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Lee AJ, Kane S, Herron LM, Matsuyama M, Lewis M. A tale of two cities: the cost, price-differential and affordability of current and healthy diets in Sydney and Canberra, Australia. Int J Behav Nutr Phys Act 2020; 17:80. [PMID: 32571334 PMCID: PMC7309977 DOI: 10.1186/s12966-020-00981-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/08/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The perception that healthy foods are more expensive than unhealthy foods has been reported widely to be a key barrier to healthy eating. However, assessment of the relative cost of healthy and unhealthy foods and diets is fraught methodologically. Standardised approaches to produce reliable data on the cost of total diets and different dietary patterns, rather than selected foods, are lacking globally to inform policy and practice. METHODS This paper reports the first application, in randomly selected statistical areas stratified by socio-economic status in two Australian cities, of the Healthy Diets Australian Standardized Affordability and Pricing (ASAP) method protocols: diet pricing tools based on national nutrition survey data and dietary guidelines; store sampling and location; determination of household incomes; food price data collection; and analysis and reporting. The methods were developed by the International Network on Food and Obesity/NCD Research, Monitoring and Action Support (INFORMAS) as a prototype of an optimum approach to assess, compare and monitor the cost and affordability of diets across different geographical and socio-economic settings and times. RESULTS Under current tax policy in Australia, healthy diets would be 15-17% less expensive than current (unhealthy) diets in all locations assessed. Nevertheless, healthy diets are likely to be unaffordable for low income households, costing more than 30% of disposable income in both cities surveyed. Households spent around 58% of their food budget on unhealthy food and drinks. Food costs were on average 4% higher in Canberra than Sydney, and tended to be higher in high socioeconomic locations. CONCLUSIONS Health and fiscal policy actions to increase affordability of healthy diets for low income households are required urgently. Also, there is a need to counter perceptions that current, unhealthy diets must be less expensive than healthy diets. The Healthy Diets ASAP methods could be adapted to assess the cost and affordability of healthy and unhealthy diets elsewhere.
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Affiliation(s)
- Amanda J Lee
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia.
| | - Sarah Kane
- Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Lisa-Maree Herron
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Misa Matsuyama
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Meron Lewis
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
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Proceedings of a Workshop on Characterizing and Defining the Social and Economic Domains of Sustainable Diets. SUSTAINABILITY 2020. [DOI: 10.3390/su12104163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Global challenges associated with a growing demand for food in the face of finite natural resources and climate change have prompted concerns about the sustainability of our current food systems. As formulated by the Food and Agriculture Organization, the four principal domains of sustainable diets are health, economics, society, and the environment. While emphasizing the environmental cost and health impacts of current diets, the research literature has virtually ignored the vital economic and social aspects of sustainability. Without these components, critical inputs for decision-making about global challenges related to climate change and a growing demand for food are missing. National Dairy Council convened experts in sociology, economics, human nutrition, food systems science, food security, environmental health, and sustainable agriculture for a one-day workshop to define the social and economic domains of sustainability in service of better characterizing food-based dietary guidance that is both healthy and sustainable. The consensus recommendations were to (1) select social and economic indicators to complement the existing environmental and health ones, (2) better define appropriate concepts, terms, and measures to foster discussion across scientific disciplines, (3) reframe the focus on sustainable diets towards the goal of “achieving healthy dietary patterns from sustainable food systems”, and (4) complement the four domains, and incorporate the notions of geography, time, and cross-cutting considerations into sustainability frameworks. This publication summarizes the presentations, discussions, and findings from the 2019 workshop, and aims to catalyze further action to advance sustainability research and practice in the context of food-based dietary guidance and the Sustainable Development Goals.
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Downs SM, Ahmed S, Fanzo J, Herforth A. Food Environment Typology: Advancing an Expanded Definition, Framework, and Methodological Approach for Improved Characterization of Wild, Cultivated, and Built Food Environments toward Sustainable Diets. Foods 2020; 9:E532. [PMID: 32331424 PMCID: PMC7230632 DOI: 10.3390/foods9040532] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023] Open
Abstract
The food environment is a critical place in the food system to implement interventions to support sustainable diets and address the global syndemic of obesity, undernutrition, and climate change, because it contains the total scope of options within which consumers make decisions about which foods to acquire and consume. In this paper, we build on existing definitions of the food environment, and provide an expanded definition that includes the parameter of sustainability properties of foods and beverages, in order to integrate linkages between food environments and sustainable diets. We further provide a graphical representation of the food environment using a socio-ecological framework. Next, we provide a typology with descriptions of the different types of food environments that consumers have access to in low-, middle-, and high-income countries including wild, cultivated, and built food environments. We characterize the availability, affordability, convenience, promotion and quality (previously termed desirability), and sustainability properties of food and beverages for each food environment type. Lastly, we identify a methodological approach with potential objective and subjective tools and metrics for measuring the different properties of various types of food environments. The definition, framework, typology, and methodological toolbox presented here are intended to facilitate scholars and practitioners to identify entry points in the food environment for implementing and evaluating interventions that support sustainable diets for enhancing human and planetary health.
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Affiliation(s)
- Shauna M. Downs
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, NJ 07102, USA;
| | - Selena Ahmed
- Sustainable Food Systems Program, Department of Health and Human Development, Montana State University, Bozeman, MT 59717, USA
| | - Jessica Fanzo
- Berman Institute of Bioethics, Nitze School of Advanced International Studies and Bloomberg School of Public Health, Johns Hopkins University, Washington, DC 21205, USA;
| | - Anna Herforth
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, University Boston, MA 02125, USA;
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Czarnocinska J, Wadolowska L, Lonnie M, Kowalkowska J, Jezewska-Zychowicz M, Babicz-Zielinska E. Regional and socioeconomic variations in dietary patterns in a representative sample of young polish females: a cross-sectional study (GEBaHealth project). Nutr J 2020; 19:26. [PMID: 32245487 PMCID: PMC7126359 DOI: 10.1186/s12937-020-00546-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Associations between dietary patterns (DPs) and socioeconomic correlates among adolescents from emerging economy countries are not fully understood. The study analysed variations in DPs adherence depending on country regions and family socioeconomic status (SES) among Polish females. Methods Data from a representative sample (n = 1107) of Polish females 13–21-year-old was used. Four DPs were previously identified by principal component analysis. Regions were ranked by Gross Domestic Product. A SES index as an overall measure of family SES was developed. Multiple logistic regression models adjusted for age and body mass index were created. Results Higher adherence to ‘Fast-food and sweets’ DP was found in the less affluent (North) region when compared to four other regions (Odds ratio (OR): 1.94 to 1.63). Higher adherence to ‘Fruit and vegetables’ DP was found in more affluent regions when compared to poorer regions: East and North-East (OR 1.71 to 1.81 and 1.69 to 2.23, respectively). Higher adherence to ‘Traditional Polish’ DP was found in 4 out of 5 regions (OR 2.02 to 2.53) when compared to the East. Higher family SES was associated with higher adherence to ‘Fruit and vegetables’ DP (OR 2.06) and lower adherence to ‘Traditional Polish’ DP (OR 0.27). Conclusions The study revealed that region’s affluence is strongly reflected in dietary behaviours of young females from a transitioning country. Recognising geographical distribution of dietary patterns within the country and shifting the resources to economically disadvantaged regions might be more effective than current national public health interventions.
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Affiliation(s)
- Jolanta Czarnocinska
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637, Poznan, Poland
| | - Lidia Wadolowska
- Department of Human Nutrition, University of Warmia and Mazury in Olsztyn, Pl. Cieszynski 1, 10-718, Olsztyn, Poland
| | - Marta Lonnie
- Department of Human Nutrition, University of Warmia and Mazury in Olsztyn, Pl. Cieszynski 1, 10-718, Olsztyn, Poland.
| | - Joanna Kowalkowska
- Department of Human Nutrition, University of Warmia and Mazury in Olsztyn, Pl. Cieszynski 1, 10-718, Olsztyn, Poland
| | - Marzena Jezewska-Zychowicz
- Department of Organization and Consumption Economics, Warsaw University of Life Sciences, Nowoursynowska 159 C, 02-776, Warsaw, Poland
| | - Ewa Babicz-Zielinska
- Faculty of Physiotherapy and Health Sciences, Gdansk Management College, Pelplinska 7, 80-335, Gdansk, Poland
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Rashidi Pour Fard N, Amirabdollahian F, Haghighatdoost F. Dietary patterns and frailty: a systematic review and meta-analysis. Nutr Rev 2020; 77:498-513. [PMID: 31038679 DOI: 10.1093/nutrit/nuz007] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CONTEXT Assessing the relationship between single nutrients and frailty fails to take into consideration the interactions between nutrients. An increasing number of investigations in recent years have evaluated the association between dietary patterns and frailty. OBJECTIVE This systematic review and meta-analysis was conducted to summarize the association between dietary patterns and frailty. DATA SOURCES PubMed, Scopus, and Google Scholar were searched for epidemiological studies published up to April 2018 that assessed the association between dietary patterns and frailty. STUDY SELECTION Cohort or cross-sectional studies that examined dietary patterns via an a priori or an a posteriori method in relation to risk of frailty without considering any specific age range were included. Studies were excluded if they examined single nutrients, single foods, or single food groups. DATA EXTRACTION Pooled effect sizes of eligible studies and their corresponding 95%CIs were estimated using random-effects models. When publication bias was present, trim and fill analysis was conducted to adjust the pooled effect. RESULTS A total of 13 studies with 15 effect sizes were identified. Results from 9 cohort and cross-sectional studies were included in the meta-analysis. Higher adherence to a healthy dietary pattern was associated with lower odds of frailty (odds ratio = 0.69; 95%CI, 0.57-0.84; P < 0.0001; I2 =92.1%; P for heterogeneity < 0.0001). CONCLUSIONS The findings suggest that a diet high in fruit, vegetables, and whole grains may be associated with reduced risk of frailty. Nevertheless, additional longitudinal studies are needed to confirm the association of dietary patterns with frailty.
