Academic year 2023-24

Ashlyn Anderson

Nutrition areas of interest

Food systems, food and nutrition policy. right to food, Latin America and Caribbean region, Asia and Pacific region

Summer project

Operationalising the right to adequate food: A qualitative case study of Mexico’s General Law on Adequate and Sustainable Food

Supervisor: Dr Helen Walls

LinkedIn: https://www.linkedin.com/in/ashlyn-j-anderson-1a0777192/

Publications:

• Navigating Hidden Hunger: An Exploratory Analysis of the Lived Experience of Food Insecurity among College Students. International Journal of Environmental Research and Public Health

Lucrezia Caselli

Area of interest

Plant-based diets, food systems, climate change

Summer project

Assessing the adequacy of the EAT-Lancet reference diet for women of reproductive age in Bangladesh, Guatemala and Uganda using Optifood: a secondary data analysis

Abstract

Background

The EAT-Lancet Commission developed a reference diet designed to be healthy for humans and the planet. While this diet is a valuable tool for addressing the increase in chronic diseases in high-income countries, questions remain about its suitability for populations with higher nutritional needs in resource-limited settings. Only a few studies have investigated the adequacy of the EAT-Lancet diet for nutritionally vulnerable groups in low- and middle- income countries. This study aimed to determine whether promoting the EAT-Lancet reference diet, adapted to the cultural and socioeconomic context of vulnerable populations in low- and middle-income countries, will ensure dietary nutrient adequacy.

Methods

In this secondary data analysis, we assessed the adequacy of the EAT-Lancet reference diet, for 12 nutrients, among women of reproductive age in Bangladesh, Guatemala and Uganda using Optifood, a linear programming tool for modelling the most nutritionally adequate diet within a given set of constraints. Household Consumption and Expenditure Surveys were used to model four types of diets within the EAT-Lancet recommendations: flexitarian, pescetarian, vegetarian and vegan. This was done for non-pregnant, non-lactating women, pregnant, and lactating women in two districts in Bangladesh, two in Guatemala and four in Uganda.

Results

All diets, across all subgroups, met the EFSA Population Reference Intakes for 9 nutrients, but not iron (except for some flexitarian diets modelled for pregnant and lactating women) and vitamin B12 (only for vegetarian and vegan diets). When adjusted to local food patterns, the nutrient content of EAT-Lancet diets was comparable or superior to that of the nutritionally optimal diets based on traditional dietary practices (i.e., did not align with the EAT-Lancet reference diet).

Conclusions

The findings suggest that the EAT-Lancet reference diet can be recommended for non-pregnant, non-lactating (NPNL), pregnant, and lactating women of reproductive age (WRA) in Bangladesh, Guatemala, and Uganda without compromising dietary adequacy.

Supervisor: Professor Elaine Ferguson and Dr Sumati Bajaj (UCL)

LinkedIn: http://linkedin.com/in/lucrezia-caselli-598396268

Katie Fulford

Nutrition areas of interest

YCF, child health, disability, inequality, sustainability.

Summer project title

Training and Guidance on Supporting Children with Disabilities in Nutrition Programmes: A thematic analysis and key-informant study.

Abstract

Background

Children with disabilities have been under-recognised and under-supported in nutrition policy and practice of care. The recent establishment of the Feeding and Disability Resource Bank provides an opportunity to evaluate the current state of the recommendations, resources and guidelines available, in meeting the needs of this group.

Methods

This is a mixed-methods study. The primary objective was a thematic analysis of training materials, program packages and programmatic guidance related to supporting nutritional care for children with disabilities. The analysis was complemented with semi-structured key-informant interviews to help identify priority areas for improvement of the resources, and to place findings in context with the main barriers and facilitators to their use.

Results

13 training resources, 8 program packages and 9 programmatic guidance were mapped for coverage and depth of recommendations for 29 key topics. These covered identification of disability, feeding difficulties and malnutrition, management of feeding difficulties and malnutrition, and integration of care for the child, family and community. Additionally, 12 interviews were conducted.

Gaps in the resources include methods of assessment of nutritional status (found in only 8 out of 30 resources), micronutrient deficiencies (0), management of the nutritional quality of a modified diet (6) and dehydration (3). Key-informants suggested the resources could be strengthened by filling gaps, standardising the recommendations, and operationalising how these practices can be integrated into programming. Additionally, the uptake of these recommendations could be maximized by concurrent consideration of the visibility of disability in nutrition agendas, accessibility of the resources and human and resource capacity of the sector.

