Adherence to a Traditional Mexican Diet Is Associated with Lower Hepatic Steatosis in US-Born Hispanics of Mexican Descent with Overweight or Obesity.

Hispanics of Mexican descent have disproportionate rates of non-alcoholic fatty liver disease (NAFLD). The purpose of this work is to investigate the association between the traditional Mexican diet score (tMexS) and hepatic steatosis and fibrosis, two NAFLD-related clinical endpoints, in Hispanic adults of Mexican descent. Data from 280 Hispanic adults of Mexican descent (n = 102 men, 178 women) with overweight or obesity enrolled in a cross-sectional observational study were analyzed. The tMexS was calculated from 24 h dietary recalls. Hepatic steatosis and fibrosis measurements were assessed using transient elastography (Fibroscan®). Linear regression models testing the association between tMexS and hepatic steatosis and fibrosis were run individually and through the stratification of significant modifiers. Mean tMexS were 5.9 ± 2.1, hepatic steatosis scores were 288.9 ± 48.9 dB/m, and fibrosis scores were 5.6 ± 2.2 kPa. Among the US-born group, with every point increase in the tMexS, there was a statistically significant 5.7 lower hepatic steatosis point (95% CI: -10.9, -0.6, p-value = 0.07). Higher adherence to a traditional Mexican diet was associated with lower hepatic steatosis in US-born Hispanics of Mexican descent. Findings from the current work may serve to inform future culturally relevant interventions for NAFLD prevention and management in individuals of Mexican descent.

The impact of country image and patient cosmopolitanism on medical tourism.

The purpose of this research is to examine the impact affective/cognitive country image, cosmopolitanism, and satisfaction with insurance have on patient willingness to go abroad for surgery. Patients are presented a scenario where they select having knee replacement surgery domestically, having to pay all co-pays and deductibles, or abroad (Mexico, India, Israel) for free surgery at a JCI certified hospital. Results indicate cosmopolitanism impacts patient perception of medical tourism whilst affective and cognitive country image exhibit varying levels of significance. This study contributes to the literature by assessing factors that impact patient likelihood to travel abroad for surgery.

The country-of-origin label impact on intention to consume insect-based food.

The global food consumption scenario and the influence of a country's image on consumer decision-making motivated this research. The global edible insect market is growing, and cultural issues, disgust, and low perception of quality are barriers to consumption. Through an online experiment (n = 194) Brazilian consumers demonstrate that the use of the country-of-origin label (COOL) can result in greater intention and quality expectation regarding a cricket flour. Consumers showed a preference for the flour produced by a positive image country label. Both intention and quality expectation were higher for the cricket flour produced in the United States. Furthermore, the mediation model indicates that quality expectation mediated the effect of COOL on the intention to consume. The results show that even though consumers have created a positive expectation concerning the product, a higher level of neophobia diminished their intention to consume the product and this relates to the aversion and disgust that can exist towards an edible-insect product. The neophobia level can weaken the effect of COOL on intention mediated by quality expectation. The study aimed to contribute to a better understanding of the consumer's perception of an insect-based food and provide insights into variables related to the intention to consume by verifying their contribution to the consumer's behavior.

Joint Associations of Maternal-Fetal APOL1 Genotypes and Maternal Country of Origin With Preeclampsia Risk.

RATIONALE & OBJECTIVES: Preeclampsia, which disproportionately affects Black women, is a leading cause of preterm delivery and risk for future hypertension and chronic kidney disease (CKD). Apolipoprotein L1 (APOL1) kidney risk alleles, common among Black individuals, contribute substantially to CKD disparities. Given the strong link between preeclampsia and CKD, we investigated whether maternal and fetal APOL1 risk alleles can jointly influence preeclampsia risk, and explored potential modifiers of the association between APOL1 and preeclampsia. STUDY DESIGN: Nested case-control study. SETTING & PARTICIPANTS: 426 Black mother-infant pairs (275 African Americans and 151 Haitians) from the Boston Birth Cohort. EXPOSURE: Maternal and fetal APOL1 risk alleles. OUTCOMES: Preeclampsia. ANALYTICAL APPROACH: Logistic regression models with adjustment for demographic characteristics were applied to analyze associations between fetal and maternal APOL1 risk alleles and risk of preeclampsia and to investigate the effects of modification by maternal country of origin. RESULTS: Fetal APOL1 risk alleles tended to be associated with an increased risk of preeclampsia, which was not statistically significant in the total genotyped population. However, this association was modified by maternal country of origin (P<0.05 for interaction tests): fetal APOL1 risk alleles were significantly associated with an increased risk of preeclampsia among African Americans under recessive (odds ratio [OR], 3.6 [95% CI, 1.3-9.7]; P=0.01) and additive (OR, 1.7 [95% CI, 1.1-2.6]; P=0.01) genetic models but not in Haitian Americans. Also, maternal-fetal genotype discordance at the APOL1 locus was associated with a 2.6-fold higher risk of preeclampsia (P<0.001) in African Americans. LIMITATIONS: Limited sample size in stratified analyses; self-reported maternal country of origin; pre-pregnancy estimated glomerular filtration rate (eGFR) and proteinuria data in mothers were not collected; unmeasured confounding social and/or environmental factors; no replication study. CONCLUSIONS: This study supports the hypothesis that fetal APOL1 kidney risk alleles are associated with increased risk for preeclampsia in a recessive mode of inheritance in African Americans and suggests that maternal-fetal genotype discordance is also associated with this risk. These conclusions underscore the need to better understand maternal-fetal interaction and their genetic and environmental factors as contributors to ethnic disparities in preeclampsia.

