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WHO estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million premature deaths worldwide every year including half a million children under the age of 5 years from pneumonia. We hypothesised that replacing open fires with cleaner burning biomass-fuelled cookstoves would reduce pneumonia incidence in young children. We did a community-level open cluster randomised controlled trial to compare the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi. Clusters were randomly allocated to intervention and control groups using a computer-generated randomisation schedule with stratification by site, distance from health centre, and size of cluster. Within clusters, households with a child under the age of 4·5 years were eligible. Intervention households received two biomass-fuelled cookstoves and a solar panel. The primary outcome was WHO Integrated Management of Childhood Illness (IMCI)-defined pneumonia episodes in children under 5 years of age. Efficacy and safety analyses were by intention to treat. The trial is registered with ISRCTN, number ISRCTN59448623. We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28, 2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95% CI 14·89–16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72–16·45) per 100 child-years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91–1·13; p=0·80). Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group (IRR 0·91 [95% CI 0·37–2·23]; p=0·83). We found no evidence that an intervention comprising cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi. Effective strategies to reduce the adverse health effects of household air pollution are needed. Medical Research Council, UK Department for International Development, and Wellcome Trust.

Background Although school garden programs have been shown to improve dietary behaviors, there has not been a cluster-randomized controlled trial (RCT) conducted to examine the effects of school garden programs on obesity or other health outcomes. The goal of this study was to evaluate the effects of a one-year school-based gardening, nutrition, and cooking intervention (called Texas Sprouts) on dietary intake, obesity outcomes, and blood pressure in elementary school children. Methods This study was a school-based cluster RCT with 16 elementary schools that were randomly assigned to either the Texas Sprouts intervention ( n  = 8 schools) or to control (delayed intervention, n = 8 schools). The intervention was one school year long (9 months) and consisted of: a) Garden Leadership Committee formation; b) a 0.25-acre outdoor teaching garden; c) 18 student gardening, nutrition, and cooking lessons taught by trained educators throughout the school-year; and d) nine monthly parent lessons. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Child outcomes measured were anthropometrics (i.e., BMI parameters, waist circumference, and body fat percentage via bioelectrical impedance), blood pressure, and dietary intake (i.e., vegetable, fruit, and sugar sweetened beverages) via survey. Data were analyzed with complete cases and with imputations at random. Generalized weighted linear mixed models were used to test the intervention effects and to account for clustering effect of sampling by school. Results A total of 3135 children were enrolled in the study (intervention n  = 1412, 45%). Average age was 9.2 years, 64% Hispanic, 47% male, and 69% eligible for free and reduced lunch. The intervention compared to control resulted in increased vegetable intake (+ 0.48 vs. + 0.04 frequency/day, p  = 0.02). There were no effects of the intervention compared to control on fruit intake, sugar sweetened beverages, any of the obesity measures or blood pressure. Conclusion While this school-based gardening, nutrition, and cooking program did not reduce obesity markers or blood pressure, it did result in increased vegetable intake. It is possible that a longer and more sustained effect of increased vegetable intake is needed to lead to reductions in obesity markers and blood pressure. Clinical trials number NCT02668744 .

In this randomized trial involving pregnant women in low- and middle-income countries, birth weight was not higher among infants born to women who used LPG stoves than among those born to women who used biomass stoves.

Abstract Rationale Hypertension during pregnancy is a leading cause of maternal mortality. Exposure to household air pollution elevates blood pressure (BP). Objectives To investigate the ability of a clean cookstove intervention to lower BP during pregnancy. Methods We conducted a randomized controlled trial in Nigeria. Pregnant women cooking with kerosene or firewood were randomly assigned to an ethanol arm (n = 162) or a control arm (n = 162). BP measurements were taken during six antenatal visits. In the primary analysis, we compared ethanol users with control subjects. In subgroup analyses, we compared baseline kerosene users assigned to the intervention with kerosene control subjects and compared baseline firewood users assigned to ethanol with firewood control subjects. Measurements and Main Results The change in diastolic blood pressure (DBP) over time was significantly different between ethanol users and control subjects (P = 0.040); systolic blood pressure (SBP) did not differ (P = 0.86). In subgroup analyses, there was no significant intervention effect for SBP; a significant difference for DBP (P = 0.031) existed among preintervention kerosene users. At the last visit, mean DBP was 2.8 mm Hg higher in control subjects than in ethanol users (3.6 mm Hg greater in control subjects than in ethanol users among preintervention kerosene users), and 6.4% of control subjects were hypertensive (SBP ≥140 and/or DBP ≥90 mm Hg) versus 1.9% of ethanol users (P = 0.051). Among preintervention kerosene users, 8.8% of control subjects were hypertensive compared with 1.8% of ethanol users (P = 0.029). Conclusions To our knowledge, this is the first cookstove randomized controlled trial examining prenatal BP. Ethanol cookstoves have potential to reduce DBP and hypertension during pregnancy. Accordingly, clean cooking fuels may reduce adverse health impacts associated with household air pollution. Clinical trial registered with www.clinicaltrials.gov (NCT02394574).

