Nutrition Bulletin最新文献

{"title":"Meat and the future of sustainable diets-Challenges and opportunities.","authors":"A Spiro, Z Hill, S Stanner","doi":"10.1111/nbu.12713","DOIUrl":"https://doi.org/10.1111/nbu.12713","url":null,"abstract":"<p><p>The British Nutrition Foundation convened a roundtable event in January 2024 entitled 'Meat and the Future of Sustainable Diets: Turning Challenges into Opportunities', bringing together multi-sector stakeholders to discuss the social, nutritional, public health and environmental aspects of meat consumption within a sustainable food system. Participants explored the challenge of the complexity of balancing nutrition and planetary goals, emphasising the need to navigate trade-offs between various dimensions of sustainability. Whilst recognising the global nature of the issue, the roundtable primarily focussed on a UK perspective. The discussion highlighted the urgency of transforming the food system to achieve net zero, whilst ensuring broader environmental benefits, nutritional adequacy and dietary and health equity across all life stages. Concerns about poor dietary patterns, particularly among vulnerable groups were raised, with participants stressing the need for policies that promote healthy, sustainable and equitable diets without worsening inequalities. These policies should also enhance livelihoods and community wellbeing, foster resilience and support local economies. On the supply side, participants called for better data within the agri-food system, particularly at the farm level. They advocated for a multidimensional, holistic approach that goes beyond greenhouse gas emissions to encompass wider environmental impacts and whole-farm benefits, such as enhancing soil health, promoting biodiversity, improving water management, supporting nutrient cycling and boosting farm-level resilience through diversified cropping systems. Roundtable participants acknowledged existing recommendations to reduce meat consumption for both environmental reasons, such as land use and greenhouse gas emissions, and health concerns, as evidence links red, particularly processed, meat consumption with increased colorectal cancer risk. Given the variation in meat consumption globally and even locally between individuals, the discussion explored the potential of targeted campaigns to reduce high meat intake, along with the role of public food procurement and the food industry in decreasing processed meat consumption. The consensus was that dietary changes must be framed within the context of a balanced diet and broader sustainability concerns. Despite some differing viewpoints on implementation, participants agreed that transitioning to healthier, more sustainable diets is a priority. Collaboration across the entire food chain, from farm to fork, with investment in innovation, robust data collection and research, alongside policy support, was emphasised as essential to achieving this goal.</p>","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":"49 4","pages":"572-598"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between food production, food security, household consumer behaviour and waist-hip ratio amongst women in smallholder farming households in Kilifi County, Kenya.","authors":"Rosebella Iseme-Ondiek, Eunice Muthoni Mwangi, Roselyter M Riang'a, Felix Agoi, Noveline Khatievi, James Orwa, Beatrice Karembo Karisa, Bibi Abdallah Bakari, Morris Ogero, Mwanamaka Mabruki, Cyprian Mostert, Anthony K Ngugi","doi":"10.1111/nbu.12718","DOIUrl":"https://doi.org/10.1111/nbu.12718","url":null,"abstract":"<p><p>Food insecurity disproportionately affects smallholder farming households and within them women, who bear primary caregiving responsibilities and contend with time and resource constraints that heighten their vulnerability to adverse nutrition-related health outcomes. This study cross-sectionally investigates the association between food production practices, household consumer behaviour, and the experience of food insecurity with women's waist-hip ratio (WHR), a key indicator of abdominal obesity, in a coastal community in Kenya. In total, 394 households were randomly selected from a list of farming households in Kaloleni and Rabai sub-counties of Kilifi. Trained enumerators administered questionnaires to adult female family members who play a pivotal role in household management. Household dietary diversity scores (HDDS) were computed from 16 food groups consumed in the 7 days preceding the survey. Waist-hip measurements focused