Scholars have demonstrated that common ways of performing charitable food aid in high-income countries maintain a powerless and alienated status of recipients. Aiming to protect the dignity of... Show moreScholars have demonstrated that common ways of performing charitable food aid in high-income countries maintain a powerless and alienated status of recipients. Aiming to protect the dignity of recipients, alternative forms of food aid have taken shape. However, an in-depth understanding of dignity in the context of food aid is missing. We undertook a scoping review to outline ways in which the dignity of recipients is violated or protected across various forms of food aid in high-income countries. By bringing scientific results together through a social dignity lens, this paper offers a complex understanding of dignity in the context of food aid. The online database Scopus was used to identify scientific literature addressing food aid in relation to the dignity of recipients in high-income countries. The final selection included 37 articles representing eight forms of food aid in twelve countries. Across diverse forms of food aid, the selected studies report signs of (in)dignity concerning five dimensions: access to food aid, social interactions, the food, the physical space, and needs beyond food. Research gaps are found in the diversity of forms of food aid studied, and the identification of social standards important for recipients. Bringing the results of 37 articles together through a social dignity lens articulates the complex and plural ways in which the dignity of recipients is violated or protected. In addition, this review has demonstrated the usefulness of a social dignity lens to understand dignity across and in particular food aid contexts. Show less
BackgroundSuboptimal vitamin D status is common in people with celiac disease (CeD), a disease that can be characterized by the presence of serum anti-tissue transglutaminase antibodies (TG2A) (i.e... Show moreBackgroundSuboptimal vitamin D status is common in people with celiac disease (CeD), a disease that can be characterized by the presence of serum anti-tissue transglutaminase antibodies (TG2A) (i.e., TG2A positivity). To date, it remains unclear whether childhood TG2A positivity is associated with vitamin D status and how this potential association can be explained by other factors than malabsorption only, since vitamin D is mainly derived from exposure to sunlight. The aim of our study was therefore to assess whether childhood TG2A positivity is associated with vitamin D concentrations, and if so, to what extent this association can be explained by sociodemographic and lifestyle factors.MethodsThis cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort. We measured serum anti-tissue transglutaminase antibodies (TG2A) concentrations and serum 25-hydroxyvitamin D (25(OH)D) concentrations of 3994 children (median age of 5.9 years). Children with serum TG2A concentrations >= 7 U/mL were considered TG2A positive. To examine associations between TG2A positivity and 25(OH)D concentrations, we performed multivariable linear regression, adjusted for sociodemographic and lifestyle factors.ResultsVitamin D deficiency (serum 25(OH)D < 50 nmol/L) was found in 17 out of 54 TG2A positive children (31.5%), as compared to 1182 out of 3940 TG2A negative children (30.0%). Furthermore, TG2A positivity was not associated with 25(OH)D concentrations (beta -2.20; 95% CI -9.72;5.33 for TG2A positive vs. TG2A negative children), and this did not change after adjustment for confounders (beta -1.73, 95% CI -8.31;4.85).ConclusionsOur findings suggest there is no association between TG2A positivity and suboptimal vitamin D status in the general pediatric population. However, the overall prevalence of vitamin D deficiency in both populations was high, suggesting that screening for vitamin D deficiency among children, regardless of TG2A positivity, would be beneficial to ensure early dietary intervention if needed. Show less
Velde, L.A. van der; Dijk, W. van; Numans, M.E.; Kiefte-de Jong, J.C. 2022
ObjectiveTo examine whether an extended Theory of Planned Behavior (TPB) that included finance-related barriers better explained dietary quality.DesignCross-sectional survey.ParticipantsOne... Show moreObjectiveTo examine whether an extended Theory of Planned Behavior (TPB) that included finance-related barriers better explained dietary quality.DesignCross-sectional survey.ParticipantsOne-thousand and thirty-three participants were included from a Dutch independent adult panel.Main OutcomeDietary quality.AnalysisFive TPB models were assessed: a traditional TPB, a TPB that included direct associations between attitude and subjective norm with dietary quality, a TPB that additionally included financial scarcity or food insecurity, and a TPB that additionally included financial scarcity and food insecurity simultaneously. Structural relationships among the constructs were tested to compare the explanatory power.ResultsThe traditional TPB showed poorest fit (χ2/degrees of freedom = 11; comparative fit index = 0.75; root mean square