Food systems transformations, ultra-processed food markets and the nutrition transition in Asia

The use of commercial food purchase data for public health nutrition research: A systematic review

BACKGROUND

Traditional methods of dietary assessment have their limitations and commercial sources of food sales and purchase data are increasingly suggested as an additional source to measuring diet at the population level. However, the potential uses of food sales data are less well understood. The aim of this review is to establish how sales data on food and soft drink products from third-party companies have been used in public health nutrition research.

METHODS

A search of five electronic databases was conducted in February-March 2018 for studies published in peer-reviewed journals that had used food sales or purchase data from a commercial company to analyse trends and patterns in food purchases or in the nutritional composition of foods. Study quality was evaluated using the National Institutes of Health (NIH) Quality Assessment Tool for Cohort and Cross-Sectional Studies.

RESULTS

Of 2919 papers identified in the search, 68 were included. The selected studies used sales or purchase data from four companies: Euromonitor, GfK, Kantar and Nielsen. Sales and purchase data have been used to evaluate interventions, including the impact of the saturated fat tax in Denmark, the soft drink and junk food taxes in Mexico and supplemental nutrition programmes in the USA. They have also been used to identify trends in the nutrient composition of foods over time and patterns in food purchasing, including socio-demographic variations in purchasing.

CONCLUSION

Food sales and purchase data are a valuable tool for public health nutrition researchers and their use has increased markedly in the last four years, despite the cost of access, the lack of transparency on data-collection methods and restrictions on publication. The availability of product and brand-level sales data means they are particularly useful for assessing how changes by individual food companies can impact on diet and public health.

Trends in Ultra-Processed Food Purchases from 1984 to 2016 in Mexican Households

Global trade agreements have shaped the food system in ways that alter the availability, accessibility, affordability, and desirability of ready-to-eat foods. We assessed the time trends of ultra-processed foods purchases in Mexican households from 1984 to 2016. Cross-sectional data from 15 rounds of the National Income and Expenditure Survey (1984, 1989, 1992, 1994, 1996, 1998, 2000, 2002, 2004, 2006, 2008, 2010, 2012, 2014 and 2016) were analyzed. Food and beverage purchases collected in a daily record instrument (over seven days) were classified according to their degree of processing according to the NOVA food framework: (1) Unprocessed or minimally processed foods; (2) processed culinary ingredients; (3) processed foods; and (4) ultra-processed foods. From 1984 to 2016, the total daily energy purchased decreased from 2428.8 to 1875.4 kcal/Adult Equivalent/day, there was a decrease of unprocessed or minimally processed foods (from 69.8% to 61.4% kcal) and processed culinary ingredients (from 14.0% to 9.0% kcal), and an increase of processed foods (from 5.7% to 6.5% kcal) and ultra-processed foods (from 10.5% to 23.1% kcal). Given that ultra-processed foods purchases have doubled in the last three decades and unprocessed or minimally processed foods purchased have gradually declined, future strategies should promote the consumption of unprocessed or minimally processed foods, and discourage ultra-processed foods availability and accessibility in Mexico.

The interface between consumers and their food environment in Myanmar: an exploratory mixed-methods study

Objective

To examine consumers’ perceptions of their food environments, their food consumption patterns and preferences, and to better understand the attributes of foods that are available within food environments in Myanmar.

Design

An exploratory mixed-methods study using a combination of focus group discussions, market and consumer surveys.

Setting

Four study settings in Myanmar were included: an upper-income township of Yangon; a lower-income township of Yangon; a middle-income township in the southern Myanmar town of Dawei; and a lower-income village in the country’s dry zone of Magway.

Participants

Thirty-two women participated in the focus groups discussions, twenty market surveys were conducted and 362 consumers (both men and women) completed food consumption surveys.

Results

Focus group participants indicated that the availability of a diverse range of foods had increased over time, while the quality of foods had decreased. Health was seen primarily through the lens of food safety and there was an overall lack of knowledge about which foods were more or less healthy. Consumers preferred fruits, vegetables and red meat compared with highly processed snack foods/beverages. Although consumers reported low intakes of highly processed snack foods, Burmese street food was consumed in high quantities. The market surveys suggested that fresh, minimally processed and highly processed foods were available at all markets across the study settings.

Conclusions

Consumers are exposed to a variety of foods, of varying quality, within their food environments in Myanmar. Interventions aimed at increasing consumer knowledge regarding healthy diets and improving food safety are needed.

