Food insecurity and household food supplies in rural Ecuador

The objective of this research is to assess the validity of a modified US Household Food Security Survey Module (HFSSM) through its correlation with food supply and demographic factors, and its fitness using Rasch model analysis in rural Ecuador. This study examines the relationship between household food insecurity and household food supplies in 52 Ecuadorian households. The sample was drawn from four rural communities participating in the project PLAN in Cantón Quijos. Questionnaires included a modified HFSSM, a household food shelf-inventory and demographic characteristics. Multiple ANOVA analysis resulted in statistically significant inverse relationships between household food insecurity and total food supply, as well as the supply of meat, vegetables, legumes, oils, and other food products (p=0.05). Rasch model measure values on the HFSSM illustrated food insecurity at different levels of severity. The majority of the items (>75%) presented adequate infit values. This study affirms that the proposed modified HFSSM may be useful to measure food insecurity and thus be used as a tool to monitor and evaluate programs aimed at improving quantity and variety of food items in rural Ecuador.     

Use of a predictive model for food insecurity estimates in Brazil

In 2004 the National Household Survey (Pesquisa Nacional por Amostras de Domicilios-PNAD) estimated the prevalence of food and nutrition insecurity in Brazil. However, PNAD data cannot be disaggregated at the municipal level. The objective of this study was to build a statistical model to predict severe food insecurity for Brazilian municipalities based on the PNAD dataset. Exclusion criteria were: incomplete food security data (19.30%); informants younger than 18 years old (0.07%); collective households (0.05%); households headed by indigenous persons (0.19%). The modeling was carried out in three stages, beginning with the selection of variables related to food insecurity using univariate logistic regression. The variables chosen to construct the municipal estimates were selected from those included in PNAD as well as the 2000 Census. Multivariate logistic regression was then initiated, removing the non-significant variables with odds ratios adjusted by multiple logistic regression. The Wald Test was applied to check the significance of the coefficients in the logistic equation. The final model included the variables: per capita income; years of schooling; race and gender of the household head; urban or rural residence; access to public water supply; presence of children; total number of household inhabitants and state of residence. The adequacy of the model was tested using the Hosmer-Lemeshow test (p = 0.561) and ROC curve (area = 0.823). Tests indicated that the model has strong predictive power and can be used to determine household food insecurity in Brazilian municipalities, suggesting that similar predictive models may be useful tools in other Latin American countries.     

Food Insecurity and Associated Factors among HIV-infected individuals receiving highly active antiretroviral therapy in Jimma zone Southwest Ethiopia

ABSTRACT: BACKGROUND: In resource limited settings, many People Living with HIV/AIDS (PLWHA) lack access to sufficient quantities of nutritious foods, which poses additional challenges to the success of antiretroviral therapy (ART). Maintaining adequate food consumption and nutrient intake levels and meeting the special nutritional needs to cope up with the disease and the ART are critical for PLWHA to achieve the full benefit of such a treatment. OBJECTIVE: To determine the prevalence and correlates of food insecurity among HIV-infected individuals receiving highly active antiretroviral therapy in resource-limited settings. METHODS: A cross sectional study was carried out from January 1, 2009 to March 3, 2009 at ART clinic at Jimma University specialized hospital (JUSH) in Ethiopia. We used multivariable logistic regression model to compare independent risk factors by food insecurity status among 319 adult PLWHA ([greater than or equal to]18 years) attending ART Clinic. RESULTS: A total of 319 adult PLWHA participated in the study giving a response rate of 100%. Out of 319 PLWHA the largest numbers of participants, 46.4% were in the age group of 25-34 years. The overall 201(63.0%) PLWHA were food insecure. Educational status of elementary or lower [OR=3.10 (95%CI; (1.68-5.71)], average family monthly income <100 USD [OR=13.1 (95% CI; (4.29-40.0)] and lower food diversity [OR=2.18 (95%CI; (1.21--3.99)] were significantly and independently associated with food insecurity. CONCLUSION: Food insecurity is a significant problem among PLWHA on HAART. Lower educational status and low family income were the predictors of food insecurity. Food security interventions should be an integral component of HIV/AIDS care and support programs. Special attention need to be given to patients who have lower educational status and are members of households with low income. KEYWORDS: Food insecurity, HAART, PLWHA, HIV/AIDS, Ethiopia.     

