The dietary quality of food pantry users from a socio-ecological perspective

In Germany, around 1.5 Mio people with a low income receive food for a small fee from one of around 940 so-called Tafel. In high-income countries like Germany, users of food pantries are a particularly vulnerable population group, as they are characterized by cumulative health risks. They often suffer from food insecurity and from chronic diseases such as hypertension, diabetes mellitus type 2 or obesity. Given that these diseases as well as food insecurity both relate to diet, the dietary quality plays a critical role in the health status of food pantry users. To illustrate the dietary quality and the different levels of factors influencing the dietary quality among food pantry users, this thesis has the following aims: 1. to provide a summary of the scientific evidence about the dietary quality of food pantry users in high-income countries; 2. to provide a summary of the scientific evidence about the nutritional quality of food provided by food pantries in high-income countries; 3. to examine the distribution of Tafel food pantries and food banks and to provide a representative picture of their resources (e.g. food, volunteers etc.), activities (e.g. provided programs) and users in Germany; 4. to examine the distribution of Tafel food pantries and to identify compositional and physical environmental correlates of food pantry use in Berlin. To reach these aims, two systematic reviews were conducted (first and second publication). In addition, an explorative cross-sectional study consisting of an analysis of secondary data and a comprehensive survey among all Tafel belonging to the federal association Tafel Deutschland was performed (third publication). Finally, an ecological study was conducted by analyzing and mapping food pantry use and compositional and physical characteristics of areas in Berlin (fourth publication). The first review revealed that the dietary quality among the reviewed food pantry users tended to be low as reflected by an inadequate intake of energy, fruit and vegetables, dairy products and calcium compared to national recommendations. The reviewed food pantry users had, in particular, a lower consumption of dairy products compared to the general populations. The second review demonstrated that the nutritional quality of reviewed pre-packed food bags provided by food pantries was highly variable within and between included studies. It also showed that the nutritional quality of most of the food bags was low, reflected, in particular, by a low provision of dairy products, vitamins A and C and calcium compared to national recommendations. None of the studies included in the reviews were nationally representative. The third publication showed that the German food bank system Tafel Deutschland provided a comprehensive net of food pantries, social supermarkets, food banks and other services. However, the number of Tafel per 10,000 welfare recipients was lower in eastern Germany (M = 1.37) compared to western Germany ((M = 2.12), t(162.54) = 4.2424, p < 0.0001). In contrast to the results of the studies included in the second review, the Tafel mainly provided perishable food such as fruits and vegetables (41.42% of the amount of food distributed), bakery products (19.85%) and dairy products (13.39%). However, due to the dependence on donors such as retailers, the amount of food distributed varied widely. The assistance of most local Tafel is based on volunteer labor as 89.97% of Tafels staff were volunteers. In 79 districts, in which all Tafel participated in the survey, there was an average of 179 Tafel beneficiaries per 1000 welfare recipients and 17 Tafel beneficiaries per 1000 residents overall. An even lower usage was found by the fourth publication which revealed that only two out of 1000 adult inhabitants and six out of 1000 children received assistance from one of the 44 investigated Tafel food pantries in Berlin. Tafel use by adults (A) or by children (B) was related to the percentage of welfare recipients (A, &#946; = 0.17, p < 0.001 und B, &#946; = 0.16, p = 0.002), the percentage of inhabitants with migration background (A, &#946; = - 0.08, p = 0.002), the number of discount grocery percentage stores per 1000 children (B, &#946; = 5.65, p = 0.010), and the number of stops of the public transport within a radius of 500 meters (A, &#946; = - 0.24, p = 0.020). The most important limitation of both studies was the unknown reliability of the data collected from the Tafel. The dietary quality of food pantry users in high-income countries was seen to be low. Although food pantries did not provide a full meal plan for a healthy diet, they may have a positive impact on the dietary quality of its users. However, to better understand the role of food pantries in the complex interplay of individual, social and environmental influences on the diet of food pantry users, multi-level approaches should be used in the future. Moreover, researchers are strongly recommended to investigate the mechanisms by which using a food pantry might impact users dietary quality. In addition to these implications for researchers, this thesis makes several recommendations to practitioners at food pantries in Germany and other high-income countries. Following these recommendations could make the position of food pantries in civil society into an important entry point for health promotion among a part of the food