Relationship between family functioning and food consumption during a health and social crisis: A COVID-19 study in Chile

The COVID-19 pandemic and government measures have challenged family functioning (FF) and eating behaviors. In non-pandemic scenarios, FF has shown a protective role in diet quality. This study aimed to explore the role of FF in family members' food consumption during the first wave of the COVID-19 pandemic in Chile. We conducted a cross-sectional, non-probabilistic study. Chilean adults (n= 821) answered an online survey based on the Family Adaptability and Cohesion Evaluation Scales (FACES) IV and a scale of food intake perceptions (non-processed and processed food). The survey also included an open space for comments (n= 147). Most participants had a medium or high FF category. Participants with higher FF had a lower risk of decreasing the consumption of non-processed foods (RR= 0.58 for fruits and RR= 0.45 for legumes) and lower risk of increasing processed foods (RR= 0.37 for sugar-sweetened beverages, RR= 0.46 for snacks, and RR= 0.64 for chocolates) when compared to lower FF participants and controlling for per-capita income. Participants commented on changes in FF: some had more conflicts and others were happy to be together during the pandemic. Most participants indicated that they maintained or increased non-processed and processed food consumption compared to the pre-pandemic period. They perceived having the opportunity of eating healthier during the pandemic. However, the stress they suffered produced them to eat unhealthily. Therefore, FF had a protective role in diet quality during the pandemic. Policymakers should consider FF when promoting healthy diets, especially in health crises.

La pandemia por COVID-19 y las medidas gubernamentales han desafiado el funcionamiento familiar (FF) y los hábitos alimentarios. En escenarios no pandémicos, el FF ha demostrado un papel protector en la calidad de la dieta. Este estudio tuvo como objetivo explorar el papel del FF en el consumo de alimentos de los miembros de la familia durante la primera ola de la pandemia de COVID-19 en Chile. Realizamos un estudio transversal, no probabilístico. Adultos chilenos (n= 821) respondieron una encuesta online basada en la Escala de Evaluación de Cohesión y Adaptabilidad Familiar (FACES) IV y una escala de percepción de consumo de alimentos (alimentos no procesados y procesados). La encuesta también incluyó un espacio abierto para comentarios (n= 147). La mayoría de los participantes tenían una categoría de FF medio o FF alto. Los participantes con mayor FF tenían un menor riesgo de disminuir el consumo de alimentos no procesados (RR= 0,58 para frutas y RR= 0,45 para legumbres) y menor riesgo de aumentar los alimentos procesados (RR= 0,37 para bebidas azucaradas, RR= 0,46 para snacks, y RR= 0,64 para chocolates) en comparación con los participantes de FF más bajos y controlando por ingreso per cápita. Los participantes comentaron cambios en sus FF y teniendo más conflictos, aunque algunos estaban felices de estar juntos durante la pandemia. La mayoría de los participantes indicaron que mantuvieron o aumentaron los alimentos procesados y no procesados en comparación con el período pre-pandemia. Ellos percibieron tener la oportunidad de comer más sano. Sin embargo, el estrés que sufrían les producía comer menos saludable. La FF tuvo un papel protector en la calidad de la dieta durante la pandemia. Quienes formulen políticas públicas deben considerar la AF cuando promuevan dietas saludables, especialmente en crisis de salud.

Adaptation and validation of the Perceived Nutrition Environment Measures Survey for the Chilean context (NEMS-P-Ch)

