Diet and Nutritional Status of West African and Caribbean Adults in the United Kingdom: Perspectives to Inform Community-Based Approaches to Healthy Eating
Round 1
Reviewer 1 Report
This study investigated Diet and nutritional status of West African and Caribbean adults in the United Kingdom. The situation these part of the community is facing is necessary for the equality of health programs. Obviously the situation of their counterpart in the original countries is much worse, so, what is the aim for such a comparison?
Line 16: Was the study solely based on literature review rather than a real monitoring survey?
Lines 24 and 25: It is suggested to present the overall conclusion of the survey and the advice authors aimed to inform authorities of community-based organization. Instead, the suggesting must be moved to conclusion for future study.
Can authors give a comparison of alcohol consumption and smoking of the target groups compared to the UK nation to understand whether the it is high for West African and Caribbean adults?
Line 282: “could also increase their risk cardiovascular diseases” is there any scientific evidence from hospitals for such risk assessments, if yes, suggest better to be included for better showing the conditions of the target group.
Line 287: Is there any evidence showing the balance between consumption of foods and alcohols or smoking to know if Black African and African-Caribbean groups in UK or Europe spends more money for foods or smoking and alcohols compared to their original counterpart?
Lines 346-7: “target population may be at risk of illnesses associated with excess adiposity, inactive lifestyle, high sodium consumption and inadequate fibre intake” this conclusion is more related to life style rather than that stated in line 37 “Despite these deep-rooted health inequality…” which emphasis on inequality. It seems that high sodium consumption and inadequate fibre intake are things that can be managed by family’s target group. I suggest conclusion be revised according to the title and introduction to make it clear whether the dietary and nutritional status of the target study group is mainly due to life style or inequality.
Author Response
Point 1: This study investigated Diet and nutritional status of West African and Caribbean adults in the United Kingdom. The situation these part of the community is facing is necessary for the equality of health programs. Obviously the situation of their counterpart in the original countries is much worse, so, what is the aim for such a comparison?
Response 1: Our database searches for relevant papers identified only one study based on West African and African Caribbean adults in the UK. Hence, the inclusion criteria were extended to include studies that compared the target groups with their counterpart in Europe and their home countries. In addition, patterns of morbidity, health related behaviours, dietary intake and habits in the target population differ from White groups due to various factors including acculturation. Traditional foods remain a major component of the diets West African and African Caribbean adults in the UK. In the light of the above, comparison with their counterparts in the countries of origin would provide useful and reliable information for culturally tailored interventions.
Point 2: Line 16: Was the study solely based on literature review rather than a real monitoring survey?
Response 2: The reviewer has overlooked that it is clearly stated that this is a literature review.
Point 3: Lines 24 and 25: It is suggested to present the overall conclusion of the survey and the advice authors aimed to inform authorities of community-based organization. Instead, the suggesting must be moved to conclusion for future study.
Response 3: Could the reviewer clarify the above queries as Lines 24 and 25 which are within the abstract do not relate to recommendations based on our review.
Point 4: Can authors give a comparison of alcohol consumption and smoking of the target groups compared to the UK nation to understand whether it is high for West African and Caribbean adults?
Response 4: We have provided additional information from line 293 to 298.
Point 5: Line 282: “could also increase their risk cardiovascular diseases” is there any scientific evidence from hospitals for such risk assessments, if yes, suggest better to be included for better showing the conditions of the target group.
Response 5: There is overwhelming scientific evidence to show that physical inactivity is a major risk factor for CVD in humans, irrespective of race or ethnicity. Citations have been included to support the statement. Please see lines 288, and 463 to 472.
Point 6: Line 287: Is there any evidence showing the balance between consumption of foods and alcohols or smoking to know if Black African and African-Caribbean groups in UK or Europe spends more money for foods or smoking and alcohols compared to their original counterpart?
Response 6: Please see response 4 lines 293 to 298.
Point 7: Lines 346-7: “target population may be at risk of illnesses associated with excess adiposity, inactive lifestyle, high sodium consumption and inadequate fibre intake” this conclusion is more related to lifestyle rather than that stated in line 37 “Despite these deep-rooted health inequality…” which emphasis on inequality. It seems that high sodium consumption and inadequate fibre intake are things that can be managed by family’s target group. I suggest conclusion be revised according to the title and introduction to make it clear whether the dietary and nutritional status of the target study group is mainly due to lifestyle or inequality.