error of approximation [95% confidence interval], 0.10 [0.091–0.12]; standardized root mean square residual = 0.049), the most extended TPB (including both financial scarcity and food insecurity) showed best fit (χ2/degrees of freedom = 3.3; comparative fit index = 0.95; root mean square error of approximation [95% confidence interval], 0.050 [0.035–0.065]; standardized root mean square residual = 0.018). All 5 structure models explained ∼42% to 43% of the variance in intention; however, the variance in dietary quality was better explained by the extended TPB models, including food insecurity and/or financial scarcity (∼22%) compared with the traditional TBP (∼7%), indicating that these models better explained differences in dietary quality.Conclusions and ImplicationsThese findings highlight the importance of accounting for finance-related barriers to healthy eating like financial scarcity or food insecurity to better understand individual dietary behaviors in lower socioeconomic groups. Show less
Janssen, J.M.M.; Velde, L.A. van der; Kiefte-de Jong, J.C. 2022
Food insecurity is an important public health concern; however, research into this phenomenon within the Netherlands is limited. Food insecurity is not solely related to individual factors, but can... Show moreFood insecurity is an important public health concern; however, research into this phenomenon within the Netherlands is limited. Food insecurity is not solely related to individual factors, but can also be influenced by various factors in the social and physical environment. Therefore, this study aimed to identify determinants of food insecurity within the personal, social and physical environment, based on the social ecological model (SEM), and to identify their relative importance for experiencing food insecurity. The study population consisted of 307 participants living in disadvantaged neighbourhoods of the Dutch city The Hague, of which approximately one-quarter were food insecure. Participant characteristics showing bivariate associations P < 0.20 were placed in a predetermined level of the SEM, after which a multivariate logistic regression was performed for each level and the Nagelkerke pseudo R-2 was presented. Determinants of food insecurity were BMI, gross monthly income, highest educational attainment, smoking status, diet quality, employment status, marital status and religion (P < 0.05). The results showed that 29.7 % of the total variance in food insecurity status was explained by all included determinants together. The personal, social and physical environment explained 20.6, 14.0 and 2.4 % of the total variance, respectively. Our findings suggest that determinants within the personal environment are most important for explaining differences in experienced food insecurity. The present study contributes to furthering the knowledge about the relative importance of the personal, social and physical environment, indicating that determinants within the personal environment may be most promising for developing targeted interventions to reduce food insecurity. Show less
Smagge, B.A.; Velde, L.A. van der; Kiefte-de Jong, J.C. 2022
In the Netherlands, the neighbourhood food environment has received little attention in initiatives to combat overweight/obesity. This study maps the food environment around primary schools in The... Show moreIn the Netherlands, the neighbourhood food environment has received little attention in initiatives to combat overweight/obesity. This study maps the food environment around primary schools in The Hague, The Netherlands, and examines associations between neighbourhood disadvantage, the school food environment and childhood overweight using Geographic Information Systems (GIS). Linear regression analyses were performed to test the association between schools' disadvantage scores (proxy for neighbourhood disadvantage) and relative fast-food density within 400 m and 1000 m and fast-food proximity. Univariable and multivariable linear regression analyses were used to test the association between the school food environment and overweight prevalence among children in the respective sub-district in which the schools is found. Multivariable analyses were adjusted for the schools' disadvantage scores. Results show that fast-food outlets were available around most primary schools. Schools in disadvantaged neighbourhoods were closer to and surrounded by a higher number of fast-food restaurants, grillrooms and kebab shops. On the sub-district level, the density of such fast-food outlets was associated with overweight prevalence among children. These findings highlight the importance of national and local policies to improve the food environment, particularly in disadvantaged neighbourhoods. Show less