Vegetables and legumes in new Australasian food launches: how are they being used and are they a healthy choice?

BACKGROUND

Despite the health benefits of regular vegetable and legume consumption, on average Australians are consuming only half of the recommended daily intake. The reasons for this low consumption are complex, and are particularly driven by societal shifts towards convenient and ready-to-eat meal options. It is currently unknown how legumes and vegetables are being utilised in food products within the Australian context, and the nutritional value or level of processing of these products.

METHODS

The Mintel Global New Food Database was used to identify all new products launched between May 2012 and May 2017 in Australasia which at least 0.5 serves of vegetables and/or legumes per recommended serving. Eligible products were coded using the NOVA food classification system and the Healthy Choices guidelines, and were categorized by the researchers based on the type and proportion of vegetable and legume ingredients used.

RESULTS

Overall, 1313 products were identified, which contained a median of 55% vegetable and legume ingredients (IQR = 45%). This translated to approximately 1 (IQR = 1) serves of vegetables and legumes per recommended serving of the products. The product launches were most likely to be classified as an 'amber' choice, and be classified as either 'processed' or 'ultra-processed'. Vegetables and legumes were mainly found in the form of new prepared meals, soups or whole vegetables products, however there were some more innovative uses of these ingredients, such as yoghurts and pastas.

CONCLUSIONS

Most of the new products currently released onto the Australian market which contain vegetable and legume ingredients do not provide meaningful amounts of these ingredients, and tend to be highly processed and unhealthier options. A multi-faceted approach is needed to improve vegetable and legume consumption, which includes improving the availability of products which help consumers to meet vegetable and legume consumption recommendations. Future research should consider the acceptability of these products to consumers, and the barriers for food manufacturers in creating products with a higher amount of vegetables and legumes.

The Western Diet-Microbiome-Host Interaction and Its Role in Metabolic Disease

The dietary pattern that characterizes the Western diet is strongly associated with obesity and related metabolic diseases, but biological mechanisms supporting these associations remain largely unknown. We argue that the Western diet promotes inflammation that arises from both structural and behavioral changes in the resident microbiome. The environment created in the gut by ultra-processed foods, a hallmark of the Western diet, is an evolutionarily unique selection ground for microbes that can promote diverse forms of inflammatory disease. Recognizing the importance of the microbiome in the development of diet-related disease has implications for future research, public dietary advice as well as food production practices. Research into food patterns suggests that whole foods are a common denominator of diets associated with a low level of diet-related disease. Hence, by studying how ultra-processing changes the properties of whole foods and how these foods affect the gut microbiome, more useful dietary guidelines can be made. Innovations in food production should be focusing on enabling health in the super-organism of man and microbe, and stronger regulation of potentially hazardous components of food products is warranted.

Implementation lessons for school food policies and marketing restrictions in the Philippines: a qualitative policy analysis

BACKGROUND

The school environment can enhance children's skills, knowledge and behaviours in relation to healthy eating. However, in many countries, unhealthy foods are commonly available in schools, and children can be exposed to aggressive marketing by the food industry. Taking the perspective of policymakers, this study aimed to identify barriers and enablers to effective school food policy development and implementation in the Philippines.

METHODS

In May 2016, semi-structured interviews were conducted with 21 policymakers and stakeholders involved in school food policymaking and implementation in the Philippines. The Health Policy Analysis Triangle was used to identify interview questions and to guide the thematic analysis. These included the political and socio-environmental context, strengths and limitations of existing policy content, roles and behaviours of actors, implementation processes, policy outcomes, and opportunities to improve policy coherence.

RESULTS

The Department of Education's policy 'Orders' represented a relatively strong policy framework for the education sector of the Philippines. However, a lack of human and financial resources for implementation, planning, and policy enforcement limited the impact of the policy on the healthiness of school food provision. Ambiguity in policy wording allowed a wide interpretation of the foods eligible to be provided in schools, and led to difficulties in effective monitoring and enforcement. Food companies used existing relationships with schools to promote their brands and compromise the establishment of a stronger food policy agenda. We found a motivated group of actors engaging in policy-oriented learning and advocating for a stronger policy alternative so as to improve the school food environment.

CONCLUSIONS

The adoption of policy mechanisms being used to promote healthy dietary practices in the school setting will be strengthened by more robust implementation planning processes, and resources to support implementation and enforcement. Policymakers should ensure policy language clearly and unequivocally promotes healthier food and beverage options. Steps should be taken to achieve policy coherence by ensuring the objectives of one agency or institution are not undermining that of any others. Where there is reliance on the private sector for school resources, safeguards should be established to protect against conflicts of interest.