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Affiliation(s)
| | | | - Fahimeh Haghighatdoost
- Department of Community Nutrition and the Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Labonté ME, Emrich TE, Scarborough P, Rayner M, L’Abbé MR. Traffic light labelling could prevent mortality from noncommunicable diseases in Canada: A scenario modelling study. PLoS One 2019; 14:e0226975. [PMID: 31881069 PMCID: PMC6934336 DOI: 10.1371/journal.pone.0226975] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Traffic-light labelling (TLL) is a promising front-of-pack system to help consumers make informed dietary choices. It has been shown that adopting TLL in Canada, through an optimistic scenario of avoiding, if possible, foods with red traffic lights, could effectively reduce Canadians’ intakes of energy, total fat, saturated fat, and sodium by 5%, 13%, 14% and 6%, respectively. However, the potential health impact of adopting TLL has not been determined in the North American context. Objective This study modelled the potential impact of adopting TLL on mortality from noncommunicable diseases (NCDs) in Canada, due to the previously predicted improved nutrient intakes. Methods Investigators used data from adults (n = 19,915) in the 2004 nationally representative Canadian Community Health Survey (CCHS)-Cycle 2.2. Nutrient amounts in foods consumed by CCHS respondents were profiled using the 2013 United Kingdom’s TLL criteria. Whenever possible, foods assigned at least one red light (non-compliant foods) were replaced with similar, but compliant, foods identified from a Canadian brand-specific food database. Respondents’ nutrient intakes were calculated under the original CCHS scenario and the counterfactual TLL scenario, and entered in the Preventable Risk Integrated ModEl (PRIME) to estimate the health impact of adopting TLL. The primary outcome was the number of deaths attributable to diet-related NCDs that could be averted or delayed based on the TLL scenario compared with the baseline scenario. Results PRIME estimated that 11,715 deaths (95% CI 10,500–12,865) per year due to diet-related NCDs, among which 72% are specifically related to cardiovascular diseases, could be prevented if Canadians avoided foods labelled with red traffic lights. The reduction in energy intakes would by itself save 10,490 deaths (9,312–11,592; 90%). Conclusions This study, although depicting an idealistic scenario, suggests that TLL (if used to avoid red lights when possible) could be an effective population-wide intervention to improve NCD outcomes in Canada.
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Affiliation(s)
- Marie-Eve Labonté
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Teri E. Emrich
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- * E-mail:
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Vandevijvere S, Mackay S, D'Souza E, Swinburn B. The first INFORMAS national food environments and policies survey in New Zealand: A blueprint country profile for measuring progress on creating healthy food environments. Obes Rev 2019; 20 Suppl 2:141-160. [PMID: 31483561 DOI: 10.1111/obr.12850] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/13/2019] [Accepted: 02/26/2019] [Indexed: 12/30/2022]
Abstract
The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support aims to benchmark national food environments. This study proposes a blueprint country profile to measure progress on creating healthy food environments, based on the results of the first, comprehensive survey in New Zealand (NZ). We assessed the implementation of national food environment policies and food industry commitments to improve population nutrition and the strength and comprehensiveness of public sector settings' nutrition policies. The healthiness of the packaged food supply, including health-related labelling, was evaluated. Food environments were measured in 833 schools, 204 supermarkets, 1500 takeaway outlets, 28 hospitals, 70 sport centres, and around all NZ schools. Food swamps, defined as areas with high relative density of unhealthy food outlets, were identified, and food marketing to children on television, websites, social media and packages, in magazines, and in and around schools was measured. The cost differential between healthy and current household diets was calculated for different population groups. NZ's food environment profile is largely unhealthy, and there are inequalities in access to healthy food environments. It is anticipated that the proposed country profile can help other countries tackle unhealthy food environments through increasing accountability of governments and the industry.
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Affiliation(s)
- Stefanie Vandevijvere
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Sally Mackay
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Erica D'Souza
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Boyd Swinburn
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
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The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases. Public Health Nutr 2019; 22:3447-3464. [PMID: 31666140 DOI: 10.1017/s1368980019002891] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Food environments may be contributing to the rapid increase in obesity occurring in most Latin American (LA) countries. The present study reviews literature from LA that (i) describes the food environment and policies targeting the food environment (FEP); and (ii) analytic studies that investigate associations between the FEP and dietary behaviours, overweight/obesity and obesity related chronic diseases. We focus on six dimensions of the FEP: food retail, provision, labelling, marketing, price and composition. DESIGN Systematic literature review. Three databases (Web of Science, SciELO, LILACS) were searched, from 1 January 1999 up to July 2017. Two authors independently selected the studies. A narrative synthesis was used to summarize, integrate and interpret findings. SETTING Studies conducted in LA countries. PARTICIPANTS The search yielded 2695 articles of which eighty-four met inclusion criteria. RESULTS Most studies were descriptive and came from Brazil (61 %), followed by Mexico (18 %) and Guatemala (6 %). Studies were focused primarily on retail/provision (n 27), marketing (n 16) and labelling (n 15). Consistent associations between availability of fruit and vegetable markets and higher consumption of fruits and vegetables were found in cross-sectional studies. Health claims in food packaging were prevalent and mostly misleading. There was widespread use of marketing strategies for unhealthy foods aimed at children. Food prices were lower for processed relative to fresh foods. Some studies documented high sodium in industrially processed foods. CONCLUSIONS Gaps in knowledge remain regarding policy evaluations, longitudinal food retail studies, impacts of food price on diet and effects of digital marketing on diet/health.
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Kehoe SH, Dhurde V, Bhaise S, Kale R, Kumaran K, Gelli A, Rengalakshmi R, Sahariah SA, Potdar RD, Fall CHD. How Do Fruit and Vegetable Markets Operate in Rural India? A Qualitative Study of the Impact of Supply and Demand on Nutrition Security. Food Nutr Bull 2019; 40:369-382. [PMID: 31167553 DOI: 10.1177/0379572119846809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diets in rural India are cereal based with low intakes of micronutrient-rich foods. The value chains for nutrition approach aims to study supply and demand of such foods. This may aid in development of interventions to improve diets and livelihoods. OBJECTIVES (1) To identify how fruit and vegetables are accessed, (2) to describe and map the structure of value chains for exemplar foods, (3) to understand how foods are priced, and (4) to explore factors that affect decisions about which crops are grown, marketed, and sold. METHODS After stakeholder consultation, we identified 2 fruits (mango and guava) and 2 vegetables (shepu and spinach) as exemplar foods. Criteria for these exemplar foods were that they should be known to participants and there should be variability in intakes. We held 24 interviews with value chain actors including farmers, wholesalers, and vendors of the exemplar foods. Data collection was stopped when no new information emerged. We used inductive thematic coding for our analysis. RESULTS The value chains for each of the exemplar foods were relatively simple and involved farmers, middlemen, and vendors at either city or village level. The main themes identified as being factors considered when making decisions about which foods to grow and sell were (1) farming resources and assets, (2) quality of produce, (3) environmental conditions, (4) financial factors, (5) transport availability, and (6) consumer demand. CONCLUSIONS There are opportunities to intervene within fruit and vegetable value chains to increase availability, affordability, and access to produce in rural India. Future research is required to determine which interventions will be feasible, effective, and acceptable to the community and other stakeholders.
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Affiliation(s)
- Sarah H Kehoe
- University of Southampton, Southampton, United Kingdom
| | - Varsha Dhurde
- Centre for Study of Social Change, Mumbai, Maharashtra, India
| | - Shilpa Bhaise
- Centre for Study of Social Change, Mumbai, Maharashtra, India
| | - Rashmi Kale
- Centre for Study of Social Change, Mumbai, Maharashtra, India
| | | | - Aulo Gelli
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - R Rengalakshmi
- Gender and Grassroots Institution, MS Swaminathan Research Foundation, Chennai, Tamil Nadu, India
| | | | - Ramesh D Potdar
- Centre for Study of Social Change, Mumbai, Maharashtra, India
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Ferretti F, Mariani M. Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries. Global Health 2019; 15:30. [PMID: 30999931 PMCID: PMC6472017 DOI: 10.1186/s12992-019-0474-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background A key component of ‘obesogenic environments’ is the ready availability of convenient, calorie-dense foods, in the form of hyper-palatable and relatively inexpensive ultra-processed products. Compelling evidence indicates that the regular consumption of soft drinks, specifically carbonated and non-carbonated sugar-sweetened beverages (SSBs), has a significant impact on the prevalence of overweight and obesity. However, to implement country-level effective prevention programmes we need to supplement this evidence with quantitative knowledge of the relationships between overweight/obesity and the main determinants of SSB consumption, notably SSB prices and consumers’ disposable income. Method Affordability considers the simultaneous effects of both price and disposable income on the buying decision. The purpose of this study was to investigate the effect of SSB affordability on the consumers’ purchasing behaviour and weight-related health outcomes. Our study was divided into three parts. First, we computed SSB consumption and affordability for approximately 150 countries worldwide. Second, we estimated a demand function for SSBs to assess the impact of affordability on consumption at the country level. Third, we used a multivariate regression model and country data on the prevalence of overweight and obesity to test the role of SSB affordability in the current obesity epidemic. Results The analysis reveals that SSB affordability: 1) showed both a large variability across countries and a clear tendency to increase substantially with the level of economic development; 2) played a key role in determining cross-country differences in the amount of soft drink consumed per capita; and 3) was significantly associated with the prevalence rates of both overweight and obesity. Specifically, we show that a 10 % increase in SSB affordability was associated, on average, with approximately 0.4 more overweight/obese adults per 100 inhabitants. Conclusions By controlling for the main possible confounding factors, our results clearly indicate that affordability is a major driver of purchasing behaviours and is significantly associated with the prevalence rates of both overweight and obesity. We thus suggest a fiscal approach to curb SSB consumption based on the effectiveness of ‘soda taxes’ to affect the long-term dynamic of SSB affordability. Electronic supplementary material The online version of this article (10.1186/s12992-019-0474-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabrizio Ferretti
- School of Social Sciences, Department of Communication and Economics, University of Modena and Reggio Emilia, Palazzo Dossetti, Viale Allegri, 9, 42121, Reggio Emilia, Italy.
| | - Michele Mariani
- School of Social Sciences, Department of Communication and Economics, University of Modena and Reggio Emilia, Palazzo Dossetti, Viale Allegri, 9, 42121, Reggio Emilia, Italy
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Lee A, Kane S, Lewis M. Healthy diets ASAP (Australian Standardized Affordability and Pricing) methods and results: Are healthy diets really more expensive and how would price be affected by changes to the GST? Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2016.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Landrigan TJ, Kerr DA, Dhaliwal SS, Pollard CM. Protocol for the Development of a Food Stress Index to Identify Households Most at Risk of Food Insecurity in Western Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010079. [PMID: 30597936 PMCID: PMC6339012 DOI: 10.3390/ijerph16010079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
Food stress, a similar concept to housing stress, occurs when a household needs to spend more than 25% of their disposable income on food. Households at risk of food stress are vulnerable to food insecurity as a result of inadequate income. A Food Stress Index (FSI) identifies at-risk households, in a particular geographic area, using a range of variables to create a single indicator. Candidate variables were identified using a multi-dimensional framework consisting of household demographics, household income, household expenses, financial stress indicators, food security, food affordability and food availability. The candidate variables were expressed as proportions, of either persons or households, in a geographic area. Principal Component Analysis was used to determine the final variables which resulted in a final set of weighted raw scores. These scores were then scaled to produce the index scores for the Food Stress Index for Western Australia. The results were compared with the Australian Bureau of Statistics’ Socio-Economic Indexes for Areas to determine suitability. The Food Stress Index was found to be a suitable indicator of the relative risk of food stress in Western Australian households. The FSI adds specificity to indices of relative disadvantage specifically related to food insecurity and provides a useful tool for prioritising policy and other responses to this important public health issue.