The adaptation and validation of the food security scale in a community of Caracas, Venezuela

This paper describes the process of modifying and validating a hunger index developed in the United States by Wehler et al (1992). It is part of a research whose main objective is to develop and validate a simple method that measures both quantitative (food sufficiency) and qualitative (female self-perception) dimensions of household food insecurity. In a pilot study, the original instrument was modified from a 2 point 8 item to a 4 point 12 item scale. Precision measured with Alpha Chronbach's coefficient was high (0.871) suggesting consistency in the scale's items. The instrument was applied to a sample of 238 poor and very poor households in a peri-urban barrio of Caracas. To determine overall internal validity of the scale the relationship between possible economic, social and behavioral determinants and food security level measured with the scale, was analyzed. Construct validity of the scale was established with factor and principal components analysis. Finally, with multiple regression analysis evidence is presented for overall validity of the scale. Four determinants: predictors of food sufficiency score, monthly income per capita, social class, and number of children in the household predict in the expected direction self-perceived food security level (R2 = 0.343). Results suggest that this instrument, together with an abbreviated measure of food sufficiency, based on strategic foods may be a valid, precise, and simple method for identifying and monitoring households that suffer from some degree of food insecurity in poor urban communities.     

Household food distribution behavior in periurban communities of Guatemala: lessons for food distribution programs

Do mothers of undernourished children recognize their offspring's needs? How do they feed these target children compared to other households members when food supplements are available? Which cultural principles of intra-household food distribution are associated with feeding behavior? How do household members perceive and use food supplements that are donated for undernourished target children? Answers were sought in a dietary-ethnographic study of 45 households receiving supplements for a low-weight child between one and five years, of age in two periurban low-income communities of the City of Guatemala. The central hypothesis was that we would find four cultural principles of food distribution: contributions, need, equity, and demand. The dietary survey combined direct measure and recall techniques and was done twice for all 230 individuals conforming these households. Ethnographic interviews were carried out with mothers of all target children. T-tests determined the relation between food distribution behavior and cultural rules. Findings revealed that the cultural principles of contributions, needs, and demand are present, but instead of the equity principle, we found one of equality. In the great majority of the feeding events observed, the child's mother prepares and distributes the food. The target child does not receive preferential treatment in the intra-household distribution of food supplements and other foodstuffs. Donated milk is destined principally for the children in the household; all other supplements are distributed among all members. Adult males are favored in the distribution of kcal at regular mealtimes. Children are favored in the distribution of kcal when total daily consumption is calculated. There are significant associations between the expressions of the cultural principle favoring equal distribution and that of contribution which favors adult men, and actual food distribution behavior. These principles seem to operate at formal meal events only. It was found that feeding behavior between meals (snacks, nibbling, etc.) is not subject to these salient principles and tends to compensate those household members who are not given preferential treatment in food distribution at formal mealtimes.     

Food insecurity,school absenteeism and educational attainment of adolescents in Jimma Zone Southwest Ethiopia: a longitudinal study

Background  

Food insecurity not only affects physical growth and health of children but also their intellectual development, school attendance and academic performance. However, most evidences are based on studies in high income countries. Although food insecurity is common in Ethiopia, to what extent it affects school attendance and educational attainment of adolescents is not explored. We hypothesized that food insecure adolescents would be more likely to be absent from school and have lower grades attained after 1 year compared to their food secure peers.     

Factors associated with nutritional supplement consumption in Mexican women aged 12 to 49 years

The objectives of this analysis are to identify the types of nutritional supplements (NS) commonly used and explore the associations between NS consumption and socio-demographic characteristics, nutritional status, measured as BMI, and anemia in a nationally representative sample Mexican women aged 12 to 49 years (n = 15,936) who participated in the Mexican National Nutrition Survey in 1999. Data on NS consumption and the other characteristics of interest were collected. We calculated the probability (P) of supplement consumption using logistic regression. For the statistical analysis characteristics at the individual and household level were included in the statistical models, and adjusted for the study design. Interaction effects were also explored. Multiple mixed vitamin and mineral supplements were the most commonly consumed (36.7%) followed by vitamins only (34.3%). Married women were significantly (p < 0.05) more likely (P = 0.16; p < 0.001) to consume NS compared to unmarried women, as were those with more access to public and private health care (P = 0.18; p = 0.010), with higher education level (P = 0.20; p = 0.004) and living in the South region (P = 0.20; p = 0.003). Anemia modified the association between supplement consumption and socioeconomic status (SES) (p = 0.016), non anemic women having greater probabilities of NS consumption. These results suggest that NS use among Mexican women is associated with better living conditions. On the other hand, we also found that women living in the South region, the poorest region of the country, had higher probability of NS consumption compared to the North region. This could be related to participation in food assistance programs; however we were unable to explore this potential explanation. This information will be used to further study trends, risks and health benefits in this population of the use of nutritional supplements.     

