Environmental impacts of dietary shifts in India: A modelling study using nationally-representative data.

Food production is a major driver of environmental change, and unhealthy diets are the leading cause of global disease burden. In high-income countries (HICs), modelling studies suggest that adoption of healthy diets could improve population health and reduce environmental footprints associated with food production. We assessed whether such benefits from dietary change could occur in India, where under-nutrition and overweight and obesity are simultaneously prevalent. We calculated the potential changes in greenhouse gas (GHG) emissions, blue and green water footprints (WFs), and land use (LU), that would result from shifting current national food consumption patterns in India to healthy diets (meeting dietary guidelines) and to "affluent diets" (those consumed by the wealthiest quartile of households, which may represent future purchasing power and nutritional trajectories). Dietary data were derived from the 2011-12 nationally-representative household expenditure survey, and we assessed dietary scenarios nationally and across six Indian sub-regions, by rural or urban location, and for those consuming above or below recommended dietary energy intakes. We modelled the changes in consumption of 34 food groups necessary to meet Indian dietary guidelines, as well as an affluent diet representative of those in the highest wealth quartile. These changes were combined with food-specific data on GHG emissions, calculated using the Cool Farm Tool, and WF and LU adapted from the Water Footprint Network and Food and Agriculture Organization, respectively. Shifting to healthy guidelines nationally required a minor increase in dietary energy (3%), with larger increases in fruit (18%) and vegetable (72%) intake, though baseline proportion of dietary energy from fat and protein was adequate and did not change significantly. Meeting healthy guidelines slightly increased environmental footprints by about 3-5% across GHG emissions, blue and green WFs, and LU. However, these national averages masked substantial variation within sub-populations. For example, shifting to healthy diets among those with dietary energy intake below recommended guidelines would result in increases of 28% in GHG emissions, 18 and 34% in blue and green WFs, respectively, and 41% in LU. Decreased environmental impacts were seen among those who currently consume above recommended dietary energy (-6 to -16% across footprints). Adoption of affluent diets by the whole population would result in increases of 19-36% across the environmental indicators. Specific food groups contributing to these shifts varied by scenario. Environmental impacts also varied markedly between six major Indian sub-regions. In India, where undernutrition is prevalent, widespread adoption of healthy diets may lead to small increases in the environmental footprints of the food system relative to the status quo, although much larger increases would occur if there was widespread adoption of diets currently consumed by the wealthiest quartile of the population. To achieve lower diet-related disease burdens and reduced environmental footprints of the food system, greater efficiency of food production and reductions in food waste are likely to be required alongside promotion of healthy diets.

Impact of baseline vitamin B12 status on the effect of vitamin B12 supplementation on neurologic function in older people: secondary analysis of data from the OPEN randomised controlled trial.

BACKGROUND/OBJECTIVES: The available evidence from randomised controlled trials suggests that vitamin B12 supplementation does not improve neurologic function in older people with marginal but not deficient Vitamin B12 status. This secondary analysis used data from the Older People and Enhanced Neurological function (OPEN) randomised controlled trial to assess whether baseline vitamin B12 status or change in vitamin B12 status over 12 months altered the effectiveness of dietary vitamin B12 supplementation on neurologic function in asymptomatic older people with depleted vitamin B12 status at study entry. SUBJECTS/METHODS: Vitamin B12 status was measured as serum concentrations of vitamin B12, holotranscobalamin, homocysteine and via a composite indicator (cB12). Neurological function outcomes included eleven electrophysiological measures of sensory and motor components of peripheral and central nerve function. Linear regression analyses were restricted to participants randomised into the intervention arm of the OPEN trial (n=91). RESULTS: Analyses revealed an inconsistent pattern of moderate associations between some measures of baseline vitamin B12 status and some neurological responses to supplementation. The directions of effect varied and heterogeneity in effect across outcomes could not be explained according to type of neurological outcome. There was no evidence of differences in the neurological response to vitamin B12 supplementation according to change from baseline over 12 months in any indicator of B12 status. CONCLUSIONS: This secondary analysis of high-quality data from the OPEN trial provides no evidence that baseline (or change from baseline) vitamin B12 status modifies the effect of vitamin B12 supplementation on peripheral or central nerve conduction among older people with marginal vitamin B12 status. There is currently insufficient evidence of efficacy for neurological function to support population-wide recommendations for vitamin B12 supplementation in healthy asymptomatic older people with marginal vitamin B12 status.