Conclusions

Although the number and comprehension of resources on disability is growing, current recommendations are not sufficient to equip health workers or programmers with the skills to meet the needs of children with disabilities. Unless addressed, children with disability will continue to experience systemic exclusion from accessing care, and opportunities to treat malnutrition and prevent further disability will be missed.

Supervisor: Dr Marko Kerac

LinkedIn: www.linkedin.com/in/katie-fulford-517a80310

Claudia Hobbs

Nutrition areas of interest

Technology, HICs, Community Health, Preventative Healthcare

Summer project

The Use of Continuous Glucose Monitors in Non-Diabetic People and their Changing Perceptions of Health: A Qualitative Study

Supervisor: Genevieve Hadid

LinkedIn: https://www.linkedin.com/in/claudiahobbs/

Parisa Kabir

Nutrition area of interest

Women’s health, adolescent and infant health, social determinants of health, sexual health, micronutrient deficiencies, and food security

Summer Project

Maternal iron deficiency onset throughout pregnancy and association with infant anthropometric outcomes in a cohort-based in Calgary, Alberta: Secondary Data Analysis

Abstract

Background

Iron deficiency, the most common micronutrient deficiency, poses greater health risks for pregnant women. Recent studies have emerged noting the importance of understanding the effects of timing of iron deficiency during pregnancy on infant anthropometric outcomes and using evidence-based thresholds of serum ferritin to identify iron deficiency. This study investigated whether the timing and definition of iron deficiency during pregnancy impact infant anthropometric outcomes at birth and three months postpartum.

Methods

This secondary data analysis examined 1689 mother-infant pairs from the Alberta Pregnancy Outcomes and Nutrition cohort study. The primary outcome variables were infant weight and length, measured at birth and three months postpartum. The predictor variable was maternal iron deficiency, defined by serum ferritin throughout pregnancy and postpartum. The primary analysis was multivariate regression analysis used to examine the associations between infant anthropometric outcomes and maternal iron deficiency status throughout pregnancy and postpartum, stratified by three thresholds of serum ferritin.

Results

Maternal iron deficiency status in the second and third trimesters was inversely associated with infant birth weight. Mothers who were severely and moderately iron deficient in the second trimester respectively had on average infants 84.52 grams (95%CI:10.66-158.38) and 82.21 grams (95%CI:20.17-145.45) heavier than infants of mothers who were not iron deficient. Mothers severely iron deficient in the third trimester had on average infants 145.15 grams 145.15 (95%CI:4.60-285.69) relative to their counterparts. Other infant outcomes were not strongly associated with maternal iron deficiency during pregnancy.

Conclusions

Iron deficiency during the second and third trimesters are critical and affected infant birth weight but was not associated with other infant anthropometric outcomes. However, national screening guidelines need to be developed to monitor the actual prevalence of iron deficiency during pregnancy and intersectional approaches are required to improve the burdens of deficiency.

Supervisor: Dr Fanny Sandalinas

LinkedIn: https://www.linkedin.com/in/parisa-kabir-507896169/

Publications

• Marginalized social identities intersect with food insecurity and poor mental health outcomes in shaping access to health care during the COVID-19 pandemic among women living with HIV. Annual Canadian Conference on HIV/AIDS Research.
• Discrimination, HIV stigma and interpersonal violence: Key barriers to mental health services access among women living with HIV in Metro Vancouver, Canada. Annual Canadian Conference on HIV/AIDS Research. 

Jessica Kee

Nutrition areas of interest

Nutrition and chronic diseases

Summer project

Dietary Patterns and Geriatric Mental Health in East Asia

Abstract

Background

Aging is often accompanied by a heightened risk of chronic health conditions, particularly mental health disorders like dementia and depression. With increase in ageing population, prevalence of these mental health illness is expected to rise. Thus, it is crucial to understand modifiable factors such as diet and dietary patterns. While East Asia faces a particularly large burden of ageing, there has been limited literature focusing on East Asian population and its diet. This study aims to review the association between dietary patterns and geriatric mental health conditions.

Methods

A systematic search of studies investigating dietary pattern and geriatric mental health in Medline, Embase, Global Health and Web of Science was done. 10 studies for depression and 21 studies for cognitive function were analysed. The exposure variables in the studies included dietary pattern, dietary variety, dietary diversity, and dietary inflammatory index.