Dietary diversity and associated factors among beneficiaries of 77 child care centers: Central Regional,Venezuela

The aim of this study was to estimate household measure diet quality, using a dietary diversity score, and its associated demographic and socio-economic factors. One hundred fifty three households representatives of the Capital District and Miranda State belonging of seventy seven day care children centers were studied. To gather data on dietary diversity, we used the food register method, collecting data on household food availability during a month. Dietary diversity at day care centers of the Capital District was 46 foods differed from that found, in Miranda State was 39 foods (p = 0.005). Likewise it differed in beneficiaries' households of the Capital District was 33 foods compared to those in Miranda State was 25 foods (p = 0.000). There were 13 and 14 foods more between day care centers and the households in both states. State (Capital District or Miranda), money spent on food per person, households size and social level were variables that explained 28.9% of dietary diversity variation in households studied. Households in the Capital District had less members, spent more money on food, and a greater proportion were non-poor compared to those in Miranda. These factors could partially explain differences in diet quality among households in the two States. Whatever perspective studied indicates that the dietary diversity had a statistically significant difference between day care centers and households in states studied. Miranda State was more deficiency than Capital District. Higher dietary diversity reflects a better quality diet at day care centers compared to households studied.     

Using multiple household food inventories to measure food availability in the home over 30 days: a pilot study

Background  

The consumption of foods, especially by children, may be determined by the types of foods that are available in the home. Because most studies use a single point of data collection to determine the types of foods in the home, which can miss the change in availability when resources are not available, the primary objective of this study was to determine the extent to which the weekly availability of household food items changed over one month by 1) developing the methodology for the direct observation of the presence and amount of food items in the home; 2) conducting five in-home household food inventories over a thirty-day period in a small convenience sample; and 3) determining the frequency that food items were present in the participating households.     

Changes in food availability in metropolitan Santiago Chile according to income (quintiles) 1988-1997

Changes in household food availability from 1988-1997 obtained in a representative sample of Metropolitan Santiago were assessed; and related to observed changes in the epidemiological profile. We evaluated expenditures in food and beverages from the IV and V Household Expenditure Surveys conducted every 10 years by the National Institute of Statistics to calculate the Consumer Price Index. Food items were similarly grouped and expenditures from both surveys adjusted to concordance by assigning prices according to of food; the units consumed outside and at home were determined. Food expenditures increased, leading to greater food availability in all households and income categories; the increment was largest in the poorest quintiles. Apparent consumption of processed cereals, pastries and baked goods, poultry and pork, processed dairies, beverages and juices, dressings and mayonnaise, pre cooked meals and meals consumed "out of home" increased. Fish, vegetables and fruits increased slightly with a concomitant decrease in legumes. The present dietary pattern is also characterized by a greater availability of animal food products and processed foods; increased energy density, fat and saturated fat energy, sugars and high glycemic index foods; lower in phytochemicals, antioxidants, dietary fiber and omega-3 fatty acids. These changes are probably having a significant impact on the epidemiological and nutritional profile of the country; as manifested by an epidemic increase in obesity and chronic disease burden related to diet and physical inactivity.     

Requirements for foods containing soy protein in the food for peace program

Under the Food for Peace Program, whole grains, milled wheat flour, milled rice, soybean oil, soybean flour, nonfat dry milk, soyacontaining blended food supplements, and soya-fortified processed foods are provided by the U.S. to needy people abroad to alleviate malnutrition. These commodities are used in maternal/child health programs, school feeding, food for work projects and disaster relief. The wide diversity of nutritional requirements and traditional food preferences has led to development of nine soya-containing food types, which are used in the PL-480 Title II donation program as blended food supplements or fortified processed foods. Research studies have led to the development of product specifications. Blended food supplements include the standardized mixtures of corn-soya-milk (CSM), instant CSM, wheat-soy blend and whey-soy drink mix. These foods, developed to fulfill the nutritional requirements of preschool children, contain from 17.5 to 29.7% either toasted-defatted or equivalent full-fat soya flour, along with vitamins and minerals. In addition, 4–19% soya oil is added to improve caloric density. These products contain 19 or 20% minimum protein and 6 or 19% minimum fat content. Fortified processed foods include soya-fortified bulgur (SFB), soya-fortified bread wheat flour (SFWF), soya-fortified cornmeal (SFCM), soya-fortified sorghum grits (SFSG), and soya-fortified rolled oats (SFRO). These foods contain toasted soya flour, grits, or flakes added at 12–15% levels. Fortified foods are generally consumed by people other than infants.     

