The Influence on Population Weight Gain and Obesity of the Macronutrient Composition and Energy Density of the Food Supply

Relationships between sodium, fats and carbohydrates on blood pressure, cholesterol and HbA1c: an umbrella review of systematic reviews

Background

The relationship between nutrition and health is complex and the evidence to describe it broad and diffuse. This review brings together evidence for the effect of nutrients on cardiometabolic risk factors.

Methods

An umbrella review identified systematic reviews of randomised controlled trials and meta-analyses estimating the effects of fats, carbohydrates and sodium on blood pressure, cholesterol and haemoglobin A1c (HbA1c). Medline, Embase, Cochrane Library and Science Citation Index were search through 26 May 2020, with supplementary searches of grey literature and websites. English language systematic reviews and meta-analyses were included that assessed the effect of sodium, carbohydrates or fat on blood pressure, cholesterol and HbA1c. Reviews were purposively selected using a sampling framework matrix. The quality of evidence was assessed with A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2) checklist, evidence synthesised in a narrative review and causal pathways diagram.

Results

Forty-three systematic reviews were included. Blood pressure was significantly associated with sodium, fibre and fat. Sodium, fats and carbohydrates were significantly associated with cholesterol. Monounsaturated fat, fibre and sugars were associated with HbA1c.

Conclusion

Multiple relationships between nutrients and cardiometabolic risk factors were identified and summarised in an accessible way for public health researchers. The review identifies associations, inconsistencies and gaps in evidence linking nutrition to cardiometabolic health.

Local Food Environment and Consumption of Ultra-Processed Foods: Cross-Sectional Data from the Nutritionists' Health Study-NutriHS

This study aimed to analyze whether community food environments are associated with individual food consumption among nutrition students and newly graduated nutritionists. This cross-sectional study used data from the Nutritionists' Health Study cohort, which included 357 undergraduate nutrition students from the city of Fortaleza, Ceará, Brazil. Exposure to the food environment was defined as the proximity and availability of food outlets within a 500 m buffer from the participants' homes. Food consumption was assessed using a Food Frequency Questionnaire and analyzed according to the NOVA classification. Multi-level linear regression models with fixed effects were used to estimate the presence of food outlets within the buffer and their association with food consumption. The presence of mini-markets in the buffer in the fourth quartile was associated with lower consumption of ultra-processed foods (UPF) when observing socioeconomic and lifestyle conditions (β = -3.29; 95% CI = -6.39 to -0.19). The presence of bakeries and coffee shops was related to lower consumption of ultra-processed foods among participants when observing socioeconomic conditions (β = -3.10; 95% CI = -6.18 to -0.02). There was no clear evidence of an association between the type of food outlet and UPF consumption. The community food environment seemed to influence food consumption among study participants, although clearer and more consistent evidence on this subject is needed.

Spatiotemporal profile of altered neural reactivity to food images in obesity: Reward system is altered automatically and predicts efficacy of weight loss intervention

Introduction

Obesity presents a significant public health problem. Brain plays a central role in etiology and maintenance of obesity. Prior neuroimaging studies have found that individuals with obesity exhibit altered neural responses to images of food within the brain reward system and related brain networks. However, little is known about the dynamics of these neural responses or their relationship to later weight change. In particular, it is unknown if in obesity, the altered reward response to food images emerges early and automatically, or later, in the controlled stage of processing. It also remains unclear if the pretreatment reward system reactivity to food images is predictive of subsequent weight loss intervention outcome.

Methods

In this study, we presented high-calorie and low-calorie food, and nonfood images to individuals with obesity, who were then prescribed lifestyle changes, and matched normal-weight controls, and examined neural reactivity using magnetoencephalography (MEG). We performed whole-brain analysis to explore and characterize large-scale dynamics of brain systems affected in obesity, and tested two specific hypotheses: (1) in obese individuals, the altered reward system reactivity to food images occurs early and automatically, and (2) pretreatment reward system reactivity predicts the outcome of lifestyle weight loss intervention, with reduced activity associated with successful weight loss.

Results

We identified a distributed set of brain regions and their precise temporal dynamics that showed altered response patterns in obesity. Specifically, we found reduced neural reactivity to food images in brain networks of reward and cognitive control, and elevated reactivity in regions of attentional control and visual processing. The hypoactivity in reward system emerged early, in the automatic stage of processing (< 150 ms post-stimulus). Reduced reward and attention responsivity, and elevated neural cognitive control were predictive of weight loss after six months in treatment.

Discussion

In summary, we have identified, for the first time with high temporal resolution, the large-scale dynamics of brain reactivity to food images in obese versus normal-weight individuals, and have confirmed both our hypotheses. These findings have important implications for our understanding of neurocognition and eating behavior in obesity, and can facilitate development of novel integrated treatment strategies, including tailored cognitive-behavioral and pharmacological therapies.

Evolving Food Choices Among the Urban Indian Middle-Class: A Qualitative Study

One of the leading risk factors for an escalating obesity burden in India is non-nutritious choices. Underpinned by the nutrition transition theory, this qualitative inquiry was designed to understand the urban middle-class Indian consumers’ views about processed foods and rapidly changing food choices. The study consisted of two phases, the first phase consisted of focus group discussions pertaining to the definition and conception of processed foods and the second phase consisted of interviews regarding the changing food environment. A convenience sample of Indian consumers aged 40–65 years were recruited from Mumbai and Kochi to participate in focus group discussions (FGD1 – nine participants and FGD2 – seven participants) and semi-structured face-to-face interviews (N = 22). Both discussions and interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the transcribed data. Features of processed foods mentioned were chemical and physical processing, prolonged shelf life and poor nutritional quality. Factors influencing food choices and consumption of processed foods reported by participants could be categorized into changes in the socio-cultural environment and changes in the food environment. Changes in the socio-cultural environment included globalization and urbanization, long work days and sedentary living, rise in income levels and decrease in household cooking. Changes in the food environment included increased availability and accessibility of processed foods, replacement of traditional Indian diet with Western food, food as indicators of status, food advertisements and convenience. These results are consistent with nutrition transition theory and provide useful direction for public health policies aimed at promoting healthy diets.

