G 2 | Orals | SPHC 2024

Room

1er étage - F130


Theme

Nutrition and health results


Chair

TBD.



Title
Reducing Food Waste Through Distribution of Food to Community Organizations: A Qualitative Study

Name
David Campbell

Affiliation
University of Calgary, Cumming School of Medicine 


Abstract

Background:
Food waste is a global problem contributing to the climate change crisis, while also being inherently morally problematic. One of the greatest sources of potential waste is at the point of food sales. To combat this issue, grocery stores in the Canton de Vaud have partnered with local charities that repurpose donated food to be given to or prepared for people in need. Our objective was to explore the experiences of the various actors participating in these donation programs within the Canton de Vaud to better understand the challenges, opportunities, and constraints of participating in the program.

Methods:
We undertook a qualitative descriptive study using interviews and field observations of organizations involved in the food redistribution process in the Canton de Vaud. Interviews were audio-recorded and transcribed, followed by inductive thematic analysis conducted by two analysts. 

Results:
We collected interviews with 2 food delivery organizations, 4 participating grocery stores and 8 recipient social service organizations, supplemented by 6 field observations. Our analysis revealed 4 major themes. i) Working collaboratively across organizations, ii) Creativity in food preparation, iii) Nutritional considerations, and iv) Food selection and triage processes. Organizations described working together for the collective good, such as being mindful of other organizations who also depend on the food delivery system. An essential component for these organizations to succeed is to foster creativity for food preparation due to the unpredictable nature of the available food products. This was commonly facilitated by hiring a professional chef who could creatively approach meal planning. Most of the foods delivered are healthy, nutritious foods such as fruits and vegetables, as well as some meats and dairy products, which are used to make balanced and nutritious meals for beneficiaries. The selection of optimal products is a theme among all organizations, starting with sorting at the grocery store, and ending with the organizations deciding which ingredients to use in their meal preparation each day. 

Conclusion:
The food donation programs currently operating in the Canton de Vaud are an effective way to reduce food waste, while supplying populations who face social disadvantages with nutritious and balanced food options. This system can only function with the cooperation of all involved but can be of great benefit if executed correctly.



Title
Eating habits of people with an intellectual disability: Exploring environmental determinants 

Name
Franziska Pfister 

Affiliation
Berner Fachhochschule Gesundheit

Abstract

Individuals with an intellectual disability (ID) face a higher risk of health inequalities and generally exhibit a higher prevalence of overweight and obesity compared to the general population. Tailored long-term health promotion strategies must facilitate a healthier diet. Eating habits of people with an ID, however, are strongly affected by social and environmental determinants arising from the residential care settings they live in. Little is known about these determinants in Swiss residential care settings. This study aimed at identifying these factors.

We chose a qualitative description study design. It included thirteen semi-structured interviews about eating and diet with support staff and parents of people with a mild to severe ID. They were recruited from three residential care settings in the Canton of Solothurn. Four additional interviews about the institutions’ eating environment were carried out with support staff. The semi-structured interviews were voice recorded, transcribed ad verbatim and analyzed with thematic analysis, while the eating environment interviews were summarized.

We identified four groups of environmental and social determinants influencing eating habits of people with an ID in residential care: Their degree of participation in meal choice and food preparation, the way housing groups dealt with weight issues, the knowledge and attitudes of caretakers regarding a balanced diet and available human resources and time. The determinants are often interdependent, the lack of human resources influencing people with an ID’s participation in meal preparation for instance. An overarching determinant faced by caretakers was the dilemma between the target group’s level of self-determination versus their health.

By adapting environmental and social determinants in Swiss residential care settings for persons with an ID, the healthier choice could be made the easier choice and pressure on the target group’s behavior could be diminished. Individuals with an ID’s attitudes towards healthier eating habits could be improved. For this to be possible, caretakers must be provided with evidence-based information regarding diet and weight management. Additional financial resources for staffing will be crucial to improve long-term health of people with an ID.


Title
Effects of a social dilemma framing and lifestyle factors on the footprint of food choices

Name
Aguirre Sánchez Lucía

Affiliation
Università della Svizzera italiana (USI) & SSPH+


Abstract

This study examined the effect of framing the climate impact of diets as a collective action problem, or social dilemma, on the climate footprint of food choices. We assessed the effect of a collective action framing (dilemma) compared or in combination with a reflective intervention (information) and a choice architecture intervention (menu nudge), as well as the interactions with lifestyle factors.

A randomized 2X2X2 between-subjects experiment was conducted among university students in Switzerland. Inclusion criteria were being 18 years or older, enrolled as a student at a Swiss university, and not following a medically prescribed diet. The main outcome was the mean climate footprint of food choices in kilograms of CO2-equivalents (kg CO2-eq) based on life cycle analysis (LCA). Food choices were elicited on a meal selection task scenario. Meals varied in climate footprints while adhering to the Swiss dietary guidelines.

This analysis focused on the subset of 1691 student meat eaters (i.e., flexitarian or omnivorous). Median age was 24 years, and 59.85% (n=1012) were female. All the seven intervention groups resulted in significantly lower climate footprints compared to the control group. The dilemma framing plus a menu nudge was the most effective intervention leading to a footprint reduction of 1.20 kg CO-eq (20.37%) compared to the control group (Mcontrol=5.94, SDcontrol=2.76; Mdilemma+nudge=4.74, SDdilemma+nudge=2.09 t(436) = -5.10, p < 0.001). Lifestyle factors linked to higher climate footprint of food choices included adherence to a low-calorie diet (1.21 kg CO2-eq, p < 0.05), or a muscle gain diet (2.12 kg CO2-eq p < 0.05) and practising physical activities (PA) while adhering to a muscle-gain diet (Aerobic/Cardio: 3.82 kg CO2-eq, p < 0.05; Muscle-strengthening: 2.24 kg CO2-eq, p < 0.05; Vigorous PA: 2.65 kg CO2-eq, p < 0.05; Moderate PA: 3.70 kg CO2-eq, p < 0.05). The dilemma plus a nudge led to footprint reductions that were large enough to offset the extra footprint associated with these factors.