on these females, representing vulnerable populations. Pathway-based regression models were constructed using STATA version 13 (p < 0.05). Most households practised mixed farming (59.9%) and monocropping (73.2%) and most female respondents were widowed (75.1%) with limited education (73.1% had no formal education) and over 20 years of farming experience. Food insecurity was prevalent, affecting 80.7% of households. Limited dietary diversity was noted with an average HDDS of 9. The most commonly consumed foods were cereals, spices, condiments and beverages, while meat, eggs and fruits were infrequently eaten. An inverse association was observed between HDDS and WHR (standardised regression coefficient = -0.1328; p = 0.026) but while food insecurity was inversely associated with both HDD and WHR, these associations did not reach statistical significance (HDDS-standardised regression coefficient -0.0294; p = 0.592: WHR-standardised regression coefficient -0.0155; p = 0.791). Existing research has primarily addressed the undernutrition and hunger-related impacts of food insecurity. The findings underscore the need to better understand the complex interplay between food insecurity and nutritional health, including markers of adiposity, to effectively promote health.</p>","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food healthiness judgements among Brazilian and German lay adults.","authors":"Jessica Maria Muniz Moraes, Gudrun Sproesser, Marle Dos Santos Alvarenga","doi":"10.1111/nbu.12638","DOIUrl":"10.1111/nbu.12638","url":null,"abstract":"<p><p>This study investigated which foods are most saliently judged as healthy and unhealthy in Brazil and Germany and the reasons for these judgements. Dietary guidelines in the two countries differ in that those in Brazil are based on a food processing classification rather than nutrient profiling, whereas dietary guidelines in Germany do not include the processing level of food. In an online study with 355 lay adults (Brazil n = 205, Germany n = 150), we explored which foods are listed as healthy and unhealthy using a free-listing method. The main reasons for these healthiness judgements were then identified with a one or two-word phrase and compared between countries. Saliency analysis was conducted to identify the 15 most salient healthy and unhealthy foods in each country. Principles of content analysis were used to assess the reasons why these 15 items were listed as most salient by the participants. Results showed that both Brazilians and Germans listed mostly natural or minimally processed food (e.g. fruits, vegetables, grains, fish and milk) as healthy, whereas types of convenience and fast food, sweets and other ultra-processed foods (e.g. chocolate, soda, French fries, pizza and hamburger) were the most salient unhealthy items listed in both countries. Differences in culturally relevant items listed in each country are discussed. Further, in both countries, despite differences in their dietary guidelines, food healthiness judgements for the most salient items listed relied heavily on the nutritional content of food, reinforced the 'good/healthy' and 'bad/unhealthy' dichotomy, and were centred on benefits or harms to the body (e.g. prevention or cause of diseases and weight control). The similarity of food healthiness judgements between the two countries, together with their agreement with conventional health claims and dietary guidelines, suggest that lay Brazilian and German adults are knowledgeable about the general concepts of 'healthy' and 'unhealthy' food. Finally, these findings suggest that rather than just providing more nutritional information, policymakers and health professionals need to take into account the multiple psychosocial and environmental determinants of eating in these countries.</p>","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":"482-499"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10298691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a divider nudge in supermarket shopping trolleys to increase fruit and vegetable purchases: A feasibility study using an intervention design.","authors":"Greg McGrath","doi":"10.1111/nbu.12642","DOIUrl":"10.1111/nbu.12642","url":null,"abstract":"<p><p>Fruit and vegetable (F&V) consumption is associated with a reduced risk of developing obesity and chronic diseases: however, only one in 16 Australian adults consume F&Vs at the recommended two servings of fruit and five servings of vegetables per day. What and how much people