Results

There is evidence that suggest that diets rich in fruits and vegetables positively impact geriatric mental health, while there is mixed evidence for diets rich in meat. High diet diversity, high diet quality and low inflammatory index are also associated with lowered risk of mental health conditions.

Conclusions

Current nutrition policies in East Asian countries should be strengthened, with continued promotion of dietary guidelines. Nutrition screening and counselling should also be integrated in healthcare. Future research into this area may help to establish relationships between specific food groups and geriatric mental health.

Supervisor: Dr Rupinder Sahote

LinkedIn: https://www.linkedin.com/in/jessica-kee-612a7a219

Violet Liao

Nutrition area of interest

Agriculture, Nutrition in emergency, Nutrition program planning, Food, Malnutrition, Global health

Summer project

Exploring the Associations of Agriculture Activities and Off-Farm Employment on Child and Maternal Dietary Diversity in Rural Cambodia - A Secondary Data Analysis

Abstract

Background

Women and children are vulnerable populations at risk for malnutrition, including micronutrient deficiencies linked to low dietary diversity. Previous studies found that interventions through the agriculture-nutrition pathway can increase dietary diversity and combat micronutrient deficiency, but little is known about how off-farm employment can affect dietary diversity. This study explored the association between agriculture activities and off-farm employment on dietary diversity among women 15 – 49 years of age and children 6 – 23 months old in rural Cambodia.

Methods

The study was a secondary data analysis of a cross-sectional survey conducted by Helen Keller International in rural Cambodia. A structured questionnaire was used to collect information on household and individual demographic and socioeconomic characteristics, agriculture practices, household food security, and women and children’s dietary patterns. Bivariate and multivariate logistic regressions were used to estimate the crude, adjusted odds ratio and 95% confidence intervals between variables associated with maternal and child dietary diversity (MDD-W, MDD-C), minimum meal frequency (MMF) and minimum acceptable diet (MAD).

Results

Overall, 66% of women and 55% of children met the minimum dietary diversity.  Being a member of agriculture cooperative was associated with MDD-W (cOR 2.68, 95% CI 1.08 – 6.63, p= 0.03). There was evidence of a positive association between non-agriculture paid work and MDD-C, MMF and MAD.  After adjusting for socio-demographic variables, there was no statistical evidence of association between agriculture activities, non-agriculture paid work and MDD-W, MDD-C, MMF, and MAD.

Conclusions

No associations were found between agriculture activities and off-farm employment on dietary diversity after adjusting for potential confounders at baseline. Future studies can be done to explore the change in minimum dietary diversity for women and children after program interventions at endline.

Supervisor: Dr Thalia Sparling and Aman Sen Gupta (HKI)

LinkedIn: www.linkedin.com/in/violet-liao-023272127

Nindhita Priscillia Muharrani

Nutrition areas of interest

Adolescent Nutrition; Eating Behavior; Eating Disorders; Nutrition in Humanitarian Context

Supervisors: Dr Kenda Cunningham (HKI) and Dr Hilary Davies-Kershaw

LinkedIn: www.linkedin.com/in/nindhita-priscillia

Publications:

• Effects of Restrained, External, and Emotional Eating Styles on Weight Gain Among Female Students at Faculty of Public Health, Universitas Indonesia DOI:10.18502/KLS.V4I1.1361 https://kneopen.com/Kne-Life/article/view/1361/
• Muharrani, Nindhita. 2022. "Addressing Disordered Eating in Schools: How Far We've Come?". SEAMEO RECFON AWESOME Southeast Asian Magazine on Food and Nutrition 3rd edition, vol. 3, no. 1, Sept 2022.
• Muharrani, Nindhita. 2021. "Mindful Eating as An Approach to Ease Your Weight Control Journey". SEAMEO RECFON AWESOME Southeast Asian Magazine on Food and Nutrition 2nd edition, vol. 2, no. 1, Sept 2021.

Scarlett Scott

Nutrition areas of interest

Agriculture and Nutrition, Social Inequities, UK Dietary Inadequacy

Summer project

Analysis of dietary protein and amino acid intakes, and determination of protein inadequacy amongst age, sex, and dietary groups in a representative sample of the UK population: A secondary data analysis

Abstract

Background

Proteins and amino acids are vital for nearly all bodily functions, yet amino acid (AA) consumption has not been previously estimated in a representative UK sample. With higher protein needs in an ageing population and more people consuming plant-based (PB) diets for health and environmental benefits, this study aimed to provide data on dietary protein and indispensable amino acid (IAA) intakes, and to assess the prevalence of inadequate protein intake across different age, sex, and dietary groups.