The overall aim of this thesis was to gain a clearer picture of the prevalence of food insecurity in the Netherlands and its consequences for dietary quality and health. The studies included in... Show moreThe overall aim of this thesis was to gain a clearer picture of the prevalence of food insecurity in the Netherlands and its consequences for dietary quality and health. The studies included in this thesis provide potential targets for interventions aimed at reducing food insecurity among affected people and families in the Netherlands.Based on this thesis, we can conclude that a considerable number of people in the Netherlands experience food insecurity. The findings described in this thesis provide insight into the consequences: food insecurity is associated with obesity, poor physical and mental health, and poor dietary quality. Our results also illuminate the role of sociodemographic and lifestyle factors, psychosocial factors and the food environment in these associations. In addition, our findings offer a clearer understanding of the perceived needs, perceptions and barriers regarding healthy eating among people at risk of experiencing food insecurity, as well as suggesting potential interventions. This thesis has shown that the issue of food insecurity needs to be better recognized and addressed in the Netherlands, for example through the development and implementation of population-based and risk group-based interventions for which appropriate screening and targeted interventions should be further explored. Show less
Objectives The aim of this study was to examine the added value of food insecurity in explaining poor physical and mental health beyond other socioeconomic risk factors. Design, setting,... Show moreObjectives The aim of this study was to examine the added value of food insecurity in explaining poor physical and mental health beyond other socioeconomic risk factors. Design, setting, participants and outcome measures Data for this cross-sectional study were collected using questionnaires with validated measures for food insecurity status and health status, including 199 adult participants with at least 1 child living at home, living in or near disadvantaged neighbourhoods in The Hague, the Netherlands. To assess the added value of food insecurity, optimism-corrected goodness-of-fit statistics of multivariate regression models with and without food insecurity status as a covariate were compared. Results In the multivariable models explaining poor physical health (Physical Component Summary: PCS) and mental health (Mental Component Summary: MCS), from all included socioeconomic risk factors, food insecurity score was the most important covariate. Including food insecurity score in those models led to an improvement of explained variance from 6.3% to 9.2% for PCS, and from 5.8% to 11.0% for MCS, and a slightly lower root mean square error. Further analyses showed that including food insecurity score improved the discriminative ability between those individuals most at risk of poor health, reflected by an improvement in C-statistic from 0.64 (95% CI 0.59 to 0.71) to 0.69 (95% CI 0.62 to 0.73) for PCS and from 0.65 (95% CI 0.55 to 0.68) to 0.70 (95% CI 0.61 to 0.73) for MCS. Further, explained variance in these models improved with approximately one-half for PCS and doubled for MCS. Conclusions From these results it follows that food insecurity score is of added value in explaining poor physical and mental health beyond traditionally used socioeconomic risk factors (ie, age, educational level, income, living situation, employment status and migration background) in disadvantaged communities. Therefore, routine food insecurity screening may be important for effective risk stratification to identify populations at increased risk of poor health and provide targeted interventions. Show less
Background and Aims: An appropriate diet is an essential component of the management of Type 2 Diabetes Mellitus (T2DM). However, for many people with T2DM, self-management is difficult. Therefore,... Show moreBackground and Aims: An appropriate diet is an essential component of the management of Type 2 Diabetes Mellitus (T2DM). However, for many people with T2DM, self-management is difficult. Therefore, the Beyond Good Intentions (BGI) education program was developed based on self-regulation and proactive coping theories to enhance people's capabilities for self-management. The aim of this study was to determine the effectiveness of the BGI program on improving dietary quality among a preselected group of people with T2DM after two-and-a-half years follow-up.Methods: In this randomized controlled trial, 108 people with T2DM were randomized (1:1) to the intervention (n = 56) (BGI-program) or control group (n = 52) (care as usual). Linear regression analyses were used to determine the effect of the BGI program on change in dietary quality between baseline and two-and-a-half years follow-up. In addition, potential effect modification by having a nutritional goal at baseline was evaluated. Multiple imputation (n = 15 imputations) was performed to account for potential bias due to missing data.Results: According to intention-to-treat analysis, participants in the intervention group showed greater improvements in dietary quality score than participants in the control group (beta = 0.71; 95%CI: 0.09; 1.33) after follow-up. Having a nutritional goal at baseline had a moderating effect on the effectiveness of the BGI program on dietary quality (p-interaction = 0.01), and stratified results showed that the favorable effect of the intervention on dietary quality was stronger for participants without a nutritional goal at baseline (no nutritional goal: beta = 1.46; 95%CI: 0.65; 2.27 vs. nutritional goal: beta = -0.24; 95%CI: -1.17; 0.69).Conclusions: The BGI program was significantly effective in improving dietary quality among preselected people with T2DM compared to care as usual. This effect was stronger among participants without a nutritional goal at baseline. A possible explanation for this finding is that persons with a nutritional goal at baseline already started improving their dietary intake before the start of the BGI program. Future studies are needed to elucidate the moderating role of goalsetting on the effectiveness of the BGI program. Show less
Objective: To examine whether an extended Theory of Planned Behavior (TPB) that included financerelated barriers better explained dietary quality. Design: Cross-sectional survey. Participants: One... Show moreObjective: To examine whether an extended Theory of Planned Behavior (TPB) that included financerelated barriers better explained dietary quality. Design: Cross-sectional survey. Participants: One-thousand and thirty-three participants were included from a Dutch independent adult panel. Main Outcome: Dietary quality. Analysis: Five TPB models were assessed: a traditional TPB, a TPB that included direct associations between attitude and subjective norm with dietary quality, a TPB that additionally included financial scarcity or food insecurity, and a TPB that additionally included financial scarcity and food insecurity simultaneously. Structural relationships among the constructs were tested to compare the explanatory power. Results: The traditional TPB showed poorest fit (x2 /degrees of freedom = 11; comparative fit index = 0.75; root mean square error of approximation [95% confidence interval], 0.10 [0.091−0.12]; standardized root mean square residual = 0.049), the most extended TPB (including both financial scarcity and food insecurity) showed best fit (x2 /degrees of freedom = 3.3; comparative fit index = 0.95; root mean square error of approximation [95% confidence interval], 0.050 [0.035−0.065]; standardized root mean square residual = 0.018). All 5 structure models explained »42% to 43% of the variance in intention; however, the variance in dietary quality was better explained by the extended TPB models, including food insecurity and/or financial scarcity (»22%) compared with the traditional TBP (»7%), indicating that these models better explained differences in dietary quality. Conclusions and Implications: These findings highlight the importance of accounting for financerelated barriers to healthy eating like financial scarcity or food insecurity to better understand individual dietary behaviors in lower socioeconomic groups. Show less
Velde, L.A. van der; Nyns, C.J.; Engel, M.D.; Neter, J.E.; Meer, I.M. van der; Numans, M.E.; Kiefte-de Jong, J.C. 2020
BackgroundFood insecurity is related to risk of adverse health outcomes such as obesity, but the explanatory factors underlying this association are still unclear. This study aimed to assess the... Show moreBackgroundFood insecurity is related to risk of adverse health outcomes such as obesity, but the explanatory factors underlying this association are still unclear. This study aimed to assess the association between food insecurity and obesity, and to explore potential mediation by sociodemographic and lifestyle factors.MethodsThis cross-sectional study was conducted among 250 participants in a deprived urban area in the Netherlands. Data on sociodemographic and lifestyle factors, food insecurity status and diet quality were collected using questionnaires. Diet quality was determined based on current national dietary guidelines. BMI was calculated from self-reported height and weight. Regression analyses were performed to explore the association between food insecurity and BMI status. Mediation analyses were performed to estimate the total-, direct-, and indirect effect and proportion of total effect mediated of the food insecurity-obesity association.ResultsThe overall prevalence of food insecurity was 26%. Food insecurity was associated with obesity (OR=2.49, 95%CI=1.16, 5.33), but not with overweight (OR=1.15, 95%CI=0.54, 2.45) in the unadjusted model. The food insecurity-obesity association was partially mediated by living situation (proportion mediated: 15.4%), diet quality (-18.6%), and smoking status (-15.8%) after adjustment for other covariates.ConclusionsThe findings of this study suggest an association between food insecurity and obesity. Living situation, diet quality and smoking status explained part, but not all, of the total association between food insecurity and obesity. Future longitudinal studies are warranted to examine the temporal order of the food insecurity-obesity association and potential mediators in this relationship. In addition, food insecurity and its potential consequences need to be taken into account in obesity prevention programs and policies. Show less