eat is influenced by their social and physical environments. Supermarkets are a key setting influencing food purchases, and as such, they can shape consumption patterns of F&Vs. Implementing effective strategies to increase F&V intake is crucial. The objective of this research was to test the feasibility of covertly modifying shopper purchasing behaviour to purchase more F&Vs using a visual divider nudge message (prompts) covering the entire base of shopping trolleys. Placards provided a visual representation of the recommended proportion of the trolley base that should be allocated to fruits and vegetables (implied social norm). Applying an intervention research design, 30 out of ~100 trolleys were fitted with the placards and shopper purchases were measured by collecting receipts to measure the weight (kg), total spending and F&V specific spending (Australian dollars) for intervention versus control trolleys for one weekend day only. We also conducted a short intercept survey that was administered independently from the research study day on non-trial shoppers. Shoppers who selected trolleys with the divider nudge placards (n = 102) purchased equal weight of F&Vs (Intervention: mean = 6.25 kg, SD = 5.60 kg, 95% CI = 5.14 kg, 7.35 kg, vs. Control: mean 6.03 kg, SD = 5.17 kg, 95% CI = 5.01 kg, 7.04 kg, p = 0.768) and spent equal amounts on F&Vs compared to shoppers in the control group (n = 102) (Intervention: mean = $41.46, SD = $36.68, 95% CI = $34.25, $48.66, vs. Control: mean $39.85, SD = $33.30, 95% CI = $33.34, $46.39, p = 0.744). There was no difference in the total spending between groups (Intervention: mean = $135.99, SD = $90.10, 95% CI = $118.29, $153.68, vs. Control: mean $155.68, SD = $96.46, 95% CI = $136.73, $174.63, p = 0.133). The divider nudge placard did not lead to any difference in shoppers' purchases of F&Vs. However, this study demonstrates the feasibility of testing a cheap, simple and easy supermarket nutrition intervention. Larger studies are required to elucidate and confirm these findings over the longer term.</p>","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":"513-522"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher atherogenic risk in schoolchildren is associated with MTMR9 rs2293855 gene polymorphism and genetic score.","authors":"Mariane Alves Silva, Cristina Maria Mendes Resende, Maíra Barros Louro, Sarah Aparecida Vieira Ribeiro, Sylvia do Carmo Castro Franceschini, Gustavo Velasquez-Melendez, Jacqueline Isaura Alvarez-Leite, Danielle Fernandes Durso, Juliana Farias de Novaes","doi":"10.1111/nbu.12644","DOIUrl":"10.1111/nbu.12644","url":null,"abstract":"<p><p>Childhood dyslipidaemia is associated with the occurrence of cardiovascular diseases in adulthood, so evaluating whether an individual has a genetic predisposition to this pathology is of great importance for early action of prevention and treatment. This study aimed to evaluate the association between the FTO (rs9939609), MC4R (rs17782313) and MTMR9 (rs2293855) polymorphisms, the obesity-related genetic risk score and atherogenic risk in Brazilian children. This is a cross-sectional study conducted in 544 children aged 4-9 years in the city of Viçosa, Minas Gerais state, Brazil. The single nucleotide polymorphisms rs9939609, rs17782313 and rs2293855, were identified by the system TaqMan SNP genotyping and the obesity-related genetic risk score was determined. The lipid profile (serum total cholesterol [TC], high density lipoprotein [HDL] cholesterol, low density lipoprotein [LDL] cholesterol, triglycerides) was analysed and the atherogenic indices (Castelli I and II indices), atherogenic coefficient (AC), lipoprotein combined index (LCI) and plasma atherogenic index (PAI) were calculated. A semi-structured questionnaire was applied, obtaining data on the sociodemographic, economic and lifestyle characteristics of the children. Weight and height measurements were performed in all children, and body composition was evaluated by Dual-Energy X-ray Absorptiometry (DXA). 55.5% of the sample had dyslipidaemia, while 28.5% of the sample had at least one polymorphism and 2.2% had three polymorphisms. Children with the AG/AA genotypes in the rs2293855 polymorphism had lower HDL cholesterol levels and higher TC/HDL cholesterol, LDL/HDL cholesterol ratios and AC. Those with one or more polymorphisms (rs9939609, rs17782313 and rs2293855) in the genetic risk score had lower HDL cholesterol levels and higher TC/HDL cholesterol ratios, AC, LCI and PAI. In conclusion, the risk allele of the rs2293855 polymorphism and a higher obesity-related genetic risk score were positively associated with higher atherogenic risk in Brazilian children.