Declaration of nutrition information on and nutritional quality of Thai ready-to-eat packaged food products

OBJECTIVE

The present study assessed the nutrition information displayed on ready-to-eat packaged foods and the nutritional quality of those food products in Thailand.

DESIGN

In March 2015, the nutrition information panels and nutrition and health claims on ready-to-eat packaged foods were collected from the biggest store of each of the twelve major retailers, using protocols developed by the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS). The Thai Nutrient Profile Model was used to classify food products according to their nutritional quality as 'healthier' or 'less healthy'.

RESULTS

In total, information from 7205 food products was collected across five broad food categories. Out of those products, 5707 (79·2 %), 2536 (35·2 %) and 1487 (20·6 %) carried a nutrition facts panel, a Guideline Daily Amount (GDA) label and health-related claims, respectively. Only 4691 (65·1 %) and 2484 (34·5 %) of the products that displayed the nutrition facts or a GDA label, respectively, followed the guidelines of the Thai Food and Drug Administration. In total, 4689 products (65·1 %) could be classified according to the Thai Nutrient Profile Model, of which 432 products (9·2 %) were classified as healthier. Moreover, among the 1487 products carrying health-related claims, 1219 (82·0 %) were classified as less healthy. Allowing less healthy food products to carry claims could mislead consumers and result in overconsumption of ready-to-eat food products.

CONCLUSIONS

The findings suggest effective policies should be implemented to increase the relative availability of healthier ready-to-eat packaged foods, as well as to improve the provision of nutrition information on labels in Thailand.

Implicit Messages Regarding Unhealthy Foodstuffs in Chinese Television Advertisements: Increasing the Risk of Obesity

Previous studies indicated that television (TV) advertising is associated with higher rates of obesity. The rate of obesity and overweight continues to rise in mainland China, bringing into question whether TV advertising to young audiences might be partly to blame. This study investigated messaging delivered through TV advertisements regarding healthy and unhealthy foodstuffs. A total of 42 major food brands and 480 advertisements were analysed for content in this study. The results showed that the majority of TV spots advertised products with poor nutritional content and had a potential to mislead audiences concerning products' actual nutritional value. The tactics of repetition and appeals of premium offerings on food brands have a potential to influence the purchase intentions. Additional qualitative observation involving the social bond, social context and cultural factors pertaining to mood alterations were highlighted. The discussion addressed product attributes reflected by culture and the implicit messages of marketing claims may increase the risk of obesity. Thus, public health policymakers and researchers were encouraged to act urgently to evaluate the obesity risks of unhealthy food advertised in the media and to support healthy foods.

Relative Validity and Reproducibility of a Food Frequency Questionnaire for Assessing Dietary Intakes in a Multi-Ethnic Asian Population Using 24-h Dietary Recalls and Biomarkers

The assessment of diets in multi-ethnic cosmopolitan settings is challenging. A semi-quantitative 163-item food frequency questionnaire (FFQ) was developed for the adult Singapore population, and this study aimed to assess its reproducibility and relative validity against 24-h dietary recalls (24 h DR) and biomarkers. The FFQ was administered twice within a six-month interval in 161 adults (59 Chinese, 46 Malay, and 56 Indian). Fasting plasma, overnight urine, and 24 h DR were collected after one month and five months. Intra-class correlation coefficients between the two FFQ were above 0.70 for most foods and nutrients. The median correlation coefficient between energy-adjusted deattenuated FFQ and 24 h DR nutrient intakes was 0.40 for FFQ1 and 0.39 for FFQ2, highest for calcium and iron, and lowest for energy and carbohydrates. Significant associations were observed between urinary isoflavones and soy protein intake (r = 0.46), serum carotenoids and fruit and vegetable intake (r = 0.34), plasma eicosapentaenoic acid and docosahexaenoic acid (EPA + DHA) and fish/seafood intake (r = 0.36), and plasma odd chain saturated fatty acids (SFA) and dairy fat intake (r = 0.25). Associations between plasma EPA + DHA and fish/seafood intake were consistent across ethnic groups (r = 0.28–0.49), while differences were observed for other associations. FFQ assessment of dietary intakes in modern cosmopolitan populations remains feasible for the purpose of ranking individuals’ dietary exposures in epidemiological studies.