Factors influencing fruit and vegetable intake among urban Fijians: A qualitative study.

Low fruit and vegetable intake is an important risk factor for micronutrient deficiencies and non-communicable diseases, but many people worldwide, including most Fijians, eat less than the World Health Organization recommended amount. The present qualitative study explores factors that influence fruit and vegetable intake among 57 urban Fijians (50 women, 7 men) of indigenous Fijian (iTaukei) and South Asian (Indian) descent. Eight focus group discussions were held in and around Suva, Fiji's capital and largest urban area, which explored motivation for eating fruit and vegetables, understandings of links to health and disease, availability and sources, determinants of product choice, and preferred ways of preparing and eating fruit and vegetables. Data were analysed using thematic content analysis. Regardless of ethnicity, participants indicated that they enjoyed and valued eating fruit and vegetables, were aware of the health benefits, and had confidence in their cooking skills. In both cultures, fruit and vegetables were essential components of traditional diets. However, increasing preferences for processed and imported foods, and inconsistent availability and affordability of high-quality, low-priced, fresh produce, were identified as important barriers. The findings indicate that efforts to improve fruit and vegetable intake in urban Fijians should target the stability of the domestic fruit and vegetable supply and access.

Adherence to a physical activity intervention among older adults in a post-transitional middle income country: a quantitative and qualitative analysis.

OBJECTIVES: The effectiveness of community level interventions depends to a great extent on adherence. Currently, information on factors related to adherence in older adults from developing countries is scarce. Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country. DESIGN, SETTING AND PARTICIPANTS: Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects (65-67.9 years at baseline) with low to medium socioeconomic status from 10 health centers randomized to receive a physical activity intervention as part of the CENEX cluster trial (ISRCTN48153354). MEASUREMENTS: Using a multilevel regression model, the relationship between adherence (defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months) and individual, intervention-related and contextual factors was evaluated. We also conducted 40 semi-structured interviews with older adults (n=36) and instructors (n=4). Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence. RESULTS: Adherence to physical activity intervention was 42.6% (CI 95% 39.5 to 45.6). Depression, diabetes mellitus, percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence (p<0.05) while being retired, participation in physical activity prior to the intervention, and green areas per habitant were positively associated with adherence (p<0.05). The qualitative interviews identified three primary barriers to adherence: current health problems, lack of time due to commitments for caring for family members, and being employed, and two primary facilitators to adherence: the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others. CONCLUSION: In order to enhance effectiveness of community exercise interventions, strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions.

Essential fats for future health. Proceedings of the 9th Unilever Nutrition Symposium, 26-27 May 2010.

The 9th Unilever Nutrition Symposium entitled 'Essential fats for future health', held on 26-27 May 2010, aimed to review the dietary recommendations for essential fatty acids (EFA); discuss the scientific evidence for the roles of EFA in cognition, immune function and cardiovascular health; and to identify opportunities for joint efforts by industry, academia, governmental and non-governmental organizations to effectively improve health behaviour. This paper summarizes the main conclusions of the presentations given at the symposium. Linoleic acid (LA) and α-linolenic acid (ALA) are EFA that cannot by synthesized by the human body. Docosahexaenoic acid (DHA) is considered as conditionally essential because of its limited formation from ALA in the human body and its critical role in early normal retinal and brain development and, jointly with eicosapentaenoic acid (EPA), in prevention of cardiovascular disease (CVD). Some evidence for possible beneficial roles of n-3 fatty acids for immune function and adult cognitive function is emerging. A higher consumption of polyunsaturated fatty acids (PUFA; >10%E), including LA, ALA and at least 250-500 mg per day of EPA+DHA, is recommended for prevention of coronary heart disease (CHD). Two dietary interventions suggest that EFA may affect CVD risk factors in children similarly as in adults. To ensure an adequate EFA intake of the population, including children, public health authorities should develop clear messages based on current science; ensure availability of healthy, palatable foods; and collaborate with scientists, the food industry, schools, hospitals, health-care providers and communities to encourage consumers to make healthy choices.

