegian diet through an assessment of food sales. DESIGN Sales data from a representative sample of food retailers in Norway, collected in September 2005 (n 150) and September 2013 (n 170), were analysed. Data consisted of barcode scans of individual food item purchases, reporting type of food, price, geographical region and retail concept. Foods were categorized as minimally processed, culinary ingredients, processed products and ultra-processed. Indicators were share of purchases and share of expenditure on food categories. SETTING Six geographical regions in Norway. SUBJECTS The barcode data included 296 121 observations in 2005 and 501 938 observations in 2013. RESULTS Ultra-processed products represented 58·8 % of purchases and 48·8 % of expenditure in 2013. Minimally processed foods accounted for 17·2 % of purchases and 33·0 % of expenditure. Every third purchase was a sweet ultra-processed product. Food sales changed marginally in favour of minimally processed foods and in disfavour of processed products between 2005 and 2013 (χ 2 (3)=203 195, P<0·001, Cramers V=0·017, P<0·001). CONCLUSIONS Ultra-processed products accounted for the majority of food sales in Norway, indicating a high consumption of such products. This could be contributing to rising rates of overweight, obesity and non-communicable diseases in the country, as findings from other countries indicate. Policy measures should aim at decreasing consumption of ultra-processed products and facilitating access (including economic) to minimally processed foods.

Migration as a turning point in food habits: the early phase of dietary acculturation among women from South Asian, African, and Middle Eastern Countries living in Norway.

This article explores the early phase of dietary acculturation after migration. South Asian, African and Middle Eastern women (N = 21) living in Norway were interviewed about their early experiences with food in a new context. The findings pointed to abrupt changes in food habits in the first period after migration. To various degrees, women reported unfamiliarity with foods in shops, uncertainty about meal formats and food preparation and fear of eating food prohibited by their religion. Their food consumption tended to be restricted to food items perceived as familiar or safe. Our findings indicate that the first period after migration represents a specific phase in the process of dietary acculturation. Early initiatives aimed at enhancing confidence in food and familiarity with the new food culture are recommended.

Smartphone application for women with gestational diabetes mellitus: a study protocol for a multicentre randomised controlled trial

Introduction The promotion of a healthy diet, physical activity and measurement of blood glucose levels are essential components in the care for women with gestational diabetes mellitus (GDM). Smartphones offer a new way to promote health behaviour. The main aim is to investigate if the use of the Pregnant+ app, in addition to standard care, results in better blood glucose levels compared with current standard care only, for women with GDM. Methods and analysis This randomised controlled trial will include 230 pregnant women with GDM followed up at 5 outpatient departments (OPD) in the greater Oslo Region. Women with a 2-hour oral glucose tolerance test (OGTT) ≥9 mmol/L, who own a smartphone, understand Norwegian, Urdu or Somali and are <33 weeks pregnant, are invited. The intervention group receives the Pregnant+ app and standard care. The control group receives standard care only. Block randomisation is performed electronically. Data are collected using self-reported questionnaires and hospital records. Data will be analysed according to the intention-to-treat principle. Groups will be compared using linear regression for the main outcome and χ2 test for categorical data and Students t-test or Mann-Whitney-Wilcoxon test for skewed distribution. The main outcome is the glucose level measured at the 2-hour OGTT 3 months postpartum. Secondary outcomes are a change in health behaviour and knowledge about GDM, quality of life, birth weight, mode of delivery and complications for mother and child. Ethics and dissemination The study is exempt from regional ethics review due to its nature of quality improvement in patient care. Our study has been approved by the Norwegian Social Science Data Services and the patient privacy protections boards governing over the recruitment sites. Findings will be presented in peer-reviewed journals and at conferences. Trial registration number NCT02588729, Post-results.

Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project

BackgroundThe uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland.MethodsSix interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher.ResultsActive involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured.ConclusionsDespite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

Correlates of fruit, vegetable, soft drink, and snack intake among adolescents: the ESSENS study