insecure population in the future.Allein in Deutschland erhalten regelmäßig etwa 1,5 Mio. Menschen mit einem niedrigen Einkommen gegen einen geringen Beitrag Lebensmittel von einer der rund 940 Tafeln. Nutzer/innen solcher Lebensmittelausgabestellen (NLMA) stellen eine besonders vulnerable Bevölkerungsgruppe dar, da sie von kumulativen Gesundheitsrisiken betroffen sind. So haben sie im Vergleich zu anderen Bevölkerungsgruppen mit einem niedrigen Einkommen ein höheres Risiko von Ernährungsunsicherheit betroffen zu sein. Zudem leiden sie häufig an ernährungsassoziierten Erkrankungen wie Adipositas, Diabetes und/oder Hypertonie. Daher kommt dem Ernährungsverhalten eine besondere Bedeutung für die Gesundheit von NLMA zu. Um die Ernährungsqualität von NLMA und die unterschiedlichen Einflussebenen auf die Ernährung der NLMA zu illustrieren, ergaben sich für die vorliegende Arbeit folgende Ziele: 1. Eine Zusammenfassung der wissenschaftlichen Evidenz zu der Ernährungsqualität von NLMA in Hocheinkommensländern zu bieten, 2. Eine Zusammenfassung der wissenschaftlichen Evidenz zu der Nährwertqualität der von LMA in Hocheinkommensländern angebotenen Lebensmittel zu bieten, 3. Die Verteilung der Tafeln in Deutschland zu untersuchen und ein repräsentatives Abbild der Ressourcen (z.B. Lebensmittel, Freiwillige), Aktivitäten (z.B. angebotene Programme) und Nutzer/innen der Tafeln zu bieten 4. Die Verteilung der LMA der Berliner Tafel e.V. zu untersuchen und kompositionelle und strukturelle Korrelate der Nutzung der LMA in Berlin zu identifizieren. Um diese Ziele zu erreichen, wurden zwei systematische Reviews (erste und zweite Publikation), eine Querschnittstudie bestehend aus der Analyse sekundärer Daten und einem umfangreichen Survey (dritte Publikation) sowie eine ökologische Querschnittstudie (vierte Publikation) durchgeführt. Gemäß der in dem ersten Review inkludierten Studien ist die Ernährungsqualität von NLMA in Hocheinkommensländern insbesondere durch einen verglichen mit nationalen Empfehlungen unzureichenden Verzehr von Obst und Gemüse, Milchprodukten und Kalzium charakterisiert. Im Vergleich zu der Allgemeinbevölkerung berichteten die untersuchten NLMA insbesondere einen niedrigeren Verzehr von Milchprodukten. Die in dem zweiten Review inkludierten Studien zeigten, dass die in den von LMA in Hocheinkommensländern angebotenen, in der Regel vorsortierten Lebensmittel-Körbe enthaltenen Energie- und Nährstoffmengen sowohl innerhalb einer Stichprobe als auch zwischen den Stichproben starken Schwankungen unterliegen. Die meisten Körbe enthalten im Vergleich zu nationalen Empfehlungen insbesondere unzureichende Mengen an Milchprodukten, Vitamin A und C sowie Kalzium. Allerdings war keine der in einem der beiden Reviews inkludierten Studienstichproben auf nationaler Ebene repräsentativ. Die dritte Publikation zeigte, dass Tafel Deutschland über ein deutschlandweites Netz an Lebensmittelbanken, -ausgabestellen, sozialen Supermärkten und anderen Services verfügt, die Dichte der Tafeln je 10 000 Transferleistungsempfänger/innen (TE) in Ostdeutschland jedoch niedriger (M = 1,37) als in Westdeutschland (M = 2.12) ist (t(162.54) = 4.2424, p < 0.0001). Anders als viele LMA in anderen Hocheinkommensländern (zweite Publikation), verteilen die Tafeln überwiegend frisches Obst und Gemüse (41.42% der verteilten Lebensmittelmenge), Backwaren (19.85%) und Milchprodukte (13.39%). Aufgrund der Abhängigkeit der Tafeln von Spendern ist das Lebensmittelangebot der Tafeln starken Schwankungen unterworfen. Insgesamt sind 89.97% der Tafel-Mitarbeitenden Freiwillige. Basierend auf Daten von 79 Landkreisen, in denen alle Tafeln an dem Survey teilnahmen, ergab die Studie eine durchschnittliche Nutzeranzahl von 179 Nutzer/innen pro 1000 TE bzw. 17 Nutzer/innen je 1000 Einwohner/innen. Eine noch niedrigere Nutzungsrate wurde durch die vierte Publikation aufgedeckt, die aufzeigte, dass lediglich zwei von 1000 Erwachsenen und sechs von 1000 minderjährigen Einwohner/innen Lebensmittel von einer der 44 untersuchten LMA der Berliner Tafel e.V. erhalten. Multiple Regressionsmodelle zeigten, dass die LMA-Nutzung von Erwachsenen (A) bzw. Kindern (B) signifikant mit dem Anteil der TE (A, &#946; = 0.17, p < 0.001 und B, &#946; = 0.16, p = 0.002 ), dem Anteil der Einwohner/innen mit Migrationshintergrund an der Wohnbevölkerung (A, &#946; = - 0.08, p = 0.002), der Anzahl der Discounter je 1000 Kinder (B, &#946; = 5.65, p = 0.010) und der Anzahl an Haltestellen des öffentlichen Personennahverkehrs innerhalb eines Radius von 500 Metern um eine LMA (A, &#946; = - 0.24, p = 0.020) zusammenhängt. Die wichtigste Einschränkung beider Originalstudien ist die unbekannte Reliabilität der Daten, die von den Tafeln erhoben wurden. Obgleich LMA keine Vollversorgung im Sinn einer ausreichenden Lebensmittelmenge für eine gesunde Ernährung bieten, könnten sie die Ernährung der NLMA positiv beeinflussen. Um die Rolle der LMA in dem komplexen Wechselspiel zwischen individuellen, sozialen und umweltbezogenen Einflussfaktoren der Ernährung besser zu verstehen, sind Mehrebenen-Ansätze notwendig. Zudem wird eine detailliertere Untersuchung der Mechanismen, über die eine LMA-Nutzung auf die Ernährung einwirkt, empfohlen. Würden die in dieser Arbeit herausgegebenen Empfehlungen für Mitarbeitende in LMA umgesetzt, könnten sich LMA zukünftig als wichtige zivilgesellschaftliche Gesundheitsförderer für einen Teil der ernährungsunsicheren Bevölkerung etablieren

