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Mora-Plazas M, Higgins ICA, Gomez LF, Hall MG, Parra MF, Bercholz M, Murukutla N, Taillie LS. Impact of nutrient warning labels on Colombian consumers' selection and identification of food and drinks high in sugar, sodium, and saturated fat: A randomized controlled trial. PLoS One 2024; 19:e0303514. [PMID: 38857209 PMCID: PMC11164358 DOI: 10.1371/journal.pone.0303514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/09/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE This study assessed the impact of nutrient warnings on product selection and ability to identify food products high in nutrients of concern in Colombia. METHODS In an online experiment (May-June 2023), Colombian adults were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition (n = 8,004). Participants completed selection tasks between two fruit drinks labeled according to their condition, one high in sugar and one not. Next, participants answered questions about products high in sugar, sodium, and/or saturated fat ("high-in" product). Finally, they selected which label would most discourage them from consuming a high-in product. RESULTS Fewer participants (17%) exposed to the nutrient warning indicated they would purchase the high-sugar fruit drink compared to Nutri-Score (27%, Holm-adjusted (adj) p<0.001) and no label conditions (31%, adj p<0.001); there were no differences between the nutrient warning and GDA label (14%, adj p = 0.087). Compared to the nutrient warning, the GDA label was slightly more effective at helping consumers identify which drink was high in sugar (89% versus 92%, adj p<0.001), while the Nutri-Score and no-label conditions were less effective. Compared to all other conditions, nutrient warnings were more effective at helping participants identify that products were high in nutrients of concern, were more effective at decreasing intentions to purchase these high-in products and were perceived as more effective. Nutrient warnings were most often selected as the label that most discouraged consumption. CONCLUSIONS Nutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern. TRIAL REGISTRATION Trial Registration: NCT05783726.
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Affiliation(s)
- Mercedes Mora-Plazas
- Departamento de Nutrición Humana, Universidad Nacional de Colombia, Bogotá, Colombia, United States of America
| | - Isabella Carolyn Aida Higgins
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Luis Fernando Gomez
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia, United States of America
| | - Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Maria Fernanda Parra
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia, United States of America
| | - Maxime Bercholz
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
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de Carvalho TC, da Mota Borges AK, Silva IFD. Stomach cancer incidence trends in selected Latin America countries: Age, period, and birth-cohort effects. Cancer Epidemiol 2023; 85:102392. [PMID: 37301017 DOI: 10.1016/j.canep.2023.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND to explore the age, period, and birth-cohort effects on stomach cancer incidence trends during 3 decades in selected Latin American countries. METHODS a time-trend study was performed using Cancer Incidence in Five Continents data from high-quality population-based cancer registries(PBCRs) in Latin American countries. Crude and age-standardized incidence rates(ASRIs) were calculated. Time trends in ASRIs were assessed using the average annual percentage change(AAPC). Age-period-cohort effects were estimated by Poisson regression for individuals aged between 20 and 79 years with stomach cancer informed by PBCRs from 1983 to 2012 in Cali(Colombia); from 1982 to 2011 in Costa Rica; and from 1988 to 2012 for Goiania(Brazil) and Quito(Ecuador). The goodness-of-fit model was tested using the deviance of the models. RESULTS a decrease in age-standardized incidence rates was observed for both genders in all populations covered by PBCRs, except for young men from Cali(AAPC 3.89 95 %IC: 1.32-7.29). The age effect was statistically significant in all areas, and the curve slope reached peaks in the older age groups. The cohort effect was observed in all PBCRs. Regarding the period effect, an increased ratio rate was observed for both genders in Costa Rica(1997-2001 women RR 1.11 95 %CI: 1.05-1.17; men RR 1.12 95 %CI: 1.08-1.17) and Goiânia(2003-2007 women RR 1.21 95 %CI: 1.08-1.35; men RR 1.09 95 %CI: 1.01-1.20), while Quito(1998-2002 women RR 0.89 95 %CI: 0.81-0.98; men RR 0.86 95 %CI: 0.79-0.93) presented a decrease. CONCLUSION the present study showed a decreasing gastric cancer trend for over the past 30 years with gender and geographic variations. Such a decrease seems to be mainly a result of cohort effects, suggesting that the economic market opening process led to changes in the risk factor exposures over successive generations. These geographic and gender variations may reflect cultural/ethnic/gender differences and differences in dietary and smoking rate patterns. However, an increased incidence was observed for young men in Cali, and additional studies are needed to determine the cause of the increasing incidence in this group.