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Affiliation(s)
- Timothy J Landrigan
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia.
| | - Deborah A Kerr
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia.
| | - Satvinder S Dhaliwal
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia.
| | - Christina M Pollard
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia.
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Lee A, Lewis M. Testing the Price of Healthy and Current Diets in Remote Aboriginal Communities to Improve Food Security: Development of the Aboriginal and Torres Strait Islander Healthy Diets ASAP (Australian Standardised Affordability and Pricing) Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122912. [PMID: 30572646 PMCID: PMC6313302 DOI: 10.3390/ijerph15122912] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Abstract
Aboriginal and Torres Strait Islander peoples suffer higher rates of food insecurity and diet-related disease than other Australians. However, assessment of food insecurity in specific population groups is sub-optimal, as in many developed countries. This study tailors the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to be more relevant to Indigenous groups in assessing one important component of food security. The resultant Aboriginal and Torres Strait Islander Healthy Diets ASAP methods were used to assess the price, price differential, and affordability of healthy (recommended) and current (unhealthy) diets in five remote Aboriginal communities. The results show that the tailored approach is more sensitive than the original protocol in revealing the high degree of food insecurity in these communities, where the current diet costs nearly 50% of disposable household income compared to the international benchmark of 30%. Sixty-two percent of the current food budget appears to be spent on discretionary foods and drinks. Aided by community store pricing policies, healthy (recommended) diets are around 20% more affordable than current diets in these communities, but at 38.7% of disposable household income still unaffordable for most households. Further studies in urban communities, and on other socioeconomic, political and commercial determinants of food security in Aboriginal and Torres Strait Islander communities appear warranted. The development of the tailored method provides an example of how national tools can be adapted to better inform policy actions to improve food security and help reduce rates of diet-related chronic disease more equitably in developed countries.
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Affiliation(s)
- Amanda Lee
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland 4006, Australia.
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo 2007, New South Wales, Australia.
| | - Meron Lewis
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland 4006, Australia.
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Healthy Diets in Rural Victoria-Cheaper than Unhealthy Alternatives, Yet Unaffordable. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112469. [PMID: 30400654 PMCID: PMC6266685 DOI: 10.3390/ijerph15112469] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 01/22/2023]
Abstract
Rural communities experience higher rates of obesity and reduced food security compared with urban communities. The perception that healthy foods are expensive contributes to poor dietary choices. Providing an accessible, available, affordable healthy food supply is an equitable way to improve the nutritional quality of the diet for a community, however, local food supply data are rarely available for small rural towns. This study used the Healthy Diets ASAP tool to assess price, price differential and affordability of recommended (healthy) and current diets in a rural Local Government Area (LGA) (pop ≈ 7000; 10 towns) in Victoria, Australia. All retail food outlets were surveyed (n = 40). The four most populous towns had supermarkets; remaining towns had one general store each. Seven towns had café/take-away outlets, and all towns had at least one hotel/pub. For all towns the current unhealthy diet was more expensive than the recommended healthy diet, with 59.5% of the current food budget spent on discretionary items. Affordability of the healthy diet accounted for 30⁻32% of disposable income. This study confirms that while a healthy diet is less expensive than the current unhealthier diet, affordability is a challenge for rural communities. Food security is reduced further with restricted geographical access, a limited healthy food supply, and higher food prices.
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Lee AJ, Kane S, Lewis M, Good E, Pollard CM, Landrigan TJ, Dick M. Healthy diets ASAP - Australian Standardised Affordability and Pricing methods protocol. Nutr J 2018; 17:88. [PMID: 30261887 PMCID: PMC6161417 DOI: 10.1186/s12937-018-0396-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper describes the rationale, development and final protocol of the Healthy Diets Australian Standardised Affordability and Pricing (ASAP) method which aims to assess, compare and monitor the price, price differential and affordability of healthy (recommended) and current (unhealthy) diets in Australia. The protocol is consistent with the International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support's (INFORMAS) optimal approach to monitor food price and affordability globally. METHODS The Healthy Diets ASAP protocol was developed based on literature review, drafting, piloting and revising, with key stakeholder consultation at all stages, including at a national forum. DISCUSSION The protocol was developed in five parts. Firstly, for the healthy (recommended) and current (unhealthy) diet pricing tools; secondly for calculation of median and low-income household incomes; thirdly for store location and sampling; fourthly for price data collection, and; finally for analysis and reporting. The Healthy Diets ASAP protocol constitutes a standardised approach to assess diet price and affordability to inform development of nutrition policy actions to reduce rates of diet-related chronic disease in Australia. It demonstrates application of the INFORMAS optimum food price and affordability methods at country level. Its wide application would enhance monitoring and utility of dietary price and affordability data from a health perspective in Australia. The protocol could be adapted in other countries to monitor the price, price differential and affordability of current and healthy diets.
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Affiliation(s)
- Amanda J Lee
- The Australian Prevention Partnership Centre, The Sax Institute, 10 Jones Street, Ultimo, NSW, 2007, Australia.
| | - Sarah Kane
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Meron Lewis
- The Australian Prevention Partnership Centre, The Sax Institute, 10 Jones Street, Ultimo, NSW, 2007, Australia
| | - Elizabeth Good
- Preventive Health Branch, Department of Health, Queensland Government, Brisbane, QLD, Australia
| | - Christina M Pollard
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth, 6845, Western Australia.,Public Health Division, Department of Health, Government of Western Australia, 189 Royal Street, East Perth, 6004, Western Australia
| | - Timothy J Landrigan
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth, 6845, Western Australia
| | - Mathew Dick
- Preventive Health Branch, Department of Health, Queensland Government, Brisbane, QLD, Australia
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Abstract
OBJECTIVE The current short communication aimed to provide a new conceptualisation of the policy drivers of inequities in healthy eating and to make a call to action to begin populating this framework with evidence of actions that can be taken to reduce the inequities in healthy eating. DESIGN The Healthy and Equitable Eating (HE2) Framework derives from a systems-based analytical approach involving expert workshops. SETTING Australia. SUBJECTS Academics, government officials and non-government organisations in Australia. RESULTS The HE2 Framework extends previous conceptualisations of policy responses to healthy eating to include the social determinants of healthy eating and its social distribution, encompassing policy areas including housing, social protection, employment, education, transport, urban planning, plus the food system and environment. CONCLUSIONS As the burden of non-communicable diseases continues to grow globally, it is important that governments, practitioners and researchers focus attention on the development and implementation of policies beyond the food system and environment that can address the social determinants of inequities in healthy eating.
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67
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Mackay S, Vandevijvere S, Lee A. Ten-year trends in the price differential between healthier and less healthy foods in New Zealand. Nutr Diet 2018; 76:271-276. [PMID: 30033532 DOI: 10.1111/1747-0080.12457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/05/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
Abstract
AIM To measure the relative change in price of healthier and less healthy foods over 10 years in New Zealand. METHODS Foods in the New Zealand food price index were classified as healthy and less healthy (WHO Europe Nutrient Profile Model) and by degree of processing (according to the NOVA classification). The change in price from February 2007 to January 2017 was analysed using a mixed model for repeated measures with healthiness (or level of processing), season and time added as covariates. RESULTS Eighty-eight (of 155) relevant items had sufficient information on weight and healthiness. The trend of increasing food prices over time was similar for healthier and less healthy foods and between the three categories of processing. There was a statistically significant interaction (P = 0.014) between seasons and healthiness of foods, and seasons and degrees of processing (P < 0.001). The price of healthy foods and minimally processed foods fluctuated more by season compared to less healthy foods and processed foods. CONCLUSIONS Food prices increased over time with no significant difference in the rate of change for healthier and less healthy foods, and between foods of different degrees of processing. This method can be used to routinely monitor relative changes in food prices according to healthiness.
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Affiliation(s)
- Sally Mackay
- School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Arier Lee
- School of Population Health, University of Auckland, Auckland, New Zealand
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68
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Mackay S, Buch T, Vandevijvere S, Goodwin R, Korohina E, Funaki-Tahifote M, Lee A, Swinburn B. Cost and Affordability of Diets Modelled on Current Eating Patterns and on Dietary Guidelines, for New Zealand Total Population, Māori and Pacific Households. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061255. [PMID: 29899249 PMCID: PMC6025104 DOI: 10.3390/ijerph15061255] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 11/17/2022]
Abstract
The affordability of diets modelled on the current (less healthy) diet compared to a healthy diet based on Dietary Guidelines was calculated for population groups in New Zealand. Diets using common foods were developed for a household of four for the total population, Māori and Pacific groups. Māori and Pacific nutrition expert panels ensured the diets were appropriate. Each current (less healthy) diet was based on eating patterns identified from national nutrition surveys. Food prices were collected from retail outlets. Only the current diets contained alcohol, takeaways and discretionary foods. The modelled healthy diet was cheaper than the current diet for the total population (3.5% difference) and Pacific households (4.5% difference) and similar in cost for Māori households (0.57% difference). When the diets were equivalent in energy, the healthy diet was more expensive than the current diet for all population groups (by 8.5% to 15.6%). For households on the minimum wage, the diets required 27% to 34% of household income, and if receiving income support, required 41–52% of household income. Expert panels were invaluable in guiding the process for specific populations. Both the modelled healthy and current diets are unaffordable for some households as a considerable portion of income was required to purchase either diet. Policies are required to improve food security by lowering the cost of healthy food or improving household income.
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Affiliation(s)
- Sally Mackay
- School of Population Health, University of Auckland, Auckland 1142, New Zealand.
| | - Tina Buch
- The Heart Foundation of New Zealand, Auckland 1051, New Zealand.
| | | | - Rawinia Goodwin
- School of Population Health, University of Auckland, Auckland 1142, New Zealand.
| | | | | | - Amanda Lee
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney 1240, Australia.
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland 1142, New Zealand.
