Helena Joycelyn Bentil

Context: Food swap interventions provide an approach to influence consumer food choices. However, evidence on their design and effectiveness has not yet been synthesized. Objective: This review systematically synthesized the literature on food swap interventions in grocery settings by addressing the following questions: (1) What were the key characteristics of the food swap interventions examined in the literature, and what was their intended purpose? (2) Have food swap interventions been effective in changing behavior? Data sources, extraction, and analysis: A search of MEDLINE, Scopus, and Web of Science up to January 23, 2025, was conducted to identify food swap intervention trials in grocery settings, with no limits on language or publication year. Covidence was used to screen titles, abstracts, and full-text articles in duplicate. Data were synthesized narratively. Results: Eleven studies, published during 2006-2024, were included in the review. One intervention was implemented in a real grocery store, 3 in real online supermarkets, and 7 in simulated online supermarkets. Most included studies targeted adults with primary or partial responsibility for their household grocery shopping. All the swaps offered healthier alternatives to selected products. Outcomes examined included shopping basket item healthiness, energy content, saturated fatty acid (SFA) content, salt density, and sodium and sugar content. All but 1 study noted evidence that the studied interventions can change behavior. Two studies found significant improvements in overall nutritional quality. Salt/sodium reductions were seen in 2 studies, while reductions in sugar content were seen in 1 study but not in another study. Studies also demonstrated significant reductions in purchased energy content/density, and SFA. Conclusion: A range of food swap interventions have been studied, and most of those identified have been found to be effective in improving the healthiness of food purchases. No studies explored the potential of swap interventions to promote sustainable food choices, which could be a topic of future research. Systematic Review Registration: PROSPERO registration No. [CRD42024539803].

This study investigated the role of early‐life nutrition supplementation in regulating the development of hypothalamic‐pituitary‐adrenal (HPA) axis activity, as evidenced by hair cortisol concentration (HCC), in the iLiNS‐DYAD randomized controlled trial in Ghana. Pregnant women were randomized to one of three conditions: (1) iron and folic acid (IFA) during pregnancy and placebo 0‐6 mo postpartum; (2) multiple micronutrients (MMN) during pregnancy and 0–6 mo postpartum; or (3) small‐quantity lipid‐based nutrient supplements (SQ‐LNS) during pregnancy and 0–6 mo postpartum and for their children from 6 to 18 mo. At 9–11 y of age, usable hair samples were obtained from 680 children from which cortisol was assayed. ANCOVA models assessed differences between groups and potential effect modifiers, including maternal education, household asset index, pre‐pregnancy BMI, child sex, child BMI, and pubertal stage. HCC did not differ between SQ‐LNS and control groups in adjusted and unadjusted models ( p > 0.10), but maternal education was a significant effect modifier ( P ‐interaction = 0.043). Children exposed to SQ‐LNS had lower HCC than control children among those whose mothers had 0–5 years schooling (Median (interquartile range): 6.3 (4.8, 9.9) vs. 7.8 (5.3, 9.9); p = 0.031) but not among those whose mothers had > 5 years of schooling ( p = 0.949). No other interactions were significant. Although these findings should be viewed with caution, they suggest that early‐life SQ‐LNS may buffer physiological stress in children of less educated mothers, highlighting its potential to compensate for socioeconomic disadvantage with regard to HPA axis regulation. Trial Registration: Clinical Trial Registry number and website: clinicaltrials.gov as NCT00970866 https://clinicaltrials.gov/ct2/show/record/NCT00970866 .

Nutrition and the home environment contribute to the development of the autonomic nervous system (ANS). However, no study has examined the long‐term effects of prenatal and postnatal small‐quantity lipid‐based nutrient supplements (SQ‐LNS) and home environment on ANS regulation. We investigated the effect of early‐life SQ‐LNS and home environment on ANS regulation at 9–11 years. Participants were children born to women who participated in a randomized controlled trial in Ghana from 2009 to 2014. Women were randomized to receive daily, from pregnancy until delivery, either SQ‐LNS, multiple micronutrients (MMN) or iron and folic acid (IFA) followed by SQ‐LNS, MMN or placebo, respectively, until 6 months postpartum. Infants in the SQ‐LNS group received SQ‐LNS from 6 to 18 months. Quality of home environment was observed at 4–6 and 9–11 years. At 9–11 years, 965 children had their respiratory sinus arrhythmia (RSA) and pre‐ejection period (PEP) measured at baseline and during two inhibitory control tasks, the RACER Simon and Emotion Go/No‐Go (EGNG) tasks. PEP reactivity to the RACER Simon task was greater in the MMN (−2.54 ± 4.45, p = 0.016) and SQ‐LNS (−2.31 ± 4.94, p = 0.093) groups than in the IFA group (−1.57 ± 3.51). A better home environment at 4–6 predicted longer baseline PEP (β = 0.13, 95% CI: 0.02, 0.23, p = 0.016) and more PEP reactivity during the EGNG task (β = −0.06, 95% CI: −0.00, −0.02, p = 0.001). Prenatal micronutrient supplementation appears to increase SNS reactivity. Children raised in disadvantaged early home environments had more tonic SNS activation and less SNS reactivity, suggesting a predisposition for stronger fight‐or‐flight activation and less likelihood to modulate arousal in response to acute situations.Trial Registration: ClinicalTrials.gov identifier: NCT00970866