How the country-of-origin impacts wine traders' mental representation about wines: A study in a world wine trade fair.

Using data collected at a world wine trade fair, we study how the country-of-origin impacts wine traders' mental representation about wines. In the analysis we use traditional exporters in Old (France) and New (Argentina) world wine countries in comparison to non-traditional exporters in Old (Switzerland) and New (Brazil) world wine countries. Three main findings are reported. First, the country-of-origin of wines was more important on guiding participants' representations, than the category of countries the traders came from. Second, participants' evocations were more precise and specific for traditional wine-exporting countries than for less traditional wine exporting countries. Finally, the lack of traders' knowledge of wines from non-traditional wine-exporting countries produced associations and beliefs related to the image of the country itself. Our findings have important implications for the marketing and export activities of the wine industry.

Minerals and Heavy Metals in the Whole Raw Milk of Dairy Cows from Different Management Systems and Countries of Origin: A Meta-Analytical Study.

The objective of this meta-analytical study was to investigate selected macrominerals, microminerals, and toxic heavy metals in the bovine whole-raw-milk (WRM) samples of published data. An analytical data set was constructed from 72 different studies from 37 countries with two types of production systems: a conventional production system (CPS) and an organic production system (OPS) compared with commercially available or retail-store-available milk (COM). Results of the meta-analytical study showed differences in the concentrations of macrominerals. Concentrations of Ca, Mg, K, and P were greater in the CPS samples, whereas Na was greater in the COM samples ( P < 0.05). Data also demonstrated that concentrations of microminerals like Cu, I, Fe, Mn, Se, and Zn in the organic WRM were lower ( P < 0.05) compared with the milk from CPS. The highest concentration of Ni was reported for COM ( P < 0.05); however, this value was below the minimum-risk level (MRL). Concentrations of heavy metals like As and Ni were greater in CPS milk than those in organic milk ( P < 0.05). In addition, there were greater concentrations of Cd and Pb in the WRM from CPS versus that from the organic farms. Concentration of Al was lowest in the OPS milk versus Al in the CPS which was 6.5-fold greater than in organic milk. The amount of Hg was below the MRL of 0.01 µmol/L for all production systems. A high variability was observed in the published data regarding the country of origin. Raw milk originating from Europe and North America was characterized by concentrations of macro- and microminerals below the MRLs as compared with that from specific countries, which had some minerals above the MRLs. For example, concentrations of Pb were above the MRL in the milk samples from Brazil, Croatia, Egypt, Mexico, Nigeria, Palestine, Romania, Serbia, and Turkey. Moreover, data from this study indicate that organic dairy farms are characterized by lower concentrations of toxic heavy metals in the WRM compared with those from CPS dairy farms.

Belgian citizens' and broiler producers' perceptions of broiler chicken welfare in Belgium versus Brazil.