Methods

Consumption data was obtained from food diaries of 3558 people in the UK National Diet and Nutrition Survey (NDNS) (Years 9-11). AA profiles from USDA FoodData Central were integrated with dietary data to obtain AA profiles of diets, and ileal digestibility coefficients were used to estimate digestible intakes by age, sex, and dietary groups. Mean intakes stratified into dietary and age groups to compare against the recommended nutrient intake (RNI) or safe level of intake. Mean protein intakes were analysed across geographic locations and equivalised household income tertiles to explore potential inequities in dietary quality.

Results

Individuals consuming PB diets had lower mean daily intakes of protein and IAAs compared to meat eaters. Vegans consumed about 60% less lysine than meat eaters, however mean intake exceeded requirements for all age groups. While mean digestible protein intake surpassed the RNI for all meat eaters except elderly women, vegans, vegetarians, and pescatarians often fell below requirements. Despite this, digestible IAA intakes were consistently above requirements.

Conclusions

There appears to be low risk of IAA inadequacy among the UK population yet mean digestible protein consumption of individuals consuming PB diets are estimated to be below recommended requirements. Adolescent girls and sedentary elderly women are at the highest risk of dietary protein inadequacy. Development of information and regulations surrounding Novel Plant-Based Foods is essential as consumption increases, and more individuals rely on them for the provision of dietary protein.   

Supervisor: Dr Edward Joy

LinkedIn: linkedin.com/in/scarlett-scott-0646931a3

Isha Shinde

Nutrition areas of interest

Chronic and acute malnutrition in children and women. Nutrition during pregnancy. Women’s health.

Summer project title

Recovery rates following CMAM treatment programmes for Severe Acute Malnutrition (SAM) in children aged 6-59 months: A systematic review

Abstract

Background

Severe Acute Malnutrition(SAM) remains a global priority, affecting 19 million children under five worldwide and resulting in 400,000 child deaths each year. There is lack of a worldwide pooled SAM Recovery Rate(RR) estimate derived from reports of individual community-based management of acute malnutrition(CMAM) programmes, and an indication of how RRs vary according to population characteristics such as sex, location and crisis-status. This can inform policymakers of the status of CMAM outcomes in resource-limited, high-burden settings worldwide.

Methods

A single reviewer independently extracted relevant data from PubMed, Cochrane library, Global Index Medicus, Google scholar, Google search and Embase. Quality assessment was conducted using a modified Newcastle-Ottawa Scale. The review presented pooled SAM RR from all included studies, and from sub-analyses by sex, location and crisis-status of population. Secondary outcomes included defaulter, mortality, referral, transfer and relapse rates.

Results

Total 39 interventional and observational studies used variable combinations of weight-for-height Z-scores >-2, mid-upper-arm-circumference >125mm or >115mm and absence of oedema for 2 consecutive weeks (14days) as recovery indicators. Across all included studies, the pooled RR using a standardised definition (77%(95% CI [71% to 82%], I² = 99%) was above acceptable(>75%) Sphere Standards, with high heterogeneity, and ranged from 33% to 99%. Pooled SAM RRs of 76%(95%CI [70%-81%], I²=99%99%,n=32studies) and 80%(95%CI [65%-91%], I²=100%, n=7studies) were calculated for WHO African and South-East Asia regions respectively. Boys and girls had similar RRs (Boys:RR76% (95%CI [69%-82%], I²=88%, Girls:RR73% (95%CI [68%-79%], I²=81%, (n=6studies). There was no difference between the RR of crisis-affected(79% (95%CI [72%-85%], I²=99%, n=24studies) and relatively-stable populations(73% (95%CI [64%-80%], I²=99%, n=15 studies). Pooled global SAM defaulter(10%) and mortality rates(1%) were well within acceptable Sphere Standard cut-offs.

Conclusion

Adherence to consistent admission/recovery criteria, uniform training of health-workers, regular weekly monitoring and frequent quality control checks, is recommended to address high global RR variability.