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Affiliation(s)
| | | | - Ilce Ferreira da Silva
- Department of Epidemiology and Quantitative Methods, National Public Health School, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Veile A, Christopher L, Azcorra H, Dickinson F, Kramer K, Varela‐Silva I. Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9314705 DOI: 10.1002/ajpa.24510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Early‐life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early‐life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross‐sectional sample of 6‐year‐olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early‐life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural‐urban differences in demographic, socioeconomic, early‐life, and anthropometric variables, then created linear mixed models to evaluate associations between early‐life variables and child anthropometric outcomes. Two‐way interactions were tested between early‐life variables and child sex, and between early‐life variables and rural‐urban residence. Results showed that rural children were shorter‐statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6‐year‐old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early‐life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.
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Affiliation(s)
- Amanda Veile
- Department of Anthropology Purdue University West Lafayette Indiana USA
| | | | - Hugo Azcorra
- Centro de Investigaciones Silvio Zavala Universidad Modelo Mérida Mexico
| | - Federico Dickinson
- Departamento de Ecología Humana Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Mérida Mexico
| | - Karen Kramer
- Department of Anthropology University of Utah Salt Lake City Utah USA
| | - Inês Varela‐Silva
- Departamento de Ecología Humana Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Mérida Mexico
- School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
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Mora-Plazas M, Aida Higgins IC, Gomez LF, Hall M, Parra MF, Bercholz M, Murukutla N, Taillie LS. Impact of nutrient warning labels on choice of ultra-processed food and drinks high in sugar, sodium, and saturated fat in Colombia: A randomized controlled trial. PLoS One 2022; 17:e0263324. [PMID: 35143553 PMCID: PMC8830675 DOI: 10.1371/journal.pone.0263324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study assessed nutrient warnings' impact on product selection and identification of food products high in nutrients of concern in Colombia. METHODS In an online experiment (October 2020), 8,061 Colombians were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition. They viewed two fruit drinks labeled according to their condition, one high in sugar and one not, and completed selection tasks. Next, they assessed four products high in sugar, sodium, and/or saturated fat ("high in" product). Finally, they selected which label would most discourage them from consuming a "high in" product. RESULTS The nutrient warning performed better on most outcomes. Twenty percent of participants exposed to the nutrient warning would purchase the high-sugar fruit drink compared to GDA (24%, p<0.01), Nutri-Score (33%, p<0.001), and no label (29%, p<0.001). GDA performed slightly better than the nutrient warning in identifying the high-sugar fruit drink (91% vs 88%, p<0.001). The nutrient warning best helped participants correctly identify other "high in" products (75% vs. 23% no-label, 26% Nutri-Score, and 43% GDA, all p<0.001) and had the highest perceived message effectiveness (3.86 on 5-point scale vs. 2.97 GDA and 2.70 Nutri-Score, both p<0.001) and lowest likelihood of purchasing "high in" products (2.58 on 5-point scale vs. 3.23 GDA, 3.49 Nutri-Score, and 3.51 no label, all p<0.001). The nutrient warning most discouraged participants from wanting to consume "high in" products. CONCLUSIONS Nutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern. TRIAL REGISTRATION Trial Registration: NCT04567004.
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Affiliation(s)
- Mercedes Mora-Plazas
- Departamento de Nutrición Humana, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Isabella Carolyn Aida Higgins
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Marissa Hall
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Maxime Bercholz
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Diet quality of Norwegian children at 3 and 7 years: changes, predictors and longitudinal association with weight. Int J Obes (Lond) 2022; 46:10-20. [PMID: 34462565 DOI: 10.1038/s41366-021-00951-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Poor diet quality in early life can have long-term health effects, but the evidence is largely from cross-sectional studies. Our objective was to examine diet quality of Norwegian children by applying a-priori diet quality indices, identify early life determinants and examine prospective associations with overweight. SUBJECTS/METHODS We included 34,074 preschoolers (3-year-olds) and 18,350 school-aged children (7-years-olds) from the prospective, population-based Norwegian Mother, Father and Child Cohort Study. Diet quality was assessed as (i) adherence to a Mediterranean diet, estimated by the food frequency-based Mediterranean Diet Score (fMDS, score range: 0-6) and (ii) by the diet quality index (DQI, score range: -33% to 100%), reflecting compliance to food-based dietary guidelines. In multivariate analyses we explored perinatal and childhood characteristics as potential determinants of diet quality. We used logistic regression to examine the associations between diet quality at 3 years and BMI status at 8 years, adjusting for relevant confounders and diet quality at 7 years. RESULTS One in three children had high MD adherence at 3 and 8 years, and DQI (mean 60%) at 3 and 7 years was strongly correlated (r = 0.48, p < 0.001). Short breastfeeding duration, physical activity and sleep duration and long screentime at 18 months were associated with 2-3% lower DQI at 3 years. At both ages, maternal diet quality was the strongest prospective predictor of DQI (beta = 5%, 95% CI = 4.7, 5.2 and beta = 3.1%, 95% CI = 2.8, 3.4), and screentime was the strongest cross-sectional predictor (beta = -5.2%, 95% CI = -5.9, -4.5 and beta = -4.1%, 95% CI = -5.0, -3.2). High DQI score at 3 years, but not MD adherence, was associated with a lower risk for overweight (including obesity) at 8 years, compared to low DQI (lower tertile) (adjusted OR = 0.77, 95% CI = 0.62, 0.96). CONCLUSIONS Our study provides evidences that high diet quality in early childhood may reduce the risk for overweight in later childhood, independent of the current dietary behaviors.
