The obesity crisis: don't blame it on the pyramid

Perspective: Food-Based Dietary Guidelines in Europe-Scientific Concepts, Current Status, and Perspectives

Food-based dietary guidelines (FBDGs) are important tools for nutrition policies and public health. FBDGs provide guidelines on healthy food consumption and are based on scientific evidence. In the past, disease prevention and nutrient recommendations dominated the process of establishing FBDGs. However, scientific advances and social developments such as changing lifestyles, interest in personalized health, and concerns about sustainability require a reorientation of the creation of FBDGs to include a wider range of aspects of dietary behavior. The present review evaluates current European FBDGs with regard to the concepts and aspects used in their derivation, and summarizes the major aspects currently discussed to be considered in future establishment or updates of FBDGs. We identified English information on official European FBDGs through an Internet search (FAO, PubMed, Google) and analyzed the aspects used for their derivation. Furthermore, we searched literature databases (PubMed, Google Scholar) for conceptional considerations dealing with FBDGs. A total of 34 out of 53 European countries were identified as having official FBDGs, and for 15 of these, documents with information on the scientific basis could be identified and described. Subsequently, aspects underlying the derivation of current FBDGs and aspects considered in the literature as important for future FBDGs were discussed. Eight aspects were identified: diet-health relations, nutrient supply, energy supply, dietary habits, sustainability, food-borne contaminants, target group segmentation, and individualization. The first 4 have already been widely applied in existing FBDGs; the others have almost never been taken into account. It remains a future challenge to (re)conceptionalize the development of FBDGs, to operationalize the aspects to be incorporated in their derivation, and to convert concepts into systematic approaches. The current review may assist national expert groups and clarifies the options for future development of local FBDGs.

Communicating science-based recommendations with memorable and actionable guidelines

For many domains of basic and applied science, a key set of scientific facts is well established and there is a need for public action in light of those facts. However, individual citizens do not consistently follow science-based recommendations, even when they accept the veracity of the advice. To address this challenge, science communicators need to develop a guideline that individuals can commit to memory easily and act on straightforwardly at moments of decision. We draw on research from psychology to discuss several characteristics that will enhance a guideline's memorability and actionability and illustrate using a case study from the US Department of Agriculture's communications based on nutrition science. We conclude by discussing the importance of careful research to test whether any given guideline is memorable and actionable by the intended target audience.

Let’s talk about health: shoppers’ discourse regarding health while food shopping

Objective

The present study aimed to examine the role of health in consumers’ food purchasing decisions through investigating the nature of people’s discourse regarding health while conducting their food shopping.

Design

The study employed the think-aloud technique as part of an accompanied shop. All mentions of health and terms relating to health were identified from the data set. Inductive thematic analysis was conducted to examine how health was talked about in relation to people’s food choice decisions.

Setting

Supermarkets in Dublin, Republic of Ireland and Belfast, Northern Ireland.

Subjects

Participants (n50) were aged over 18 years and represented the main household shopper.

Results

Responsibility for others and the perceived need to illicit strict control to avoid ‘unhealthy’ food selections played a dominant role in how health was talked about during the accompanied shop. Consequently healthy shopping was viewed as difficult and effort was required to make the healthy choice, with shoppers relating to product-based inferences to support their decisions.

Conclusions

This qualitative exploration has provided evidence of a number of factors influencing the consideration of health during consumers’ food shopping. These results highlight opportunities for stakeholders such as public health bodies and the food industry to explore further ways to help enable consumers make healthy food choices.

Initial development and testing of a questionnaire of parental self-efficacy for enacting healthy lifestyles in their children

PURPOSE

The purpose of this study was to develop and test a questionnaire to assess parental self-efficacy for enacting healthy diet and physical activity behaviors in their 6- to 11-year-old children.

DESIGN AND METHODS

A 35-item questionnaire was developed and tested with 146 U.S. parents.

RESULTS

Participant responses resulted in a 34-item questionnaire with two subscales (dietary behaviors and physical activity behaviors), which were valid and reliable in the study sample.

