bluuebunny/crossref_metadata_2025_split huggingface dataset:
Body mass index and obesity in Italy: results of CUORE Project-Health Examination Survey 2018-2019
Authors: Donfrancesco C , Profumo E , Buttari B , Lo Noce C , Minutoli D , Di Lonardo A , Bellisario P , Giampaoli S , Strazzullo P , Palmieri L 
Published: October 2020

Abstract

Background
The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends to halt the rise of obesity by 2025. Obesity is largely preventable. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project to investigate if Italy can meet the WHO-NCD target.

Methods
Within the health examination survey conducted in 2018-2019, mean level of BMI and prevalence of obesity (BMI &gt; =30 kg/m2) and overweight (25 &lt; =BMI&lt;30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women), from 8 Italian Regions in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. A standardized questionnaire was used to collect data on educational level that was used as a proxy of socio-economic status. The survey is funded by the Italian Ministry of Health-CCM.

Results
In this preliminary analysis, mean level of BMI was 26.8 kg/m2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m2 (25.6-26.3) in women. Prevalence of obesity was 19% (16-22) in men and 22% (19-25) in women; prevalence of overweight was 45% (41-48) in men and 28% (25-31) in women. Obesity resulted significantly higher in persons with lower educational level (primary or middle school) vs those with higher education: 26% (20-31) vs 16% (13-19) in men and 33% (27-38) vs 17% (14-20) in women. Both in men and women prevalence of obesity was significantly higher in the Southern regions.

Conclusions
Preliminary data show that more than half of Italian adults are overweight/obese. However, in comparison to BMI measured in the CUORE Project 10 years earlier, the prevalence of people at normal weight is increasing, moving in the direction of the WHO-NCDs obesity target. Preventive actions at community level should be more incisive in the population at low socio-economic level.

Key messages
Mean BMI and prevalence of obesity in the Italian general adult population are still high. If confirmed, in the last ten years an increase of normal weight prevalence in the Italian general adult population seems to be occurred.
Dietary and lifestyle habits of secondary school students in Subotica
Authors: Kosic Bibic N , Berenji K , Kovacevic J 
Published: October 2020

Abstract
Dietary habits, alcohol use and physical activity initiated in childhood and adolescence are often maintained during later life. Study objective was to investigate high school students' behavior patterns and nutritional status.
The cross-sectional study involved 301 students (16 years old) from two secondary schools in Subotica, North Backa Region. Study took place in October 2019. Students anonymously filled out a modified national questionnaire consisting of 27 questions and covering the areas: free time, physical activity, alcohol use, eating habits. Anthropometric measurements (height, weight) were done in schools. Statistical data processing was done in SPSS.
Boys were more physically active than girls, both in regard to competitive sports (36.4% vs. 8.2%) and recreational sports or other physical activity for at least 4 hours per week (15.2% vs. 7.3%). This difference is statistically significant (χ2=40.534; DF = 3; p = 0.001). More than a half of the students (58%) admitted drinking alcohol occasionally in the last 12 months and every fifth student during weekends. Daily consumption of breakfast is present in 44% students, fresh fruits in 28.3% and vegetables in 25.9%. On the contrary, 31.6% of them eat sweets and 30.8% drink sweetened soft drinks daily. There is a statistically significant difference in type of used fats, with boys using more often “bad” fats (χ2=12.884; DF = 3; p = 0.005). Every third student (32.5%) is overweight or obese (&gt;85th percentile).
The high percentage of students with BMI &gt; 85th percentile, poor nutrition habits, lack of physical activity, frequent alcohol use, indicated a need for stronger implementation of interventions aimed at adolescents and younger age groups. Following the study, a comprehensive intervention program was implemented in the period October-December 2019. The program included educational seminars, peer education, demonstrational cooking workshops, stands for parents, preparing an e-cookbook, sports and recreation fair.

Key messages
The results obtained underline a need for youth empowerment and environmental interventions to support their lifestyle change. It is our obligation to help them find a way to enhance their health potential as early as possible.
Exploring the relation between methylxanthines and plasma lipids in two population-based studies
Authors: Petrovic D , Pruijm M , Ponte B , Ackermann D , Ehret G , Zhang Z , Thijs L , Staessen J , Bochud M , Guessous I 
Published: October 2020

Abstract

Background
Chronic intake of caffeinated beverages might be associated with plasma lipids via disturbed lipid metabolism. Previous investigations have been limited by the use of self-reported caffeine intake instead of measured caffeine, whereas the associations between plasma lipids and other methylxanthines (paraxanthine, theobromine, theophylline) are unknown. Here, we investigated the associations of plasma lipids with caffeine and its metabolites in plasma and urine in two European populations.

