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Nutrition Status and Policies in Low- and Middle-Income Countries

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (22 December 2023) | Viewed by 20548

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Dr. Haider Mannan

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Guest Editor

Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
Interests: nutritional status; nutritional policies; infant feeding; physical activity

Special Issue Information

Dear Colleagues,

The primary nutritional status indicators including obesity, overweight, underweight, and short stature are changing in many low- and middle income countries (LMICs). Thus, it is important to examine the determinants of these indicators in these countries using the most recently available data and if possible compare how these have changed over time. Furthermore, understanding the public health implication of fiscal policies is crucial to combat recently increasing overweight and obesity rates in many LMICs, some of which are experiencing an unprecedented rise in these rates. It is important to examine the implication of food policies, mainly tariff rates on “unhealthy” foods, including sugar and confectionery products as well as fats and oils, and governments’ subsidies on individuals’ body weight outcomes. Furthermore, it is important to examine the implications of the increase in subsidy rates, as a share of government expenditure, on higher overweight and obesity rates including identification of population sub-groups where the implications of these food policies are more pronounced. This is intuitive because these sub-groups are more likely to spend a larger share of their income on food consumption or unhealthy foods, and they are beneficiaries of government subsidies in many LMICs. Such studies have important implications for informing public health policies in LMICs.

Dr. Haider Mannan
Guest Editor

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Keywords

low-and-middle income countries
nutritional status indicators
public health
food policies
obesity
overweight

Published Papers (11 papers)

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Research

10 pages, 553 KiB

Open AccessArticle

Determinants of Undernutrition among Children Admitted to a Pediatric Hospital in Port Sudan, Sudan

by Giulia Chiopris, Caterina Chiopris, Manuela Valenti and Susanna Esposito

Nutrients 2024, 16(6), 787; https://doi.org/10.3390/nu16060787 - 10 Mar 2024

Viewed by 1150

Abstract

Severe acute undernutrition (SAU) is still a crucial global health issue in the 0–59 months population, increasing the risk of mortality as well as of long-term consequences. In Sudan, 3.3 million children suffered from acute malnutrition between 2018 and 2019. This study was planned to evaluate, in the area of Port Sudan, the prevalence of acute undernutrition after the COVID-19 pandemic and to identify the most important factors favoring the development of acute undernutrition. The available clinical records of all the under-five children (n = 1012) admitted to the Port Sudan Emergency Pediatric Hospital from 1 February 2021 to 31 January 2022 were analyzed. The presence of wasting and kwashiorkor was assessed and children were categorized according to age, gender, place of residence, main reason for hospitalization, and underlying comorbidities. Acute undernutrition was evidenced in 493 (48.7%) children. Of them, only 16 (3.2%) were diagnosed with kwashiorkor. Children with SAU had a higher prevalence of acute gastroenteritis (p < 0.05) and parasitosis (p < 0.05). Infants aged 0–6 months were those with the lowest risk of undernutrition, whereas those aged 7–12 months were those with the greater risk. In these patients, multivariate analysis revealed that SAU and MAU were 2.5 times (OR 2.51; 95% CI, 1.79–3.55) and 5.5 times (OR 5.56; 95% CI, 2.59–18.7) higher. This study shows that the area of Port Sudan is still suffering from an alarming prevalence of severe wasting and the risk of developing acute undernutrition seems strictly related to the introduction of complementary feeding and tends to reduce with increasing age. Measures already in place to prevent acute malnutrition should be reinforced with improvement of mother education on child feeding. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

