Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study

Background
There is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies.

Methods/Design
Intervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.

A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake.

Discussion
Salt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.

Effect of diet versus diet and exercise on weight loss and body composition in class II and III obesity: A systematic review

Class II and III obesity (BMI >35 kg·m2) have increased dramatically in recent years. Current clinical guidelines suggest diet and exercise as first line treatment for adults throughout the spectrum of overweight and obesity. However, to date there is no systematic review that examines the effects of diet and exercise on this high risk population. This systematic review will examine the combined effects of diet versus diet and exercise on body composition in severe obesity. Medline and Cinahl were searched for randomised controlled trials comparing diet and exercise to diet alone. Studies published until July 2013 were included if they used reliable methods for analysing body composition in adults with BMI ≥ 35 kg·m2. Five of 459 studies met the inclusion criteria. Two studies, both in older adults, reported that exercise reduced lean mass loss during weight loss. Two studies showed that exercise facilitated (greater) fat mass loss. The remaining study reported no differences in body composition when exercise is added to energy restriction. Exercise training during energy restriction for individuals with BMI ≥35 kg.m2 may influence body composition outcomes but the evidence is limited. Further studies should focus on the efficacy of different exercise protocols during energy restriction for this population in order to better inform decision making for the treatment of severe obesity in respect to favourable body composition outcomes.

Longitudinal predictors of frequent vegetable and fruit consumption among socio-economically disadvantaged Australian adolescents

Adequate vegetable and fruit consumption is necessary for preventing nutrition-related diseases. Socio-economically disadvantaged adolescents tend to consume relatively few vegetables and fruits. However, despite nutritional challenges associated with socio-economic disadvantage, a minority of adolescents manage to eat vegetables and fruit in quantities that are more in line with dietary recommendations. This investigation aimed to identify predictors of more frequent intakes of fruits and vegetables among adolescents over a 2-year follow-up period. Data were drawn from 521 socio-economically disadvantaged (maternal education ≤Year 10 of secondary school) Australian adolescents aged 12–15 years. Participants were recruited from 37 secondary schools and were asked to complete online surveys in 2004/2005 (baseline) and 2006/2007 (follow-up). Surveys comprised a 38-item FFQ and questions based on Social Ecological models examining intrapersonal, social and environmental influences on diet. At baseline and follow-up, respectively, 29% and 24% of adolescents frequently consumed vegetables (≥2 times/day); 33% and 36% frequently consumed fruit (≥1 time/day). In multivariable logistic regressions, baseline consumption strongly predicted consumption at follow-up. Frequently being served vegetables at dinner predicted frequent vegetable consumption. Female sex, rarely purchasing food or drink from school vending machines, and usually being expected to eat all foods served predicted frequent fruit consumption. Findings suggest nutrition promotion initiatives aimed at improving eating behaviours among this at-risk population and should focus on younger adolescents, particularly boys; improving adolescent eating behaviours at school; and encouraging families to increase home availability of healthy foods and to implement meal time rules.

Factors influencing women’s choice of weight-loss diet

Women's motives for weight-loss dieting and choice of method were investigated in 151 current and 182 prospective dieters. Problematically, appearance-motivated dieters preferred ‘fad’ diets with the promise of quick results, and prospective dieters preferred marketing information supporting such diets over health advice cautioning against their use.

Does personality affect dietary intake?

The purpose of this review is to evaluate the evidence for an association between the Big Five dimensions of personality, dietary intake, and compliance to dietary recommendations. Poor diet is a known risk factor for overweight and obesity and associated chronic lifestyle diseases and it has been proposed that personality may be linked to dietary choices. Findings from cross-sectional surveys from different countries and cultures show a positive association between Openness and consumption of fruits and vegetables and between Conscientiousness and healthy eating. Although no evidence has been found that personality dimensions are associated with adherence to dietary recommendations over time, Conscientiousness is associated with a number of prosocial and health-promoting behaviors that include avoiding alcohol-related harm, binge-drinking, and smoking, and adherence to medication regimens. With emerging evidence of an association between higher Conscientiousness and lower obesity risk, the hypothesis that higher Conscientiousness may predict adoption of healthy dietary and other lifestyle recommendations appears to be supported.