Food environment of the economic capital of the Northeast: social and territorial disparities in the availability of food stores

ABSTRACT Objective Characterize the community food environment through the different types of food outlets in the city of Fortaleza and associate their distribution according to sociodemographic indicators. Methods This is an ecological study carried out in the city of Fortaleza in which data from the Health Surveillance Service were used with the location of all licensed food stores in the city in the years 2018 and 2019. Georeferenced maps were set up to illustrate the spatial distribution of the establishments. Correlation analyses were performed to verify the association between food outlets and socioeconomic data. Values of p≤0.005 were considered significant. Results We identified a greater concentration of food stores in the neighborhoods with better socioeconomic levels. Snack bars (n=2051; 27.7%) and restaurants (n=1945; 26.3%), were in greater quantity and exhibited a positive correlation with the Human Development Index and average income. Supermarkets and hypermarkets (n=288; 3.9%) and street markets (n=81; 1.1%) were in a smaller number and had the worst spatial distribution. Conclusion We observed socioeconomic inequalities in the distribution of different types of food outlets. The little diversity and the limited number of establishments in peripheral neighborhoods, besides the centralization of outlets that sell food that is harmful to health, constitute obstacles for the population to make healthy food choices.

Neural network modelling reveals changes in directional connectivity between cortical and hypothalamic regions with increased BMI

BACKGROUND/OBJECTIVES

Obesity has been ascribed to corticostriatal regions taking control over homeostatic areas. To test this assumption, we applied an effective connectivity approach to reveal the direction of information flow between brain regions and the valence of connections (excitatory versus inhibitory) as a function of increased BMI and homeostatic state.

SUBJECTS/METHODS

Forty-one participants (21 overweight/obese) underwent two resting-state fMRI scans: after overnight fasting (hunger) and following a standardised meal (satiety). We used spectral dynamic causal modelling to unravel hunger and increased BMI-related changes in directed connectivity between cortical, insular, striatal and hypothalamic regions.

RESULTS

During hunger, as compared to satiety, we found increased excitation of the ventromedial prefrontal cortex over the ventral striatum and hypothalamus, suggesting enhanced top-down modulation compensating energy depletion. Increased BMI was associated with increased excitation of the anterior insula over the hypothalamus across the hunger and satiety conditions. The interaction of hunger and increased BMI yielded decreased intra-cortical excitation from the dorso-lateral to the ventromedial prefrontal cortex.

CONCLUSIONS

Our findings suggest that excess weight and obesity is associated with persistent top-down excitation of the hypothalamus, regardless of homeostatic state, and hunger-related reductions of dorso-lateral to ventromedial prefrontal inputs. These findings are compatible with eating without hunger and reduced self-regulation views of obesity.

Sprague Dawley Rats Gaining Weight on a High Energy Diet Exhibit Damage to Taste Tissue Even after Return to a Healthy Diet

Many reports detail taste dysfunction in humans and animals with obesity. For example, mice consuming an obesogenic diet for a short period have fewer taste buds than their lean littermates. Further, rats with diet-induced obesity (DIO) show blunted electrophysiological responses to taste in the brainstem. Here, we studied the effects of high energy diet (HED)-induced peripheral taste damage in rats, and whether this deficiency could be reversed by returning to a regular chow diet. Separate groups of rats consumed a standard chow diet (Chow), a HED for 10 weeks followed by a return to chow (HED/chow), or a HED for 10 weeks followed by a restricted HED that was isocaloric with consumption by the HED/chow group (HED/isocal). Fungiform taste papilla (FP) and circumvallate taste bud abundance were quantified several months after HED groups switched diets. Results showed that both HED/chow and HED/isocal rats had significantly fewer FP and lower CV taste bud abundance than control rats fed only chow. Neutrophil infiltration into taste tissues was also quantified, but did not vary with treatment on this timeline. Finally, the number of cells undergoing programmed cell death, measured with caspase-3 staining, inversely correlated with taste bud counts, suggesting taste buds may be lost to apoptosis as a potential mechanism for the taste dysfunction observed in obesity. Collectively, these data show that DIO has lasting deleterious effects on the peripheral taste system, despite a change from a HED to a healthy diet, underscoring the idea that obesity rather than diet predicts damage to the taste system.

Obesity-induced taste dysfunction, and its implications for dietary intake

The incidence of obesity has dramatically increased in recent years, and poses a public health challenge for which an effective and scalable intervention strategy is yet to be found. Our food choices are one of the primary drivers of obesity, where the overconsumption of energy from foods high in fat and sugar can be particularly problematic. Unfortunately, these same foods also tend to be highly palatable. We select foods more on their sensory properties than on any other factor, such as price, convenience, or healthfulness. Previous evidence from human sensory studies has suggested a depressed sense of taste in panelists with obesity. Evidence from animal models also demonstrates a clear deficiency in taste buds occurring with obesity, suggesting that damage to the taste system may result from an obese state. In this review only taste, as opposed to smell, will be examined. Here we seek to bring together evidence from a diverse array of human and animal studies into taste response, dietary intake, and physiology, to better understand changes in taste with obesity, with the goal of understanding whether taste may provide a novel target for intervention in the treatment of obesity.

