The Mediterranean Diet (MedDiet) has been promoted as a means of preventing and treating cardiodiabesity. The aim of this study was to answer a number of key clinical questions (CQs) about the role ...of the MedDiet in cardiodiabesity in order to provide a framework for the development of clinical practice guidelines. A systematic review was conducted to answer five CQs formulated using the Patient, Intervention, Comparison, and Outcome (PICO) criteria. Twenty articles published between September 2013 and July 2016 were included, adding to the 37 articles from the previous review. There is a high level of evidence showing that MedDiet adherence plays a role in the primary and secondary prevention of cardiovascular disease (CVD) and improves health in overweight and obese patients. There is moderate-to-high evidence that the MedDiet prevents increases in weight and waist circumference in non-obese individuals, and improves metabolic syndrome (MetS) and reduces its incidence. Finally, there is moderate evidence that the MedDiet plays primary and secondary roles in the prevention of type 2 diabetes mellitus (T2DM). The MedDiet is effective in preventing obesity and MetS in healthy and at-risk individuals, in reducing mortality risk in overweight or obese individuals, in decreasing the incidence of T2DM and CVD in healthy individuals, and in reducing symptom severity in individuals with T2DM or CVD.
Eat Better South Africa (EBSA) is an organization that provides low-carbohydrate, high-fat (LCHF) nutrition and health education programs for women from under-resourced South African communities. ...Community assessments are essential to explore participants' potential facilitators and challenges of adhering to new dietary behaviours and should be implemented before any dietary interventions. This study is a qualitative community assessment to enable the EBSA program to better meet potential participants' needs and explore their willingness to enrol in the EBSA program. Sixty women from two communities in the Western Cape were interviewed through six focus group discussions. A thematic analysis was conducted using NVivo 12 software, and four themes were developed around the women's (1) role within the households; (2) dietary behaviour; (3) health perceptions; and (4) willingness to participate in an LCHF program. Women mentioned that they were responsible for cooking and shopping for their households. They expressed their understanding of healthy and unhealthy behaviours and their dietary patterns. Some women showed concerns about LCHF diets, but others wanted to learn more due to their knowledge of other people's positive experiences with the diet. There was a general desire to become healthy. However, the women anticipated dietary behaviour change to be challenging. Those challenges mostly revolved around their socioeconomic environments. The findings are intended to inform EBSA (or other nutrition interventions) on what to consider when implementing their interventions in these communities.
The prevention of bone mass loss and related complications associated with osteoporosis is a significant public health issue. The Mediterranean diet (MD) is favorably associated with bone health, a ...potentially modifiable risk factor. The objective of this research was to determine MD adherence in a sample of women with and without osteoporosis. In this observational case-control study of 139 women (64 women with and 75 without osteoporosis) conducted in a primary-care health center in Girona (Spain), MD adherence, lifestyle, physical exercise, tobacco and alcohol consumption, pathological antecedents, and FRAX index scores were analyzed. Logistic multilinear regression modeling to explore the relationship between the MD and bone fracture risk indicated that better MD adherence was associated with a lower bone risk fracture. Non-pharmacological preventive strategies to reduce bone fracture risk were also reviewed to explore the role of lifestyle and diet in bone mass maintenance and bone fracture prevention.
Scientific evidence suggests that low-carbohydrate high-fat (LCHF) diets may be effective for managing non-communicable diseases (NCDs). Eat Better South Africa (EBSA) is an organization that runs ...LCHF nutrition education programs for women from low-income communities. Three focus group discussions (FGDs) were held with 18 women who had taken part in an EBSA program between 2015 and 2017, to explore their perceptions and to identify the facilitators and barriers they faced in implementing and sustaining dietary changes. Thematic analysis of the focus groups was conducted using NVivo 12 software. Women reported that they decided to enroll in the program because they suffered from NCDs. Most women said that the EBSA diet made them feel less hungry, more energetic and they felt that their health had improved. Most women spoke of socioeconomic challenges which made it difficult for them to follow EBSA's recommendations, such as employment status, safety issues in the community, and lack of support from relatives and doctors. Hence, women felt they needed more support from EBSA after the program. The social determinants that affected these women's ability to change their health behavior are also NCD risk factors, and these should be assessed to improve the program for other communities.