PRACTICE IMPLICATIONS

This new measure will serve as a tool for the assessment of parental self-efficacy for enacting healthy lifestyles in their children 6-11 years old.

Monitoring my multiple sclerosis: a patient-administered health-assessment scale

Optimal health of people with multiple sclerosis (MS) can be promoted by patients' sharing of health information gained through periodic self-monitoring with their health-care providers. The purpose of this study was to develop a valid and reliable self-administered scale to obtain information about MS patients' health status and the impact of the disease on their daily lives. We named this scale "Monitoring My Multiple Sclerosis" (MMMS). A cross-sectional survey was conducted of 171 MS patients who completed the MMMS and Patient-Determined Disease Steps (PDDS) scales and provided information on their MS disease classification and demographic characteristics. Data analysis included several parametric procedures. Factor analysis of the 26-item MMMS resulted in four factors with satisfactory α reliability coefficients for the total scale (0.90) and factored subscales: Physical (0.85), Relationships (0.80), Energy (0.70), and Cognitive/Mental (0.67). Analysis of variance demonstrated that the total scale and the Physical subscale, but not the Relationships subscale, showed significantly worse functioning for patients with either moderate or severe disability as measured by the PDDS than for patients with mild disability (P < .001). The Cognitive/Mental subscale showed significantly worse functioning for patients with moderate disability than for patients with mild disability (P < .05). However, the Energy subscale showed significantly worse functioning among moderately disabled patients than among severely disabled patients (P < .01). Independent t tests demonstrated that patients classified as having secondary progressive multiple sclerosis had significantly worse scores on the total MMMS (P < .05) and the Physical subscale (P < .001) than those classified as having relapsing-remitting multiple sclerosis. The MMMS demonstrated satisfactory reliability and validity and is recommended for use by MS patients and their health-care providers as a mechanism to promote the sharing of health information, to the benefit of both patients and providers.

[Vegetarian nutrition: Preventive potential and possible risks. Part 1: Plant foods]

Today vegetarian nutrition is more accepted and widespread in Europe than in former years. For a long time scientific research on vegetarian diets has focused mostly on malnutrition, whereas nowadays research centers increasingly on the preventive potential of plant-based diets. We followed a nutritive and a metabolic-epidemiological approach to obtain dietary recommendations. A MEDLINE research was performed for all plant food groups relevant for a vegetarian diet (key words: all relevant food groups, "vegetarian diet", "chronic disease", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis"). All relevant food groups were characterized regarding their nutrient content and rated with respect to the available metabolic-epidemiological evidence. Based on the evidence criteria of the WHO/FAO, cancer risk reduction by a high intake of vegetables and fruits is assessed as probable or possible, while a lowered risk of cardiovascular disease is convincing and a lowered risk of osteoporosis is probable. The evidence of a risk reducing effect of whole grain relating to colorectal cancer is assessed as possible, whereas it is probable relating to cardiovascular disease and diabetes mellitus type 2. There is an insufficient risk-reducing effect of legumes like soja relating to epithelial tumours and cardiovascular disease. The evidence of a risk-reducing effect of nuts to cardiovascular disease is assessed as probable, and in relation to cholelithiasis and diabetes mellitus type 2 as possible and insufficient, respectively. In conclusion, high consumption of fruits, vegetables, whole grains and nuts can lower the risk for several chronic diseases.

Developing the consumer interface for the MyPyramid Food Guidance System

OBJECTIVE

To assess consumer response to potential graphics, slogans, and messages for the consumer interface of the MyPyramid Food Guidance System.

DESIGN

Qualitative research conducted in two phases, composed of focus groups and Web-TV testing.

SETTING

Professional market research facilities in Baltimore, MD, and Chicago, IL, and Web-TV.

PARTICIPANTS

Phase 1,77 adults in 10 groups; Phase 2,407 adults via Web-TV.

PHENOMENON OF INTEREST

Consumer response to potential graphic images, slogans, and messages for the Food Guidance System.

ANALYSIS

A content analysis was used to summarize comments from focus groups and Web-TV tests into meaningful themes. Frequencies were calculated for responses.