Background Identifying modifiable correlates of dietary behaviors is of utmost importance for the promotion of healthy dietary behaviors. Objective This study explores individual, home, and school/neighborhood environmental correlates of dietary behaviors (intake of fruits, vegetables, soft drinks, and unhealthy snacks) among adolescents. Methods In total, 742 adolescents with a mean age of 13.6 (SD=0.3) were included in this cross-sectional study conducted in 11 secondary schools located in the eastern part of Norway. A web-based questionnaire was used to collect data. Univariable and multivariable linear regression analyses were used to explore factors associated with the dietary behaviors included. Results A higher frequency of food/drink purchase in the school canteen was related to a higher consumption of soft drinks and snacks. A higher frequency of food/drink purchase in shops around schools during break or recess was related to a higher consumption of snacks. A higher frequency of food/drink purchase in shops around the neighborhood on the way to and from school was related to a higher consumption of soft drinks. Perceived parental modeling and perceived accessibility at home were found to be positively associated with all dietary behaviors. Perceived parental rules were inversely associated with soft drink and snack consumption; self-efficacy related to healthy eating was positively associated with fruit and vegetable consumption. Other included school and neighborhood environmental correlates were not associated with the dietary behaviors. Conclusions There is a need to address the food purchasing behavior of the adolescents using different approaches. The findings also highlight the important role of parents and the home environment for healthy and unhealthy dietary behaviors of adolescents.

Developing a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe - a DEDIPAC study

BackgroundSome ethnic minority populations have a higher risk of non-communicable diseases than the majority European population. Diet and physical activity behaviours contribute to this risk, shaped by a system of inter-related factors. This study mapped a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe, to inform research prioritisation and intervention development.MethodsA concept mapping approach guided by systems thinking was used: i. Preparation (protocol and terminology); ii. Generating a list of factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe from evidence (systematic mapping reviews) and ‘eminence’ (89 participants from 24 academic disciplines via brainstorming, an international symposium and expert review) and; iii. Seeking consensus on structuring, rating and clustering factors, based on how they relate to each other; and iv. Interpreting/utilising the framework for research and interventions. Similar steps were undertaken for frameworks developed for the majority European population.ResultsSeven distinct clusters emerged for dietary behaviour (containing 85 factors) and 8 for physical activity behaviours (containing 183 factors). Four clusters were similar across behaviours: Social and cultural environment; Social and material resources; Psychosocial; and Migration context. Similar clusters of factors emerged in the frameworks for diet and physical activity behaviours of the majority European population, except for ‘migration context’. The importance of factors across all clusters was acknowledged, but their relative importance differed for ethnic minority populations compared with the majority population.ConclusionsThis systems-based framework integrates evidence from both expert opinion and published literature, to map the factors influencing dietary and physical activity behaviours in ethnic minority groups. Our findings illustrate that innovative research and complex interventions need to be developed that are sensitive to the needs of ethnic minority populations. A systems approach that encompasses the complexity of the inter-related factors that drive behaviours may inform a more holistic public health paradigm to more effectively reach ethnic minorities living in Europe, as well as the majority host population.

Mediators of the association between parental education and breakfast consumption among adolescents : the ESSENS study

BackgroundRegular breakfast consumption has several health benefits. However, breakfast skipping is common among adolescents, in particular among those with a low socioeconomic background. The aims of the study were to explore individual and home environmental correlates of breakfast consumption, and to assess their potential mediating role in the association between parental education and breakfast consumption.MethodsA cross-sectional study including 706 adolescents with a mean age of 13.6 (SD = 0.3) was conducted between October and December 2016. Data were collected at school through an online questionnaire. Regression analyses were used to explore whether parental modelling, parental co-participation in breakfast consumption, parental rules, the availability of breakfast foods at home and screen time were associated with breakfast consumption. Mediation analyses were conducted to assess whether these factors mediated the association between parental education and breakfast consumption.ResultsBreakfast consumption was significantly positively associated with parental education (OR = 1.97 (95% CI 1.43–2.72)). A higher parental modelling (OR = 2.17 (95% CI 1.70–2.79)), a higher parental co-participation in breakfast consumption (OR = 1.37 (95% CI 1.26, 1.49)), higher parental rules (OR = 1.36 (95% CI 1.21, 1.53)) and a higher availability of breakfast foods at home (OR = 2.21 (95% CI 1.65, 2.97)) were associated with higher odds of being a daily breakfast consumer. Higher levels of screen time (hrs/day) were associated with lower odds of being a daily breakfast consumer (OR = 0.85 (95% CI 0.79, 0.91). Parental modelling (B = 0.254 (95% CI 0.149, 0.358)) and the availability of breakfast foods at home (B = 0.124 (95% CI 0.033, 0.214)) were significantly positively related to parental education, whereas screen time (hrs/day) (B = −1.134 (95% CI −1.511, −0.758)) was significantly inversely related to parental education. Parental modelling, the availability of breakfast foods at home and screen time were found to mediate parental educational differences in breakfast consumption.ConclusionsIncreasing the availability of breakfast food, improving parental modelling of breakfast consumption and targeting screen time might be promising strategies to reduce parental educational differences in breakfast consumption.