Ultra-Processed Food Availability and Noncommunicable Diseases: A Systematic Review

Ultra-processed food (UPF) can be harmful to the population's health. To establish associations between UPF and health outcomes, food consumption can be assessed using availability data, such as purchase lists or household budget surveys. The aim of this systematic review was to search studies that related UPF availability with noncommunicable diseases or their risk factors. PRISMA guidelines were used. Searches were performed in PubMed, EBSCO, Scopus and Web of Science in February 2021. The search strategy included terms related to exposure (UPF) and outcomes (noncommunicable diseases and their risk factors). Studies that assessed only food consumption at an individual level and did not present health outcomes were excluded. Two reviewers conducted the selection process, and a third helped when disagreement occurred. The Newcastle-Ottawa Scale was used to assess the studies' quality; 998 records were analyzed. All 11 eligible studies were ecological and assessed overweight and obesity as a health outcome, only one showed no positive association with UPF availability. Two studies included the prevalence of diabetes as an outcome, however no significant association was found with UPF availability. Studies relating UPF availability and health outcomes are focused on overweight and obesity. It is necessary to further explore the relationship between other health outcomes and UPF availability using purchase or sales data.

Meal composition during an ad libitum buffet meal and longitudinal predictions of weight and percent body fat change: The role of hyper-palatable, energy dense, and ultra-processed foods

BACKGROUND

Foods that increase obesity risk are ubiquitous in the US food environment. Such foods may be the target of hedonic eating, which may facilitate weight gain and lead to obesity. The study tested whether meal composition during an ad libitum buffet meal was associated with 1-year weight and percent body fat changes among healthy younger adults without obesity. Hyper-palatable foods (HPF) were the study focus; comparisons were conducted with high energy dense (HED) and ultra-processed foods (UPF).

DESIGN

Younger adults without obesity (N = 82; 43% male; mean age 26.8) completed an ad libitum buffet meal and provided body composition measurements at baseline and 1-year follow up. Multiple regression models tested associations between the proportion of the target food consumed (HPF, HED, or UPF) during the ad libitum meal and 1) weight change and 2) percent body fat change. The proportion of HPF was characterized by HPF group, specifically carbohydrate and sodium (CSOD) foods or fat and sodium (FSOD) foods.

RESULTS

Participants who consumed a greater proportion of CSOD HPF in their ad libitum buffet meals had significantly greater weight change (b = 0.354, p = .003) and percent body fat change (b = 0.247, p = .036) at 1-year follow up. In contrast, no significant associations were found between the proportion of FSOD HPF, HED, or UPF consumed and anthropometric outcomes (p values = .099-.938).

CONCLUSIONS

Eating a greater proportion of hyper-palatable CSOD foods ad libitum appears to be a pattern of hedonic eating, which may increase an individual's risk for weight and body fat gain in early adulthood.

Interventions to change purchasing behaviour in supermarkets: a systematic review and intervention content analysis

This systematic review and intervention content analysis used behavioural science frameworks to characterise content and function of interventions targeting supermarket shoppers' purchasing behaviour, and explore if coherence between content and function was linked to intervention effectiveness. Study eligibility: in-store interventions (physical supermarkets) with control conditions, targeting objectively measured food and/or non-alcoholic drink purchases, published in English (no date restrictions). Eleven electronic databases were searched; reference lists of systematic reviews were hand-searched. Methodological quality was assessed using the GATE checklist. A content analysis was performed to characterise intervention content and function, and theoretical coherence between these, using the Behaviour Change Wheel, Behaviour Change Techniques Taxonomy, and Typology of Interventions in Proximal Physical Micro-Environments (TIPPME). Forty-six articles (49 interventions) met inclusion criteria; 26 articles (32 interventions) were included in the content analysis. Twenty behaviour change techniques (BCTs), and four TIPPME intervention types were identified; three BCTs ('Prompts/cues', 'Material incentive', and 'Material reward') were more common in effective interventions. Nineteen interventions solely employed theoretically appropriate BCTs. Theoretical coherence between BCTs and intervention functions was more common in effective interventions. Effective interventions included price promotions and/or in-store merchandising. Future research should explore the effect of specific BCTs using factorial study designs. PROSPERO Registration: CRD42017071065.

Conceptual Models of Food Choice: Influential Factors Related to Foods, Individual Differences, and Society

Understanding individual food choices is critical for transforming the current food system to ensure healthiness of people and sustainability of the planet. Throughout the years, researchers from different fields have proposed conceptual models addressing factors influencing the food choice, recognized as a key leverage to improve planetary and human health. However, a multidisciplinary approach is needed to better understand how different factors are involved and interact with each other in the decision-making process. The present paper reviews and analyzes existing models, providing an intact point-of-view by integrating key elements into a bigger framework. Key determinants of general food choice are identified and categorized, including food-internal factor (sensory and perceptual features), food-external factors (information, social environment, physical environment), personal-state factors (biological features and physiological needs, psychological components, habits and experiences), cognitive factors (knowledge and skills, attitude, liking and preference, anticipated consequences, and personal identity), as well as sociocultural factors (culture, economic variables, political elements). Moreover, possible directions of influence among the factors towards final food choice were discussed. The need of multidisciplinary impulses across research field with the support of empirical data are crucial for understanding factors influencing food choice as well as for enriching existing conceptual models. The framework proposed here would serve as a roadmap for facilitating communications and collaborations between research fields in a structural and systematic way.