</p>","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":"559-571"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in dietary carbohydrate and lipid quality indices between 2008 and 2018: Analysis of the Brazilian dietary surveys.","authors":"Luciana Guerra Cardoso, Luana Silva Monteiro, Rosely Sichieri, Edna Massae Yokoo, Rosângela Alves Pereira","doi":"10.1111/nbu.12641","DOIUrl":"10.1111/nbu.12641","url":null,"abstract":"<p><p>The aim of the study was to evaluate characteristics and changes over a decade in dietary carbohydrate and lipid quality according to socio-demographic variables. Data was obtained from two Brazilian National Dietary Surveys 2008-2009 (n = 34 003) and 2017-2018 (n = 46 164) examining a nationwide representative sample of individuals ≥10 years old. Food intake was assessed by means of two non-consecutive diet records (2008-2009) and 24 h diet recalls (2017-2018). Carbohydrate Quality Index is a score ranging from 4 to 20 calculated from fibre intake, global dietary glycaemic index, solid/total carbohydrate (CHO) and whole grains/total grains CHO. Lipid Quality Index was estimated by dividing the sum of the dietary content of monounsaturated and polyunsaturated fatty acids by the sum of saturated and trans fatty acids. Indices were categorised into five categories (1 for lowest and 5 for highest quality). Socio-demographic variables were sex, age, income, urban/rural area and place of food consumption. The estimates (95% CI) were generated separately for each survey and then compared to identify changes in time. Our main findings refer to changes in diet quality according to income. At the lowest income level, the proportions of individuals in the best carbohydrate and lipid quality categories reduced from 26.9% to 20.6% and from 30.0% to 24.9%, respectively. Alternatively, at the highest income level, these proportions increased from 22.9% to 26.6% and from 11.9% to 15.7%, respectively. Furthermore, the quality of lipids improved in women and among individuals reporting some away-from-home food consumption, while the quality of carbohydrates was reduced among adolescents and in rural areas.</p>","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":"546-558"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting iron absorption and the role of fortification in enhancing iron levels.","authors":"Dipun Nirmal Perera, Chathurangi Lakshika Palliyaguruge, Dasuni Dilkini Eapasinghe, Dilmi Maleesha Liyanage, R A C Haily Seneviratne, S M D Demini, J A S M Jayasinghe, Mishal Faizan, Umapriyatharshini Rajagopalan, B Prasanna Galhena, Hasi Hays, Kanishka Senathilake, Kamani H Tennekoon, Sameera R Samarakoon","doi":"10.1111/nbu.12643","DOIUrl":"10.1111/nbu.12643","url":null,"abstract":"Iron is an important micronutrient required for a number of biological processes including oxygen transport, cellular respiration, the synthesis of nucleic acids and the activity of key enzymes. The World Health Organization has recognised iron deficiency as the most common nutritional deficiency globally and as a major determinant of anaemia. Iron deficiency anaemia affects 40% of all children between the ages of 6 and 59 months, 37% of mothers who are pregnant and 30% of women between the ages of 15 and 49 years worldwide. Dietary iron exists in two main forms known as haem iron and non-haem iron. Haem iron is obtained from animal sources such as meat and shows higher bioavailability than non-haem iron, which can be obtained from both plant and animal sources. Different components in food can enhance or inhibit iron absorption from the diet. Components such as meat proteins and organic acids increase iron absorption, while phytate, calcium and polyphenols reduce iron absorption. Iron levels in the body are tightly regulated since both iron overload and iron deficiency can exert harmful effects on human health. Iron is stored mainly as haemoglobin and as iron bound to proteins such as ferritin and hemosiderin. Iron deficiency affects individuals at increased risk due to factors such as age, pregnancy, menstruation and various diseases. Different solutions for iron deficiency are applied at individual and community levels. Iron supplements and intravenous iron can be used to treat individuals with iron deficiency, while various types of iron-fortified foods and biofortified crops can be