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69
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Sainsbury E, Hendy C, Magnusson R, Colagiuri S. Public support for government regulatory interventions for overweight and obesity in Australia. BMC Public Health 2018; 18:513. [PMID: 29669551 PMCID: PMC5907362 DOI: 10.1186/s12889-018-5455-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background There is growing recognition among public health circles of the need for regulatory action for overweight and obesity, but there has been limited research into whether the Australian public supports government intervention. This study aimed to determine the level of public support for food-related regulations for obesity, and to assess the determinants of support. Methods A nationally representative sample of Australian adults (n = 2011) was recruited by market research company Online Research Unit to complete an online survey. The survey measured respondents’ perception of the obesity problem in Australia, and level of agreement on a 5-point Likert scale (strongly disagree to strongly agree) with proposed regulations in three domains; advertising, sponsorship of children’s sport, and taxation. Binary logistic regression models were run to examine the association between demographic variables and support for regulation. Results The majority of respondents (92.5%) considered overweight and obesity to be a somewhat or very serious problem in Australia, and almost 90% felt there should be at least some government regulation to protect the public. Respondents agreed that the government should regulate food and beverage advertising (69.5%), with strongest support for restricting unhealthy food advertising to children (78.9%). There was lower support for prohibiting unhealthy food and beverage company sponsorship of children’s sport (63.4% agreement), and for taxing sugar-sweetened beverages (54.5%), although the majority were still in favour. Support for fiscal policies slightly increased if revenue was to be used for health purposes. Females and tertiary educated respondents showed stronger agreement with proposed regulations (p < 0.05). Conclusions The survey findings suggest the majority of the Australian population recognises obesity to be a serious health problem, and support government regulation of the food environment as a population-level preventative strategy. Electronic supplementary material The online version of this article (10.1186/s12889-018-5455-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia.
| | - Chelsea Hendy
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia
| | - Roger Magnusson
- Sydney Law School, The University of Sydney, Camperdown, 2006, Australia
| | - Stephen Colagiuri
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia
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70
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Vandevijvere S, Young N, Mackay S, Swinburn B, Gahegan M. Modelling the cost differential between healthy and current diets: the New Zealand case study. Int J Behav Nutr Phys Act 2018; 15:16. [PMID: 29426334 PMCID: PMC5807767 DOI: 10.1186/s12966-018-0648-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Evidence on whether healthy diets are more expensive than current diets is mixed due to lack of robust methodology. The aim of this study was to develop a novel methodology to model the cost differential between healthy and current diets and apply it in New Zealand. Methods Prices of common foods were collected from 15 supermarkets, 15 fruit/vegetable stores and from the Food Price Index. The distribution of the cost of two-weekly healthy and current household diets was modelled using a list of commonly consumed foods, a set of min and max quantity/serves constraints for each, and food group and nutrient intakes based on dietary guidelines (healthy diets) or nutrition survey data (current diets). The cost differential between healthy and current diets was modelled for several diet, prices and policy scenarios. Acceptability of resulting meal plans was validated. Results The average cost of healthy household diets was $27 more expensive than the average cost of current diets, but 25.8% of healthy diets were cheaper than the average cost of current diets. This cost differential could be reduced if fruits and vegetables became exempt from Goods and Services Tax. Healthy diets were cheaper with an allowance for discretionary foods and more expensive when including takeaway meals. For Māori and Pacific households, healthy diets were on average $40 and $60 cheaper than current diets due to large energy intakes. Discretionary foods and takeaway meals contributed 30-40% to the average cost of current diets. Conclusion Healthy New Zealand diets were on average more expensive than current diets, but one-quarter of healthy diets were cheaper than the average cost of current diets. The impact of diet composition, types of prices and policies on the cost differential was substantial. The methodology can be used in other countries to monitor the cost differential between healthy and current household diets. Electronic supplementary material The online version of this article (10.1186/s12966-018-0648-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefanie Vandevijvere
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Nick Young
- Centre for e-Research, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Sally Mackay
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Boyd Swinburn
- School of Population Health, Department of Epidemiology and Biostatistics, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Mark Gahegan
- Centre for e-Research, Faculty of Science, The University of Auckland, Auckland, New Zealand
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71
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Identifying foods with good nutritional quality and price for the Opticourses intervention research project. Public Health Nutr 2017; 20:3051-3059. [DOI: 10.1017/s1368980017002282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePeople on a limited budget want to know the ‘good price’ of foods. Here we report the methodology used to produce an educational tool designed to help recognize foods with good nutritional quality and price, and assess the validity and relevancy of the tool.DesignA ‘Good Price Booklet’ presenting a list of foods with good nutritional quality and price was constructed. The validity of the in-booklet prices was assessed by comparing them with prices actually paid by households from the Opticourses project. The relevancy of the booklet tool was assessed by semi-structured interviews with Opticourses participants.SettingSocio-economically disadvantaged neighbourhoods of Marseille, France.SubjectsNinety-one participants collected household food-purchase receipts over a 1-month period.ResultsBased on the French food database, foods with higher-than-median nutritional quality were identified. After grouping similar foods, 100 foods were selected and their corresponding in-booklet prices were derived based on the distribution of average national prices by food group. Household food purchases data revealed that of the 2386 purchases of foods listed in the booklet, 67·1 % were bought at prices lower than the in-booklet prices. Nineteen semi-structured interviews showed that participants understood the tool and most continued using it more than a month after the intervention.ConclusionsA method was developed to ease the identification of foods with good nutritional quality and price. The Good Price Booklet is an effective tool to help guide people shopping on a low budget.
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72
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Landrigan TJ, Kerr DA, Dhaliwal SS, Savage V, Pollard CM. Removing the Australian tax exemption on healthy food adds food stress to families vulnerable to poor nutrition. Aust N Z J Public Health 2017; 41:591-597. [PMID: 28898477 DOI: 10.1111/1753-6405.12714] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 05/01/2017] [Accepted: 07/01/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To assess the impact of changing the Australian Goods and Services Tax (GST) on household food stress, which occurs when >25% of disposable income needs to be spent on food. METHODS Weekly healthy meal plan costs for average-income (AI), low-income (LI) and welfare-dependent (WDI) families were calculated using the 2013 Western Australian (WA) Food Access and Costs Survey. Four GST scenarios were compared: 1) status quo; 2) increasing GST to 15%; 3) expanding base to include exempt foods at 10% GST; and 4) expanding base to include exempt foods and increasing the tax to 15%. RESULTS Single-parent families risk food stress regardless of their income or the GST scenario (requiring 24-42% of disposable income). The probability of food stress in Scenario 1 is 100% for WDI two-parent families and 36% for LI earners. In Scenarios 3 and 4, food stress probability is 60-72% for two-parent LI families and AI single-parent families, increasing to 88-94% if residing in very remote areas. CONCLUSION There is food stress risk among single-parent, LI and WDI families, particularly those residing in very remote areas. Implications for public health: Expanding GST places an additional burden on people who are already vulnerable to poor nutrition and chronic disease due to their socioeconomic circumstances.
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Affiliation(s)
| | - Deborah A Kerr
- School of Public Health, Curtin University, Western Australia
| | | | - Victoria Savage
- School of Public Health, Curtin University, Western Australia
| | - Christina M Pollard
- School of Public Health, Curtin University, Western Australia.,Public Health Division, Department of Health in Western Australia
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73
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The impact of financial incentives on participants' food purchasing patterns in a supermarket-based randomized controlled trial. Int J Behav Nutr Phys Act 2017; 14:115. [PMID: 28841892 PMCID: PMC5574131 DOI: 10.1186/s12966-017-0573-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background The impacts of supermarket-based nutrition promotion interventions might be overestimated if participants shift their proportionate food purchasing away from their usual stores. This study quantified whether participants who received price discounts on fruits and vegetables (FV) in the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial (RCT) shifted their FV purchasing into study supermarkets during the intervention period. Methods Participants were 642 females randomly assigned to a 1) skill-building (n = 160), 2) price reduction (n = 161), 3) combined skill-building and price reduction (n = 160), or 4) control (n = 161) group. Participants self-reported the proportion of FV purchased in study supermarkets at baseline, 3- and 6-months post-intervention. Fisher’s exact and χ2 tests assessed differences among groups in the proportion of FV purchased in study supermarkets at each time point. Multinomial logistic regression assessed differences among groups in the change in proportionate FV purchasing over time. Results Post-intervention, 49% of participants purchased ≥50% of their FV in study supermarkets. Compared to all other groups, the price reduction group was approximately twice as likely (RRR: 1.8-2.2) to have increased proportionate purchasing of FV in study supermarkets from baseline to post-intervention (p< 0.05). Conclusions Participants who received price reductions on FV were approximately twice as likely to shift their FV purchasing from other stores into study supermarkets during the intervention period. Unless food purchasing data are available for all sources, differential changes in purchasing patterns can make it difficult to discern the true impacts of nutrition interventions. Trial registration The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901, Registered 30 June 2010, Retrospectively registered (http://www.isrctn.com/ISRCTN39432901).
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74
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Hugo C, Isenring E, Sinclair D, Agarwal E. What does it cost to feed aged care residents in Australia? Nutr Diet 2017; 75:6-10. [DOI: 10.1111/1747-0080.12368] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/22/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Cherie Hugo
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
| | - Elisabeth Isenring
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
| | - David Sinclair
- Stewart Brown Accountancy Firm; Sydney New South Wales Australia
| | - Ekta Agarwal
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
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75
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Chrysostomou S, Andreou S. Do low-income Cypriots experience food stress? The cost of a healthy food basket relative to guaranteed minimum income in Nicosia, Cyprus. Nutr Diet 2017; 74:167-174. [PMID: 28731637 DOI: 10.1111/1747-0080.12322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 07/12/2016] [Accepted: 08/05/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to assess the cost, acceptability and affordability of the healthy food basket (HFB) among low-income families in Cyprus. METHODS HFBs were constructed based on the National Guidelines for Nutrition and Exercise for six different types of households. Acceptability was tested through focus groups. Affordability was defined as the cost of the HFB as a percentage of the guaranteed minimum income (GMI). The value of the GMI is set to be equal to €480 for a single individual and increases with the size of the recipient unit in accordance with the Organization for Economic Co-operation and Development equivalence scales. The Ministry of Labour estimates that, on average, nearly 50% of the GMI is required for food. RESULTS The total monthly budget for HFB is 0.80, 1.11, 1.27, 1.28, 1.44 and 1.48 times higher than the GMI budget for food among different types of households in Cyprus (a single woman, a single man, a couple, a single woman with two children, a single man with two children and a couple with two children, respectively). In particular, a family with two children on GMI would need to spend a large proportion of their income on the HFB (71.68%). CONCLUSIONS The GMI scheme appears not to consider the cost of healthy food, and thus, families on welfare payments in Cyprus are at a high risk of experiencing food stress. Therefore, additional research is required to measure the cost of the six HFBs in various settings.