Supervisor: Oliver Cumming and Sara Strout

Hollie Sweet

Nutrition areas of interest

School and Child Nutrition, Nutrition Related Chronic Diseases, Nutrition Policy

Summer project

The Impact of Having Children, on Fruit and Vegetable Purchasing in Households in Great Britain, Between 2012-2019: Secondary Data Analysis

Abstract

Background

Fruit and vegetables are a micronutrient-dense food group, which can protect against cancers and non-communicable diseases, but only 28% of the UK’s population met the 5-a-day recommendation in 2018, increasing pressure on public health services. This secondary data analysis, using longitudinal panel data, analyses the impact of having children, on fruit and vegetable purchasing patterns in households in Great Britain, between 2012-2019.

Methods

Fruit and vegetable purchase volume (g/person/day) is explored between childless households and those with children, as well as sub-group analysis on households who had their first child during the panel period. Age of the youngest child, number of children in the household and years since birth of the first child were also explored. Data was analysed using Wilcoxon rank-sum tests, Chi-squared tests and a random effects model, with confounders identified through multivariable analysis.

Results

In 2019, households with children had lower fruit (-94g/person/day, 95% CI:-88 to -99, p<0.001) and lower vegetable purchase volume (-94g/person/day, 95% CI:-88 to -96, p<0.001). Fruit purchase volume decreased consistently in the years after the birth of a first child. Fruit purchase volume decreased by 1.4g/person/day (95% CI:-1.2 to -1.7, p<0.001) and vegetables by 1.6g/person/day (95% CI:-1.4 to -1.8, p<0.001) with increasing age of the youngest child. For each additional child in the household, there was a decrease in fruit purchase volume, of 26g/person/day (95% CI:-25 to -27, p<0.001) and a decrease in vegetables, of 28g (95% CI:-27 to -29, p<0.001).

Conclusions

These findings show evidence that having children in households in Great Britain is associated with a decrease in volume of fruit and vegetables purchased. This is exacerbated in households with more children, and as children get older. There is a need for targeted interventions that encourage the maintenance of fruit and vegetable consumption during the transition to, and early stages of parenthood to improve long-term nutrition for parents and their children.

Supervisors: Dr Arli Zarate and Grace O'Donovan

LinkedIn: https://www.linkedin.com/in/hsweet/

Alexander Tunkuda

Areas of interest

Adolescent, nutrition, supplementation, body composition

Summer project

Analysing changes in body composition after vitamin D and calcium supplementation in Zambian and Zimbabwean adolescents with HIV

Abstract

Background

Human immunodeficiency virus (HIV) is stubbornly prevalent among adolescents living in sub-Saharan Africa. Adolescence is a crucial period for an individual in many regards including body composition: 50% of adult body weight is acquired during puberty. HIV can disrupt this period due to impaired growth caused by among other things, undernutrition, chronic inflammation, and gastrointestinal illnesses. During an infection, fat mass tends to be lost first followed by muscle (lean) mass. However, HIV appears to induce an effect in hosts involving a preferential loss of lean over fat. Adolescents living with HIV (ALHIV) are therefore less likely to finish puberty with an optimal body composition.

Objectives

To test the hypothesis that vitamin D and calcium supplementation leads to gains in lean mass and gains in lean mass as a proportion of total mass gained, compared to controls and at different time points (48 and 96 weeks).

Methods

This was a secondary data analysis of a randomised controlled trial of 48 weeks of oral 20,000 IU vitamin D3 (weekly) and oral 500mg calcium carbonate (daily). It was given to ALHIV aged 11-19 who were on antiretroviral treatment (ART) for at least 6 months. Following descriptive analyses, data were analysed by linear regression, in models controlling for age categories, sex, baseline measures of the outcome variable, Tanner stage and viral load (by categories).

Results

After 48 and 96 weeks, there were no observed effects of supplementation on lean or fat mass or lean mass as a proportion of the total mass gained. There were no interactions between the trial arm and key covariables, Tanner stage and viral load. Individual analyses showed that at week 96 viral load negatively affected lean mass. Intervention participants with 60-1000 copies/uL demonstrated a 1.771 kg decrease in lean mass (p = 0.008), while intervention participants with >1000 copies/uL showed a 1.386 kg decrease in lean mass (p = 0.01).

Conclusions

While vitamin D and calcium supplementation did not lead to significant gains in lean mass outcomes in participants in the intervention cohort over time, it did not have a negative effect either. Public health recommendations should continue to encourage adequate intake of these nutrients to support various aspects of health, particularly in populations at risk of deficiency.

Supervisors: Professor Suzanne Filteau