Sedentary lifestyles and ultra-processed food (UPF) consumption contribute to a high prevalence of overweight and obesity among adolescents. Screen time may be associated with higher UPF consumption ...and affect eating behaviors substantially.
The aim of this study was to explore adolescents’ perceptions, attitudes, and motivations concerning the consumption of UPF when using screens; investigate their perceived educational needs regarding nutrition; and explore their knowledge about UPF.
This was a qualitative study using focus groups.
Four focus groups with 30 adolescents aged 12 to 16 years at a Spanish high school were recruited in May 2022. Participants were chosen using purposive sampling based on a theoretical saturation criterion.
Focus group discussions were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis.
Three themes emerged from the thematic analysis. Participants explained that most of their meals were eaten in front of screens. They confirmed more consumption of UPF at breakfast, as mid-afternoon snacks, on weekends, and during their main meals when alone. Participants reported that the high consumption of UPF during social gatherings was related to its easy availability, convenience, and palatability. Adolescents expressed that eating in front of screens and exposure to UPF advertising led to compulsive and impulsive consumption of these products. They described UPF as addictive and unhealthy. Although participants had little awareness of UPF health effects, they expressed interest in learning about healthy eating habits. Parental attitudes toward food were considered by the participants as relevant in establishing their eating behaviors.
Loneliness, social gatherings, and parental attitudes toward UPF consumption emerged as important influences on adolescents’ dietary behaviors in front of screens. In addition, availability, palatability, and exposure to advertising were key factors reported to influence adolescents’ UPF consumption in front of screens. Addressing these influences through nutritional and educational interventions, as well as regulating the adolescent obesogenic environment and managing screen time could help modulate these effects.
Active travel, as a key form of physical activity, can help offset noncommunicable diseases as rapidly urbanising countries undergo epidemiological transition. In Africa a human mobility transition ...is underway as cities sprawl and motorization rises and preserving active travel modes (walking, cycling and public transport) is important for public health. Across the continent, public transport is dominated by paratransit, privately owned informal modes serving the general public. We reviewed the literature on active travel and paratransit in African cities, published from January 2008 to January 2019. We included 19 quantitative, 14 mixed-method and 8 qualitative studies (n = 41), narratively synthesizing the quantitative data and meta-ethnographically analysing the qualitative data. Integrated findings showed that walking was high, cycling was low and paratransit was a critical mobility option for poor peripheral residents facing long livelihood-generation journeys. As an indigenous solution to dysfunctional mobility systems shaped by colonial and apartheid legacies it was an effective connector, penetrating areas unserved by formal public transport and helping break cycles of poverty. From a public health perspective, it preserved active travel by reducing mode-shifting to private vehicles. Yet many city authorities viewed it as rogue, out of keeping with the ‘ideal modern city’, adopting official anti-paratransit stances without necessarily considering the contribution of active travel to public health. The studies varied in quality and showed uneven geographic representation, with data from Central and Northern Africa especially sparse; notably, there was a high prevalence of non-local authors and out-of-country funding. Nevertheless, drawing together a rich cross-disciplinary set of studies spanning over a decade, the review expands the literature at the intersection of transport and health with its novel focus on paratransit as a key active travel mode in African cities. Further innovative research could improve paratransit's legibility for policymakers and practitioners, fostering its inclusion in integrated transport plans.
•Noncommunicable diseases are rising in Africa as populations urbanise and motorise.•To offset this, active travel (walking, cycling, public transport) is desirable.•Paratransit (informal public transport) is a key mode for urban African residents.•Despite limited formal public transport many city authorities are anti-paratransit.•Further paratransit research can foster more effective integrated mobility systems.