Acute Myocardial Infarction and Associated Deaths in Switzerland—An Approach to Estimating Incidence

Background and question under study: In Switzerland, there is a lack of populationbased data on the event rate of acute myocardial infarction (AMI) and case fatality. The aim of this study was to estimate theAMI incidence rate in Switzerland and case fatality for both in-hospital and out-of-hospital deaths due to AMI. Methods: All data were taken from the Swiss Hospital Statistics (HOST) and Cause of Death Statistics (CoD) databases 2004. Data were coded according to ICD 10. In order to estimate AMI event rate, we considered (1.) all cases with hospital discharge diagnosis “AMI” (I 21; I 22; HOST) and (2.) all cases with AMI as underlying cause of death (I 21; I 22; CoD). Results: In the HOST, the rate for age-standardised hospital discharges was 118/100 000 overall (60/100 000 for women; 183/100 000 for men). The age-standardised AMI incidence rate was 131/100 000 overall (for women 68/100 000; for men 202/100 000).Age-standardised out-of-hospital case fatality (5.0% for women, 5.3% for men) was higher than agestandardised in-hospital case fatality (2.3% for women, 2.4% for men). In both sexes, on average, six out of ten deaths due to AMI occurred outside the hospital. Conclusion: To our knowledge, this was the first estimation of AMI incidence and case fatality for Switzerland. Data from the HOST database revealed only 11514 AMI cases (3799 women; 7735 men). By using both, HOST and CoD database estimated incidence could be increased to 13007 AMI cases (4414 women, 8593 men). Nevertheless, the estimated AMI incidence rate still does not represent the actual AMI incidence rate for Switzerland since an uncertain proportion of AMI cases and AMI deaths might be unrecognised due to methodological limitations