Urbanization and food consumption in India

The shift towards urban living is changing food demand. Past studies on India show significant urban–rural differences in food consumption. However, a scientific understanding of the underlying relationships between urbanization and food consumption is limited. This study provides the first detailed analysis of how urbanization influences both quantity and diversity of food consumption in India by harnessing the strength of multiple datasets, including consumer expenditure surveys, satellite imagery, and census data. Our statistical analysis shows three main findings. First, in contrast to existing studies, we find that much of the variation in food consumption quantity is due to income and not urbanization. After controlling for income and state-level differences, our results show that average consumption is higher in urban than rural areas for fewer than 10% of all commodities. That is, there is nearly no difference in average consumption between urban and rural residents. Second, we find the influence of urbanization as a population share on food consumption diversity to be statistically insignificant (p-value > 0.1). Instead, the results show that infrastructure, market access, percentage working women in urban areas, and norms and institutions have a statistically significant influence. Third, all covariates of food consumption diversity we tested were found to be associated with urbanization. This suggests that urbanization influences on food consumption are both indirect and multidimensional. These results show that increases in the urban population size alone do not explain changes in food consumption in India. If we are to understand how food consumption may change in the future due to urbanization, the study points to the need for a more complex and multidimensional understanding of the urbanization process that goes beyond demographic shifts.

Dietary intake of advanced glycation end products (AGEs) and changes in body weight in European adults

PURPOSE

Advanced glycation end products (AGEs) can be formed in foods by the reaction of reducing sugars with proteins, and have been shown to induce insulin resistance and obesity in experimental studies. We examined the association between dietary AGEs intake and changes in body weight in adults over an average of 5 years of follow-up.

METHODS

A total of 255,170 participants aged 25-70 years were recruited in ten European countries (1992-2000) in the PANACEA study (Physical Activity, Nutrition, Alcohol, Cessation of smoking, Eating out of home in relation to Anthropometry), a sub-cohort of the EPIC (European Prospective Investigation into Cancer and Nutrition). Body weight was measured at recruitment and self-reported between 2 and 11 years later depending on the study center. A reference database for AGEs was used containing UPLC-MS/MS-measured Nε-(carboxymethyl)-lysine (CML), Nε-(1-carboxyethyl)-lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) in 200 common European foods. This reference database was matched to foods and decomposed recipes obtained from country-specific validated dietary questionnaires in EPIC and intake levels of CEL, CML, and MG-H1 were estimated. Associations between dietary AGEs intake and body weight change were estimated separately for each of the three AGEs using multilevel mixed linear regression models with center as random effect and dietary AGEs intake and relevant confounders as fixed effects.

RESULTS

A one-SD increment in CEL intake was associated with 0.111 kg (95% CI 0.087-0.135) additional weight gain over 5 years. The corresponding additional weight gain for CML and MG-H1 was 0.065 kg (0.041-0.089) and 0.034 kg (0.012, 0.057), respectively. The top six food groups contributing to AGEs intake, with varying proportions across the AGEs, were cereals/cereal products, meat/processed meat, cakes/biscuits, dairy, sugar and confectionary, and fish/shellfish.

CONCLUSION

In this study of European adults, higher intakes of AGEs were associated with marginally greater weight gain over an average of 5 years of follow-up.

The Influence of Taste Liking on the Consumption of Nutrient Rich and Nutrient Poor Foods

Repeated consumption of high-energy nutrient poor foods can lead to undesirable health outcomes such as obesity. Taste plays an important role in food choice, and a better understanding of the links between the taste of foods, individual taste preferences, food choices, and intakes will aid in our understanding of why some people might select and consume unhealthy foods. The present review focuses on three main questions: (1) do nutrient poor and nutrient rich foods significantly differ in taste profile? (2) are humans predisposed toward developing a liking or preference for certain taste profiles? (3) how are individual variations in liking of the basic taste qualities related to long term food intake and adverse health outcomes such as obesity? Results indicated that nutrient poor foods were likely to be sweet, salty and fatty mouthfeel, while the taste profiles of nutrient rich foods were diverse. Although humans are born with a universal liking for sweet and aversion for bitter taste, large individual differences exist in liking of all the basic taste qualities. These individual differences partly explain differences in short term intakes of foods varying in taste profiles. However they fail to sufficiently explain long term food choices and negative health outcomes such as obesity. Future studies should focus on how the full sensory profile of food which includes taste, smell and texture interacts with individual characteristics (e.g., taste or health motivations, taste preferences) to affect consumption of nutrient rich and nutrient poor foods.

New Insights into Adipokines as Potential Biomarkers for Type-2 Diabetes Mellitus

A large number of studies have been focused on investigating serum biomarkers associated with risk or diagnosis of type-2 diabetes mellitus. In the last decade, promising studies have shown that circulating levels of adipokines could be used as a relevant biomarker for diabetes mellitus progression as well as therapeutic future targets. Here, we discuss the possible use of recently described adipokines, including apelin, omentin-1, resistin, FGF-21, neuregulin-4 and visfatin, as early biomarkers for diabetes. In addition, we also include recent findings of other well known adipokines such as leptin and adiponectin. In conclusion, further studies are needed to clarify the pathophysiological significance and clinical value of these biological factors as potential biomarkers in type-2 diabetes and related dysfunctions.

Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study

OBJECTIVE

This study aimed to describe the consumption of ultra-processed foods in Australia and its association with the intake of nutrients linked to non-communicable diseases (NCDs).

DESIGN

Cross-sectional study.

SETTING

National Nutrition and Physical Activity Survey (2011-2012).

PARTICIPANTS

12,153 participants aged 2+ years.

MAIN OUTCOME MEASURES

Average dietary content of nutrients linked to NCDs and the prevalence of intake outside levels recommended for the prevention of NCDs.

DATA ANALYSIS

Food items were classified according to the NOVA system, a classification based on the nature, extent and purpose of industrial food processing. The contribution of each NOVA food group and their subgroups to total energy intake was calculated. Mean nutrient content of ultra-processed food and non-ultra-processed food fractions of the diet were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of nutrients linked to NCDs as well as in the prevalence of intakes outside levels recommended for the prevention of NCDs were examined.