Methods
Individuals were selected from the general population of North Belgium (FLEMENGHO) and Switzerland (SKIPOGH). Total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were measured in plasma using standard enzymatic methods. Plasma and 24h urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured using ultra-high performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of methylxanthines with plasma lipids while adjusting for major confounders.

Results
Overall, 1946 FLEMENGHO participants (911 men, age 45.9±15.2 years) and 990 SKIPOGH participants (467 men, age 47.1±17.3 years) were included. Mean plasma total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in FLEMENGHO/SKIPOGH were 5.37/5.06, 3.12/3.12, 1.43/1.50, and 2.4/1.02 mmol/L. In both cohorts, adjusted mean total cholesterol, LDL cholesterol, and HDL cholesterol, increased with quartile of plasma caffeine, with stronger associations in men. Similar positive associations were observed for paraxanthine and theophylline. Similar associations were observed using 24h urine excretions in SKIPOGH.

Conclusions
Plasma and urinary caffeine, paraxanthine, and theophylline were positively associated with plasma lipids in men, whereas there were fewer meaningful associations in women. The increase in plasma lipids might mitigate the overall beneficial impact of caffeinated beverages on health.

Key messages
Caffeine constitutes one of the most widely consumed biological active substances. Plasma concentration and urinary excretion of caffeine and its derived metabolites is positively associated with plasma lipids.
Policy infrastructure and mechanism to Promote “Health by All” Movement for Overturning Obesity
Authors: Lord A , Pan W , Li G , Chen H , Peng K , Song L , Chu N , Liou T , Liou Y , Wang Y 
Published: October 2020

Abstract

Background
Obesity is a pressing pandemic. However, major policies have targeted individual responsibility and focused on “losing weight or lowering calories”. Such approach has limited effect and overlooks the hidden obesity.

Methods
Under auspices of NHRI Forum, Taiwan; the WAKE.TAIWAN Research Team analyzed the global trends of policies, strategies, and literatures to formulate guiding principles for a total solution. 1. Defining obesity should go beyond body weight and emphasize more on healthy body composition and muscle mass, etc. 2. Effective obesity control strategy should facilitate building healthy living environments, lifestyle, and culture for natural flow of healthy behaviors. 3. All sectorial leaders should be involved in engaging and promoting healthy lifestyle culture and environment.

Results
”Guidelines for Establishing a lifestyle and Culture of Healthy Body Build” has been published as a blueprint for policy reform and strategies development, which consists of three parts. Part I emphasizes the active roles, social responsibilities, influence, and opportunities confronted the leaders and experts in all sectors and how government may facilitate these societal engagements, “Healthy by All”. The crucial sectors should include academia, NGO/NPO, industry/business, workplaces, healthcare systems, educational sectors, media and press, etc. Part II details on community spatial planning and architectural designs for healthy lifestyles. Part III proposes governmental “Health in All” infrastructure and mechanism.

Conclusions
We anticipate that the Guideline may draw out expertise and volunteering in all sectors of the society and help guide the public to take initiative in building such a culture of healthy-body-build and achieving this goal in all aspects of daily life.

Key messages
Emphasize on healthy body composition rather than body weight. Propagate 'Health by all' movement to foster building 'healthy physique' culture.
Factors that antimicrobial resistance in food systems: a participatory modelling approach
Authors: Majowicz S , Lambraki I , Cousins M , Parmley E J , Carson C 
Published: October 2020

Abstract

Background
Antimicrobial resistance (AMR) emerges from a complex web of factors; understanding their dynamics is key to determining sustainable solutions. Thus, we aimed to create a model of the diverse factors influencing AMR in two food systems and model the impacts of interventions.

Methods
We built a causal loop diagram (CLD) of the factors driving AMR in the food chain via 4 participatory workshops (2 in Sweden; 2 in Malaysia) with diverse stakeholders. The CLD became the structure of a compartmental model, which was populated using data from multiple sources (e.g., interviews, surveillance data). Using fuzzy set theory, quantitative and qualitative data were converted to categorical variables. The compartmental model was created in AnyLogic and was used to test how expert-selected solutions (e.g., taxation) might impact AMR under different scenarios.

Results
Factors identified as influencing AMR across Europe and Southeast Asia clustered around key themes: on-farm (e.g., biosecurity); social (e.g., consumer demand); research (e.g., alternatives to antimicrobials [AMs]); economic (e.g., agricultural production levels); policy (e.g., trade agreements); and environment (e.g., waste management). Differences were identified between regions, for example, regulations and standards regarding imports or food safety were more relaxed in Southeast Asia than in Europe. Identified interventions included: AMR education in schools, training diverse stakeholders in AM stewardship, increased on-farm biosecurity measures to limit disease and the need for AMs, and taxing AM-containing products.

