Socio-economic and environmental factors affecting breastfeeding and complementary feeding practices among Batwa and Bakiga communities in south-western Uganda

Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs

Affordability of healthy and environmentally friendly diets in the UK

Although diets that meet dietary health recommendations can be more environmentally friendly, few studies have examined whether such diets are affordable(1). However, studies on optimising diets usually focus on the average population diet, without taking into consideration differences between individual diets. In this study, we assess the change in food costs that people face when changing to healthier, more environmentally friendly diets whilst also minimising changes in the quantity of the foods consumed. An average daily diet was estimated for adult participants in the National Diet and Nutrition Survey (NDNS) based on data in four food diaries collected from 2014–2017 (N = 2,165)(2). Environmental impact measures were assigned for greenhouse gas emissions (GHGE), land use and freshwater withdrawal(3). Food prices were assigned to each food subgroup to calculate the daily diet cost(4). Linear programming, a mathematical optimisation technique, was used for optimising diets. It is comprised of an objective function, either to minimise or maximise, along with constraints of the optimisation problem. The aim of linear programming is the minimisation of changes in the portions of the foods consumed by each participant to increase their acceptability. The recommendations of the Eatwell Guide, as well as environmental restrictions, are the constraints, which were relaxed by up to ±50% to ensure that the changes to the quantities would be minimal. The environmental impact for each indicator was restricted to be below the median of each impact respectively. Overall, people's daily diets were associated with 5.8kgCO2eq, 5.7m2year land use, 601litres of freshwater and cost £5.10. Only 23 (1%) of diets could be optimised to achieve Eatwell Guide recommendations with minimal changes. When constraints were relaxed so diets only had to be within ±50% of recommendations, 1,512 (70%) of diets could be optimised. Before optimisation, the optimised diets were associated with 6.5 kg CO2eq, 6.3m2year land use, 654litres of freshwater and cost £5.40. After optimisation, these diets were associated with reductions in GHGE (4.9 kg), land use (4.6 m2year), freshwater withdrawals (492 liters) and costs (£4.40). The diets that were not optimised had below average environmental and monetary cost with a weighted mean 5.2kgCO2eq GHGE, 5.0m2year land use, 546 litres of freshwater and £4.40 cost. Our study suggests that shifting towards healthier and more sustainable diets can be affordable with minimal changes only when the dietary recommendations are considerably relaxed. Diets that could not be optimised with minimal changes to the relaxed recommendations had similar environmental footprint and cost with the optimised ones. If price is not a deterrent to people switching to healthier, more environmentally diets, then policy makers may need to consider other factors that may prevent their uptake when designing policies to promote better dietary health

Optimising people's diets using linear programming: to what extent are the Eatwell guidelines a barrier?

People's diets are not always good for their health or the planet. Studies suggest that healthier diets have lower environmental footprints and typically cost less(1). But efforts to encourage people to change their diet might not be easily accepted by the population, partly because of their reluctance to make large changes to their food habits. Firstly, we explored the feasibility of optimising diets towards the national dietary guidelines whilst minimising changes in the portions of foods that people would have to make. Secondly, the impact of these changes on the environmental footprint and diet cost was measured. An average daily diet was estimated for each participant (N = 2,165 adults) based on four food diaries from the 2014–2017 National Diet and Nutrition Survey (NDNS)(2). The environmental impact was calculated for greenhouse gas emissions (GHGE), land use and freshwater withdrawals(3). Food prices were assigned to each food subgroup to calculate the diet cost(4). Diets were optimised using linear programming to identify diets that meet the dietary guidelines of the Eatwell Guide whilst minimising the changes in the portions of the foods consumed by each participant. The dietary guideline constraints were relaxed in steps of ±10% in each iteration. Without relaxing these constraints somewhat, the dietary guidelines were unachievable without unrealistic changes to most people's diets. Additional analyses were performed to identify which nutrient guidelines were hardest to achieve and the optimisation failed on. Using the Eatwell constraints for energy, protein, carbohydrates, fat (total, saturated, polyunsaturated and monounsaturated), salt, free sugars and fibre, only 24 (1%) diets could be optimised. Relaxing these constraints by ±10%, ±20%, ±30%, ±40% and ±50%, the number of diets that could be optimised whilst only making minimal changes were 96 (5%), 286 (13%), 592 (27%), 1040 (48%) and 1555 (71%) respectively. The restrictions were also lifted entirely for each of the recommendations while relaxing the recommendations for all other nutrients by ±50%. The nutrients that led to the highest number of diets being optimised were salt, free sugars and fibre with 1587 (73%), 1796 (83%) and 1800 (83%) respectively. People's daily diets were associated with 5.8kgGHGE, 5.7m2year land use, 601litres of freshwater and cost £5.10. After relaxing ±50% of the recommendations, the GHGE, land use, freshwater and costs fell in the optimised diets by 6–15%. We show that achieving the Eatwell Guide recommendations is not feasible with only minimal changes to people's current diets, even when relaxing constraints for some nutrients by ±50%. Shifting to healthier diets may be marginally cheaper and better for the environment, but making minimal dietary changes are not sufficient to meet the Eatwell nutrient guidelines

Assessing diet in a university student population: A longitudinal food card transaction data approach

Starting university is an important time with respect to dietary changes. This study reports a novel approach to assessing student diet by utilising student-level food transaction data to explore dietary patterns. First year students living in catered accommodation at the University of Leeds (UK) received pre-credited food cards for use in University catering facilities. Food card transaction data were obtained for semester 1, 2016, and linked with student age and gender. K-means cluster analysis was applied to the transaction data to identify clusters of food purchasing behaviours. Differences in demographic and behavioural characteristics across clusters were examined using Chi-squared tests. The semester was divided into three time periods to explore longitudinal changes in purchasing patterns. Seven dietary clusters were identified: ‘Vegetarian’, ‘Omnivores’, ‘Dieters’, ‘Dish of the Day’, ‘Grab-and-Go’, ‘Carb Lovers’ and ‘Snackers’. There were statistically significant differences in: gender (p<0.001) with women dominating the Vegetarian and Dieters; age (p = 0.003) with over 20's representing a high proportion of the Omnivores; and time of day of transactions (p<0.001) with Dieters and Snackers purchasing least at breakfast. Many students (n = 474, 60.4%) changed dietary cluster across the semester. This study demonstrates that transactional data presents a feasible method for dietary assessment, collecting detailed dietary information over time and at scale, while eliminating participant burden and possible bias from self-selection, observation and attrition. It revealed that student diets are complex and that simplistic measures of diet, focussing on narrow food groups in isolation, are unlikely to adequately capture dietary behaviours