RESULTS

Ultra-processed foods had the highest dietary contribution (42.0% of energy intake), followed by unprocessed or minimally processed foods (35.4%), processed foods (15.8%) and processed culinary ingredients (6.8%). A positive and statistically significant linear trend was found between quintiles of ultra-processed food consumption and intake levels of free sugars (standardised β 0.43, p<0.001); total (β 0.08, p<0.001), saturated (β 0.18, p<0.001) and trans fats (β 0.10, p<0.001); sodium (β 0.21, p<0.001) and diet energy density (β 0.41, p<0.001), while an inverse relationship was observed for dietary fibre (β -0.21, p<0.001) and potassium (β -0.27, p<0.001). The prevalence of non-recommended intake levels of all studied nutrients increased linearly across quintiles of ultra-processed food intake, notably from 22% to 82% for free sugars, from 6% to 11% for trans fat and from 2% to 25% for dietary energy density, from the lowest to the highest ultra-processed food quintile.

CONCLUSION

The high energy contribution of ultra-processed foods impacted negatively on the intake of non-ultra-processed foods and on all nutrients linked to NCDs in Australia. Decreasing the dietary share of ultra-processed foods would substantially improve the diet quality in the country and help the population achieve recommendations on critical nutrients linked to NCDs.

Hostage to fortune: an empirical study of the tobacco industry's business strategies since the advent of e-cigarettes

The tobacco market has been transformed by the arrival of e-cigarettes and array of alternative nicotine delivery systems (ANDS). Public health has struggled to cope with these changes and clear divisions are apparent, but less is known about the tobacco industry (TI) response. This first empirical study to examine TI and independent ANDS companies' business strategies fills this gap. Primary data were collected through 28 elite interviews with senior/influential TI and independent stakeholders, triangulated with a documentary analysis of company reports, investor analyses, market research, and consultation responses (1022 documents). A deliberately emic analysis shows that tobacco multinationals were initially disconcerted by ANDS, but logic provided by the fiduciary imperative is enabling them to turn a potential threat into profitable opportunities. Interviewees argue market changes played to their strengths: customer links, expertise in nicotine, and enormous financial resources. This enabled portfolio diversification in which combustible and ANDS coexist; providing potential to develop robust scientific and regulatory positions and hope of retrieving corporate reputations. The principal threat for major tobacco players comes from the independent sector, which is prepared and able to satisfy bespoke consumer needs. Multinationals by contrast need to turn ANDS into a genuinely mass-market product appealing to its global customers. They are making progress. Given the continued buoyancy of the combustibles market, they have extensive resources to continue their efforts. Disruptive innovations are not unique to tobacco control. Equivalent technological solutions - with concomitant business opportunities - are emerging in obesity and alcohol fields with implications for public health.

Supermarket retailers' perspectives on healthy food retail strategies: in-depth interviews

BACKGROUND

Excess calorie consumption and poor diet are major contributors to the obesity epidemic. Food retailers, in particular at supermarkets, are key shapers of the food environment which influences consumers' diets. This study seeks to understand the decision-making processes of supermarket retailers-including motivators for and barriers to promoting more healthy products-and to catalogue elements of the complex relationships between customers, suppliers, and, supermarket retailers.

METHODS

We recruited 20 supermarket retailers from a convenience sample of full service supermarkets and national supermarket chain headquarters serving low- and high-income consumers in urban and non-urban areas of New York. Individuals responsible for making in-store decisions about retail practices engaged in online surveys and semi-structured interviews. We employed thematic analysis to analyze the transcripts.

RESULTS

Supermarket retailers, mostly representing independent stores, perceived customer demand and suppliers' product availability and deals as key factors influencing their in-store practices around product selection, placement, pricing, and promotion. Unexpectedly, retailers expressed a high level of autonomy when making decisions about food retail strategies. Overall, retailers described a willingness to engage in healthy food retail and a desire for greater support from healthy food retail initiatives.

CONCLUSIONS

Understanding retailers' in-store decision making will allow development of targeted healthy food retail policy approaches and interventions, and provide important insights into how to improve the food environment.

Prevalence, temporal trend and associated factors with excess body weight in mothers of children under five years

ABSTRACT Objective This study aims to evaluate the prevalence, temporal trends and associated factors with excess weight in mothers of children under five years of age. Methods This is a time-series study using data from two household surveys conducted in 2005 and 2015. A total of 1,436 mothers were evaluated in 2005, and 690 were evaluated in 2015. The dependent variables were excess body weight (Body Mass Index [BMI] ≥25.0kg/m2), high percentage of Body Fat (%BF ≥33%) and abdominal obesity (waist circumference >80cm). The independent variables were the socioeconomic and demographic factors. The changes that occurred between the two surveys were expressed in percentages, and the measure of association was the Prevalence Ratio, calculated by Poisson regression, in both the crude and multivariate analyses. Results There were increases of 33.2%, 59.2% and 31.0%, respectively, for the prevalence of excess weight (PR=1.33, 95% Confidence Interval [CI]:1.21-1.46), abdominal obesity (PR=1.59, 95% CI:1.43-1.77) and high %BF (PR=1.31, 95% CI:1.07-1.60). The factors independently associated with excess weight and abdominal obesity were the highest age group (>30 years), menarche ≤12 years and higher parity (>2 children). The same was observed for high %BF, except for the loss of significance in the adjusted analysis for the variable menarche ≤12 years. Conclusion The prevalence of high body adiposity is a problem of relevant importance in the studied population and has presented an upward trend in the last 10 years. Women over 30 years and with more than two children should be given priority in prevention and control.

Fruit vinegars attenuate cardiac injury via anti-inflammatory and anti-adiposity actions in high-fat diet-induced obese rats

CONTEXT

Fruit vinegars (FVs) are used in Mediterranean folk medicine for their hypolipidemic and weight-reducing properties.