The significance of physiological regulation in relation to behavioral and emotional regulation is well documented, but primarily in economically advantaged contexts. Few studies have been conducted in low‐ and middle‐income countries. We investigated the feasibility and reliability of measuring autonomic nervous system (ANS) activity and behavior during challenge tasks in 30 children aged 8–10 years in Ghana during two visits, 1 week apart. Completeness of ANS data ranged from 80% to 100% across all tasks. There was low‐to‐moderate test–retest reliability of video mood induction (VMI) emotion ratings and balloon analog risk task (BART) pumps (r = 0.34–0.52). VMI elicited higher targeted emotion ratings in Visit 2 than Visit 1. Respiratory sinus arrhythmia (RSA) was higher, and pre‐ejection period (PEP) was longer at Visit 2 than Visit 1 for baseline and both tasks. RSA was higher at baseline than during the VMI anger scene at Visit 1, whereas PEP was shorter at baseline than during all VMI emotion scenes at Visit 2. RSA was higher at baseline than during BART at both visits. In conclusion, ANS data collection within evocative and arousing challenge tasks was feasible in Ghana, and the tasks were generally reliable and effective in eliciting target emotions and risk‐taking behavior in this sample.

Despite the importance of magnesium to health and most importantly to women of reproductive age who are entering pregnancy, very few surveys have investigated the magnesium status of women of reproductive age, particularly in Africa. Additionally, the software and programs used to analyze dietary intake vary across countries in the region. To assess the dietary magnesium intake of women of reproductive age in Ghana and to compare the estimate of magnesium intake obtained from two commonly used dietary analysis programs. We collected magnesium intake from 63 Ghanaian women using a semiquantitative 150-item food frequency questionnaire. Dietary data was analyzed using two different dietary analysis programs, Nutrient Data Software for Research (NDSR) and the Elizabeth Stewart Hands and Associates (ESHA) Food Processor Nutrition Analysis software. We used the Wilcoxon signed rank test to compare the mean differences between the two dietary programs. There were significant differences between the average dietary magnesium intake calculated by the two dietary programs, with ESHA estimating higher magnesium intake than NDSR (M±SE; ESHA: 200 ± 12 mg/day; NDSR: 168 ± 11 mg/day; p<0. 05). The ESHA database included some ethnic foods and was flexible in terms of searching for food items which we found to be more accurate in assessing the magnesium intake of women in Ghana. Using the ESHA software, 84% of the study women had intake below the recommended dietary allowances (RDA) of 320mg/day. It is possible that the ESHA software provided an accurate estimate of magnesium in this population because it included specific ethnic foods. Concerted efforts such as magnesium supplementation and nutrition education should be considered to improve the magnesium intake of women of reproductive age in Ghana.

In several studies conducted in high-income countries, low magnesium intake has been linked to an increased risk of type 2 diabetes mellitus (T2DM). However, very no studies have been conducted in Africa, where the prevalence of T2DM is increasing in many countries. Furthermore, few studies have investigated the risk of magnesium deficiency in women of reproductive age, a group where lower levels of dietary magnesium intake have been linked to gestational diabetes and pre-eclampsia during pregnancy. The purpose of this dissertation was to conduct a pilot cross-sectional study to investigate the dietary magnesium intakes of women of reproductive age in Ghana and the association between dietary magnesium intake and glycemic markers including fasting blood glucose and glycated hemoglobin (HbA1c). Manuscript 1 “Association Between Dietary Magnesium Intake and Glycemic Markers in Ghanaian Women of Reproductive Age: A Pilot Cross-Sectional Study” is a research article that sought to investigate the relationship between dietary magnesium intake and glycemic markers in Ghanaian women of reproductive age. The results did not show a significant association, but the finding necessitates further research with larger representative samples to substantiate the study findings. Manuscript 2 “Dietary Magnesium Intake among Women of Reproductive Age in Ghana - A Comparison of Two Dietary Analysis Programs” is also a research article that aimed to assess the dietary magnesium intake in non-pregnant women of reproductive age in Ghana and to compare magnesium intakes using two dietary analysis programs, ESHA (Elizabeth Stewart Hands and Associates) and NDSR (Nutrient Data Software for Research). The results indicate that based on the calculations of both dietary analysis programs, the average magnesium intake in the study women were below recommended dietary allowances (RDA) of 320mg/day, representing 53% - 63% of the RDA. The average dietary magnesium intake calculated by the two dietary programs differed significantly.

