Comparison of nutrition-related risk factors for chronic diseases across countries, using CIH field trial data

Background. Chronic diseases have been among the most dominant sources of mortality and morbidity worldwide in recent decades. Community intervention, aiming to change unhealthy behavior and to build an environment encouraging and supporting healthy activities, has been suggested to be an effective and economic means to prevent and control for some non-communicable diseases (NCDs). Community Intervention for Health (CIH) program is a multi-site community intervention program launched by Oxford Health Alliance. This program targets three major risk factors (poor diet, tobacco use and physical inactivity) to chronic disease and is carried out in several kinds of communities. The prevalence of those risk factors in the population level is associated with the related community environment. A pilot study is now under way in China, India, UK and Mexico. A 6% or more decrease in the prevalence of each risk factor is expected to be observed after a 2.5-year intervention.;Methods. Before the baseline, a field trial was performed to test surveys and 94 students from the four settings (China, India, UK and Mexico) participated in the Youth Module test. The questionnaire measured demographics, socioeconomic status, general health, food item consumption, nutrition-related knowledge and supportive environments from school and family related to healthy eating. It also measured public influences such as advertisements mentioned eating more fruits and vegetables through various media. ANOVA for continuous covariates and the chi2-test for categorical covariates were applied to compare the differences across countries. Ordinal logistic regression models for each food item intake frequency and the Generalized Estimating Equations (GEE) model for overall dietary habits were applied to explore the potential relationship between food item consumption (the primary outcome) and other factors.;Results. Students from China had the best dietary habits (an overall score of 14.53 for China vs. 12.06 for India, 10.35 for the UK and 10.74 for Mexico) and their families provided them a good environment for healthy diet (an overall score of 15.80 for China vs. 12.61 for India, 13.04 for the UK and 13.11 for Mexico). The UK had the most supportive environments from schools, media and other social departments to distribute information related to healthy eating (an average count of exposure types of 6.14 for the UK vs. 5.60 for China, 2.54 for India and 4.57 for Mexico). Multivariate analysis suggested that Chinese students performed better than students from the other three countries in terms of foods consumption frequencies overall, including both healthy and unhealthy foods (compared with China, the GEE model obtained the odds of the healthiest food behavior was 0.779 (p=0.265) for India, 0.514 (p=0.005) for the UK, and 0.398 (p<0.001) for Mexico). Additionally, a healthier style of overall food item consumption was significantly associated with a lighter depression/stress burden (GEE model coefficient estimate -0.044, p<0.001) and a more positive reaction to nutrition labels (0.325, p<0.001). However, unexpectedly, a lower score for knowledge on the vegetables and fruits daily intake also predicted significant relationships with a better diet habits (-0.538, p=0.021); the possible reason would be discussed later.;Conclusions. Based on the available data and the analysis performed, an individual's reaction to the nutrition labels and his/her psychological health status played important roles in dietary habits. Chinese students had the highest food item consumption scores and the most positive reactions to nutrition labels, though their depression and stress burden was also shown to be the highest. An improvement in the utilization of nutrition labels would enhance the healthy eating. The data showed that the maximum value for the nutrition label reaction score was 3 and even China scored 1.75 on average, the highest of all four countries. This indicates that there is considerable room for this aspect to be improved. Therefore, an important strategy to improve diet is to develop a standard nutrition labeling system and to provide instructions for how to use the nutrition labels to buy and consume foods or drinks.