Peanut sprout is a high-quality healthy food, which not only has beneficial effects, but also a higher phenol content than peanut seed. In this study, peanut sprout was treated with five cooking methods, namely boiling, steaming, microwave heating, roasting, and deep-frying, and the phenol content, monomeric phenol composition, and antioxidant activity were determined. The results showed that, compared with unripened peanut sprout, the total phenol content (TPC) and total flavonoid content (TFC) decreased significantly after the five ripening processes, and the highest retention of phenols and flavonoids was associated with microwave heating (82.05% for TPC; 85.35% for TFC). Compared with unripened peanut sprout, the monomeric phenol composition in germinated peanut was variable after heat processing. After microwave heating, except for a significant increase in the cinnamic acid content, no changes in the contents of resveratrol, ferulic acid, sinapic acid, and epicatechin were observed. Furthermore, there was a significant positive correlation of TPC and TFC with 2,2-diphenyl-1-picrylhydrazyl scavenging capacity, 2,2-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) scavenging capacity, and ferric ion reducing antioxidant power in germinated peanut, but not with hydroxyl free radical scavenging capacity, in which the main monomer phenolic compounds were resveratrol, catechin, and quercetin. The research results indicate that microwave heating can effectively retain the phenolic substances and antioxidant activity in germinated peanuts, making it a more suitable ripening and processing method for germinated peanuts.

Dietary interventions are a key strategy to promote healthy ageing. Cooking skills training emerges as a promising approach to acquiring and maintaining healthy eating habits. The purpose was to evaluate the effectiveness of a culinary programme to improve healthy eating habits among overweight/obese adults (55–70 years old). A total of 62 volunteers were randomly (1:1) assigned to an culinary intervention group (CIG) or a nutritional intervention group (NIG). Dietary, cooking, and health-related outcomes, including body advanced glycation end product (AGE) levels, were evaluated at baseline and after four weeks. Mixed-effects linear models were used to assess the effects of the interventions within and between groups. Among the 56 participants who completed the trial, CIG participants achieved a significant improvement in Mediterranean diet adherence (1.2; 95%CI, 0.2 to 2.2) and a reduction in the use of culinary techniques associated with a higher AGE formation in foods (−2.8; 95%CI, −5.6 to −0.2), weight (−1.5; 95%CI, −2.5 to −0.5), body mass index (−0.5; 95%CI, −0.8 to −0.2), waist circumference (−1.4; 95%CI, −2.6 to −0.2), and hip circumference (−1.4; 95%CI, −2.4 to −0.4) compared with the NIG participants. Although a greater confidence in cooking in the CIG was found, attitudes and cooking habits did not improve. No significant differences in biochemical parameters or AGEs were found between groups. In conclusion, a culinary intervention could be successful in promoting healthy eating and cooking habits compared to a programme based on nutrition education alone. Nevertheless, further efforts are needed to strengthen attitudes and beliefs about home cooking, to address potential barriers and understand the impact of cooking interventions on biological parameters. Larger studies with longer follow-ups are needed to evaluate the relationship between cooking, diet, and health.

To evaluate the immediate and sustained effectiveness of the first Jamie's Ministry of Food Program in Australia on individuals' cooking confidence and positive cooking/eating behaviours. A quasi- experimental repeated measures design was used incorporating a wait-list control group. A questionnaire was developed and administered at baseline (T1), immediately post program (T2) and 6 months post completion (T3) for participants allocated to the intervention group, while wait -list controls completed it 10 weeks prior to program commencement (T1) and just before program commencement (T2). The questionnaire measured: participants' confidence to cook, the frequency of cooking from basic ingredients, and consumption of vegetables, vegetables with the main meal, fruit, ready-made meals and takeaway. Analysis used a linear mixed model approach for repeated measures using all available data to determine mean differences within and between groups over time. All adult participants (≥18 years) who registered and subsequently participated in the program in Ipswich, Queensland, between late November 2011- December 2013, were invited to participate. In the intervention group: 694 completed T1, 383 completed T1 and T2 and 214 completed T1, T2 and T3 assessments. In the wait-list group: 237 completed T1 and 149 completed T1 and T2 assessments. Statistically significant increases within the intervention group (P<0.001) and significant group*time interaction effects (P<0.001) were found in all cooking confidence measures between T1 and T2 as well as cooking from basic ingredients, frequency of eating vegetables with the main meal and daily vegetable intake (0.52 serves/day increase). Statistically significant increases at T2 were sustained at 6 months post program in the intervention group. Jamie's Ministry of Food Program, Australia improved individuals' cooking confidence and cooking/eating behaviours contributing to a healthier diet and is a promising community-based strategy to influence diet quality.

