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      Meal kit subscription services and opportunities to improve family vegetable consumption

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          Abstract

          Popular commercial meal kit subscription services (MKSSs) may support families to overcome barriers to cooking and eating at home, and facilitate improved vegetable consumption. The global meal kit market has expanded rapidly creating a gap in our understanding of the health-promoting potential of MKSSs. This paper describes the contemporary MKSS market in Australia and provides a vegetable-specific content analysis of a sample of recipes. A 1-week subscription was purchased for all Australian-based MKSSs ( n = 9) and websites were systematically reviewed to document key characteristics and recipe features. Vegetable content of all available recipes within a 1-week period were analysed. Our findings highlight the rapid expansion and evolution of MKSS market offerings over the past decade and their potential to support family vegetable consumption. Across all analysed recipes ( n = 179), MKSSs provided a median of 2.5 vegetable serves per person (range 0.7–7.5 serves) and a median of 3 different types of vegetables from 2 vegetable subgroups (i.e. dark green, red and orange, starchy, legumes and all other vegetables). This suggests that MKSSs may support family vegetable consumption if families select recipes with a greater number and variety of vegetables. However, an opportunity remains for MKSSs to improve both vegetable quantity and variety to positively influence population health. Further research is required to describe how families use meal kits promoting a greater understanding of their potential to improve family nutrition.

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          Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies

          Abstract Background: Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations. Methods: PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included. Results: For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90–0.94, I2 = 0%, n = 15] for coronary heart disease, 0.84 (95% CI: 0.76–0.92, I2 = 73%, n = 10) for stroke, 0.92 (95% CI: 0.90–0.95, I2 = 31%, n = 13) for cardiovascular disease, 0.97 (95% CI: 0.95–0.99, I2 = 49%, n = 12) for total cancer and 0.90 (95% CI: 0.87–0.93, I2 = 83%, n = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal. Conclusions: Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.
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            The development of instruments to measure the work disability assessment behaviour of insurance physicians

            Background Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants. Methods Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items. Results Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour. The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'. Conclusions The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.
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              Ultra‐processed foods and the nutrition transition: Global, regional and national trends, food systems transformations and political economy drivers

              Understanding the drivers and dynamics of global ultra-processed food (UPF) consumption is essential, given the evidence linking these foods with adverse health outcomes. In this synthesis review, we take two steps. First, we quantify per capita volumes and trends in UPF sales, and ingredients (sweeteners, fats, sodium and cosmetic additives) supplied by these foods, in countries classified by income and region. Second, we review the literature on food systems and political economy factors that likely explain the observed changes. We find evidence for a substantial expansion in the types and quantities of UPFs sold worldwide, representing a transition towards a more processed global diet but with wide variations between regions and countries. As countries grow richer, higher volumes and a wider variety of UPFs are sold. Sales are highest in Australasia, North America, Europe and Latin America but growing rapidly in Asia, the Middle East and Africa. These developments are closely linked with the industrialization of food systems, technological change and globalization, including growth in the market and political activities of transnational food corporations and inadequate policies to protect nutrition in these new contexts. The scale of dietary change underway, especially in highly populated middle-income countries, raises serious concern for global health.
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                Author and article information

                Contributors
                Journal
                Health Promot Int
                Health Promot Int
                heapro
                Health Promotion International
                Oxford University Press (US )
                0957-4824
                1460-2245
                December 2023
                22 November 2023
                22 November 2023
                : 38
                : 6
                : daad155
                Affiliations
                Faculty of Health, School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Faculty of Health, School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Faculty of Health, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Faculty of Health, School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Faculty of Health, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Faculty of Health, School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Faculty of Health, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Faculty of Health, School of Exercise & Nutrition Sciences, Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Faculty of Health, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne Burwood Campus , 221 Burwood Highway, Burwood, Victoria 3125, Australia
                Author notes
                Corresponding author. E-mail: k.fraser@ 123456deakin.edu.au
                Author information
                https://orcid.org/0000-0003-1806-4267
                https://orcid.org/0000-0002-1244-3947
                Article
                daad155
                10.1093/heapro/daad155
                10664410
                37991401
                ec68dddb-4622-4153-ab51-d163390750a7
                © The Author(s) 2023. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Pages: 13
                Funding
                Funded by: Deakin University PhD Scholarship;
                Categories
                Article
                AcademicSubjects/MED00860

                Public health
                meal kits,family nutrition,family meals,vegetable intakes,home cooking
                Public health
                meal kits, family nutrition, family meals, vegetable intakes, home cooking

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