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27 pages, 893 KiB

Open AccessArticle

Factors Associated with Childhood Stunting in Four North African Countries: Evidence from Multiple Indicator Cluster Surveys, 2014–2019

by Nagwa Farag Elmighrabi, Catharine A. K. Fleming and Kingsley E. Agho

Nutrients 2024, 16(4), 473; https://doi.org/10.3390/nu16040473 - 6 Feb 2024

Viewed by 1296

Abstract

Stunting remains a significant public health issue among North African children, even though significant progress has been made in reducing hunger and poverty. This study aimed to identify factors associated with stunting among children in four North African countries (Algeria, Egypt, Sudan, and Tunisia). A logistic regression model adjusted for clustering and sampling weights was used to identify factors associated with childhood stunting. It was found that the prevalence of stunting in Algeria, Egypt, Sudan, and Tunisia was 9.7%(95% CI: 9.1, 10.3), 21.1% (95% CI: 19.8, 22.5), 33.8% (95% CI: 32.7, 34.9), and 8.2% (95% CI: 7.3, 9.2), respectively. Stunting was more common among children from Sudan and Egypt. Our analysis showed that a low wealth index, being a boy, low BMI, dietary diversity <5 foods, and low birth weight were associated with stunting from 0 to 23 months; however, rural residency, a low-educated mother, low BMI, family size, and diarrhea were associated with stunting from 24 to 59 months. A collaborative approach that prioritizes maternal health and nutrition, invests in struggling families, and customizes interventions to meet the specific needs of each North African country is essential for eradicating undernutrition by 2030. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

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17 pages, 6991 KiB

Open AccessArticle

Effectiveness of NCD-Related Fiscal Policies: Evidence from the Pacific

by Shazna M. Buksh, Annie Crookes and John B. F. de Wit

Nutrients 2023, 15(21), 4669; https://doi.org/10.3390/nu15214669 - 3 Nov 2023

Viewed by 1451

Abstract

Obesity in Pacific Island countries (PICs) has hit crisis levels, and the consequent high non-communicable disease (NCD) burden is devastating for their developing economies. Nutrition transitions from traditional, plant and seafood diets to a dependence on processed foods are at the core of the obesity and NCD epidemic in PICs. Fiscal policies are widely promoted as an effective mechanism to reduce consumption of unhealthy foods and increase consumption of fruits and vegetables. However, there are little data to evaluate the effectiveness of these policies as rates of NCDs and obesity in PICs continue to rise. This study used an online survey to recruit 4116 adults from six PICs: Fiji, Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu. The study measured the consumption of and household access to sugar-sweetened beverages, ultra-processed packaged snacks, fruits and vegetables and attitudes on food prices and unhealthy eating. The study also assessed the relationship between consumption of these foods and drink and (1) household access, (2) price as a food choice motive, and (3) unhealthy eating attitudes. This study provides novel data on food-related behaviours in PICs, offers insights into the potential impact of NCD-related fiscal policies on food consumption and identifies other variables of interest. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

13 pages, 631 KiB

Open AccessArticle

Perceptions on Healthy Eating Impact the Home Food Environment: A Qualitative Exploration of Perceptions of Indigenous Food Gatekeepers in Urban Fiji

by Shazna M. Buksh, Phillipa Hay and John B. F. de Wit

Nutrients 2023, 15(18), 3875; https://doi.org/10.3390/nu15183875 - 6 Sep 2023

Cited by 1 | Viewed by 1712

Abstract

The home food environment (HFE) can have important direct and indirect impacts on dietary practices. Nutrient transitions in the HFE of Pacific Island countries (PICs) are key contributors of the high rates of adult and childhood overweight and obesity in the region. Pacifica mothers are important sociocultural agents who play critical roles in their HFE through setting eating-appropriateness standards and mitigating the impacts of food availability and accessibility on the HFE. This study used an interpretative phenomenological approach to explore how urban indigenous Fijian mothers perceive healthy eating and how these perceptions impacted the food decisions they made for their families. Mothers in this study held complex, multifaceted perceptions on healthy eating and these perceptions had both positive and negative impacts on the family food choices they made, the strategies they adopted for healthy eating and their perceived motivators for healthy eating. The findings of this study underscore the need for a deeper understanding and analysis of uptake of public health messaging related to healthy and unhealthy eating and the importance of targeted promotion of healthful nutrition in this community. Promoting consumption of traditional and locally grown foods can enhance nutrition and food security and combat nutrition transition in the region. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