Adherence to a muscle-gain diet was identified as critical lifestyle factor linked to higher climate footprint. Overall, a dilemma framing plus a nudge was the most effective intervention to lower the climate footprint of food choices, even among the muscle-gain diet sub-group. Our findings provide supporting evidence on the potential of combining collective action communication with menu nudges to reduce the climate footprint of food choices.



Title
Ferritin testing and iron deficiency rates in primary care: a retrospective cohort study

Name
Jäger Levy

Affiliation
University Hospital Zurich, Institute of Primary Care


Abstract

Introduction:
Iron deficiency is a common condition that presents as either non-anaemic iron deficiency (NAID) or as iron deficiency anaemia (IDA). The diagnosis of iron deficiency is mainly based on the assessment of serum ferritin (SF) concentrations. Although SF is frequently requested by Swiss general practitioners (GPs), little is known about how SF testing is used. Furthermore, guidelines vary widely regarding the recommended SF cut-off for the diagnosis of iron deficiency, which may have a substantial impact on the rates of iron deficiency diagnosis and, as a consequence, may lead to substantial overtreatment. The aim of this study was to investigate the determinants of SF testing and to estimate the impact of the choice of SF cut-off on the incidence of iron deficiency and its two sub-forms, IDA and NAID, in Swiss primary care.

Methods:
We conducted a retrospective cohort study using data from the FIRE project, an electronic medical records database of Swiss primary care, for the period 2021–2023. We examined SF testing using Cox models, expressing associations as adjusted hazard ratios (aHRs). We estimated the incidence rate of SF testing and the incidence rate of iron deficiency, IDA and NAID using SF cut-offs of 15, 30 and 45 ng/mL.

Results:
Among the 218256 study patients, SF testing had an incidence rate of 229.2 tests per 1000 patient-years (95% confidence interval 227.7–230.6) and showed the strongest sex- and age-adjusted associations with anaemia (AHR 1.69 [1.65–1.72]) and history of iron therapy (AHR 1.51 [1.48–1.54]). Female patients were more likely to receive SF testing than male patients, even at postmenopausal age and after adjustment for anaemia and previous iron therapy. Female GPs were more likely to request SF testing than male GPs (AHR 1.23 [1.06–1.43]). Per 1000 patient-years and with SF cut-offs of 15, 30 and 45 ng/mL, the incidence rates of iron deficiency were 13.3 cases (13.0–13.7), 37.1 cases (36.5–37.7) and 60.4 cases (59.7–61.2), respectively. NAID accounted for 66.9%, 79.6% and 84.2% of iron deficiency cases at the 15, 30 and 45 ng/mL cut-off, respectively.

Conclusions:
Our study revealed a strong impact of the choice of SF cut-off on the rates of iron deficiency diagnosis, particularly of NAID. The underlying inconsistency in guidelines calls for a harmonisation of diagnostic criteria for iron deficiency in primary care to address potential overdiagnosis and overtreatment.



Title
Lessons from the 1st Swiss national survey on child and adolescent nutrition: menuCH-Kids

Name
Julia Vincentini

Affiliation
Unisanté


Abstract

The 1st national nutrition survey in children and adolescents in Switzerland, menuCH-Kids, is currently carried on by a dozen institutions on a FSVO mandate. It aims at collecting dietary, health and lifestyle data, including blood and urine samples, in 2000 randomly selected 6-17 years old, in the 3 main linguistic regions. By its complexity, this project raised challenges, and lessons can be drawn from its implementation, even if it’s running successfully.

The complexity of this project came from several “added” layers:

- the administrative load of working with 13 institutions

- the challenges of studying children (specific communication, higher no-shows, age-specific requirements)

- the high level of coordination and training to ensure interoperable procedures for six study centers

- the complex organization of the 1h45 visit, shared by a pediatric nurse and a dietician

- Switzerland's multilingual character

- the wide variety of data collected (questionnaire, anthropometry, complex dietary data…) demanding considerable work to integrate, clean and link them

- the collection of biosamples under strict procedures for analysis and biobanking

- the influence of seasons on diet and some biomarkers, requiring to spread the participants over a whole year

- the tight budget pressurizing all the above.

To meet these challenges, we signed a consortium agreement regulating governance and finances, and carried out a set-up phase and dry runs to test the study design against field reality and anticipate potential pitfalls. Overall, an appropriate task division is probably the keys to success: we have a close-knit coordinating team, a data management team, a biobank manager, an institute recruiting participants, a communication agency and professional translators. Finally, extended SOPs, centralized training, regular data quality checks, monthly meetings, site visits and continuous recruitment monitoring enable us to anticipate potential issues and stick to the protocol, to collect data of the highest possible quality to monitor what’s happening in the population today.

The complexity of this data collection emphasizes the importance of sharing the data, which will help to better understand cultural, age-related, sex-related or other differences in nutrition and health behaviors, and maybe outline specific “at-risk” subgroups. Ultimately, the analyses of these science-based data aim to help to develop further public health nutrition policies.