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Affiliation(s)
| | - Sofia Andreou
- Economics Research Center, University of Cyprus, Nicosia, Cyprus
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76
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Crawford B, Byun R, Mitchell E, Thompson S, Jalaludin B, Torvaldsen S. Socioeconomic differences in the cost, availability and quality of healthy food in Sydney. Aust N Z J Public Health 2017; 41:567-571. [PMID: 28712112 DOI: 10.1111/1753-6405.12694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/01/2017] [Accepted: 05/01/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the cost of a basket of staple foods, together with the availability and quality of fresh fruit and vegetables, by supermarket store type in high and low socioeconomic suburbs of Sydney. METHODS A food basket survey was undertaken in 100 supermarkets in the 20 highest and 20 lowest socioeconomic suburbs of Sydney. We assessed the cost of 46 foods, the range of 30 fresh fruit and vegetables and the quality of ten fresh fruit and vegetables. Two major supermarket retailers, a discount supermarket chain and independent grocery stores were surveyed. RESULTS The food basket was significantly cheaper in low compared to high socioeconomic suburbs ($177 vs $189, p<0.01). Discount supermarkets were at least 30% cheaper than other supermarket stores. There were fewer varieties and poorer quality fruit and vegetables in stores in low socioeconomic suburbs. CONCLUSIONS Food basket prices and the availability and quality of fruit and vegetables varied significantly by store type and socioeconomic status of suburb. Implications for public health: A nationwide food and nutrition surveillance system is required to inform public health policy and practice initiatives. In addition to the food retail environment, these initiatives must address the underlying contributors to inequity and food insecurity for disadvantaged groups.
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Affiliation(s)
- Belinda Crawford
- NSW Public Health Officer Training Program, NSW Ministry of Health, New South Wales.,School of Public Health and Community Medicine, University of New South Wales
| | - Roy Byun
- Oral Health Services, Centre for Oral Health Strategy, New South Wales.,Faculty of Dentistry, University of Sydney, New South Wales
| | - Emily Mitchell
- City Futures Research Centre, Faculty of the Built Environment, University of New South Wales
| | - Susan Thompson
- City Futures Research Centre, Faculty of the Built Environment, University of New South Wales
| | - Bin Jalaludin
- Healthy People and Places Unit, South Western Sydney Local Health District, New South Wales.,Ingham Institute, University of New South Wales
| | - Siranda Torvaldsen
- School of Public Health and Community Medicine, University of New South Wales.,Clinical and Population Perinatal Health Research, Sydney Medical School Northern, University of Sydney, New South Wales
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77
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Paying for convenience: comparing the cost of takeaway meals with their healthier home-cooked counterparts in New Zealand. Public Health Nutr 2017. [PMID: 28625211 DOI: 10.1017/s1368980017000805] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Convenience and cost impact on people's meal decisions. Takeaway and pre-prepared foods save preparation time but may contribute to poorer-quality diets. Analysing the impact of time on relative cost differences between meals of varying convenience contributes to understanding the barrier of time to selecting healthy meals. DESIGN Six popular New Zealand takeaway meals were identified from two large national surveys and compared with similar, but healthier, home-made and home-assembled meals that met nutrition targets consistent with New Zealand Eating and Activity Guidelines. The cost of each complete meal, cost per kilogram, and confidence intervals of the cost of each meal type were calculated. The time-inclusive cost was calculated by adding waiting or preparation time cost at the minimum wage. SETTING A large urban area in New Zealand. RESULTS For five of six popular meals, the mean cost of the home-made and home-assembled meals was cheaper than the takeaway meals. When the cost of time was added, all home-assembled meal options were the cheapest and half of the home-made meals were at least as expensive as the takeaway meals. The home-prepared meals were designed to provide less saturated fat and Na and more vegetables than their takeaway counterparts; however, the home-assembled meals provided more Na than the home-made meals. CONCLUSIONS Healthier home-made and home-assembled meals were, except one, cheaper options than takeaways. When the cost of time was added, either the home-made or the takeaway meal was the most expensive. This research questions whether takeaways are better value than home-prepared meals.
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78
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Menezes MC, Costa BVL, Oliveira CDL, Lopes ACS. Local food environment and fruit and vegetable consumption: An ecological study. Prev Med Rep 2017; 5:13-20. [PMID: 27872803 PMCID: PMC5114690 DOI: 10.1016/j.pmedr.2016.10.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/31/2016] [Accepted: 10/27/2016] [Indexed: 12/27/2022] Open
Abstract
Ecological studies are essential for understanding the environment-diet relationship. The purpose of this study was to describe environmental conditions and their relationship with fruit and vegetable (FV) consumption among Brazilian public health service users in the city of Belo Horizonte. We evaluated food stores contained within 1600 m buffer zones at 18 Health Academy Programme sites, from 2013 to 2014. Variables at the community (density, proximity and type) and the consumer (sectional location of FV; availability, quality, variety, price and advertising of FV and ultra-processed foods) nutrition environment were measured by direct observation, while aggregate data from users (income and FV consumption) were obtained by interview. Data were analysed using the Kernel intensity estimator, average nearest neighbour value and Local Moran's Index for local spatial autocorrelation. We interviewed 3414 users and analysed 336 food stores. Major geographical variations in the FV consumption were identified. Average consumption was higher (site 2A: 410.5 ± 185.7 g vs. site 4B: 311.2 ± 159.9 g) in neighbourhoods with higher income and concentration of food stores, and better index of access to healthy foods. Sites with poor FV consumption had the most stores with poor access to healthy foods (index in the first tertile, ≤ 10). In conclusion, negative characteristics of the food environment, as seen in the present study, may contribute to low FV consumption, suggesting the need for the development and consolidation of public policies aimed at creating healthy environments through built environment interventions that increase access to and consumption of healthy foods like FV.
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Affiliation(s)
- Mariana Carvalho Menezes
- Department of Nutrition, Nursing School, Federal University of Minas Gerais, Avenida Alfredo Balena, 190, Room 316, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Bruna Vieirade Lima Costa
- Department of Nutrition, Nursing School, Federal University of Minas Gerais, Avenida Alfredo Balena, 190, Room 316, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Cláudia Di Lorenzo Oliveira
- Department of Medicine, Campus Midwest, Federal University of Sao Joao del-Rei, Rua Sebastião Goncalves Coelho, 400, Divinópolis, Minas Gerais 35501-296, Brazil
| | - Aline Cristine Souza Lopes
- Department of Nutrition, Nursing School, Federal University of Minas Gerais, Avenida Alfredo Balena, 190, Room 316, Belo Horizonte, Minas Gerais 30130-100, Brazil
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Understanding barriers to fruit and vegetable intake in the Australian Longitudinal Study of Indigenous Children: a mixed-methods approach. Public Health Nutr 2016; 20:832-847. [PMID: 27894381 PMCID: PMC5426329 DOI: 10.1017/s1368980016003013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective To identify barriers to fruit and vegetable intake for Indigenous Australian children
and quantify factors related to these barriers, to help understand why children do not
meet recommendations for fruit and vegetable intake. Design We examined factors related to carer-reported barriers using multilevel Poisson models
(robust variance); a key informant focus group guided our interpretation of
findings. Setting Eleven diverse sites across Australia. Subjects Australian Indigenous children and their carers (N 1230) participating
in the Longitudinal Study of Indigenous Children. Results Almost half (45 %; n 555/1230) of carers reported barriers to their
children’s fruit and vegetable intake. Dislike of fruit and vegetables was the most
common barrier, reported by 32·9 % of carers; however, we identified few factors
associated with dislike. Carers were more than ten times less likely to report barriers
to accessing fruit and vegetables if they lived large cities v. very
remote areas. Within urban and inner regional areas, child and carer well-being,
financial security, suitable housing and community cohesion promoted access to fruit and
vegetables. Conclusions In this national Indigenous Australian sample, almost half of carers faced barriers to
providing their children with a healthy diet. Both remote/outer regional carers and
disadvantaged urban/inner regional carers faced problems accessing fruit and vegetables
for their children. Where vegetables were accessible, children’s dislike was a
substantial barrier. Nutrition promotion must address the broader family, community,
environmental and cultural contexts that impact nutrition, and should draw on the
strengths of Indigenous families and communities.
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81
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Håkansson A. Are Food Advertisements Promoting More Unhealthy Foods and Beverages over Time? Evidence from Three Swedish Food Magazines, 1995-2014. Ecol Food Nutr 2016; 56:45-61. [PMID: 27880047 DOI: 10.1080/03670244.2016.1256286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Unhealthy food in advertising has been suggested as a mediator for the increase in diet-related illness. This study quantitatively investigates changes in food advertising between 1995 and 2014 in terms of food categories promoted, macronutrient content, and percentage of foods classified as heathy or unhealthy from a sample of 7,199 ads from three Swedish food magazines. With the exception of increased alcoholic beverage and decreased carbohydrate-rich-food promotion, no monotonic trends of increasingly unhealthy food advertisement are found. From these findings, it is argued that food magazine advertising is not a mediator of the adverse dietary trend.
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Affiliation(s)
- Andreas Håkansson
- a Food and Meal Science, School of Education and Environment , Kristianstad University , Kristianstad , Sweden
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Parlesak A, Tetens I, Dejgård Jensen J, Smed S, Gabrijelčič Blenkuš M, Rayner M, Darmon N, Robertson A. Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets. PLoS One 2016; 11:e0163411. [PMID: 27760131 PMCID: PMC5070943 DOI: 10.1371/journal.pone.0163411] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022] Open
Abstract
Background Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Methods Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods. Results The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it. Conclusion Use of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable.