Response: We would argue against putting the blame on the target population, rather addressing the real issues of health inequalities. These issues relating to health inequalities with regards to minoritised groups in the UK have also been highlighted by the independent charitable organisation working to improve the health and care in England (The health of people from ethnic minority groups in England | The King's Fund (kingsfund.org.uk)
In the light of the above, the meaning of health inequalities (unfair and avoidable difference in health shaped by wider determinants) including the fact that the target groups have unequal access to health information (including culturally relevant food-based resources for promote healthy eating) and opportunities, and poorer experience of using health services compared to the White population, we would retain our conclusion.
Reviewer 2 Report
1. The article “Diet and nutritional status of West African and Caribbean 2 adults in the United Kingdom: A narrative review to inform community-based approaches to healthy eating” primarily intended to investigate the dietary habit and nutrient intake (macronutrients) of Black adults residing in the UK descended from African Nations and to suggest community-based interventions to support healthy eating and lifestyles.
2. The study is interesting and could be useful for community intervention. While it is understood that it could not derive this information from the existing survey data repository in the UK, however, the classification of the Black people here include in the study is confusing. Does it mean to “Afro-Caribbean people”?
3. From the perspective of gene-nutrient response on disease risk over the years, one should consolidate races from similar origins. On the other way, it is not understood the further segregation between black Africans and the black Caribbean in the UK as both were of African origin, and their genetic response to diets is likely to be similar as they are living in the UK for several years.
4. Line 4 Full stop in the title? Line 2 “adults” includes both genders
5. Out of six studies finally selected, five were from one country i.e. Ghana. Several countries constitute West Africa including Ghana. The data to represent the Black people of West Africa could be biased when presented data for a single nation.
6. Line 26 odd keyword …Non-Starch Polysaccharide;
7. Line 36 the statement “Some minorities ethnic groups have a poorer health-related quality of life compared to Whites in the UK” needs citation.
8. The authors used several terminologies like “health inequalities”, and “health-related quality of life” which are qualitative and descriptive indicating a broad perspective in the study objective. The authors must be specific to the questions and focus more on available community based-approaches that may include social networking and digital advertisement etc.
9. Line 68-75 the section (NDNS) is irrelevant to the present study. It would be misleading to include details about NDNS. Current work could be stated as supplementary to NDNS.
10. Line 112 “North Africa” used in the search option where the study title added “West African”. Other African regions should have been included if race is primary over geography.
11. Table 2 further subdivision of carbohydrate intake by NSP has little relevance unless NSP could have been connected with BMI. Moreover, there are limited data is cited in this category does not deserve a separate subcategory of carbohydrate intake. Make a column for geography location so that data would be focussed.
12. Line 321 the recommendation may include advocating diversity in food choice in addition to the quality of the foods.
Author Response
Point 1: The article “Diet and nutritional status of West African and Caribbean 2 adults in the United Kingdom: A narrative review to inform community-based approaches to healthy eating” primarily intended to investigate the dietary habit and nutrient intake (macronutrients) of Black adults residing in the UK descended from African Nations and to suggest community-based interventions to support healthy eating and lifestyles.
The study is interesting and could be useful for community intervention. While it is understood that it could not derive this information from the existing survey data repository in the UK, however, the classification of the Black people here include in the study is confusing. Does it mean to “Afro-Caribbean people”?
Response 1: Please see line 62 to 64 where this was explained in the manuscript.
Point 2: From the perspective of gene-nutrient response on disease risk over the years, one should consolidate races from similar origins. On the other way, it is not understood the further segregation between black Africans and the black Caribbean in the UK as both were of African origin, and their genetic response to diets is likely to be similar as they are living in the UK for several years.
Response 2: As evidenced in our paper, irrespective of history of origin, these ethnic groups are diverse in terms of ancestry, migration patterns, environmental exposures (including the wider determinants of health), cultural experiences and practices, and in diet and health related behaviours. Hence, homogenising the two ethnic groups would be highly inappropriate. Our focus is on ethnicity, not on classifications of people based on phenotypical characteristics and false claims of genetic similarity that underpin reductive concepts of ‘race’. In addition, the priority for our paper is modifiable risk factors and not nutrigenomics. Hence understanding modifiable risk factors relevant to nutritional status and health behaviours of the two groups would inform tailored and potentially impactful interventions.
Point 3: Line 4 Full stop in the title? Line 2 “adults” includes both genders.
Response 3: Full stop has been removed from the title. ‘Adult’ refers to both genders.