OBJECTIVE

To investigate the preventive effects of three types of FV, commonly available in Algeria, namely prickly pear [Opuntia ficus-indica (L.) Mill (Cectaceae)], pomegranate [Punica granatum L. (Punicaceae)], and apple [Malus domestica Borkh. (Rosaceae)], against obesity-induced cardiomyopathy and its underlying mechanisms.

MATERIALS AND METHODS

Seventy-two male Wistar rats were equally divided into 12 groups. The first group served as normal control (distilled water, 7 mL/kg bw), and the remaining groups were respectively treated with distilled water (7 mL/kg bw), acetic acid (0.5% w/v, 7 mL/kg bw) and vinegars of pomegranate, apple or prickly pear (at doses of 3.5, 7 and 14 mL/kg bw, acetic acid content as mentioned above) along with a high-fat diet (HFD). The effects of the oral administration of FV for 18 weeks on the body and visceral adipose tissue (VAT) weights, plasma inflammatory and cardiac enzymes biomarkers, and in heart tissue were evaluated.

RESULTS

Vinegars treatments significantly (p < .05) attenuated the HFD-induced increase in bw (0.2-0.5-fold) and VAT mass (0.7-1.8-fold), as well as increase in plasma levels of CRP (0.1-0.3-fold), fibrinogen (0.2-0.3-fold), leptin (1.7-3.7-fold), TNF-α (0.1-0.6-fold), AST (0.9-1.4-fold), CK-MB (0.3-1.4-fold) and LDH (2.7-6.7-fold). Moreover, vinegar treatments preserved myocardial architecture and attenuated cardiac fibrosis.

DISCUSSION AND CONCLUSION

These findings suggest that pomegranate, apple and prickly pear vinegars may prevent HFD-induced obesity and obesity-related cardiac complications, and that this prevention may result from the potent anti-inflammatory and anti-adiposity properties of these vinegars.

Impact of supplementation with a food-derived microbial community on obesity-associated inflammation and gut microbiota composition

Background

Obesity is a complex pathology associated with dysbiosis, metabolic alterations, and low-grade chronic inflammation promoted by immune cells, infiltrating and populating the adipose tissue. Probiotic supplementation was suggested to be capable of counteracting obesity-associated immune and microbial alterations, based on its proven immunomodulatory activity and positive effect on gut microbial balance. Traditional fermented foods represent a natural source of live microbes, including environmental strains with probiotic features, which could transiently colonise the gut. The aim of our work was to evaluate the impact of supplementation with a complex foodborne bacterial consortium on obesity-associated inflammation and gut microbiota composition in a mouse model.

Methods

C57BL/6J mice fed a 45% high fat diet (HFD) for 90 days were supplemented with a mixture of foodborne lactic acid bacteria derived from the traditional fermented dairy product “Mozzarella di Bufala Campana” (MBC) or with the commercial probiotic GG strain of Lactobacillus rhamnosus (LGG). Inflammation was assessed in epididymal white adipose tissue (WAT) following HFD. Faecal microbiota composition was studied by next-generation sequencing.

Results

Significant reduction of epididymal WAT weight was observed in MBC-treated, as compared to LGG and control, animals. Serum metabolic profiling showed correspondingly reduced levels of triglycerides and higher levels of HDL cholesterol, as well as a trend toward reduction of LDL-cholesterol levels. Analysis of the principal leucocyte subpopulations in epididymal WAT revealed increased regulatory T cells and CD4⁺ cells in MBC microbiota-supplemented mice, as well as decreased macrophage and CD8⁺ cell numbers, suggesting anti-inflammatory effects. These results were associated with lower levels of pro-inflammatory cytokines and chemokines in WAT explants. Faecal bacterial profiling demonstrated increased Firmicutes/Bacteroidetes ratio in all mice groups following HFD.

Conclusions

Taken together, these results indicate a protective effect of MBC microbiota supplementation toward HFD-induced fat accumulation and triglyceride and cholesterol levels, as well as inflammation, suggesting a stronger effect of a mixed microbial consortium vs single-strain probiotic supplementation. The immunomodulatory activity exerted by the MBC microbiota could be due to synergistic interactions within the microbial consortium, highlighting the important role of dietary microbes with yet uncharacterised probiotic effect.

Electronic supplementary material

The online version of this article (10.1186/s12263-017-0583-1) contains supplementary material, which is available to authorized users.

Brain substrates of unhealthy versus healthy food choices: influence of homeostatic status and body mass index

BACKGROUND/OBJECTIVES

Unhealthy dietary choices are a major contributor to harmful weight gain and obesity. This study interrogated the brain substrates of unhealthy versus healthy food choices in vivo, and evaluated the influence of hunger state and body mass index (BMI) on brain activation and connectivity.

SUBJECTS/METHODS

Thirty adults (BMI: 18-38 kg m^-2) performed a food-choice task involving preference-based selection between beverage pairs consisting of high-calorie (unhealthy) or low-calorie (healthy) options, concurrent with functional magnetic resonance imaging (fMRI). Selected food stimuli were delivered to participants using an MRI-compatible gustometer. fMRI scans were performed both after 10-h fasting and when sated. Brain activation and hypothalamic functional connectivity were assessed when selecting between unhealthy-healthy beverage pairings, relative to unhealthy-unhealthy and healthy-healthy options. Results were considered significant at cluster-based family-wise error corrected P<0.05.

RESULTS

Selecting between unhealthy and healthy foods elicited significant activation in the hypothalamus, the medial and dorsolateral prefrontal cortices, the anterior insula and the posterior cingulate. Hunger was associated with higher activation within the ventromedial and dorsolateral prefrontal cortices, as well as lower connectivity between the hypothalamus and both the ventromedial prefrontal cortex and dorsal striatum. Critically, people with higher BMI showed lower activation of the hypothalamus-regardless of hunger state-and higher activation of the ventromedial prefrontal cortex when hungry.