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Affiliation(s)
- Alexandr Parlesak
- WHO Collaborating Centre for Global Nutrition and Health, Metropolitan University College, Copenhagen, Denmark
- * E-mail:
| | - Inge Tetens
- National Food Institute, Technical University of Denmark, Research Group for Risk-Benefit, Søborg, Denmark
| | - Jørgen Dejgård Jensen
- Department of Food and Resource Economics, Section for Consumption, Bioethics and Governance, Copenhagen University, Copenhagen, Denmark
| | - Sinne Smed
- Department of Food and Resource Economics, Section for Consumption, Bioethics and Governance, Copenhagen University, Copenhagen, Denmark
| | - Mojca Gabrijelčič Blenkuš
- Nacionalni inštitut za javno zdravje—NIJZ (National Institute of Public Health), Ljubljana, Slovenia
| | - Mike Rayner
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Oxford University, Oxford, United Kingdom
| | - Nicole Darmon
- The Institut National de la Recherche Agronomique 1260 INRA, the Institut National de la Santé et de la Recherche Médicale 1062 INSERM, Aix-Marseille University, Unité Mixte de Recherche (UMR) “Nutrition, Obesity and Risk of Thrombosis”, Marseille, France
| | - Aileen Robertson
- WHO Collaborating Centre for Global Nutrition and Health, Metropolitan University College, Copenhagen, Denmark
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Lee A. Affordability of fruits and vegetables and dietary quality worldwide. LANCET GLOBAL HEALTH 2016; 4:e664-5. [DOI: 10.1016/s2214-109x(16)30206-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022]
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Costing ‘healthy’ food baskets in Australia – a systematic review of food price and affordability monitoring tools, protocols and methods. Public Health Nutr 2016; 19:2872-2886. [PMID: 27609696 PMCID: PMC10270823 DOI: 10.1017/s1368980016002160] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo undertake a systematic review to determine similarities and differences in metrics and results between recently and/or currently used tools, protocols and methods for monitoring Australian healthy food prices and affordability.DesignElectronic databases of peer-reviewed literature and online grey literature were systematically searched using the PRISMA approach for articles and reports relating to healthy food and diet price assessment tools, protocols, methods and results that utilised retail pricing.SettingNational, state, regional and local areas of Australia from 1995 to 2015.SubjectsAssessment tools, protocols and methods to measure the price of ‘healthy’ foods and diets.ResultsThe search identified fifty-nine discrete surveys of ‘healthy’ food pricing incorporating six major food pricing tools (those used in multiple areas and time periods) and five minor food pricing tools (those used in a single survey area or time period). Analysis demonstrated methodological differences regarding: included foods; reference households; use of availability and/or quality measures; household income sources; store sampling methods; data collection protocols; analysis methods; and results.Conclusions‘Healthy’ food price assessment methods used in Australia lack comparability across all metrics and most do not fully align with a ‘healthy’ diet as recommended by the current Australian Dietary Guidelines. None have been applied nationally. Assessment of the price, price differential and affordability of healthy (recommended) and current (unhealthy) diets would provide more robust and meaningful data to inform health and fiscal policy in Australia. The INFORMAS ‘optimal’ approach provides a potential framework for development of these methods.
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Miller V, Yusuf S, Chow CK, Dehghan M, Corsi DJ, Lock K, Popkin B, Rangarajan S, Khatib R, Lear SA, Mony P, Kaur M, Mohan V, Vijayakumar K, Gupta R, Kruger A, Tsolekile L, Mohammadifard N, Rahman O, Rosengren A, Avezum A, Orlandini A, Ismail N, Lopez-Jaramillo P, Yusufali A, Karsidag K, Iqbal R, Chifamba J, Oakley SM, Ariffin F, Zatonska K, Poirier P, Wei L, Jian B, Hui C, Xu L, Xiulin B, Teo K, Mente A. Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study. LANCET GLOBAL HEALTH 2016; 4:e695-703. [PMID: 27567348 DOI: 10.1016/s2214-109x(16)30186-3] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 06/13/2016] [Accepted: 07/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several international guidelines recommend the consumption of two servings of fruits and three servings of vegetables per day, but their intake is thought to be low worldwide. We aimed to determine the extent to which such low intake is related to availability and affordability. METHODS We assessed fruit and vegetable consumption using data from country-specific, validated semi-quantitative food frequency questionnaires in the Prospective Urban Rural Epidemiology (PURE) study, which enrolled participants from communities in 18 countries between Jan 1, 2003, and Dec 31, 2013. We documented household income data from participants in these communities; we also recorded the diversity and non-sale prices of fruits and vegetables from grocery stores and market places between Jan 1, 2009, and Dec 31, 2013. We determined the cost of fruits and vegetables relative to income per household member. Linear random effects models, adjusting for the clustering of households within communities, were used to assess mean fruit and vegetable intake by their relative cost. FINDINGS Of 143 305 participants who reported plausible energy intake in the food frequency questionnaire, mean fruit and vegetable intake was 3·76 servings (95% CI 3·66-3·86) per day. Mean daily consumption was 2·14 servings (1·93-2·36) in low-income countries (LICs), 3·17 servings (2·99-3·35) in lower-middle-income countries (LMICs), 4·31 servings (4·09-4·53) in upper-middle-income countries (UMICs), and 5·42 servings (5·13-5·71) in high-income countries (HICs). In 130 402 participants who had household income data available, the cost of two servings of fruits and three servings of vegetables per day per individual accounted for 51·97% (95% CI 46·06-57·88) of household income in LICs, 18·10% (14·53-21·68) in LMICs, 15·87% (11·51-20·23) in UMICs, and 1·85% (-3·90 to 7·59) in HICs (ptrend=0·0001). In all regions, a higher percentage of income to meet the guidelines was required in rural areas than in urban areas (p<0·0001 for each pairwise comparison). Fruit and vegetable consumption among individuals decreased as the relative cost increased (ptrend=0·00040). INTERPRETATION The consumption of fruit and vegetables is low worldwide, particularly in LICs, and this is associated with low affordability. Policies worldwide should enhance the availability and affordability of fruits and vegetables. FUNDING Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
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Affiliation(s)
- Victoria Miller
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Clara K Chow
- Westmead Hospital and the George Institute for Global Health, Sydney University, Sydney, NSW, Australia
| | - Mahshid Dehghan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | | | - Karen Lock
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Barry Popkin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Rasha Khatib
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA; Institute of Community and Public Health, Birzeit University, Ramallah, Occupied Palestinian Territory
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Prem Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur, India
| | - Annamarie Kruger
- Faculty of Health Science North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | | | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omar Rahman
- Independent University, Bangladesh Bashundhara, Dhaka, Bangladesh
| | - Annika Rosengren
- Sahlgrenska Academy and Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Alvaro Avezum
- Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | | | - Noorhassim Ismail
- Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur Malaysia
| | - Patricio Lopez-Jaramillo
- Grupo Investigaciones FOSCAL, Fundacion Oftalmologica de Santander and Medical School, Universidad de Santander, Bucaramanga, Colombia
| | | | - Kubilay Karsidag
- Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Romaina Iqbal
- Department of Community Health Sciences and Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Jephat Chifamba
- Physiology Department, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Farnaza Ariffin
- Faculty of Medicine, UiTM Sungai Buloh Campus, Selangor, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Medical University in Wroclaw, Wroclaw, Poland
| | - Paul Poirier
- Laval University Heart and Lungs Institute, Quebec City, QC, Canada
| | - Li Wei
- National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Bo Jian
- National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Chen Hui
- National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Liu Xu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Bai Xiulin
- National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Andrew Mente
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada.
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Allen T, Prosperi P. Modeling Sustainable Food Systems. ENVIRONMENTAL MANAGEMENT 2016; 57:956-75. [PMID: 26932834 PMCID: PMC4828486 DOI: 10.1007/s00267-016-0664-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 12/22/2015] [Indexed: 05/19/2023]
Abstract
The processes underlying environmental, economic, and social unsustainability derive in part from the food system. Building sustainable food systems has become a predominating endeavor aiming to redirect our food systems and policies towards better-adjusted goals and improved societal welfare. Food systems are complex social-ecological systems involving multiple interactions between human and natural components. Policy needs to encourage public perception of humanity and nature as interdependent and interacting. The systemic nature of these interdependencies and interactions calls for systems approaches and integrated assessment tools. Identifying and modeling the intrinsic properties of the food system that will ensure its essential outcomes are maintained or enhanced over time and across generations, will help organizations and governmental institutions to track progress towards sustainability, and set policies that encourage positive transformations. This paper proposes a conceptual model that articulates crucial vulnerability and resilience factors to global environmental and socio-economic changes, postulating specific food and nutrition security issues as priority outcomes of food systems. By acknowledging the systemic nature of sustainability, this approach allows consideration of causal factor dynamics. In a stepwise approach, a logical application is schematized for three Mediterranean countries, namely Spain, France, and Italy.
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Affiliation(s)
- Thomas Allen
- Bioversity International, Parc Scientifique Agropolis II, 1990 bd de la Lironde, 34397, Montpellier Cedex 5, France.
| | - Paolo Prosperi
- CIHEAM-IAMM, University of Catania, UMR MOISA Montpellier SupAgro, 3191 Route de Mende, 34090, Montpellier, France
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Jones NRV, Monsivais P. Comparing Prices for Food and Diet Research: The Metric Matters. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2016; 11:370-381. [PMID: 27630754 PMCID: PMC5000873 DOI: 10.1080/19320248.2015.1095144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An important issue in research into access to healthy food is how best to compare the price of foods. The appropriate metric for comparison has been debated at length, with proponents variously stating that food prices should be compared in terms of their energy content, their edible mass, or their typical portion size. In this article we assessed the impact of using different food price metrics on the observed difference in price between food groups and categories of healthiness, using United Kingdom consumer price index data for 148 foods and beverages in 2012. We found that the choice of metric had a marked effect on the findings and conclude that this must be decided in advance to suit the reason for comparing food prices.
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Affiliation(s)
- N R V Jones
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus , Cambridge , UK
| | - P Monsivais
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus , Cambridge , UK
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88
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Lee AJ, Kane S, Ramsey R, Good E, Dick M. Testing the price and affordability of healthy and current (unhealthy) diets and the potential impacts of policy change in Australia. BMC Public Health 2016; 16:315. [PMID: 27067642 PMCID: PMC4828857 DOI: 10.1186/s12889-016-2996-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Price and affordability of foods are important determinants of health. Targeted food pricing policies may help improve population diets. However, methods producing comparable data to inform relevant policy decisions are lacking in Australia and globally. The objective was to develop and pilot standardised methods to assess the price, relative price and affordability of healthy (recommended) and current (unhealthy) diets and test impacts of a potential policy change. METHODS Methods followed the optimal approach proposed by INFORMAS using recent Australian dietary intake data and guidelines. Draft healthy and current (unhealthy) diet baskets were developed for five household structures. Food prices were collected in stores in a high and low SES location in Brisbane, Australia. Diet prices were calculated and compared with household incomes, and with potential changes to the Australian Taxation System. Wilcoxen-signed rank tests were used to compare differences in price. RESULTS The draft tools and protocols were deemed acceptable at household level, but methods could be refined. All households spend more on current (unhealthy) diets than required to purchase healthy (recommended) diets, with the majority (53-64 %) of the food budget being spent on 'discretionary' choices, including take-away foods and alcohol. A healthy diet presently costs between 20-31 % of disposable income of low income households, but would become unaffordable for these families under proposed changes to expand the GST to apply to all foods in Australia. CONCLUSIONS Results confirmed that diet pricing methods providing meaningful, comparable data to inform potential fiscal and health policy actions can be developed, but draft tools should be refined. Results suggest that healthy diets can be more affordable than current (unhealthy) diets in Australia, but other factors may be as important as price in determining food choices.