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12 pages, 592 KiB

Open AccessArticle

Grazing Is Associated with ADHD Symptoms, Substance Use, and Impulsivity in a Representative Sample of a Large Metropolitan Area in Brazil

by Andreea I. Heriseanu, Dean Spirou, Carlos E. F. Moraes, Phillipa Hay, Rosely Sichieri and Jose C. Appolinario

Nutrients 2023, 15(13), 2987; https://doi.org/10.3390/nu15132987 - 30 Jun 2023

Viewed by 1432

Abstract

Grazing is a clinically relevant eating behaviour, especially when it presents with a sense of loss of control (compulsive grazing). There is evidence that other disordered eating patterns are associated with problematic substance use and impulsivity-related conditions, such as attention-deficit/hyperactivity disorder (ADHD). This overlap contributes to higher psychopathology and treatment complications. Less is known about grazing, and most information originates in high-income countries. Hence, we sought to investigate relationships between grazing, tobacco and alcohol use, ADHD, and impulsivity in a large representative sample from Brazil. Data were collected by trained interviewers from adults (N = 2297) through an in-person household survey based on a stratified and clustered probability sample. We found significant associations between compulsive grazing and problematic alcohol use (OR = 3.02, 95% CI: 1.65, 5.53), ADHD (OR = 8.94, 95% CI: 5.11, 15.63), and smoking (OR = 1.67, 95% CI: 1.12, 2.47), with impulsivity contributing to the first two relationships. The substantial association with ADHD suggests that other executive functions may promote disordered eating, possibly expressed through difficulties in adhering to regular meals. Clinically, these findings highlight the importance of assessing problematic eating patterns, such as compulsive grazing, in those presenting with difficulties with substance use or impulsivity, and vice versa. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

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16 pages, 10136 KiB

Open AccessArticle

Healthy Eating for All? The Challenge of Adhering to Dietary Guidelines for Low-Income Groups in China

by Jingjing Yin, Jingfen Hua, Xinhuan Zhang, Alexandre Tuyishimire and Degang Yang

Nutrients 2023, 15(12), 2704; https://doi.org/10.3390/nu15122704 - 9 Jun 2023

Cited by 1 | Viewed by 1537

Abstract

The Chinese Dietary Guidelines propose a balanced diet for healthy living, but the affordability of this diet needs to be considered, especially for low-income households. To investigate the affordability of a healthy diet, this study analyzes the daily retail prices of 46 food items in 36 Chinese cities from 2016 to 2021. This study compares expenditure, diet composition, and nutritional status in two scenarios aligned with the guidelines. The results show that the mean minimum cost of a balanced diet exceeds the current per capita food expenditure for at least 182.85 million urban households. This suggests that low-income people would need to increase their expenditure by at least 20–121% to achieve the recommended diets. This study also identifies affordable and nutrient-dense foods such as standard flour, eggs, black beans, and cabbage, which policymakers should focus on when monitoring food prices. The findings recommend a combination of social and food system policies to reduce prices and make healthy diets accessible. This study identifies the gaps in the Chinese Dietary Guidelines for ensuring accessibility for vulnerable groups and provides a template for policymakers and researchers to track diet affordability using available food price data in China, contributing to China’s 2030 Health Plan and the UN’s Sustainable Development Goals. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

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12 pages, 327 KiB

Open AccessArticle

Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City

by Carlos Eduardo Ferreira de Moraes, Marina Maria Leite Antunes, Carla Mourilhe, Rosely Sichieri, Phillipa Hay and Jose Carlos Appolinario