Conclusions
Our model captured a range of multi-level, interlinked factors that impact AMR in the European and Southeast Asian food system contexts. Preliminary findings suggest that different principles need to be cultivated (e.g., polycentric governance, cross-sector partnerships) to ensure that interventions addressing AMR are sustainable over time.

Key messages
Our study visually characterized the interlinked factors that impact AMR transmission and emergence in food systems. Our approach provides a tool to model impacts of potential interventions.
Listeria monocytogenes clones in Italian food products: virulence and environmental adaptation
Authors: Torresi M , Rinaldi A , Centorotola G , Di Domenico M , Cammà C , Di Pasquale A , Pomilio F , Acciari V A 
Published: October 2020

Abstract

Background
Food is the main source of Listeria monocytogenes (Lm) infection. Lm is a highly heterogeneous species composed of hypervirulent and hypovirulent clones. Understanding the distribution of Lm clonal complexes (CCs) in different food categories has strong implications for risk assessment. The aim of this work was to analyse collection of Lm strains of National Reference Laboratory (NRL Lm) in order to assess link between genetic profile and matrices and the level of pathogenicity of circulating strains based on CCs.

Methods
NRL Lm database actually consists of 906 sequenced strains isolated in 10 years from 5 food compartments (meat, fish, dairy, vegetables and composite dishes). Epidata were analysed to remove redundant strains based on the same epidemiological description. After that, WGS data from 465 Lm strains were investigated. In silico MLST was defined and Roary 3.12.0 was used to obtain a pan-genome profile. Genes were later uploaded to Pasteur Institute platform for characterization.

Results
In silico MLST identified 36 CCs and 6 singleton. CC9 (23.0%), CC8 (15.3%) and CC121 (13.3%) were the prevalent CCs. In particular, CC9 was present in 35.2% of meat samples and CC8 in 25.8% of fish samples. Pan genome profile revealed high prevalence (&gt;98%) of genes related to biofilm formation and resistance to environmental stress in CC9 strains and genes involved in tolerance to quaternary ammonium compounds in CC121 strains.

Conclusions
Results, in particular for meat products, confirmed in Italy, the prevalence of hypovirulent Lm strains previously observed at European Union level. The high presence of stress resistance and disinfectant tolerance genes in these strains could make them able to persist in food-production environment and should be taken into account evaluating the health hazards. In fish product is also relevant the prevalence of CC8 strains which are potentially highly pathogenic and have been responsible of recent European multi country outbreak.

Key messages
Pangenome of Listeria monocytogenes isolated from Italian food revealed high presence of disinfectant tolerance and stress resistance genes in meat products and virulence genes in fish products. Listeria monocytogenes CC9 and CC121 prevalence in Italian meat product confirms occurrence of hypovirulent strains detected at European Union level.
Evaluation of a food safety training intervention in an asylum-seeking population in Rome
Authors: Pattavina F , Barbara A , Cruciani I , Calabrese A C , Mazzetta E , Sezzatini R , Tuti F , Laurenti P 
Published: October 2020

Abstract
The integration of asylum seekers is a public health issue in various contexts, including food, where they often work. According to European legislation, every food operator is obliged to follow training courses on food safety knowledge in order to prevent food-borne diseases. This study aims to evaluate a food safety training intervention in a population of asylum seekers in Rome through the use of a specific tool validated by the WHO, to introduce them in of catering.
The 'Five Key Points for Safer Food' manual was used to deliver the course. An evaluation test for participants to assess the impact of the food safety training is included, divided into 4 categories: General Information, Knowledge (11 items), Attitudes (10) and Behavior (10). The involved food handlers received the same test before and after training. In order to evaluate the effectiveness of the training intervention, the difference in the average of correct pre and post-test answers, overall and by category, was analyzed.
Overall, the 69 food handlers comprised 34 (49.3%) females and 35 (50.7%) males, from different continents (36.2% from Africa, 30.5% Central-South America and 33.3% Asia). The 57.3% has previously worked as cook or waiter. The average age was 36.6 (±12.5) with 11.4 (±3.9) years of education. Overall, the average of correct answers increases of 11.6% (from 76.4% to 88.0% correct answers pre and post-test; p &lt; 0.0001). Knowledge pre test was 7.7 (±1.4), while post test was 8.9 (±1.7) (p &lt; 0.0001). Attitude pre test was 8.3 (±2.2), post test was 9.6 (±0.9) (p &lt; 0.0001). Behavior pre test was 7.7 (±2.2), post test 8.8 (±1.9) (p &lt; 0.0001).
Despite cultural and linguistic differences, our training intervention has been effective in improving knowledge, attitudes and behaviors on food safety in the target population. The food safety in these contexts cannot be understood only as the fulfilment of a regulatory obligation, but also as an opportunity for aggregation and social integration.