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Affiliation(s)
- Amanda J Lee
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Sarah Kane
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rebecca Ramsey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elizabeth Good
- Preventive Health Branch, Prevention Division, Department of Health, Brisbane, QLD, Australia
| | - Mathew Dick
- Preventive Health Branch, Prevention Division, Department of Health, Brisbane, QLD, Australia
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Bertoluci G, Masset G, Gomy C, Mottet J, Darmon N. How to Build a Standardized Country-Specific Environmental Food Database for Nutritional Epidemiology Studies. PLoS One 2016; 11:e0150617. [PMID: 27054565 PMCID: PMC4824438 DOI: 10.1371/journal.pone.0150617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/16/2016] [Indexed: 11/30/2022] Open
Abstract
There is a lack of standardized country-specific environmental data to combine with nutritional and dietary data for assessing the environmental impact of individual diets in epidemiology surveys, which are consequently reliant on environmental food datasets based on values retrieved from a heterogeneous literature. The aim of this study was to compare and assess the relative strengths and limits of a database of food greenhouse gas emissions (GHGE) values estimated with a hybrid method combining input/output and LCA approaches, with a dataset of GHGE values retrieved from the literature. France is the geographical perimeter considered in this study, but the methodology could be applied to other countries. The GHGE of 402 foodstuffs, representative of French diet, were estimated using the hybrid method. In parallel, the GHGE of individual foods were collected from existing literature. Median per-food-category GHGE values from the hybrid method and the reviewed literature were found to correlate strongly (Spearman correlation was 0.83), showing similar rankings of food categories. Median values were significantly different for only 5 (out of 29) food categories, including the ruminant meats category for which the hybrid method gave lower estimates than those from existing literature. Analysis also revealed that literature values came from heterogeneous studies that were not always sourced and that were conducted under different LCA modeling hypotheses. In contrast, the hybrid method helps build reliably-sourced, representative national standards for product-based datasets. We anticipate this hybrid method to be a starting point for better environmental impact assessments of diets.
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Affiliation(s)
- Gwenola Bertoluci
- Laboratoire Génie Industriel, CentraleSupélec, Grande Voie des Vignes, 92290, Châtenay-Malabry, France
- AgroParisTech, SESG UFR MIDEAL, Massy, France
| | - Gabriel Masset
- Unité Mixte de Recherche (UMR) “Nutrition, Obesity and Risk of Thrombosis,” Institut National de la Recherche Agronomique 1260 INRA, Institut National de la Santé et de la Recherche Médicale 1062 INSERM, Aix- Marseille Université, 13385, Marseille, France
| | | | - Julien Mottet
- UMR GENIAL, AgroParisTech, INRA1145, Cnam, Massy, France
| | - Nicole Darmon
- Unité Mixte de Recherche (UMR) “Nutrition, Obesity and Risk of Thrombosis,” Institut National de la Recherche Agronomique 1260 INRA, Institut National de la Santé et de la Recherche Médicale 1062 INSERM, Aix- Marseille Université, 13385, Marseille, France
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Palermo C, McCartan J, Kleve S, Sinha K, Shiell A. A longitudinal study of the cost of food in Victoria influenced by geography and nutritional quality. Aust N Z J Public Health 2016; 40:270-3. [PMID: 27027641 DOI: 10.1111/1753-6405.12506] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/01/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To monitor the cost and affordability of a nutritious diet and to assess the influence of distance from the capital city and socioeconomic status on the cost of nutritious food in Victoria. METHODS Twenty-six of Victoria's 79 local government areas (33%) were randomly chosen for inclusion in the study. A random sample of stores was selected for inclusion from each local government area. The cost of the 44 'healthy' and 10 'discretionary' food and drinks in the healthy food basket for a family of four for a fortnight was collected during the winter and summer of 2012, 2013 and 2014. RESULTS The mean cost of the basket increased from $424.06 ± 38.22 in winter 2012 to $451.19 ± 33.83 in summer 2014 (p<0.001), representing about 31% of government benefit household income. Fruit and vegetables prices were the most varied over time. Distance of the store from state capital city centre predicted difference in food cost. CONCLUSIONS These findings show that a healthy diet may be unaffordable for some Victorians. IMPLICATIONS The cost of food is a key factor influencing intake. Public health strategies may need to consider strategies to make healthy food more affordable for some.
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Affiliation(s)
- Claire Palermo
- Department of Nutrition and Dietetics Monash University, Victoria
| | - Julia McCartan
- Department of Nutrition and Dietetics Monash University, Victoria
| | - Sue Kleve
- Department of Nutrition and Dietetics Monash University, Victoria
| | - Kompal Sinha
- Centre for Health Economics, Monash University, Victoria
| | - Alan Shiell
- Centre of Excellence and Intervention and Prevention Science, Victoria
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91
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Charlton KE. Food security, food systems and food sovereignty in the 21st century: A new paradigm required to meet Sustainable Development Goals. Nutr Diet 2016. [DOI: 10.1111/1747-0080.12264] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Karen E. Charlton
- School of Medicine; Faculty of Science; Medicine and Health; University of Wollongong
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92
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Charlton EL, Kähkönen LA, Sacks G, Cameron AJ. Supermarkets and unhealthy food marketing: An international comparison of the content of supermarket catalogues/circulars. Prev Med 2015; 81:168-73. [PMID: 26348452 DOI: 10.1016/j.ypmed.2015.08.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/21/2015] [Accepted: 08/31/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Supermarket marketing activities have a major influence on consumer food purchases. This study aimed to assess and compare the contents of supermarket marketing circulars from a range of countries worldwide from an obesity prevention perspective. METHODS The contents of supermarket circulars from major supermarket chains in 12 non-random countries were collected and analysed over an eight week period from July to September 2014 (n=89 circulars with 12,563 food products). Circulars were largely English language and from countries representing most continents. Food products in 25 sub-categories were categorised as discretionary or non-discretionary (core) food or drinks based on the Australian Guide to Healthy Eating. The total number of products in each subcategory in the whole circular, and on front covers only, was calculated. RESULTS Circulars from most countries advertised a high proportion of discretionary foods. The only exceptions were circulars from the Philippines (no discretionary foods) and India (11% discretionary food). Circulars from six countries advertised more discretionary foods than core foods. Front covers tended to include a much greater proportion of healthy products than the circulars overall. CONCLUSIONS Supermarket circulars in most of the countries examined include a high percentage of discretionary foods, and therefore promote unhealthy eating behaviours that contribute to the global obesity epidemic. A clear opportunity exists for supermarket circulars to promote rather than undermine healthy eating behaviours of populations. Governments need to ensure that supermarket marketing is included as part of broader efforts to restrict unhealthy food marketing.
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Affiliation(s)
- Emma L Charlton
- School of Exercise and Nutrition Science, Deakin University, 221 Burwood Hwy, Burwood 3125, VIC Australia; World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, 221 Burwood Hwy, Burwood 3125, VIC, Australia
| | - Laila A Kähkönen
- School of Exercise and Nutrition Science, Deakin University, 221 Burwood Hwy, Burwood 3125, VIC Australia
| | - Gary Sacks
- World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, 221 Burwood Hwy, Burwood 3125, VIC, Australia
| | - Adrian J Cameron
- World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, 221 Burwood Hwy, Burwood 3125, VIC, Australia.
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93
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Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev 2015; 73:643-60. [PMID: 26307238 PMCID: PMC4586446 DOI: 10.1093/nutrit/nuv027] [Citation(s) in RCA: 645] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CONTEXT It is well established in the literature that healthier diets cost more than unhealthy diets. OBJECTIVE The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. DATA SOURCES A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. STUDY SELECTION Publications linking food prices, dietary quality, and socioeconomic status were selected. DATA EXTRACTION Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. DATA SYNTHESIS Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. CONCLUSIONS Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.
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Affiliation(s)
- Nicole Darmon
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA.
| | - Adam Drewnowski
- N. Darmon is with the Unité Mixte de Recherche "Nutrition, Obesity and Risk of Thrombosis," Institut National de la Recherche Agronomique 1260, Institut National de la Santé et de la Recherche Médicale 1062, Aix-Marseille Université, Marseille, France. A. Drewnowski is with the Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
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94
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Herforth A, Ahmed S. The food environment, its effects on dietary consumption, and potential for measurement within agriculture-nutrition interventions. Food Secur 2015. [DOI: 10.1007/s12571-015-0455-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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95
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Håkansson A. Has it become increasingly expensive to follow a nutritious diet? Insights from a new price index for nutritious diets in Sweden 1980-2012. Food Nutr Res 2015; 59:26932. [PMID: 25862145 PMCID: PMC4393418 DOI: 10.3402/fnr.v59.26932] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 11/14/2022] Open
Abstract
Background Health-related illnesses such as obesity and diabetes continue to increase, particularly in groups of low socioeconomic status. The increasing cost of nutritious food has been suggested as an explanation. Objective To construct a price index describing the cost of a diet adhering to nutritional recommendations for a rational and knowledgeable consumer and, furthermore, to investigate which nutrients have become more expensive to obtain over time. Methods Linear programming and goal programming were used to calculate two optimal and nutritious diets for each year in the interval under different assumptions. The first model describes the rational choice of a cost-minimizing consumer; the second, the choice of a consumer trying to deviate as little as possible from average consumption. Shadow price analysis was used to investigate how nutrients contribute to the diet cost. Results The cost of a diet adhering to nutritional recommendations has not increased more than general food prices in Sweden between 1980 and 2012. However, following nutrient recommendations increases the diet cost even for a rational consumer, particularly for vitamin D, iron, and selenium. The cost of adhering to the vitamin D recommendation has increased faster than the general food prices. Conclusions Not adhering to recommendations (especially those for vitamin D) offers an opportunity for consumers to lower the diet cost. However, the cost of nutritious diets has not increased more than the cost of food in general between 1980 and 2012 in Sweden.