CONCLUSIONS

People who are overweight and obese have weaker activation of brain regions involved in energy regulation and greater activation of reward valuation regions while making choices between unhealthy and healthy foods. These results provide evidence for a shift towards hedonic-based, and away from energy-based, food selection in obesity.

Increasing Incidence of Colorectal Cancer in Adolescents and Young Adults Aged 15-39 Years in Western Australia 1982-2007: Examination of Colonoscopy History

Aims

To examine trends in colorectal cancer (CRC) incidence and colonoscopy history in adolescents and young adults (AYAs) aged 15–39 years in Western Australia (WA) from 1982 to 2007.

Design

Descriptive cohort study using population-based linked hospital and cancer registry data.

Method

Five-year age-standardized and age-specific incidence rates of CRC were calculated for all AYAs and by sex. Temporal trends in CRC incidence were investigated using Joinpoint regression analysis. The annual percentage change (APC) in CRC incidence was calculated to identify significant time trends. Colonoscopy history relative to incident CRC diagnosis was examined and age and tumor grade at diagnosis compared for AYAs with and without pre-diagnosis colonoscopy. CRC-related mortality within 5 and 10 years of incident diagnosis were compared for AYAs with and without pre-diagnosis colonoscopy using mortality rate ratios (MRRs) derived from negative binomial regression.

Results

Age-standardized CRC incidence among AYAs significantly increased in WA between 1982 and 2007, APC = 3.0 (95% CI 0.7–5.5). Pre-diagnosis colonoscopy was uncommon among AYAs (6.0%, 33/483) and 71% of AYAs were diagnosed after index (first ever) colonoscopy. AYAs with pre-diagnosis colonoscopy were older at CRC diagnosis (mean 36.7 ± 0.7 years) compared to those with no prior colonoscopy (32.6 ± 0.2 years), p < 0.001. At CRC diagnosis, a significantly greater proportion of AYAs with pre-diagnosis colonoscopy had well-differentiated tumors (21.2%) compared to those without (5.6%), p = 0.001. CRC-related mortality was significantly lower for AYAs with pre-diagnosis colonoscopy compared to those without, for both 5-year [MRR = 0.44 (95% CI 0.27–0.75), p = 0.045] and 10-year morality [MRR = 0.43 (95% CI 0.24–0.83), p = 0.043].

Conclusion

CRC incidence among AYAs in WA has significantly increased over the 25-year study period. Pre-diagnosis colonoscopy is associated with lower tumor grade at CRC diagnosis as well as significant reduction in both 5- and 10-year CRC-related mortality rates. These findings warrant further research into the balance in benefits and harms of targeted screening for AYA at highest risk.

Restaurant-based intervention to facilitate healthy eating choices and the identification of allergenic foods at a family-oriented resort and a campground

BACKGROUND

Restaurant-based interventions can be an enjoyable way to encourage healthier eating choices by all members of a family. Thus, the principal aims of this study were a) to promote healthy diets by increasing healthy food offerings and b) to increase the number of foods offered specifically as gluten-free and lactose-free and to inform patrons by including nutritional and allergen information that complies with Regulation 1169/2011 regarding the food served in restaurants, takeaways and snack bars.

METHODS

A restaurant-based intervention was implemented at 16 food establishments at 2 resorts (the Cambrils Park Resort and Camping Sangulí, Spain, from 2014 to 2015) based on the following 4 components: 1) providing nutritional and allergen analyses of the offered dishes, 2) increasing the number of healthy food choices, 3) identifying menu items associated with allergies and intolerance, and 4) training staff on healthy eating and allergens. Customer satisfaction regarding food aspects was assessed using surveys (10-point scale).

RESULTS

Both resorts significantly increased their offerings of healthy dishes (28.6% to 44.7%; P = 0.003) and desserts with fruit (20% to 51.3%; P = 0.013), thus obtaining the Spanish Government's Mediterranean Diet certification. Additionally, both resorts obtained Catalan Celiac Association certification. Moreover, both resorts significantly increased their percentages of gluten-free dishes (2.1% to 50.5%; P < 0.001) and lactose-free dishes (5.5% to 37.5%; P < 0.001) after the intervention. Customer satisfaction increased (mean ± standard deviation) from 6.9 ± 1.6 to 8.5 ± 1.5 (P < 0.001).

CONCLUSION

This restaurant-based intervention expanded the number of healthy and allergen-free foods offered in a family-oriented holiday resort environment to encourage healthy food choices, resulting in increased customer satisfaction.

Development and Validation of a Brief Instrument to Measure Knowledge About the Energy Content of Meals

OBJECTIVE

To develop and validate a brief scale to assess knowledge about the energy content of meals for adults in Switzerland.

METHODS

Based on a random sample, the scale was developed using a Rasch model approach. To assess validity and reliability, the model was replicated and scores were compared with another nutrition knowledge measure and with dietitian trainees' scores. A test-retest was performed.

RESULTS

Survey studies included 477, 505, and 136 participants from the general population and 59 dietician trainees. The Rasch scale consisted of 11 multiple-choice items ranging from easy to difficult and correlated with general nutrition knowledge (r = .47; P < .001; r² = .22). Dietitian trainees achieved higher scores (P < .001; d = 2.17) than did people from the general population; test-retest reliability results were r = .73, P < .001, and r² = .53.

CONCLUSIONS AND IMPLICATIONS

Results showed that the scale is efficient, valid, and reliable for use in the general population in Switzerland.

Does the incorporation of portion-control strategies in a behavioral program improve weight loss in a 1-year randomized controlled trial?