Nutrients 2023, 15(7), 1573; https://doi.org/10.3390/nu15071573 - 24 Mar 2023

Cited by 2 | Viewed by 1625

Abstract

The prevalence of binge eating spectrum conditions (BESC) are increasing globally. However, there is a lack of data from general population samples in low- and middle-income countries. Thus, this study described the food consumption during objective binge eating episodes (OBE) in people with BESC from a metropolitan city in Brazil. Participants comprised 136 adults (18 years old–60 years old) with Binge Eating Disorder (BED), Bulimia Nervosa (BN), or recurrent binge eating (RBE) from a two-phase epidemiological survey. They were interviewed in their homes by trained lay interviewers using the Questionnaire on Eating and Weight Patterns updated for the DSM-5 to assess BESC diagnosis and food consumption during a typical OBE. Overall, participants consumed a mean of 1067 kcal during the episodes. For the most part, these calories were derived from carbohydrates (58%) and lipids (30%), irrespective of the diagnosis. Regarding food item consumption, individuals with BED and RBE consumed staple foods (mainly rice and beans) more frequently than those with BN. Conversely, participants with BN ingested sugar-sweetened beverages more frequently than the BED group. In conclusion, there were differences in the eating patterns of individuals with BESC in Brazil. BED and RBE participants consumed more typical foods, whereas those with BN preferred foods with a high content of energy during their OBE. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

14 pages, 300 KiB

Open AccessArticle

Urban–Rural Disparities in Knowledge, Use and Perceived Benefits of Nutrition Labels in China: Evidence from 10 Provinces

by Linlin Fan, Zhigang Wang, Yiwen Zhao and Ye Ma

Nutrients 2023, 15(5), 1171; https://doi.org/10.3390/nu15051171 - 26 Feb 2023

Cited by 2 | Viewed by 1847

Abstract

There exist significant gaps in nutritional status between urban and rural populations in China. The previous literature has shown that more knowledge and usage of nutrition labels are instrumental in improving diet quality and health. The aim of the study is to analyze: (1) Are there urban–rural disparities in consumer knowledge, use and perceived benefits of nutrition labels in China; (2) If so, what are the magnitudes of the disparities; (3) What can explain the disparities, and how can the disparities be reduced? The Oaxaca–Blinder (O-B) decomposition is utilized to analyze the predictors of urban–rural disparities in nutrition labels based on a self-conducted study of Chinese individuals. The information from a total of 1635 individuals (aged 11–81 years) across China in 2016 was collected in the survey. We find that rural respondents have less knowledge, lower usage and perceived benefits of nutrition labels than their urban counterparts. Demographics, focus on food safety, frequent shopping locations and income jointly explain 98.9% of the disparity in the knowledge of nutrition labels. Nutrition label knowledge is the predictor which contributes most to urban–rural disparity in label use—accounting for 29.6% of the disparity. Nutrition label knowledge and use are the two biggest predictors of disparities in perceived benefits—accounting for 29.7% and 22.8% of the disparity in perceived benefits, respectively. Our study suggests that policies aiming to improve income and education, as well as raising awareness of food safety in rural areas, are promising in closing the urban–rural disparities in nutrition labels knowledge, use, diet quality and health in China. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

13 pages, 321 KiB

Open AccessArticle

Grazing Prevalence and Associations with Eating and General Psychopathology, Body Mass Index, and Quality of Life in a Middle-Income Country

by Dean Spirou, Andreea I. Heriseanu, Rosely Sichieri, Phillipa Hay, Carlos E. Moraes and Jose C. Appolinario

Nutrients 2023, 15(3), 557; https://doi.org/10.3390/nu15030557 - 20 Jan 2023

Cited by 5 | Viewed by 2073

Abstract

Research from high-income countries has shown that grazing is a common but problematic eating pattern, particularly when associated with a sense of loss of control. However, it is unclear whether these patterns hold globally. Thus, the goal of this study was to extend previous research by examining the prevalence and clinical correlates of compulsive grazing (CG) and non-compulsive grazing (NCG) in a middle-income country. Participants (N = 2297) comprised adult residents from Rio de Janeiro, Brazil. Recruitment of this population-based household survey occurred from September 2019 to February 2020. The short inventory of grazing was used to operationalise grazing subtypes. Chi-square analyses, logistic regression, and univariate tests were conducted using the complex samples procedure. The point prevalence of regular CG was 10.2% (n = 239) and was consistent with high-income countries, while NCG was 29.8% (n = 679) and was less frequent than reported in high-income countries. Additionally, similar to high-income countries, CG was associated with a higher body mass index and higher odds of eating disorders, eating disorder symptomatology, depression, anxiety, and a lower physical and mental health-related quality of life, than no grazing and NCG. Overall, this study demonstrated that grazing patterns in high-income countries extend to middle-income countries. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