Point 4: Out of six studies finally selected, five were from one country i.e. Ghana. Several countries constitute West Africa including Ghana. The data to represent the Black people of West Africa could be biased when presented data for a single nation.
Response 4: We have stated the limitations of the paper to address this query. Please see line 328 to 330.
Point 5: Line 26 odd keyword …Non-Starch Polysaccharide
Response 5: The word ‘fibre’ (see line 26) has been added to NSP to capture the essence of the paper given that it was one of the key nutrients identified for targeted intervention (also see lines 194 to 198).
Point 6: Line 36 the statement “Some minorities ethnic groups have a poorer health-related quality of life compared to Whites in the UK” needs citation.
Response 6: We have included a citation. See lines 35 and 382.
Point 7: The authors used several terminologies like “health inequalities”, and “health-related quality of life” which are qualitative and descriptive indicating a broad perspective in the study objective. The authors must be specific to the questions and focus more on available community based-approaches that may include social networking and digital advertisement etc.
Response 7: The suggested areas for focus do not align with the intended aim of the paper which were ‘To synthesise recent research on the nutrient composition of the diets, nutritional status and health-related behaviours of West African and Caribbean adults living in the UK. The review also identified priorities for research and interventions, including community-based interventions to support healthy eating and lifestyles’.
Point 8: Line 68-75 the section (NDNS) is irrelevant to the present study. It would be misleading to include details about NDNS. Current work could be stated as supplementary to NDNS.
Response 8: This section is very relevant to the paper in providing context related to the lack of reliable data on the diet and nutritional status of minoritised groups in the UK, and the need for tailored interventions to reduce health inequalities.
Point 9: Line 112 “North Africa” used in the search option where the study title added “West African”. Other African regions should have been included if race is primary over geography.
Response 9: This was a typo and North Africa has been deleted. See line 108.
Point 10: Table 2 further subdivision of carbohydrate intake by NSP has little relevance unless NSP could have been connected with BMI. Moreover, there are limited data is cited in this category does not deserve a separate subcategory of carbohydrate intake. Make a column for geography location so that data would be focussed.
Response 10: Information on the geographical location has already been provided in Table 1.
It is good practice and recommended in nutrition and food research to provide information on key nutrients such as NSP fibre when evaluating diet adequacy. Hence the need to show this in the table.
Point 11: Line 321 the recommendation may include advocating diversity in food choice in addition to the quality of the foods.
Response 11: See text added in line 337.
Reviewer 3 Report
The authors may consider using the asterisk symbol (*) to identify the significant differences in the tables.
Author Response
Point 1: The authors may consider using the asterisk symbol (*) to identify the significant differences in the tables.
Response: We are unable to address this query since the values reported in the tables relate to descriptive and not inferential statistics.
Reviewer 4 Report
Firstly I want to thank you for giving me the opportunity to review the article entitled "Diet and nutritional status of West African and Caribbean adults in the United Kingdom: A narrative review to inform community-based approaches to healthy eating". I think the purpose of this paper is unclear and the research method is inappropriate. Although the author said it was a narrative review, I think a survey or national data analysis approach is appropriate for this study. Otherwise, a systematic review method based on randomized controlled trials should be conducted to identify which interventions affect diet and nutritional status of West African and Caribbean adults in the United Kingdom. The following is comments for systematic review.
(comment 1) I recommend authors to re-write Method Section as follows;
2.1. Information Sources and Search Strategy
2.2. Eligibility Criteria
2.3. Study Selection
2.4. Data Extraction
2.5. Risk of Bias Assessment(If necessary)
2.6. Data Synthesis and Analysis(If necessary)
e.g. https://doi.org/10.3390/jcm10143087
(comment 2) I think it is essential to include guidelines for reporting systematic reviews. Do the authors follow any guidelines?
(Comment 3) Figure 1 should be included in the Result Section, supplementing the description of the selection process. Also, I recommend authors to supplement the following points. I doubt the systematic search was done properly.
- 6,165: Please indicate which database you searched for and how many articles you extracted from reference lists.
- 6,111: Please provide details on why you excluded it.
- 48: Please indicate how many articles are related to 'no dietary assessment method' and 'outside UK or no comparison to UK paricipants'.
Author Response
Point 1: I recommend authors to re-write Method Section as follows;
2.1. Information Sources and Search Strategy
2.2. Eligibility Criteria
2.3. Study Selection
2.4. Data Extraction
2.5. Risk of Bias Assessment(If necessary)
2.6. Data Synthesis and Analysis(If necessary)
Response 1: See lines 105 to 134. There is nowhere in our paper where it has been indicated that it was a systematic review.