Background: Diet-related non-communicable diseases (NCDs) pose a substantial burden in terms of financial cost, morbidity, and mortality. In South Africa there is currently a double burden of ...infectious diseases and NCDs. Overconsumption of sugar, refined carbohydrates, and poor-quality fats, increases the risk for developing chronic diseases. Families from poor communities are often forced to eat these harmful foods due to a lack of nutrition education, or because they cannot afford or don't know how to access healthy foods. While poverty is an important barrier to health and education for both men and women, it tends to yield a higher burden in women. There is evidence that low-carbohydrate high-fat (LCHF) diets can improve metabolic health in well-controlled clinical trials where quality food is either provided or where participants have the financial and logistical means to access the foods promoted by this diet. However, one cannot assume that the same nutritional advice will translate to residents of underserved communities, who may not understand the advice nor be able to afford or access the foods promoted by this diet. Women from these communities are often the gatekeepers to healthy food choices for their families, but they are at a particular disadvantage. Eat Better South Africa (EBSA) runs nutrition education programs to teach – predominately women – how to choose affordable healthier foods that are lower in refined carbohydrates and higher in healthy fats to prevent or manage metabolic conditions. Aims: This research aims to optimise the EBSA program for women from underresourced communities and to evaluate its effectiveness for changing dietary behaviour and improving metabolic health. The objectives were: 1) to explore women's perceptions of the EBSA program and the barriers and facilitators that they faced to change their dietary habits and adhere to the EBSA recommended diet; 2) to conduct community assessments in the under-resourced communities that EBSA planned to run programs, better address women's needs and explore their willingness to participate in a nutrition and health education program; 3) to assess the effects of the EBSA program on women's metabolic health and wellbeing through mixed-methods and to explore EBSA's team perceptions of the program, and 4) to explore health practitioners' perceptions of the health and nutritional advice recommended by EBSA. Methods: The first part of this project consisted of a qualitative study through focus group discussions (FGDs) with women from previous EBSA programs (n=18) and naïve EBSA participants (n=60). The second part of the project consisted of a mixed-method evaluation (n=32) of a pilot study on an EBSA intervention to assess health status changes. These methods included qualitative methods (in-depth individual (IDIs) interviews with both EBSA participants and EBSA team members and FGDs with the EBSA participants), and quantitative methods (diet assessment, metabolic health markers and physical activity behaviour) to assess changes before and after the pilot intervention program. The last part of this project consisted of a qualitative IDI study on health practitioners' perceptions and understanding of a LCHF diet (n=16). Thematic analysis of the qualitative data was conducted using NVivo 12 software. Descriptive and statistical analysis of the quantitative data was done using Stata 16 and Jamovi. Results: The first formative study indicated that the EBSA participants' greatest facilitators and barriers revolved around understanding the educational content and on how to implement the dietary advice. The mixed methods results of the second study, the pilot, indicated that, overall, the women experienced improvements in dietary behaviours and biomarkers related to inflammation, lipids, and glycaemic profiles. Furthermore, the participants waist circumference, weight, blood pressure, triglycerides and HbA1c were significantly reduced, and those changes were sustained six months after the EBSA intervention. Women's carbohydrate intake was significantly reduced, and their health markers improved despite a slight increase in sedentary behaviour. The qualitative results found that the major reason women enrolled in the program was because they suffered from NCDs. Most women found that the EBSA diet made them feel less hungry, more energetic and they felt that their health had improved. Most women spoke of socioeconomic challenges which made it difficult for them to follow EBSA's recommendations, such as employment status, safety issues in the community, and lack of support from relatives. Women felt that some health practitioners were not supportive of the diet, but that they became more positive after observing the related health outcomes. Quantitative results converged with qualitative results except for physical activity behaviour. EBSA's team perceptions of the program and participants' challenges matched participants' experiences. The final qualitative study indicated that health practitioners' approaches to LCHF diets seemed to be supportive but not advocating. Conclusion: Although, currently, some international food guidelines endorse LCHF diets, there is still a considerable amount of confusion and lack of knowledge regarding this diet. This study provided data on the dietary intake and health risk status of women from under-resourced South African communities, and the facilitators and challenges of a LCHF education program to change their dietary behaviour. Results suggested that most participants followed EBSA's dietary recommendations and experienced health improvements as a result. Follow up data at six months suggested that those changes could be sustainable. For people with diet-related chronic diseases, LCHF diets should be supported by experienced health care professionals who can facilitate optimal nutritional intake. This is the same for any other diet; the evidence for long-term compliance and the sustainability of carbohydrate restriction is currently not yet established. In the absence of this evidence, existing data suggest that it is a legitimate and potentially effective treatment to adopt a LCHF diet as an option for patients to manage and prevent NCDs in under-resourced communities.