11 pages, 2575 KiB

Open AccessArticle

Policy to Decrease Low Birth Weight in Indonesia: Who Should Be the Target?

by Ratna Dwi Wulandari, Agung Dwi Laksono and Ratu Matahari

Nutrients 2023, 15(2), 465; https://doi.org/10.3390/nu15020465 - 16 Jan 2023

Cited by 1 | Viewed by 3017

Abstract

The study aimed to analyze the target of the policy to decrease low birth weight (LBW) in Indonesia. This cross-sectional study used a sample of live births in last five years preceding the survey of birth weight. Data collection took place from July to September 2017. The weighted sample size was 17,848 participants. The variables analyzed included residence, age, marital status, education, employment, parity, and wealth. The study employed binary logistic regression in the final stage to determine the target of policy regarding LBW. The results showed that women in urban areas were 1.200 times more likely to deliver babies with LBW than women in rural areas. All age groups were less likely to deliver babies with LBW than those aged 45–49. The study also found all marital statuses had a lower likelihood of providing babies with LBW than those who had never been in a marriage. Women of all education levels had a greater risk of giving birth to babies with LBW than women with higher education levels. Unemployed women had 1.033 times more chances of delivering babies with LBW than employed women. Primiparous women were 1.132 times more likely to give birth to babies with LBW than multiparous women. Overall, the women in all wealth status categories had a higher probability of delivering babies with LBW than the wealthiest groups. The study concluded that policymakers should target women who live in urban areas, are old, have never been married, have low education, and are unemployed, primiparous, and poor to decrease LBW cases in Indonesia. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

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14 pages, 1347 KiB

Open AccessArticle

Role of Residence Area on Diet Diversity and Micronutrient Intake Adequacy in Urban and Rural Costa Rican Adolescents

by Rafael Monge-Rojas, Rulamán Vargas-Quesada and Georgina Gómez

Nutrients 2022, 14(23), 5093; https://doi.org/10.3390/nu14235093 - 1 Dec 2022

Cited by 4 | Viewed by 2140

Abstract

Dietary diversity might be essential to meet nutritional demands during adolescence. Diet diversity among 818 urban and rural Costa Rican adolescents aged 13–18 years was studied using the Minimum Dietary Diversity Score for Women. The Nutrient Adequacy Ratio (NAR) was calculated for 11 nutrients to estimate the nutrient adequacy of the diet. A NAR < 0.7 was considered inadequate for micronutrient intake. The optimal Diet Diversity Score (DDS) cut-off point for this study was 4, established using receiver-operating characteristic curves. The mean DDS for the overall sample was 4.17 ± 1.43, although DDS was significantly higher in adolescents from rural vs. urban areas (4.33 ± 1.43 vs. 4.00 ± 1.42, p-value = 0.001). The odds of having a diverse diet were 62% higher in rural vs. urban adolescents. Overall, 80–95% of adolescents reached a NAR ≥ 0.70 for 8 nutrients except for calcium, zinc, and vitamin A. The residence area plays a key role in adolescent dietary diversity. Although overall DDS was low, foods that make up the rural adolescent diet were nutritionally dense enough to satisfy the EAR for most micronutrients. A high DDS is not necessarily required for the diet to meet most micronutrient demands in adolescence. Improved dietary adequacy of vitamin A, zinc, and calcium is required due to the importance of these micronutrients in maintaining optimal health. Full article

(This article belongs to the Special Issue Nutrition Status and Policies in Low- and Middle-Income Countries)

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