Point 2: (comment 2) I think it is essential to include guidelines for reporting systematic reviews. Do the authors follow any guidelines?
Response 2: See our response above. We do follow guidelines. The authors have expertise in systematic review and meta-analysis and have published extensively in this area.
Point 3: Figure 1 should be included in the Result Section, supplementing the description of the selection process. Also, I recommend authors to supplement the following points.
Response 3: Figure 1 has been moved to the results section.
Point 4: I doubt the systematic search was done properly.
Response 4: This is a matter of opinion as we have clearly described the search process in the methodology.
Point 5: Please indicate which database you searched for and how many articles you extracted from reference lists.
Response 6: The above were clearly outlined in lines 105 to 134.
Point 6: Please provide details on why you excluded it.
Response 7: See line 125 to 128. Studies were excluded because they did not meet the inclusion criteria.
Point 7: Please indicate how many articles are related to 'no dietary assessment method' and 'outside UK or no comparison to UK participants'.
Response 7: See Figure 1, lines 155 to 158.
Round 2
Reviewer 1 Report
Authors adequately responded to queries
Author Response
Thank you.
Reviewer 2 Report
The authors used NDNS data (published) in strengthening the present study. Thus, all the data presented in this article may not original (see previous comment).
Still, I am not convinced how data from a single country "Ghana" would represent West Africa.
Author Response
Point 1: The authors used NDNS data (published) in strengthening the present study. Thus, all the data presented in this article may not original (see previous comment).
Response 1: The NDNS is not a study. It is the UK’s annual National Diet and Nutrition Survey (NDNS), funded by the government and conducted by the Epidemiology Unit at the University of Cambridge. This is the only source of high-quality data on dietary intakes and nutritional status of the UK population. The citation is from the government website, and therefore reliable. The NDNS data is therefore appropriate to cite. It also strengthens the argument that the data does not allow for ethnicity level analysis.
Point 2: Still, I am not convinced how data from a single country "Ghana" would represent West Africa.
Response 2: In addition, to a statement of caution in the limitation section of the paper (lines 306 to 308), the study by Goff et al (Table 1) included people of West African ancestry i.e. ‘an ancestry originating from the countries of the Economic Community of West African States (seventeen in total)’.
Reviewer 4 Report
(Comment 1) Regarding comment 1 (I recommend authors to re-write Method Section as follows), authors did not supplement the Methods Section based on the comments.
e.g. https://doi.org/10.3390/jcm10143087
2.1. Information Sources and Search Strategy
2.2. Eligibility Criteria
2.3. Study Selection
2.4. Data Extraction
2.5. Risk of Bias Assessment
2.6. Data Synthesis and Analysis
(Comment 2) Regarding comment 2 (I think it is essential to include guidelines for reporting systematic reviews. Do the authors follow any guidelines?), The authors mentioned that this study is systematic review. Thus, I recommend authors to state PRISMA guideline. Also, the protocol of this systematic review should be presented in the "Method section".
(Comment 3) Authors did not adress my comment.
- Figure 1 should be included in the Result Section, supplementing the description of the selection process. Also, I recommend authors to supplement the following points.), authors did not move Figure 1
- Please indicate which database you searched for and how many articles you extracted from reference lists.
- Please provide details on why you excluded it.
e.g. https://doi.org/10.3390/jcm10143087
Author Response
Point 1: (Comment 2) Regarding comment 2 (I think it is essential to include guidelines for reporting systematic reviews. Do the authors follow any guidelines?), The authors mentioned that this study is systematic review. Thus, I recommend authors to state PRISMA guideline. Also, the protocol of this systematic review should be presented in the "Method section".
Response 1: See lines 102 to 134. PRISMA flowchart has been deleted so we don’t need to follow systematic review protocol since the paper isn’t. Ther
Point 2: Comment 3) Authors did not address my comment.
- Figure 1 should be included in the Result Section, supplementing the description of the selection process. Also, I recommend authors to supplement the following points.), authors did not move Figure 1
- Please indicate which database you searched for and how many articles you extracted from reference lists.
- Please provide details on why you excluded it.
Response 2: See lines 102 to 134 and 136 to 143.
Round 3
Reviewer 2 Report
The manuscript may be considered
Reviewer 4 Report
After reviewing the author responses, the authors did not adress my comments and suggestions. Also, systematic search process must be presented as a detailed Figure. For this reason, I decided to reject this paper.