There is an increasing interest in having validated instruments that can classify food environments due to their influence on eating behavior and nutritional status. In Chile, it is not known how people perceive food environments and only a few studies have adapted instruments to the Chilean context, all of which use objective measures. The aim of this study is to present the adaptation and validation of the Perceived Nutrition Environment Measures Survey (NEMS-P-Ch) for Chile using a cross-sectional, non-probability study. First, the NEMS-P was adapted in 3 stages: cultural translation and adaptation, expert judgment (focus groups), and cognitive interviews with a population similar to the target audience. Then, the adapted questionnaire (NEMS-P for Chile, NEMS-P-Ch) was tested on people responsible for buying food in their homes in the Metropolitan Region, Chile, for statistical validation. After 200 people completed the questionnaire a final version of the NEMS-P-Ch was generated with 48 questions and seven sections that measure food environments: home, food supply, restaurants and street. NEMS-P-Ch had acceptable reliability in more than half of the questions analyzed, with Cronbach's alpha values between 0.44 and 0.82. Acceptable values were also obtained for most of the questions when the consistency of the instrument was evaluated after applying it for the second time (n= 167). The NEMS-P-Ch adapted to the Chilean context showed acceptable validity and reliability. Having instruments adapted and validated to the national reality will promote their use and adaptation in other countries of the region and thus deepen the study of food environments in various territories and populations.

El creciente interés por contar con instrumentos validados que clasifiquen los ambientes alimentarios se debe a la influencia que estos tienen en la conducta alimentaria y el estado nutricional. En Chile, se desconoce cómo las personas perciben los ambientes alimentarios y son pocos los estudios que han adaptado instrumentos al contexto chileno, todos utilizando medidas objetivas. En este estudio se presenta la adaptación y validación para Chile de la Encuesta de Medición del Entorno Nutricional Percibido (NEMS-P-Ch). Estudio transversal, no probabilístico. Inicialmente, NEMS-P fue adaptado siguiendo 3 etapas: traducción y adaptación cultural, juicio de expertos (grupos focales) y entrevistas cognitivas con población similar a la audiencia objetivo. Luego, el cuestionario adaptado (NEMS-P-Ch) fue testeado en personas responsables de la compra de alimentos del hogar, Región Metropolitana, Chile, para finalmente validarlo estadísticamente. Tras su aplicación a 200 personas, se generó la última versión de NEMS-PCh, instrumento con 48 preguntas y 7 secciones que mide los ambientes alimentarios: doméstico, de abastecimiento, restauración y vía pública. NEMS-P-Ch mostró una confiabilidad aceptable en más de la mitad de las preguntas analizadas, con valores alfa de Cronbach entre 0,44 y 0,82. También se obtuvieron valores aceptables en la mayoría de las preguntas cuando se evaluó su consistencia al aplicarlo por segunda vez (n= 167). NEMS-P-Ch adaptado al contexto chileno mostró una validez y confiabilidad aceptables. Contar con instrumentos validados a la realidad nacional promoverá su uso, su adaptación en otros países de la región y la profundización del estudio de los ambientes alimentarios en diversos territorios y poblaciones.

Derecho a la alimentación en la Constitución chilena: elementos jurídicos, sociales y nutricionales para una propuesta / Right to food in the Chilean constitution: legal, social and nutritional elements for a proposal

BACKGROUND: The Human Right to Food is not incorporated in the Chilean Constitution. Aim: To identify the legal, social, and nutritional elements for its incorporation into the new Constitution, and to draft a text proposal for the constituent discussion. MATERIAL AND METHODS: Descriptive and qualitative study on the perceptions of experts and key actors of the food chain in Chile. The sample was for convenience and included civil society, academia, international organizations, parliamentarians, food traders and producers, and national and local authorities (n = 26). The research team, previously trained and standardized, applied semi-structured online surveys, which were recorded and transcribed. Through an inductive approach, a thematic analysis was carried out using the Atlas.ti 9.0 software. RESULTS: Eighty-one percent of the interviewees were in favor of the Constitutional incorporation of the Right to Food. According to interviews, a constitutional text was proposed considering the characteristics of adequate, healthy, safe, and nutritious foods. Also, the food items must be available, physically and economically accessible, and culturally relevant. A guaranteed citizen participation, food sovereignty, food security, and environmental sustainability must be considered. Conclusions: The high prevalence of malnutrition due to excess, poor diet, and food insecurity during the COVID-19 pandemic, and a current Constitution that does not explicitly guarantee physical and economic access to food, establish a factual and normative background that justifies the incorporation of this right in a new Constitution.