RESULTS

Respondents preferred the familiarity of the pyramid shape and found graphics and slogans that were personal, active, and positive to be appealing.

CONCLUSIONS AND IMPLICATIONS

The consumer interface for the MyPyramid Food Guidance System was shaped by consumer feedback that identified appealing and useful elements and avoided elements that were potentially confusing or less meaningful. Consumers preferred images and messages that were perceived as new, personal, and active, but they desired some continuity with the original Pyramid shape.

Consumer research for development of educational messages for the MyPyramid Food Guidance System

OBJECTIVE

To assess consumer understanding and use of messages from the original Food Guide Pyramid and potential concepts for a revised Food Guidance System.

DESIGN

Focus groups conducted in two phases, in 2002 and 2004.

SETTING

Market research facilities in Baltimore, Chicago, and Houston.

PARTICIPANTS

Phase I, 178 participants in 18 groups: 6 of general adult consumers, 4 of adults over 60 years of age, 4 of food stamp recipients, and 4 of overweight adults. Phase II, 75 participants in 8 groups: 4 of younger adults and 4 of older adults.

PHENOMENON OF INTEREST

Understanding and use of original Pyramid symbol and messages and potential concepts for a revised food guidance system.

ANALYSIS

Focus group sessions were audiotaped and transcribed. Content analysis summarized comments into meaningful themes.

RESULTS

Key concepts of the original Pyramid were widely understood, but specific knowledge was limited and misunderstandings common, especially related to servings and food group placement. Detailed information about whole grains, types of fats, vegetable subgroups, and physical activity was lacking.

CONCLUSIONS AND IMPLICATIONS

While consumers are aware of general concepts about healthy eating, they lack specific knowledge to help them implement recommendations. Educators can help by providing consumers with concrete examples and specific information.

Dietary quality predicts adult weight gain: findings from the Framingham Offspring Study

OBJECTIVE

We tested the hypothesis that dietary quality, measured by adherence to the Dietary Guidelines, was related to weight change in adults.

RESEARCH METHODS AND PROCEDURES

Dietary intake was assessed among 2245 adult men and women (average age, 49 to 56 years) in the Framingham Offspring cohort. Three-day dietary records were collected in 1984 to 1988 and again in 1991 to 1996. Weight change was measured over 8 years after each assessment. A five-point diet quality index (DQI) was computed based on mean nutrient intake levels from each set of diet records. One DQI point was contributed for each of five nutrients if intake met Dietary Guidelines for total and saturated fat, cholesterol, sodium, and carbohydrate. Gender-specific generalized estimating equations pooled data across the two assessments to relate DQI to 8-year weight gain.

RESULTS

Men and women with higher DQI scores gained less weight during follow-up (p < 0.05). Average gain over 8 years was approximately 3 pounds among those with highest scores, compared with 5 to 8 pounds among those with lower scores. Smoking cessation was an important predictor of weight gain, accounting for about a 5- to 9-pound difference in weight gain.

DISCUSSION

A high-quality diet, one that is consistent with the Dietary Guidelines, may help curb rising rates of obesity at the population level. Poor compliance with the Guidelines, rather than the guidelines themselves, is likely responsible for the weight gain observed in the American population. Adoption of an eating pattern consistent with the Dietary Guidelines should facilitate population weight control if sustained long term.

The 2005 USDA Food Guide Pyramid is associated with more adequate nutrient intakes within energy constraints than the 1992 Pyramid