The role of nutrients in the prevention and treatment of Alzheimer's disease: methodology for a systematic review.

There is a large body of existing data on nutrition in Alzheimer's disease (AD). We are conducting a systematic review of published scientific literature to determine the role of specific nutrients, both individually and in combination, in the prevention and treatment of AD. This will contribute towards a structured evidence base to help inform the clinical management of AD. The objective of the systematic review is to evaluate the strength of evidence from both observational cohort studies and randomized controlled trials on the role of fats, vitamins, antioxidants and other nutrients in the prevention and treatment of AD. We present here the methodology of our systematic review.

Fish consumption and cognitive function among older people in the UK: baseline data from the OPAL study.

BACKGROUND: Observational epidemiological data suggest that habitual consumption in later life of oily fish, rich in n-3 long-chain polyunsaturated fatty acids (n-3 LCPs), is associated with better cognitive function, slower rates of cognitive decline and a lower risk of dementia. In this paper we present data on baseline fish consumption and cognitive function in cognitively healthy older people randomised onto the Older People And n- 3 Long-chain polyunsaturated fatty acid (OPAL) study. METHODS: In total, 867 older people were recruited to join the OPAL study from 20 general practices in England and Wales. Participants were aged 70-79 years at baseline were free of dementia and diabetes, had a Mini-Mental State Examination score of 24 or greater and did not report daily fish oil supplement consumption. Self-reported habitual fish consumption was assessed at baseline via questions on frequency and type of fish consumption. Cognitive function at baseline was assessed via validated cognitive tests assessing memory, executive function, psychomotor speed and attention, including the Californian Verbal Learning Test (CVLT), the primary outcome of the OPAL study. Reported age at leaving full time education was recorded as a measure of educational achievement and psychological health was measured using the GHQ-30 questionnaire. RESULTS: Unadjusted analysis revealed significant positive associations between reported fish consumption and the CVLT scores with a mean increase of approximately 0.24 words remembered for each increase in level of reported fish consumption. These associations were noticeably attenuated on adjustment for age, gender and reported age at leaving full-time education and did not remain significant on further adjustment for GHQ-30 score. Similar associations were also observed between fish consumption and the global cognitive z-score, memory score, executive function score and delay scores in unadjusted analysis with the associations again attenuated on adjustment. CONCLUSIONS: Baseline data from participants randomised into the OPAL study provide support for the hypothesis that higher fish consumption is associated with better cognitive function in later life. However, although in the main associations remain after adjusting for education and psychological health, the data do not allow us to rule out the possibility of residual confounding e.g. from socioeconomic status or other health behaviours. Evidence is needed from randomised clinical trials to clarify the role of n-3 LCPs in cognitive health in later life in the normal older person population.

Omega 3 fatty acid for the prevention of dementia.