Background: A high-quality diet is linked to cardiometabolic risk reduction. Culinary medicine interventions are effective in improving nutrition and health outcomes. While personalized nutrition is usually related to improving patient outcomes through knowledge about gene-nutrient interactions, tailoring interventions based on participant motivation and biopsychosocial environment may improve outcomes. The stage of change framework categorized participants based on current behaviors and intentions for future behaviors. Our goal was to assess participant perceptions regarding accomplishments, challenges, and needs up to one year following a culinary medicine program according to their stage of change at entry. Methods: Participant perceptions were collected at (1) the intervention end (open-ended questionnaire), (2) six months (semi-structured interview), and (3) twelve months (open-ended questionnaire). Analysis was performed inductively following a thematic analysis approach. Results: Twenty-four participants completed 70 perspectives (58/12 from participants who entered at a contemplation/action stage of change). Perceptions were related to (1) acquire culinary and nutritional knowledge: improve knowledge about healthy nutrition, use new recipes, and ask for hands-on cooking classes; (2) improve culinary and self-regulatory skills: improve confidence in the kitchen, expand cooking skills, organizing and planning, and creativity and pleasure; (3) adopt home cooking and healthy nutrition: adopt home-cooking habits, spreading home cooking to other family members, improve nutrition habits throughout the day, and decrease consumption of ultra-processed food; and (4) address the sustainability of health changes: achievements in maintaining long-term health changes, challenges in maintaining long-term health changes, and facilitators for a long-term change. Conclusions: These results provide one-year-long information about participant facilitators, barriers, and needs for making home-cooking changes categorized to the participant stage of change at program entry. This information can help reform effective personalized culinary medicine programs.

Household air pollution (HAP) from biomass combustion in traditional cooking methods poses significant health risks, particularly in rural communities of low- and middle-income countries. Improved cookstoves (ICS), designed to enhance combustion efficiency and reduce emissions, have been promoted as a transitional alternative towards cleaner cooking. However, evidence of their benefits remains mixed and context-specific. A randomized controlled trial was conducted to evaluate the impact of introducing the Save80 ICS on the respiratory health of adults in rural settlements in Rwanda. The study comprised two assessment rounds, and participants ( n  = 1001) were divided into two groups: one using traditional cooking methods and one using improved cookstoves. Baseline and follow-up data were collected through structured questionnaires and lung function tests. Furthermore, HAP was measured in a field campaign at households cooking with the ICS or traditional methods. The primary outcomes included respiratory symptoms, spirometry (FVC, FEV 1 , and PEF), and exposure to particulate matter (PM 0.3−2.5 ) and its components (EC, OC, BC, BrC, and PAH). We found that households using the ICS spent, on average, 34% less time cooking and had 77% lower indoor PM 0.3−2.5 levels. BC and BrC exposure decreased by 50% and 78%, respectively; OC and TC concentrations were 58% and 45% lower. PAH concentrations showed inconsistent patterns, with most species presenting non-statistically significant changes, constraining objective conclusions. Over the study period (3 years), ICS users reported lower prevalence of cough (-11%) and mucus production (-9%), and showed better forced vital capacity than users of traditional methods. A comparison of lung function decline over time showed that the ICS users had lower deterioration of FVC over three years. This study documents the effects and benefits of introducing ICS. While limitations such as the lack of baseline HAP data during the first health assessment and inconclusive PAH concentrations constrain interpretations and quantified causality, the results contribute to the evidence on the health and indoor air pollution impacts of ICS adoption in rural East African areas.

School gardens have become common school-based health promotion strategies to enhance dietary behaviors in the United States. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, cooking, and nutrition cluster randomized controlled trial, on students’ dietary intake and quality. Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016–2019). The intervention arm received: formation and training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly in the teaching garden during school hours; and nine parent lessons, taught monthly. Dietary intake data via two 24 h dietary recalls (24 hDR) were collected on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015). The intervention group compared to control resulted in a modest increase in protein intake as a percentage of total energy (0.4% vs. −0.3%, p = 0.021) and in HEI-2015 total vegetables component scores (+4% vs. −2%, p = 0.003). When stratified by ethnicity/race, non-Hispanic children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (+4% vs. −8%, p = 0.026). Both the intervention and control groups increased added sugar intake; however, to a lesser extent within the intervention group (0.3 vs. 2.6 g/day, p = 0.050). School-based gardening, cooking, and nutrition interventions can result in significant improvements in dietary intake. Further research on ways to scale and sustain nutrition education programs in schools is warranted. The trial is registered at ClinicalTrials.gov (NCT02668744).