Derecho a la alimentación: ¿Qué dicen las constituciones de América y el Caribe?

RESUMEN Introducción: Numerosos países de América y el Caribe cuentan con el derecho constitucional a la Alimentación. Chile no cuenta con este derecho constitucionalizado. Objetivo: Describir comparativamente cómo se encuentra explícito el derecho a la alimentación (DA) en la Constitución de los países de América y el Caribe, generando insumos para aquellos países que no cuentan con este derecho explícito, como en Chile. Fuentes de datos: Esta búsqueda se realizó en las plataformas: Seguridad Alimentaria y Nutricional (SAN-CELAC), Derecho a la Alimentación en el Mundo (FAO) y Constitute Project que presenta las constituciones del mundo. Método de revisión: Se realizó una revisión todas las constituciones disponibles de los países independientes de América y el Caribe y de países con territorios dependientes y departamentos de ultramar en la Región. Posteriormente, en aquellos países que presentan el DA de forma explícita en su texto constitucional, se realizó una revisión sobre las características generales del texto constitucional y de los conceptos asociados a la definición del DA, sugeridos por la FAO. La revisión se llevó a cabo entre los meses de junio y septiembre de 2020. Resultados: Del total de los países revisados (n= 42), solo el 40,5% presentó el DA explícito en su texto constitucional. La seguridad alimentaria es el concepto que aparece con mayor frecuencia. Conclusión: La mayor parte de las constituciones acompañan el DA con características de seguridad alimentaria, disponibilidad y accesibilidad, e incluyen alguna forma de judicialización, conceptos que deberían ser incorporadas la nueva Carta Magna de Chile.

ABSTRACT Introduction: Many American and Caribbean countries consider the right to food as constitutional right. Chile does not have this explicit right in the Constitution. Objective: To describe comparatively how the right to food is explicit in the constitutions of American and Caribbean countries, generating inputs for those countries that do not have this constitutional right, such as the case of Chile. Data sources: This research was carried out on platforms: Food and Nutritional Security (SAN-CELAC), Right to Food in the World (FAO) and Constitute Project which presents constitutions of the world. Revision method: A revision was made of all available constitutions of American and independent Caribbean countries, dependent territories and overseas departments in the Region. Subsequently, in those countries which explicitly consider the right to food in constitutional texts, a review of general characteristics and right to food-associated concepts, suggested by FAO, was carried out. The review was carried out between June and September 2020. Results: Of the total of countries reviewed (n= 42), 40.5% presented the right to food in constitutional text. The most frequently associated concept was food security. Conclusion: Most of the revised constitutions accompany the right to food with food safety, availability and accessibility characteristics, and include kinds of judicialization, concepts that should be incorporated into the new Magna Carta of Chile.

"Comemos así porque… ". Entendiendo las conductas alimentarias de mujeres chilenas de bajos recursos / "We eat in this way because… ". Understanding eating behaviors of Chilean women of low socioeconomic status

Background: The prevalence of obesity is higher in women than in men, especially in those of lower socioeconomic status. It is established that this group tends to have a less healthy diet. Aim: To explore the eating behaviors of low-income Chilean women. Material and Methods: Semi-structured interviews with photo-elicitation were conducted with 31 Chilean women aged 36 ± 6 years, who lived with a partner and had at least one sibling under 12 years of age. The interviews were transcribed and an inductive analysis of the participants' discourses was made. Results: Seven themes were described in relation to their influence on three eating behaviors (food purchase, preparation and intake): Family, preferences, temporality, financial issues, special occasions, perceptions about food, and availability of food. The family exerted a strong influence on the behaviors and had an impact on the other themes encountered. Conclusions: Eating behaviors were influenced by several factors, both at the personal and environment levels. These factors interacted with each other to produce different forms of behavior modulation. It is therefore problematic to promote healthy eating behaviors while not considering all the influences on this behavior.