BACKGROUND: Accruing evidence from observational and epidemiological studies suggests an inverse relationship between dietary intake of omega 3 polyunsaturated fatty acid (PUFA) and risk of dementia. Postulated mechanisms that might qualify omega 3 PUFA as an interventional target for the primary prevention of dementia include its anti-atherogenic, anti-inflammatory, anti-oxidant, anti-amyloid and neuroprotective properties. OBJECTIVES: To review the evidence that omega 3 PUFA supplementation prevents cognitive impairment and dementia in cognitively intact elderly persons. SEARCH STRATEGY: The Cochrane Dementia and Cognitive Improvement Group's (CDCIG) Specialized register, MEDLINE, EMBASE,CINAHL PsycINFO, AMED AND CENTRAL and several ongoing trials databases were searched on 5 and 6 October 2005. The CDCIG Register is updated regularly and contains records from all major medical databases and many ongoing trials databases. SELECTION CRITERIA: In order to be selected, trials needed to be randomized, placebo-controlled, doubled blinded, of minimum study duration of 6 months, involved persons aged 60 years and above without pre-existing dementia at study onset, and employed cognitive endpoints. DATA COLLECTION AND ANALYSIS: Reviewers, working independently, were to select, quality assess and extract relevant data where appropriate and possible. In comparing intervention with placebo, the pooled odds ratios or weighted mean differences and standardized mean difference were to be estimated. MAIN RESULTS: There were no randomized trials found in the search that met the selection criteria. Results of two clinical trials are expected in 2008. AUTHORS' CONCLUSIONS: There is a growing body of evidence from biological, observational and epidemiological studies that suggests a protective effect of omega 3 PUFA against dementia. However, until data from randomized trials become available for analysis, there is no good evidence to support the use of dietary or supplemental omega 3 PUFA for the prevention of cognitive impairment or dementia.

Anthropometric status of Kazakh children in the 1990s.

The 1990s were a period of considerable economic and social instability in Kazakhstan. The current study documents information on the growth performance of children living in Kazalinsk district in the far west of Kazakhstan over this turbulent period. Using anthropometric data of children, from random samples collected in 1992, 1994 and 2000, we investigate changes in body size of 4.0-4.9-year-old children over the 8-year-study period. Between 1992 and 2000, there was no statistically significant change in body size of 4.0-4.9-year-old boys, but 4.0-4.9-year-old girls became significantly smaller. This may have resulted from the prolonged period of economic instability in Kazakhstan. Furthermore, using detailed dietary intake data collected in 1994, evidence is presented to support a suggestion that the different responses to economic hardship, evidenced in the achieved body size of boys and girls, may have been influenced by gender-discrimination in household food allocation.

Height, weight and haemoglobin status of 6 to 59-month-old Kazakh children living in Kzyl-Orda region, Kazakhstan.

OBJECTIVE: To estimate the prevalence of stunting, wasting and anaemia among children aged 6-59 months in the Kzyl-Orda region of Kazakhstan, and to determine the association between childhood height and haemoglobin concentration and a range of environmental and biological factors. DESIGN: A cross-sectional study using a randomly selected sample. The mothers of children were interviewed, and finger-prick blood samples and anthropometric measurements were collected on both mothers and their children. Associations between haemoglobin (Hb) concentration, anthropometric measurements and questionnaire data were evaluated by multivariate analysis. SETTING: Health centres in Kazalinsk, Djalagash and Zhanakorgan districts of Kzyl-Orda region, Kazakhstan. SUBJECTS: Two-thousand and twenty-four children aged between 6 and 59 months born to 1501 mothers who were randomly selected from health centre records. RESULTS: The overall prevalence of stunting (<-2.0 Z-scores height for age), wasting (<-2.0 Z-scores weight for height) and anaemia (Hb<11.0 g/dl) in the study children was found to be 15.8, 0.8 and 50.1%, respectively. However, analysis demonstrated considerable variation by age, with the second year of life showing the highest prevalence of both stunting and anaemia. Both childhood height and haemoglobin concentration were found to be significantly associated with a range of environmental and maternal variables. CONCLUSIONS: This study demonstrates that the prevalence of both stunting and anaemia among Kazakh children in the Kzyl-Orda region is considerable, and similar to that of other Central Asian children. These findings highlight Central Asia as a region with levels of childhood nutritional status that are of concern. SPONSORSHIP: Funding was provided by the United States Agency for International Development, Office of Nutrition, the United Kingdom Department for International Development, and the Polden-Puckham Trust.

Sitting height and subischial leg length centile curves for boys and girls from Southeast England.