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Dietary patterns in middle childhood and behavior problems in adolescence. Eur J Clin Nutr 2021; 75:1809-1818. [PMID: 33674775 DOI: 10.1038/s41430-021-00888-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND/OBJECTIVES Adherence to a "Western" style dietary pattern has been related to behavior problems in children in high-income countries; however, dietary patterns may differ in countries undergoing the nutrition transition. Associations of dietary patterns with behavior problems in a Latin American context have not been evaluated. SUBJECTS/METHODS Mothers of 385 children 5 to 12 y old completed a food frequency questionnaire (FFQ) on the children's usual intake at enrollment into a cohort study. Four dietary patterns were identified through principal component analysis of the FFQ: animal protein, snacking, cheaper protein, and traditional/starch. After a median 6 y follow-up, adolescents reported behavior problems via the Youth Self Report, a standardized questionnaire. We compared the continuous distributions of externalizing and internalizing behavior problems and their subscales across quartiles of adherence to the four dietary patterns using multivariable linear regression. RESULTS Boys in the highest quartile of adherence to the animal protein pattern in middle childhood had an adjusted 5.5 units lower (95% CI -9.5, -1.5) mean total externalizing problems score compared with boys in the lowest quartile (P trend = 0.008). Adherence to the animal protein pattern was also inversely related to the aggressive behavior externalizing subscale in a dose-response manner among boys (P trend = 0.009). There were no associations between adherence to other dietary patterns and externalizing problems in boys or girls. There were no associations with internalizing problems. CONCLUSION Adherence to an animal protein dietary pattern in middle childhood was associated with less externalizing behavior problems in adolescent boys.
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Total and whole grain intake in Latin America: findings from the multicenter cross-sectional Latin American Study of Health and Nutrition (ELANS). Eur J Nutr 2021; 61:489-501. [PMID: 34232375 PMCID: PMC8783851 DOI: 10.1007/s00394-021-02635-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/28/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Understanding whole-grain intake and its associated factors is essential to tackle the double burden of malnutrition faced by Latin American countries. This study aimed to characterize total and whole grain intake in Latin American countries and to investigate foods contributing to these intake in the region. METHODS Data were obtained from the multicenter cross-sectional survey Latin American Study of Nutrition and Health (ELANS), including 9128 participants residing in urban areas of eight Latin American countries. Data collection was performed via two household visits using a standardized questionnaire and two 24 h dietary recalls. Usual dietary intake of total grain foods and foods containing whole grains was estimated. The association between the intake of grain food groups and sociodemographic variables was investigated using multiple linear regression models with random intercepts. RESULTS Mean intake of total grain foods and foods containing whole grains was 318.6 g/d and 14.7 g/d, respectively. Total grain foods were less consumed by participants at older ages (-9.8 g/d), and females (-9.9 g/d), and more consumed by those in the lowest socioeconomic category (24.8 g/d). Foods containing whole grains were more consumed by participants at older ages (3.3 g/d), and females (4.0 g/d), while those in the lowest socioeconomic category consumed 2.9 g/d less. Major contributors to energy provided from foods containing whole grains were oatmeal, masa harina, whole-wheat bread, corn chips, and wheat crackers. CONCLUSION The intake of grain foods represented a substantial part of the Latin American population's diet, but the intake of foods containing whole grains was extremely low in all assessed countries.
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