Impact of income strategies on food security in rural Mayan communities in northern Campeche

This paper examines the effect of income strategies on sufficiency of caloric intake in Mayan domestic groups (DG) of Campeche, Mexico. The analysis was based on the sustainable livelihoods approach. Information was obtained through a survey of households (N = 237) in four communities. The results reveal that all of the DG have diversified income strategies with clearly defined orientations. The caloric sufficiency index (CSI) is different (p < 0.05) among conglomerates (C) of DG and increases with the increase of the proportion of agricultural income in relation to total income. The wage labor strategy (37.6%) corresponding to C1 of DG (CSI-C = 0.69) and the agriculture-wage labor strategy (42.6%; CSI-C2 = 0.87) do not cover energy requirements of the DG. Only the agricultural strategy satisfies caloric intake needs (CSI-C3 = 1.09; CSI-C4 = 1.30) of the DG (19.8%). These results are associated with the heterogeneity of resources of the DG's, particularly, with the quality and extent of land, presence of producer organizations, and current rural policies. Implementation of differentiated local policies, interinstitutional coordination, and community participation could contribute to improving effectiveness of policies aimed at eradicating food insecurity.     

Rural development, household food safety, and nutrition in western Honduras

The authors studied the impact of a rural development project on household food security and nutrition. A quasi-experimental study design was used to compare the experience of members of thirteen Honduran small-holder farmers groups which had already received a year of credit and technical assistance, with another thirteen groups which had just joined the project, and thirteen control communities. All these communities were followed-up for one year (March/April 1997-March/April 1998). Farmers participating in the project showed a greater increase in maize stores than farmers in the control communities (p = 0.01), but did not increase their dietary energy consumption. There was, however, a small improvement in their dietary diversity (p = 0.01). The impact of the project on the nutritional status of under 5's was complex. The study underlined the importance of monitoring the impact of programs which may affect food and nutrition.     

Gauging food and nutritional care quality in hospitals

ABSTRACT: BACKGROUND: Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. METHODS: Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. RESULTS: Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones. CONCLUSIONS: Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.     

Food satisfaction in Mapuche persons in the Metropolitan Region of Santiago, Chile

Although the study and measurement of satisfaction with life has generated great interest in the last 15 years, there are few works which address satisfaction with food-related life. In order to identify variables which have an influence on satisfaction with food-related life among Mapuche persons, a survey was applied to 400 Mapuche subjects in the Santiago Metropolitan Region, Chile. The scales evaluated in the questionnaire included: SWFL (Satisfaction with Food-related Life), lifestyles, food, and Mapuche acculturation. It was found that 41.0% were extremely satisfied, 40.5% satisfied, 17.2% somewhat satisfied and 1.2% dissatisfied with their food-related life. To identify variables which have an influence on satisfaction with food, an ordinal multinomial logit model was proposed, which was significant (p < 0.01) as a whole. The probability of high satisfaction with food-related life increases as there are fewer children in the household, the person's expenditure on food increases, the person consumes some Mapuche foods, is aged 55 or more, consumes red meat in moderation, consumes foods without additives, try to balance work and private life, does not read the labels of products, and if he/she had Mapuche friends at school. Thus satisfaction with food-related life in Mapuche persons in the Metropolitan Region is related to demographic variables, expenditure on food, consumption of Mapuche foods and life-style.     

Nutritional supplementation according to energy and protein requirements in malnourished HIV-infected patients

To evaluate the effects of nutritional supplements on nitrogen and energy balances, body composition and immune parameters, HIV-infected malnourished adult outpatients were prospectively studied. Forty-six patients (4 females and 42 males; 37 +/- 12 y) were supplemented with a polymeric diet (PD) or regular foods (RF) on two consecutive 45-day periods on a crossover design. Weight, skinfold thicknesses, plasma albumin (PA), CD4 and CD8 lymphocyte counts (LC), resting energy expenditure (REE) and urinary nitrogen excretion were measured at baseline, 45 and 90-day. Food intake was weekly recorded by food surveys. Thirty-five patients completed the protocol (18 in Group 1:PD-->RF; 17 in Group 2:RF-->PD). In both groups, weight, fat free mass (FFM), energy balance (EB) and nitrogen balance (NB) increased significantly after PD, whereas LC and PA remained unchanged in both groups. The best results in terms of weight gain were obtained in the PD group and PD plus zidovudine subgroup (n = 8) during the first 45 days (weight gain/FFM gain: 4.8/2.6 kg and 6.8/3.1 kg, respectively). Nutritional supplement with PD, according to the EB and NB goals, was well tolerated and permitted to achieve a significant weight and FFM gain over a 90-day follow-up.     