PRIMARY OBJECTIVES: The only reference centile curves currently available for body proportions of children in the UK were constructed more than 20 years ago by Tanner and Whitehouse. The current study was designed to produce up-to-date sitting height and subischial leg length centile curves for boys and girls in Southeast England. RESEARCH DESIGN AND METHODS: A convenience sample of 1424 boys and 1208 girls aged under 25 years from Southeast England was measured by a single observer in 1995-1996. Using Cole's LMS method, centile curves were constructed for sitting height and subischial leg length, and the medians by age and sex were then scaled to sum to the corresponding median height of the British 1990 reference. RESULTS: The new centile curves for boys and girls are presented. They differ significantly from those of Tanner and Whitehouse in leg length (boys p < 0.001; girls p < 0.01), but not in sitting height. CONCLUSIONS: The Tanner and Whitehouse reference curves for body segment length are not suitable for contemporary British children, whose legs are longer than they were a generation ago. It is proposed that the curves presented here be adopted provisionally as the new British reference.

Growth of upper- and lower-body segments in Patamona and Wapishana Amerindian children (cross-sectional data).

PRIMARY OBJECTIVE: To describe the upper- and lower-body growth of two populations of lowland Amazonian Amerindian children. RESEARCH DESIGN AND METHODS: The stature and sitting height of a convenience sample of 659 Patamona and 543 Wapishana children of known ages between 0 and 16 years of age was collected using standard techniques. Subischial leg length was calculated as stature less sitting height. The raw data were compared with reference data of British children, and body segment z-score values were calculated. RESULTS: The data suggest that Amerindian children were significantly shorter than their British contemporaries, and that considerable faltering in total stature occurred by the third year of life. However, there were contrasting patterns of faltering in the upper and lower body which may well reflect differences in the tempo of growth of body segments at different ages. The two study populations differed significantly in their total stature and this was shown to be due to significant differences in leg length but not in sitting height. CONCLUSIONS: The adverse effects on childhood growth of poor environmental conditions are well known, and it is argued that the variation in body size found between the populations in this study were the results of marked differences in the quality of their living conditions. This paper provides baseline data on the growth of Amerindian populations that are currently facing unprecedented changes in their economic and environmental circumstances.

Haemoglobin status of adult non-pregnant Kazakh women living in Kzyl-Orda region, Kazakhstan.

OBJECTIVE: To estimate the prevalence of anaemia among adult non-pregnant women in the Kzyl-Orda region of Kazakhstan, and to determine the association between haemoglobin concentration and anthropometric, socioeconomic, reproductive and dietary factors. DESIGN: A cross-sectional study using a randomly selected sample. Subjects were interviewed, and finger-prick blood samples and anthropometric measurements were collected. Associations between haemoglobin concentration and anthropometric and questionnaire data were evaluated by sequential linear regression analysis. SETTING: Health centres in Kazalinsk, Djalagash and Zhanakorgan districts of Kzyl-Orda region, Kazakhstan. SUBJECTS: Three-thousand six-hundred and twenty-five non-pregnant women aged 18-45 y randomly selected from health centre records. RESULTS: Iron deficiency anaemia, as reflected by low haemoglobin levels (Hb<12 g/dl), was detected in 40.2% of the total sample. There was a significant curvilinear relationship between haemoglobin concentration and age, with the nadir of the curve in the 30-40 y age-group. Haemoglobin concentration was found to be positively associated with body mass index (BMI) and socioeconomic factors. Significant negative associations were found between haemoglobin concentration and duration of menses, use of the intra-uterine contraceptive device and the consumption of tea. CONCLUSIONS: This study demonstrates that iron deficiency anaemia is present at considerable levels among adult women living in Kzyl-Orda region, Kazakhstan, and provides important baseline information for future research and public health interventions. SPONSORSHIP: Funding was provided by the United States Agency for International Development, Office of Nutrition, the United Kingdom Department for International Development, and the Polden-Puckham Trust.