employed for larger communities. Foods such as rice, flour and biscuits have been used to prepare fortified iron products. However, it is important to ensure the fortification process does not exert significant negative effects on organoleptic properties and the shelf life of the food product.","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":"442-457"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing fibre in white flour and bread: Implications for health and processing.","authors":"Peter R Shewry, Edward J M Joy, Lucia Segovia De La Revilla, Annalene Hansen, Joe Brennan, Alison Lovegrove","doi":"10.1111/nbu.12648","DOIUrl":"10.1111/nbu.12648","url":null,"abstract":"<p><p>Dietary fibre is beneficial for human health, but dietary intakes are below recommended levels in most countries. Cereals are the major source of dietary fibre in Western diets, with bread providing about 20% of the daily intake in the United Kingdom. Despite the promotion of fibre-rich wholegrain products, white bread (which has a lower fibre content) remains dominant in many countries due to cultural preferences. Increasing the fibre content of white bread and other products made from white flour is therefore an attractive strategy for increasing fibre intake. This can be achieved by exploiting genetic variation in wheat without major effects on the processing quality or the consumer acceptability of products. Modelling data for food consumption in the United Kingdom shows that increasing the fibre content of white flour by 50% (from about 4% to 6% dry weight) and in wholegrain by 20% will increase total fibre intake by 1.04 g/day and 1.41 g/day in adult females and males, respectively. Furthermore, in vitro studies indicate that the increased fibre content of white bread should reduce the rate of starch digestion and glucose release in the human gastrointestinal tract.</p>","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":"587-593"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10947016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eliminating industrially produced trans fats from our diet-How well is it going?","authors":"Johanna Helen Bruce","doi":"10.1111/nbu.12647","DOIUrl":"10.1111/nbu.12647","url":null,"abstract":"","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":"427-434"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72211417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Taking from Peter to pay Paul\": The experience of people in receipt of fuel and food vouchers from a UK foodbank.","authors":"Sarah Hanson, Pippa Belderson, Emily Player, Anne-Marie Minihane, Anna Sweeting","doi":"10.1111/nbu.12639","DOIUrl":"10.1111/nbu.12639","url":null,"abstract":"<p><p>For people on very low incomes, household fuel and food environments are increasingly uncertain. Many live in precarious situations with little control over their lives. In addition to food parcels, many foodbanks also supply emergency fuel payments. There has been a surge in demand due to the cost of living crisis in the United Kingdom. This qualitative study, using semi-structured interviews, explored the lived experience of people who received a fuel voucher via a foodbank to gain insights into food preparation, eating practices and heating and appliance use in their homes. All participants (n = 6) described a change in life circumstances leaving them at crisis point with overwhelming uncertainty. Using Thematic Analysis, we identified four themes: (1) Bewilderment in using foodbank services; (2) The need to make trade-offs between food and fuel; (3) Feeling shame at using the services and (4) Missing out on pleasurable eating practices. Three case studies give fuller insights and context. All interviewees had acute and complex needs and described being 'at rock bottom', with fuel vouchers viewed as a 'lifeline' to address essential cooking, heating and electrical appliance needs. We, therefore, suggest the need for extra support and follow-up for first-time users who are in a state of denial and shock when seeking help. Further research is needed on how to best help organisations develop strategies to address and ameliorate a sense of powerlessness and shame felt by their clients which likely limits them from seeking help, despite being in acute, complex and dire need.</p>","PeriodicalId":48536,"journal":{"name":"Nutrition Bulletin","volume":" ","pages":"500-512"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10302557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}