New EU regulations require more stringent country-of-origin labeling, while imports of broiler meat from non-EU countries are increasing. In light of these trends, we have studied citizens' and producers' perceptions of broiler meat originating from Belgium versus Brazil and their perception of broiler production in Belgium versus Brazil. A particular focus was the association between country of origin and perceived level of animal welfare. We also investigated the perception of scaling-up and outdoor access in terms of perceived level of animal welfare. Cross-sectional survey data was collected among Flemish citizens (n = 541) and broiler producers (n = 114). In accordance with literature on general farm animal welfare, both stakeholder types claimed to allocate great importance to broiler welfare and generally agreed with the Welfare Quality model of broiler welfare. Citizens disagreed with the producers that 1) consumers are not willing to pay more for higher welfare products, 2) that broilers suffer little, 3) that broiler welfare in current Belgian production units is generally non-problematic, 4) that scaling-up production units would not have a positive impact on profitability nor a profoundly negative impact on broiler welfare, and 5) that the impact of providing broilers with outdoor access is negative for consumers, farmers, and broilers. Country of origin had a strong influence on the perception of both broiler production and broiler meat. Belgian citizens, and producers (much more than citizens) considered nearly all aspects related to broiler production and broiler meat to be significantly superior for chicken produced in Belgium compared to Brazil. Further research should focus on how these perceptions influence purchase intentions and production decisions. Future avenues for research are to quantify market opportunities for country-of-origin labeling and to investigate to which extent stakeholders' perceptions correspond with reality.

Assessment of welfare of Brazilian and Belgian broiler flocks using the Welfare Quality protocol.

The Welfare Quality consortium has proposed a science-based protocol for assessing broiler chicken welfare on farms. Innovative features make the protocols particularly suited for comparative studies, such as the focus on animal-based welfare measures and an integration procedure for calculating an overall welfare status. These protocols reflect the scientific status up to 2009 but are meant to be updated on the basis of inter alia implementation studies. Because only few such studies have been done, we applied the Welfare Quality protocol to compare the welfare of broiler flocks in Belgium (representing a typical European Union (EU) country which implies stringent animal welfare legislation) versus Brazil (the major broiler meat exporter to the EU and with minimal animal welfare legislation). Two trained observers performed broiler Welfare Quality assessments on a total of 22 farms in Belgium and south Brazil. All of the farms produced for the EU market. Although the overall welfare was categorized as 'acceptable' on all farms, many country differences were observed at the level of the welfare principles, criteria, and measures. Brazilian farms obtained higher scores for 3 of the 4 welfare principles: 'good feeding' (P = 0.007), 'good housing' (P < 0.001), and 'good health' (P = 0.005). Four of the 10 welfare criteria scores were, or tended to be, higher on Brazilian than Belgian farms: 'absence of prolonged thirst' (P < 0.001), 'ease of movement' (P < 0.001), 'absence of injuries' (P = 0.002), and 'positive emotional state' (P = 0.055). The only criteria with a higher score for the Belgian farms than their Brazilian counterparts were 'absence of prolonged hunger' (P = 0.048) and 'good human-animal relationship' (P = 0.002). Application of the Welfare Quality protocol has raised several concerns about the validity, reliability, and discriminatory potential of the protocol. The results also call for more research into the effect of animal welfare legislation as broiler welfare on the south Brazilian farms appeared to be superior to that on the Belgian farms. Animal-based welfare assessments on a larger sample of farms are needed to evaluate to what extent these findings may be generalized.

Country of origin and bariatric surgery in Sweden during 2001-2010.

BACKGROUND: The prevalence of obesity, as well as use of bariatric surgery, has increased worldwide. The aim of the present study was to investigate the potential differences in the use of bariatric surgery among Swedes and immigrants in Sweden and whether the hypothesized differences remain after adjustment for socioeconomic factors. METHODS: A closed cohort of all individuals aged 20-64 years was followed during 2001-2010. Further analyses were performed in 2 periods separately (2001-2005 and 2006-2010). Age-standardized cumulative incidence rates (CR) of bariatric surgery were compared between Swedes and immigrants considering individual variables. Cox proportional hazards models were used in univariate and multivariate models for males and females. RESULTS: A total of 12,791 Swedes and 2060 immigrants underwent bariatric surgery. The lowest rates of bariatric surgery were found in immigrant men. The largest difference in CR between Swedes and immigrants was observed among low-income individuals (3.4 and 2.3 per 1000 individuals, respectively). Adjusted hazard ratios (HRs) were lower for all immigrants compared with Swedes in the second period. The highest HRs were observed among immigrants from Chile and Lebanon and the lowest among immigrants from Bosnia. Except for Nordic countries, immigrants from all other European countries had a lower HR compared with Swedes. CONCLUSIONS: Men in general and some immigrant groups had a lower HR of bariatric surgery. Moreover, the difference between Swedes and immigrants was more pronounced in individuals with low socioeconomic status (income). It is unclear if underlying barriers to receive bariatric surgery are due to patients' preferences/lack of knowledge or healthcare structures. Future studies are needed to examine potential causes behind these differences.