The German Food Bank System and Its Users—A Cross-Sectional Study

Although food banks are a well-known resource for low-income people struggling to meet their food needs, they have rarely been investigated on a large scale. This study aims to contribute to the actual debate about the potential and limitations of food banks to decrease the prevalence of food insecurity by providing a representative picture of the German food bank system and its users. Publicly accessible data were used to map residents, public welfare recipients, and food banks. In addition, a comprehensive survey was distributed to all 934 &ldquo;Tafel&rdquo; food banks. The results show that nearly all residents and welfare recipients have access to at least one food bank located in the districts in which they reside. Differences in the density of food banks exist between eastern and western Germany. Food banks provide mainly healthy fresh food, but they heavily rely on food donations from local retailers and on volunteer labor. Although changes in the number of user households by income seem to mirror trends in the number of welfare recipients, food bank users appear to represent only a fraction of the food-insecure population in Germany. Food banks might have the potential to improve users&rsquo; diet and food security, but they are not able to reach all food-insecure residents in Germany

Impact of a smoking cessation program on smoking prevalence and food security among food pantry users – a study protocol for a pragmatic cluster randomised controlled trial

AbstractBackgroundAmong food pantry users there is a high prevalence of both smoking and food insecurity, which may be related to one another. This study aims to evaluate the impact of a smoking cessation program carried out in food pantries on the smoking status and the food security status of food pantry users.Methods / designBefore starting the cluster randomised controlled trial, stakeholders will be engaged to adapt a behavioural group counselling program for smoking cessation to the needs of the food pantry users in a pre study. Food pantry users and workers as well as other experts, such as smoking cessation trainers, social workers, and psychologists, will be involved, using the world café technique and telephone interviews and a qualitative thematic analysis for data analysis to design the concept of the intervention program will be applied. In the second phase, the impact of the intervention on the smoking status and on food insecurity will be investigated by a cluster randomised controlled trial. A total of 416 food pantry users across 32 clusters (food pantries) in Berlin, Germany, should be recruited and randomly assigned to either the intervention group or the waiting list control group. The intervention will consist of a behavioural group counselling program for smoking cessation, specially tailored for food pantry users, as well as optional nicotine replacement therapy and the implementation of environmental smoking reduction measures in the food pantries. The primary outcomes 6 months after the treatment will be self-reported continuous smoking abstinence, validated by exhaled carbon monoxide (&lt; 10 ppm of carbon monoxide), and increased food security level (the percentage of participants with an improved food security level).DiscussionThis study will be the first long-term investigation into the effect of a smoking cessation program on smoking status and food insecurity. The results of this study will inform the implementation of smoking cessation programs in food pantries throughout Germany.Trial registrationProspectively registeredDRKS00020037. Registered 29 April 2020</jats:sec

Heart failure events, and case fatalities in Switzerland based on hospital statistics and cause of death statistics

In Switzerland there is a shortage of population-based information on heart failure (HF) incidence and case fatalities (CF). The aim of this study was to estimate HF event rates and both in- and out-of-hospital CF rates

The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study

<div><p>Objectives</p><p>To investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS).</p><p>Methods</p><p>Prospective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15–36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0–3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient’s assessment of pain (painVAS) and physician’s global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models.</p><p>Results</p><p>Short-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes.</p><p>Conclusions</p><p>Ultrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings.</p></div