BACKGROUND/OBJECTIVES

Controlling food portion sizes can help reduce energy intake, but the effect of different portion-control methods on weight management is not known. In a 1-year randomized trial, we tested whether the efficacy of a behavioral weight-loss program was improved by incorporating either of the two portion-control strategies instead of standard advice about eating less.

SUBJECTS/METHODS

The Portion-Control Strategies Trial included 186 women with obesity (81%) or overweight (19%). Participants were randomly assigned to one of three equally intensive behavioral programs, consisting of 19 individual sessions over 12 months. The Standard Advice Group was instructed to eat less food while making healthy choices, the Portion Selection Group was instructed to choose portions based on the energy density using tools such as food scales and the Pre-portioned Foods Group was instructed to structure meals around pre-portioned foods such as single-serving main dishes, for which some vouchers were provided. In an intention-to-treat analysis, a mixed-effects model compared weight loss trajectories across 23 measurements; at month 12, weight was measured for 151 participants (81%).

RESULTS

The trajectories showed that the Pre-portioned Foods Group initially lost weight at a greater rate than the other two groups (P=0.021), but subsequently regained weight at a greater rate (P=0.0005). As a result, weight loss did not differ significantly across groups at month 6 (mean±s.e. 5.2±0.4 kg) or month 12 (4.5±0.5 kg). After 1 year, measured weight loss averaged 6% of baseline weight. The frequency of using portion-control strategies initially differed across groups, then declined over time and converged at months 6 and 12.

CONCLUSIONS

Incorporating instruction on portion-control strategies within a 1-year behavioral program did not lead to a greater weight loss than standard advice. Using pre-portioned foods enhanced early weight loss, but this was not sustained over time. Long-term maintenance of behavioral strategies to manage portions remains a challenge.

Dietary Intake at 9 Years and Subsequent Body Mass Index in Adolescent Boys and Girls: A Study of Monozygotic Twin Pairs

There is a lack of evidence pointing to specific dietary elements related to weight gain and obesity prevention in childhood and adulthood. Dietary intake and obesity are both inherited and culturally transmitted, but most prospective studies on the association between diet and weight status do not take genetics into consideration. The objective of this study was to document the association between dietary intake at 9 years and subsequent Body Mass Index (BMI) in adolescent monozygotic boy and girl twin pairs. This research used data from 152 twin pairs. Dietary data were collected from two 24-hour-recall interviews with a parent and the child aged 9 years. Height and weight were obtained when the twins were aged 9, 12, 13, and 14 years. Intrapair variability analysis was performed to identify dietary elements related to BMI changes in subsequent years. BMI-discordant monozygotic twin pairs were also identified to analyze the dietary constituents that may have generated the discordance. After eliminating potential confounding genetic factors, pre-adolescent boys who ate fewer grain products and fruit and consumed more high-fat meat and milk had higher BMIs during adolescence; pre-adolescent girls who consumed more grain products and high-fat meat and milk had higher BMIs during adolescence. Energy intake (EI) at 9 years was not related to BMI in subsequent years. Our study suggests that messages and interventions directed at obesity prevention could take advantage of sex-specific designs and' eventually' genetic information.

Factors associated with parents' attitudes to unhealthy foods and beverages

AIM

Previous research has identified convenience, enjoyment, value for money and perceived goodness as primary dimensions of parents' attitudes to foods and beverages. The aim of the present study was to examine the factors associated with parents' scores on each of these attitudinal dimensions to identify key issues for future interventions designed to improve parents' food provision behaviours and children's diets.

METHODS

A sample of 1302 Australian parents of children aged 8 to 14 years completed an online survey relating to their food-related beliefs. Linear regression analyses were undertaken to examine factors associated with parents' attitudes to soft drinks and energy-dense nutrient-poor foods.

RESULTS

Consistent factors were identified for both energy-dense, nutrient-poor foods and soft drinks, indicating that similar approaches could be adopted in interventions for both product categories. The primary factors were social norms, child pestering, television viewing and exposure to food advertising.

CONCLUSIONS

Food advertising represents a common link between the primary factors, indicating that it constitutes a critical component of future interventions designed to modify parents' attitudes to unhealthy food products and to reduce the frequency with which these foods are consumed by children.

Anti-obesity effects of artificial planting blueberry (Vaccinium ashei) anthocyanin in high-fat diet-treated mice

This study aimed to evaluate the anti-obesity effects of artificial planting blueberry (Vaccinium ashei) anthocyanin (BA) in high-fat diet-induced obese male C57BL/6 mice. BA at doses of 50, 100, and 200 mg/kg was supplemented in the daily food of obese C57BL/6 mice during an 8-week experiment. Our findings indicate that consumption of BA at high doses reduced body weight by 19.4%, whereas both low and middle doses did not affect the body weight. Furthermore, BA supplementation at high dose could effectively decrease serum glucose, attenuate epididymal adipocytes, improve lipid profiles, and significantly down-regulate expression levels of TNFα, IL-6 PPARγ, and FAS genes. Therefour, BA might alter bodyweight by suppressing fatty acid synthesis and alleviating inflammation.

Odd versus even: a scientific study of the 'rules' of plating

We report on the results of a series of large-scale computer-based preference tests (conducted at The Science Museum in London and online) that evaluated the widely-held belief that food should be plated in odd rather than even numbers of elements in order to maximize the visual appeal of a dish. Participants were presented with pairs of plates of food showing odd versus even number of seared scallops (3 vs. 4; 1-6 in Experiment 7), arranged in a line, as a polygon or randomly, on either a round or square white plate. No consistent evidence for a preference for odd or even numbers of food items was found, thus questioning the oft-made assertion that odd number of items on a plate looks better than an even number. The implications of these results are discussed.