The acute effects of the thermogenic supplement Meltdown on energy expenditure,fat oxidation,and hemodynamic responses in young,healthy males

The purpose of this study was to evaluate the effects of a thermogenic supplement, Meltdown, on energy expenditure, fat oxidation, and hemodynamics before and after maximal treadmill exercise. In a double-blind, randomized, placebo-controlled, cross-over design, 12 male participants underwent two testing sessions after consuming either the Meltdown or placebo supplement. While in a fasted state, participants rested for one hour, orally ingested either Meltdown or placebo and rested for another hour, performed a maximal treadmill exercise test, and then rested for another hour. Throughout the testing protocol, resting energy expenditure (REE) and respiratory exchange ratio (RER) were assessed. In addition, heart rate (HR) and blood pressure (BP) were assessed before and after exercise. Meltdown increased REE significantly more than placebo at 45 min (1.44 ± 0.25 vs. 1.28 ± 0.23 kcal/min; p = 0.003), 60 min (1.49 ± 0.28 vs. 1.30 ± 0.22 kcal/min; p = 0.025), and 120 min (1.51 ± 0.26 vs. 1.33 ± 0.27 kcals/min; p = 0.014) post-ingestion. Meltdown significantly decreased RER at 30 min (0.84 ± 0.03 vs. 0.91 ± 0.04; p = 0.022) and 45 min post-ingestion (0.82 ± 0.04 vs. 0.89 ± 0.05; p = 0.042), and immediately post-exercise (0.83 ± 0.05 vs. 0.90 ± 0.07; p = 0.009). Furthermore, over the course of the evaluation period, area under the curve assessment demonstrated that REE was significantly increased with Meltdown compared to placebo (992.5 ± 133.1 vs. 895.1 ± 296.1 kcals; p = 0.043), while RER was significantly less than placebo (5.55 ± 0.61 vs. 5.89 ± 0.44; p = 0.002) following ingestion. HR and BP were not significantly affected prior to exercise with either supplement (p > 0.05) and the exercise-induced increases for HR and BP decreased into recovery and were not different between supplements (p > 0.05). These data suggest that Meltdown enhances REE and fat oxidation more than placebo for several hours after ingestion in fully rested and post-exercise states without any adverse hemodynamic responses associated with maximal exercise.     

The Clinical Significance of Drug–Food Interactions of Direct Oral Anticoagulants

Cardiovascular diseases are the most common cause of death in the world. For almost 60 years, vitamin K antagonists (VKAs) were the mainstay of anticoagulation therapy, but in recent years direct oral anticoagulants (DOACs) have become the anticoagulant treatment of choice. DOACs were initially considered drugs with no significant food interactions; however, clinical observations from daily practice have proved otherwise as interactions with food ingredients have been reported. Food, dietary supplements or herbs may contain substances that, when administered concomitantly with DOACs, can potentially affect the plasma concentration of the drugs. The aim of this paper was to evaluate the clinical significance of drug–food interactions of DOACs, such as dabigatran, rivaroxaban, apixaban, edoxaban and betrixaban. Patients treated with anticoagulants should avoid products containing St. John’s wort and take special care with other food ingredients. As the interest in dietary supplements is on the rise, healthcare providers can contribute to the development of well-designed clinical trials on interactions between DOACs and food, and distribute sufficient knowledge about the proper use of these supplements among patients.     

Network analysis of N flows and food self-sufficiency—a comparative study of crop-livestock systems of the highlands of East and southern Africa

Smallholder farming systems in sub-Saharan Africa are often nutrient-limited, and therefore imports must be increased to compensate exports and losses. To explore whether the properties of nutrient cycling networks relate to the systems’ capability to sustain rural families, we investigated N flows within contrasting crop-livestock systems in Ethiopia, Kenya and Zimbabwe applying concepts from ecological network analysis. Farm households were conceptualised as networks, the compartments were the household and their farming activities which were connected by the N flows. Indicators assessing network size, activity and cycling, and the organisation and diversity of the N flows were compared with system productivity and food self-sufficiency. Results showed that organisation and diversity of N flows to, from and within the farm households differed more between farms of different resource endowments than across sites. The amount of N cycled per household was small and comparable across sites: less than 25 kg N year⁻¹, and for the poor households less than 5 kg N year⁻¹. Poor households with soil N stocks that were 50–60% smaller than wealthier households depended more on external inputs (e.g. a dependence of 65% vs. 45% in Zimbabwe). Productivity was positively related to network size, its organisation and N cycling, but utilisation efficiencies were different across sites in relation to soil N stock and the importance of livestock for N flows. Greater size of the N flow network and its organisation led to increased productivity and food self-sufficiency, reducing dependence, which may increase the adaptability and reliability of smallholder crop-livestock systems.