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Affiliation(s)
- Andreas Håkansson
- Food and Meal Science, School of Education and Environment, Kristianstad University, Kristianstad, Sweden;
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96
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Nakamura R, Suhrcke M, Jebb SA, Pechey R, Almiron-Roig E, Marteau TM. Price promotions on healthier compared with less healthy foods: a hierarchical regression analysis of the impact on sales and social patterning of responses to promotions in Great Britain. Am J Clin Nutr 2015; 101:808-16. [PMID: 25833978 PMCID: PMC4381774 DOI: 10.3945/ajcn.114.094227] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is a growing concern, but limited evidence, that price promotions contribute to a poor diet and the social patterning of diet-related disease. OBJECTIVE We examined the following questions: 1) Are less-healthy foods more likely to be promoted than healthier foods? 2) Are consumers more responsive to promotions on less-healthy products? 3) Are there socioeconomic differences in food purchases in response to price promotions? DESIGN With the use of hierarchical regression, we analyzed data on purchases of 11,323 products within 135 food and beverage categories from 26,986 households in Great Britain during 2010. Major supermarkets operated the same price promotions in all branches. The number of stores that offered price promotions on each product for each week was used to measure the frequency of price promotions. We assessed the healthiness of each product by using a nutrient profiling (NP) model. RESULTS A total of 6788 products (60%) were in healthier categories and 4535 products (40%) were in less-healthy categories. There was no significant gap in the frequency of promotion by the healthiness of products neither within nor between categories. However, after we controlled for the reference price, price discount rate, and brand-specific effects, the sales uplift arising from price promotions was larger in less-healthy than in healthier categories; a 1-SD point increase in the category mean NP score, implying the category becomes less healthy, was associated with an additional 7.7-percentage point increase in sales (from 27.3% to 35.0%; P < 0.01). The magnitude of the sales uplift from promotions was larger for higher-socioeconomic status (SES) groups than for lower ones (34.6% for the high-SES group, 28.1% for the middle-SES group, and 23.1% for the low-SES group). Finally, there was no significant SES gap in the absolute volume of purchases of less-healthy foods made on promotion. CONCLUSION Attempts to limit promotions on less-healthy foods could improve the population diet but would be unlikely to reduce health inequalities arising from poorer diets in low-socioeconomic groups.
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Affiliation(s)
- Ryota Nakamura
- From the Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom (RN, MS, SAJ, RP, and TMM); the Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (RN and MS); the Centre for Health Economics, University of York, York, United Kingdom (RN and MS); the UKCRC Centre for Diet and Activity Research, Cambridge, United Kingdom (RN and MS); the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (SAJ); and the Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom (EA-R)
| | - Marc Suhrcke
- From the Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom (RN, MS, SAJ, RP, and TMM); the Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (RN and MS); the Centre for Health Economics, University of York, York, United Kingdom (RN and MS); the UKCRC Centre for Diet and Activity Research, Cambridge, United Kingdom (RN and MS); the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (SAJ); and the Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom (EA-R)
| | - Susan A Jebb
- From the Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom (RN, MS, SAJ, RP, and TMM); the Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (RN and MS); the Centre for Health Economics, University of York, York, United Kingdom (RN and MS); the UKCRC Centre for Diet and Activity Research, Cambridge, United Kingdom (RN and MS); the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (SAJ); and the Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom (EA-R)
| | - Rachel Pechey
- From the Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom (RN, MS, SAJ, RP, and TMM); the Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (RN and MS); the Centre for Health Economics, University of York, York, United Kingdom (RN and MS); the UKCRC Centre for Diet and Activity Research, Cambridge, United Kingdom (RN and MS); the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (SAJ); and the Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom (EA-R)
| | - Eva Almiron-Roig
- From the Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom (RN, MS, SAJ, RP, and TMM); the Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (RN and MS); the Centre for Health Economics, University of York, York, United Kingdom (RN and MS); the UKCRC Centre for Diet and Activity Research, Cambridge, United Kingdom (RN and MS); the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (SAJ); and the Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom (EA-R)
| | - Theresa M Marteau
- From the Behaviour and Health Research Unit, University of Cambridge, Cambridge, United Kingdom (RN, MS, SAJ, RP, and TMM); the Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (RN and MS); the Centre for Health Economics, University of York, York, United Kingdom (RN and MS); the UKCRC Centre for Diet and Activity Research, Cambridge, United Kingdom (RN and MS); the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (SAJ); and the Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom (EA-R)
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97
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Jones HA, Charlton KE. A cross-sectional analysis of the cost and affordability of achieving recommended intakes of non-starchy fruits and vegetables in the capital of Vanuatu. BMC Public Health 2015; 15:301. [PMID: 25885864 PMCID: PMC4392615 DOI: 10.1186/s12889-015-1644-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/16/2015] [Indexed: 11/20/2022] Open
Abstract
Background The low-income Pacific Island nation of Vanuatu is experiencing a double burden of diet-related disease whereby micronutrient deficiencies and underweight occur at the same time as obesity related non-communicable diseases. Increasing intakes of nutrient dense, energy dilute foods such as fruits and vegetables will be important to address this issue. However, reduced access to agricultural land in urban areas provides limited opportunities for traditional subsistence fruit and vegetable production. Set in Port Vila, Vanuatu’s capital and main urban centre, this study aimed to determine the cost and affordability of meeting international recommendations to consume at least 400 g of non-starchy fruits and vegetables (NSFV) per person per day, and assess the adequacy of households’ NSFV expenditure. Methods NSFV prices from the 2010 Vanuatu Consumer Price Index (n = 56) were used to determine the minimum monthly cost of purchasing 400 g of local NSFV per person, after accounting for wastage. The 2010 Vanuatu Household Income and Expenditure Survey (n = 578 households) was analysed to determine the proportion of households’ total and food budget required to purchase 400 g of local NSFV for all household members. Household NSFV costs were also compared against actual household expenditure on these items. Consumption of own-produce and gifts received were included within estimates of food expenditure. Results The minimum cost of purchasing the recommended amount of local NSFV was 1,486.24 vatu ($16.60 US) per person per month. This level of expenditure would require an average of 9.6% (SD 6.4%) of households’ total budget and 26.3% (SD 25.8%) of their food budget. The poorest households would need to allocate 40.9% (SD 34.3%) of their total food budget to NSFV to purchase recommended amounts of these foods. Twenty-one percent of households recorded sufficient NSFV expenditure while 23.4% recorded less than 10% of the expenditure required to meet the NSFV recommendations. Conclusions Achieving recommended intakes of local NSFV in Port Vila is largely unaffordable, and expenditure on these foods was inadequate for most households in Port Vila in 2010. Addressing fruit and vegetable affordability will be an important consideration in prevention of non-communicable diseases in the Pacific region.
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Affiliation(s)
- Holly A Jones
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia.
| | - Karen E Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia.
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98
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An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta. Public Health Nutr 2015; 18:3211-23. [PMID: 25753315 DOI: 10.1017/s1368980015000476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies. DESIGN We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990. SETTING Malta. SUBJECTS Whole population, with a focus on children. RESULTS Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and socio-cultural dimensions of the Maltese obesogenic environment are explored. CONCLUSIONS Malta's obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed.
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99
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Olstad DL, Raine KD, Nykiforuk CIJ. Development of a report card on healthy food environments and nutrition for children in Canada. Prev Med 2014; 69:287-95. [PMID: 25450497 DOI: 10.1016/j.ypmed.2014.10.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/15/2014] [Accepted: 10/19/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of the Report Card on Healthy Food Environments and Nutrition for Children is to assess how current environments and policies in Canada support or create barriers to improving children's dietary behaviours and body weights. METHOD In 2014 we reviewed the literature to identify indicators of the quality of children's food environments and related policies. Scoring systems used to monitor and report on progress on a variety of public health activities were consulted during development of a grading scheme. The Report Card was revised following reviews by an Expert Advisory Committee. RESULTS The Report Card assigns a grade to policies and actions (42 indicators and benchmarks) within 4 micro-environments (physical, communication, economic, social) and within the political macro-environment. Grade-level scores of A through F are assigned that reflect achievement of, supports for, and monitoring of indicator-specific benchmarks. A Canadian Report Card will be released annually starting in 2015. CONCLUSION The Report Card is a novel tool to monitor the state of children's food environments and supportive policies, inform stakeholders of the state of these environments and policies, engage society in a national discussion, and outline a policy-relevant research agenda for further study.
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Affiliation(s)
- Dana Lee Olstad
- School of Public Health, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Kim D Raine
- School of Public Health, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Candace I J Nykiforuk
- School of Public Health, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave, University of Alberta, Edmonton, AB T6G 1C9, Canada.
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100
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Woods J, Bressan A, Langelaan C, Mallon A, Palermo C. Australian school canteens: menu guideline adherence or avoidance? Health Promot J Austr 2014; 25:110-5. [PMID: 25200467 DOI: 10.1071/he14009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 07/10/2014] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED Since 2005, all states and territories across Australia have progressively introduced policy guidelines to promote nutritious food sales in school canteens. This study aimed to assess the compliance of school canteens with their state or territory canteen guidelines. METHODS School canteen menus from a convenience sample of online government school websites were assessed for compliance with guidelines for the inclusion of foods meeting the criteria for 'red' ('not recommended' or 'only occasional - no more than twice per term'), 'amber' ('select carefully') and 'green' ('always on the menu', 'everyday', 'fill the menu' or 'plenty'). The costs of a salad and a regular pie were also collected where present. RESULTS A total of 263 school menus were sourced and assessed (4% of government schools). Western Australia was the most compliant, with 62% of menus adhering to the state guidelines; compliance in other jurisdictions ranged from 5-35%. Compared with primary schools, a higher proportion of secondary schools offered 'red' items on the menu (P<0.05). The mean cost of a regular pie (A$3.17 ± 0.51) was significantly cheaper than the cost of a salad (A$4.2 5 ± 0.82) (P<0.001). A range of discretionary food items were present on a large proportion of menus. CONCLUSION This study found that the majority of school canteens were not complying with relevant state or territory guidelines, particularly those schools in which no monitoring or enforcement of the guidelines was conducted. SO WHAT? Monitoring and enforcement by those responsible for the policy, together with efforts to build the capacity for schools and manufacturers to improve the food supply, may increase compliance.
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Affiliation(s)
- Julie Woods
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Vic. 3125, Australia
| | - Alex Bressan
- Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Corrina Langelaan
- The Parents' Jury, 570 Elizabeth Street, Melbourne, Vic. 3000, Australia
| | - Angela Mallon
- The Parents' Jury, 570 Elizabeth Street, Melbourne, Vic. 3000, Australia
| | - Claire Palermo
- Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
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