Travel has individual, societal and planetary health implications. We explored socioeconomic and gendered differences in travel behaviour in Africa, to develop an understanding of travel-related ...inequity. We conducted a mixed-methods systematic review (PROSPERO CRD42019124802). In 2019, we searched MEDLINE, TRID, SCOPUS, Web of Science, LILACS, SciELO, Global Health, Africa Index Medicus, CINAHL and MediCarib for studies examining travel behaviour by socioeconomic status and gender in Africa. We appraised study quality using Critical Appraisal Skills Programme checklists. We synthesised qualitative data using meta-ethnography, followed by a narrative synthesis of quantitative data, and integrated qualitative and quantitative strands using pattern matching principles. We retrieved 103 studies (20 qualitative, 24 mixed-methods, 59 quantitative). From the meta-ethnography, we observed that travel is: intertwined with social mobility; necessary to access resources; associated with cost and safety barriers; typified by long distances and slow modes; and dictated by gendered social expectations. We also observed that: motorised transport is needed in cities; walking is an unsafe, ‘captive’ mode; and urban and transport planning are uncoordinated. From these observations, we derived hypothesised patterns that were tested using the quantitative data, and found support for these overall. In lower socioeconomic individuals, travel inequity entailed reliance on walking and paratransit (informal public transport), being unable to afford travel, travelling less overall, and travelling long distances in hazardous conditions. In women and girls, travel inequity entailed reliance on walking and lack of access to private vehicles, risk of personal violence, societally-imposed travel constraints, and household duties shaping travel. Limitations included lack of analytical rigour in qualitative studies and a preponderance of cross-sectional quantitative studies (offering a static view of an evolving process). Overall, we found that travel inequity in Africa perpetuates socioeconomic and gendered disadvantage. Proposed solutions focus on improving the safety, efficiency and affordability of public transport and walking.
•Utilised meta-ethnography and pattern-matching principles.•Revealed travel patterns differed by socioeconomic status and gender.•Travel inequity compounded disadvantage.•Females and poor people more likely to rely on walking.•Cost, safety and cultural factors were barriers to travel.
The Human Mobility Transition model describes shifts in mobility dynamics and transport systems. The aspirational stage, ‘human urbanism’, is characterised by high active travel, universal public ...transport, low private vehicle use and equitable access to transport. We explored factors associated with travel behaviour in Africa and the Caribbean, investigating the potential to realise ‘human urbanism’ in this context. We conducted a mixed-methods systematic review of ten databases and grey literature for articles published between January 2008 and February 2019. We appraised study quality using Critical Appraisal Skills Programme checklists. We narratively synthesized qualitative and quantitative data, using meta-study principles to integrate the findings. We identified 39,404 studies through database searching, mining reviews, reference screening, and topic experts’ consultation. We included 129 studies (78 quantitative, 28 mixed-methods, 23 qualitative) and 33 grey literature documents. In marginalised groups, including the poor, people living rurally or peripheral to cities, women and girls, and the elderly, transport was poorly accessible, travel was characterised by high levels of walking and paratransit (informal public transport) use, and low private vehicle use. Poorly controlled urban growth (density) and sprawl (expansion), with associated informality, was a salient aspect of this context, resulting in long travel distances and the necessity of motorised transportation. There were existing population-level assets in relation to ‘human urbanism’ (high levels of active travel, good paratransit coverage, low private vehicle use) as well as core challenges (urban sprawl and informality, socioeconomic and gendered barriers to travel, poor transport accessibility). Ineffective mobility systems were a product of uncoordinated urban planning, unregulated land use and subsequent land use conflict. To realise ‘human urbanism’, integrated planning policies recognising the linkages between health, transport and equity are needed. A shift in priority from economic growth to a focus on broader population needs and the rights and wellbeing of ordinary people is required. Policymakers should focus attention on transport accessibility for the most vulnerable.
In this Viewpoint, we discuss how the identification of oral antibiotics and their distinction from other commonly used medicines can be challenging for consumers, suppliers, and health-care ...professionals. There is a large variation in the names that people use to refer to antibiotics and these often relate to their physical appearance, although antibiotics come in many different physical presentations. We also reflect on how the physical appearance of medicine influences health care and public health by affecting communication between patients and health-care professionals, dispensing , medicine use, and the public understanding of health campaigns. Furthermore, we report expert and stakeholder consultations on improving the identification of oral antibiotics and discuss next steps towards a new identification system for antibiotics. We propose to use the physical appearance as a tool to support and nudge awareness about antibiotics and their responsible use.
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