Overweight/obesity (OWOB) often co-occurs with anemia or micronutrient deficiencies (MNDs) among women of reproductive age (WRA) in Ghana; identifying the risk factors of these conditions is essential for prevention. We aimed to examine the prevalence of OWOB, anemia, and MNDs and their co-occurrence and risk factors among non-pregnant women 15–49 years of age in Ghana. Data were from a 2017 two-stage national survey of 1063 women. We estimated the weighted prevalence of single and co-occurring malnutrition, and used logistic regression to explore risk factors. The prevalence of OWOB, anemia, and ≥1 MND was 39%, 22%, and 62%, respectively; that of OWOB co-occurring with anemia was 6.7%, and OWOB co-occurring with ≥1 MND was 23.6%. There was no significant difference between observed and expected prevalence of co-occurrence OWOB with anemia or MND. Risk factors were: living in southern (vs. northern) belt, high- (vs. low-) wealth household, being ≥ 25 years old, and being married (vs. single) for OWOB, and living in northern (vs. southern) belt and medium- (vs. low-) wealth household for anemia and ≥1 MND, respectively. Different interventions are required for addressing OWOB in WRA than those for anemia and MNDs.

Low magnesium intake has been shown to be associated with an increased risk of type 2 diabetes mellitus (T2DM) in several studies conducted in high-income countries. However, very few studies have been performed in Africa, where many countries have a growing rate of T2DM. We conducted a pilot cross-sectional study among 63 women in Ghana to investigate the association between magnesium intake and glycemic markers. We assessed dietary magnesium using a food frequency questionnaire and glycemic markers using fasting blood glucose and glycated hemoglobin A1c (HbA1c). Our findings showed that the mean magnesium intake was 200 ± 116 mg/day. The prevalence of T2DM was 5% by measuring fasting blood glucose and 8% by measuring HbA1c. Unadjusted linear regression models revealed that higher magnesium intake significantly predicted higher fasting blood glucose levels (β = 0.31; 95% CI: 0.07, 0.55; p = 0.01) and HbA1c levels (β = 0.26; 95% CI: 0.01, 0.51; p = 0.04). In adjusted analyses, magnesium intake was no longer significantly associated with either fasting blood glucose levels (β = 0.22; 95% CI: −0.03, 0.46; p = 0.08) or HbA1c levels (β = 0.15; 95% CI: −0.08, 0.39; p = 0.20). In conclusion, our study did not show a significant association between magnesium intake and glycemic markers in women of reproductive age in Ghana. The results of this study need to be further substantiated because this was the first study to examine magnesium intake and glycemic markers in this population in Africa.

Background: Optimal complementary feeding is critical for adequate growth and development in infants and young children. The associations between complementary feeding and growth have been studied well, but less is known about the relationship between complementary feeding and micronutrient status. Methods: Using data from a national cross-sectional survey conducted in Ghana in 2017, we examined how multiple WHO-recommended complementary feeding indicators relate to anemia and the micronutrient status of children aged 6–23 months. Results: In total, 42%, 38%, and 14% of the children met the criteria for minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), respectively. In addition, 71% and 52% of the children consumed iron-rich foods and vitamin A-rich foods, respectively. The prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA) and vitamin A deficiency (VAD) was 46%, 45%, 27%, and 10%, respectively. Inverse associations between MMF and socio-economic status were found, and MMF was associated with an increased risk of ID (55%; p < 0.013) and IDA (38%; p < 0.002). Conclusion: The pathways connecting complementary feeding and micronutrient status are complex. Findings related to MMF should be further investigated to ensure that complementary feeding programs account for the potential practice of frequent feeding with nutrient-poor foods.