The USDA issued the Food Guide Pyramid (FGP) to help Americans choose healthy diets. We examined whether adherence to the 1992 and 2005 FGP was associated with moderate energy and adequate nutrient intakes. We used data for 2138 men and 2213 women > 18 y old, from the 2001-2002 U.S. National Health and Nutrition Examination Survey (NHANES). Quadratic programming was used to generate diets with minimal departure from intakes reported for the NHANES 2001-02. We examined the effect of the number of servings/d of Food Pyramid groups set at 1992 and at 2005 FGP recommendations for 1600, 2200, and 2800 kcal (1 kcal = 4.184 kJ) levels. We calculated energy and nutrients provided by different FGP dietary patterns. Within current U.S. dietary practices, following the 1992 FGP without sodium restriction may provide 200 more kcal than recommended for each energy level. Although it can meet most of old nutrient recommendations (1989), it fails to meet the latest dietary reference intakes, especially for the 1600 kcal level. The 2005 FGP appears to provide less energy and more adequate nutrient intakes, with the exception of vitamin E and potassium for some groups. However, without discretionary energy restriction, Americans are at risk of having excessive energy intake even if they follow the 2005 FGP food serving recommendations. Our analysis suggests that following the 2005 FGP may be associated with lower energy and optimal nutrient intake. Careful restriction of discretionary calories appears necessary for appropriate energy intakes to be maintained.

Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum

OBJECTIVES

The goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance.

SUBJECTS/SETTING

Participants were 146 triethnic, low-income women who were recruited 0 to 1 days after childbirth and who visited a clinic site at 1 year postpartum.

DESIGN

At 1 year postpartum, multiple psychosocial characteristics were measured, and food choices and nutrient intakes were assessed via a validated food frequency questionnaire. Dietary guidelines index scores and measures of adherence to dietary recommendations were computed.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics, analysis of variance with post-hoc Scheffe tests, chi 2 with follow-up tests of independent proportions, and Pearson correlation coefficients were utilized.

RESULTS

For dietary compliance, 60% had adequate intakes of meat, but less than 30% met recommendations for grains, vegetables, fruits, dairy foods, total fat, and added sugar. Healthful weights (body mass index <25) were observed in 37% of women. Those in the highest tertile of dietary compliance had a more positive body image than those in the lowest tertile, and less neglect of self-care, weight-related distress, stress, depressive symptoms, and perceived barriers to weight loss ( P <.05). Dietary compliance and psychosocial scale scores did not vary by ethnicity.

CONCLUSIONS

Adherence to dietary guidelines was limited in the low-income, postpartum women. Psychosocial variables, such as neglect of self-care, weight-related distress, negative body image, stress, and depressive symptoms were associated with less healthful diets and lifestyle in late postpartum. Programs that target diet-related behavior change in low-income women might be improved by inclusion of psychosocial assessment and counseling components.

Comparative physiology of hypoxic pulmonary hypertension: historical clues from brisket disease

Some of the most valuable contributions to science have come about serendipitously, and, in 1913, when George Glover and Issac Newsom were commissioned by Colorado cattle ranchers to study high mountain disease, there was no way to anticipate the tremendous impact they would have on the study of high-altitude cardiopulmonary physiology. It was through the study of this agricultural malady that the correlation between chronic hypoxia, pulmonary hypertension, medial hypertrophy of the small pulmonary arteries, and right ventricular (RV) hypertrophy was recognized. The amount of vascular smooth muscle comprising the medial layer of pulmonary arteries varies significantly across species and can be used to predict the magnitude of pulmonary hypertension and RV hypertrophy elicited in response to chronic hypoxia. Within species, age and gender both significantly influence the severity of chronic hypoxic pulmonary hypertension and RV hypertrophy. However, despite all that we now know about hypoxic pulmonary hypertension, the specific mechanism(s) that differentiate the hypo- from the hyperresponder have yet to be elucidated. Adventitial fibroblast differentiation, circulating vascular progenitor cells, the presence or absence of specific vascular smooth muscle phenotypes, the upregulation or downregulation of vasoactive mediators, splice variants of oxygen-sensitive transcription factors, upregulation of growth factors, Ca(2+) sensitization, and/or the Rho/Rho-kinases signaling cascade could all potentially play a role in determining the extent of the vascular response to hypoxia within a species. Understanding the mechanisms that determine why some people, as well as some animals, exhibit a marked susceptibility to hypoxia is an important endeavor with far-reaching implications.

Atkins and the new diet revolution: is it really time for regimen change?

Weight loss occurs in the short term, but not enough is known to recommend long term use.