Key messages
Food cooking represents a social integration tool: asylum seekers from the most disadvantaged countries could prepare safe multi-ethnic dinners based on the typical courses of their country of origin. WHO training intervention on food safety was effective in improving knowledge, attitudes and behaviors in the target population.
Store Environment Assessment (SEA) Tool: Design and validation of a food environment audit protocol
Authors: Jago E , Minaker L , Mah C L 
Published: October 2020

Abstract

Background
Unhealthy food environments are key factors in diet-related disease risk. Many audit methods have been designed for the retail food environment, but weaknesses of existing methods include: validity in study methods and design, and heterogeneity in adaptation and analysis methods. This paper describes the development and validation of a novel protocol for designing store audit instruments - the Store Environment Assessment (SEA) Tool.

Methods
This research involved four steps: 1. a scoping review of consumer food environment audit tools; 2. classify key variables from the literature; 3. use the variables to design a protocol for development of audit instruments tailored to local contexts and research questions; and 4. validate the protocol by designing and validating a sample audit tool based on Canada's Food Guide (2019).

Results
Variables from the literature included: Product (availability, variety, size, reference), Price, Promotion, Placement-accompanied by: definition, type of variable, range of values, scale of measurement, and measurement outcome. The protocol has seven steps: identify dietary guideline criteria; conduct content analysis; define setting; align research questions with scale and scope; variable selection; audit tool design; and validation strategy. The protocol was used to design a store audit instrument for Canadian jurisdictions, based on Canada's Food Guide, and validated against the gold standard, Nutrition Environment Measures Survey (NEMS).

Discussion
The SEA protocol can strengthen researchers and practitioners' capacity to use structured guidelines to develop geographically and socio-demographically relevant Store Environment Assessments, and avoid heterogeneity arising from ad hoc adaptations of tools such as NEMS. Our methodological approach can support greater consistency, feasibility, and rigour of food environment audits for diverse public health research and practice objectives.

Key messages
Researchers and practitioners will be able to utilize the SEA tool protocol, using jurisdictional food and nutrition criteria, to better assess 4Ps related to food, in retail food environments. The variables and measurement outcomes included in the SEA tool protocol will support public health practitioners in developing relevant interventions to support healthy consumer food purchasing.
Potential effects of a sugar-sweetened beverages tax on socioeconomic inequalities in health
Authors: Djojosoeparto S K , Eykelenboom M , Renders C , Olthof M R , van Stralen M M , Steenhuis I , Poelman M P , Kamphuis C B M 
Published: October 2020

Abstract

Background
Sugar-Sweetened Beverages (SSBs) taxes have been implemented in several countries, however, little is known on how an SSBs tax may impact on low and high socioeconomic groups differently. Therefore, the aim of this study was to gain insight into the perceptions of different stakeholder groups in the Netherlands on (1) the contribution of an SSBs tax to socioeconomic inequalities in diet and health and (2) the mechanisms via which an SSBs tax may influence these inequalities.

Methods
Semi-structured interviews were held in the Netherlands in March-May 2019 with 27 participants from the following stakeholder groups: health and consumer organisations, health professional associations, advisory bodies, scientists, trade organisations, policy makers, and politicians. Interview transcripts were analysed following a thematic content approach.

Results
Participants from all stakeholder groups indicated that an SSBs tax would have a larger impact on the budget and SSB consumption of lower socioeconomic groups. With that, an SSBs tax could have larger health benefits among lower socioeconomic groups as a result of cutting down on SSBs. A few participants - from science and a health professional association - discussed possible unwanted effects of an SSBs tax (e.g. lower socioeconomic groups may compensate their lower SSB consumption with other unhealthy behaviour). Some participants emphasised that an SSB tax should only be introduced when accompanied by other measures (e.g. educational efforts, offering healthy alternatives).

Conclusions
Our results imply that most stakeholders agree that an SSBs tax could contribute to a reduction of socioeconomic inequalities in diet and health. However, in order to be effective and to prevent that an SSBs tax leads to a widening of inequalities, it is important to carefully monitor behavioural changes of socioeconomic groups in response to an SSBs tax, and to implement an SSBs tax as part of a comprehensive policy approach.

Key messages
An SSBs tax could contribute to a reduction of socioeconomic inequalities in health, according to Dutch stakeholders. It is important to carefully monitor behavioural changes of socioeconomic groups in response to an SSBs tax, and to implement an SSBs tax as part of a comprehensive policy approach.