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Gilbert R, Costlow L, Matteson J, Rauschendorfer J, Krivonos E, Block SA, Masters WA. Trade policy reform, retail food prices and access to healthy diets worldwide. WORLD DEVELOPMENT 2024; 177:106535. [PMID: 38693961 PMCID: PMC10958742 DOI: 10.1016/j.worlddev.2024.106535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 05/03/2024]
Abstract
Recent use of least-cost diets as a measure of global food security revealed that over 3 billion people are unable to afford sufficient nutritious food for an active and healthy life, driving demand for policy changes to improve access and affordability. This study quantifies the role of imports in consumer prices, matching retail prices in 144 countries to imports by origin of the item or its main ingredient, resulting in a total of 13,846 pairs of a retail price and its import cost in 2017. We find that 55% of retail items had some active imports supplementing domestic production, and of those around 48% have nonzero tariffs whose average effective rate is around 6.7% of the imported commodity price. Over all countries for which data are available, the share of consumer prices for least-cost healthy diets that is attributable to tariffs and non-tariff measures averages 0.67% and 2.45% globally. The highest restrictions are on nutrient-rich vegetables, fruits and animal-sourced foods. Access to bulk commodities from diverse origins is essential for food and nutrition security, providing a greater diversity of foods and food ingredients at lower and more stable prices than can be grown at any one location. On average over all food products that are imported, 83% of the retail price is domestic value added after arrival. We conclude that food imports are best understood as inputs to the domestic production and distribution of retail items, with consumer prices and growth of the food sector dependent on the cost levels, infrastructure and institutions underlying each product's entire value chain.
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Affiliation(s)
- Rachel Gilbert
- Friedman School of Nutrition Science and Policy, Tufts University, USA
| | - Leah Costlow
- Friedman School of Nutrition Science and Policy, Tufts University, USA
| | - Julia Matteson
- Friedman School of Nutrition Science and Policy, Tufts University, USA
| | | | | | - Steven A. Block
- Fletcher School of Law & Diplomacy, Tufts University, 160 Packard Ave., Medford, MA 02155, USA
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Weil K, Coulibaly I, Fuelbert H, Herrmann A, Millogo RM, Danquah I. Dietary patterns and their socioeconomic factors of adherence among adults in urban Burkina Faso: a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:107. [PMID: 37817202 PMCID: PMC10566033 DOI: 10.1186/s41043-023-00451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/03/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Sub-Saharan African populations undergo a nutrition transition towards diets associated with increased risk for metabolic and cardiovascular diseases. For targeted prevention, we aimed to characterize dietary patterns and determine their sociodemographic factors of adherence. METHODS We recruited 1,018 adults aged > = 25 years from two formal and three informal settlements within the Health and Demographic Surveillance System, Ouagadougou, Burkina Faso, between February and April 2021. In a cross-sectional sample, a culture-specific food-propensity questionnaire with 134 food items and a sociodemographic questionnaire were used to collect the data. Exploratory dietary patterns were derived using principal component analysis, and sociodemographic factors of adherence were calculated using multivariable linear regression models. RESULTS In this study population (median age: 42 years, interquartile range 21 years; male: 35.7%), the diet relied on starchy foods and other plant-based staples with rare consumption of animal-based products. We identified three dietary patterns, explaining 10.2%, 9.8%, and 8.9% of variation in food intake, respectively: a meat and egg-based pattern associated with younger age, male sex, better education, and economic situation; a fish-based pattern prevailed among women, higher educational levels, and better economic situation; and a starchy food-based was associated with younger age and sharing a home with other adults. CONCLUSIONS This study population is at an early stage of the nutrition transition and shows low intakes of health-beneficial food groups. Yet, progress along the nutrition transition varies according to age, educational attainment, and economic status. Particularly, younger and well-off people seem to adhere more strongly to diets high in animal-based products. These findings can inform strategies in public health nutrition for sub-Saharan African populations.
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Affiliation(s)
- Konstantin Weil
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
| | - Issa Coulibaly
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Hannah Fuelbert
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Alina Herrmann
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Roch Modeste Millogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
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Reeve E, Ravuvu A, Johnson E, Nasiga S, Brewer T, Mounsey S, Thow AM. Scaling up food pricing policies in the Pacific: a guide to action. BMJ Glob Health 2023; 8:e012041. [PMID: 37813442 PMCID: PMC10565307 DOI: 10.1136/bmjgh-2023-012041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/21/2023] [Indexed: 10/13/2023] Open
Abstract
There are calls for governments around the world to adopt pricing policies, including taxes, subsidies and price controls that ensure all people have access to, and can afford, healthy diets. Despite the strong potential of pricing policies to promote healthy diets and to support a post-COVID-19 recovery, there are gaps in evidence with regard to 'how' to design and apply effective food taxes in practice, and countries report challenges in navigating the different policy options.In this practice piece, we examine the global evidence for food taxes with a view to identifying practical lessons for policy design, adoption and implementation, using the Pacific Islands Region as a case study. We present a systematic resource that draws on locally generated evidence, and a Pacific conceptualisation of healthy diets, to address considerations in setting the tax base, rate and mechanisms, and to ensure tax targets are clearly identifiable within national tax and administrative systems. Health and Finance collaboration at the country level could ensure tax design addresses concerns for the impacts of food taxes on employment, economics and equity, as well as position food taxes as an opportunity to fund revenue shortfalls faced by governments following the COVID-19 pandemic. We demonstrate a need to review other policies for consistency with national health objectives to ensure that countries avoid inadvertently undermining health taxes, for example, by ensuring that foods with known non-communicable disease risk are not being price protected or promoted.
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Affiliation(s)
- Erica Reeve
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Amerita Ravuvu
- Non-Communicable Disease (NCD) Prevention and Control Programme, Public Health Division, Pacific Community, Suva, Fiji
| | - Ellen Johnson
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
| | - Selai Nasiga
- Independent consultant, Commonwealth Secretariat, London, UK
| | - Tom Brewer
- Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sarah Mounsey
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
| | - Anne Marie Thow
- Sydney School of Public Health, The University of Sydney Menzies Centre for Health Policy, Sydney, New South Wales, Australia
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Hawkins B, Barlow P, van Schalkwyk MC, Holden C. Brexit, trade and the governance of non-communicable diseases: a research agenda. Global Health 2023; 19:61. [PMID: 37612704 PMCID: PMC10463402 DOI: 10.1186/s12992-023-00956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The UK's post-Brexit trade strategy has potentially important implications for population health and equity. In particular, it will impact on the structural risk factors for non-communicable diseases (NCDs), including the consumption of health-harming commodities such as tobacco, alcohol and ultra-processed food and beverages. This article catalogues recent developments in UK trade policy. It then presents a narrative review of the existing research literature on trade and health and previous, prospective studies on the health impacts of Brexit. In so doing it identifies key questions and foci for a future research agenda on the implications of UK's emerging trade regime for NCD prevention. MAIN TEXT We identify five key areas for future research. (1) Additional scholarship to document the health effects of key trade agreements negotiated by the UK government; (2) The implications of these agreements for policy-making to address health impacts, including the potential for legal challenges under dispute settlement mechanisms; (3) The strategic objectives being pursued by the UK government and the extent to which they support or undermine public health; (4) The process of trade policy-making, its openness to public health interests and actors and the impact of the political and ideological legacy of Brexit on outcomes; (5) The impact of the UK's post-Brexit trade policy on partner countries and blocs and their cumulative impact on the global trade regime. CONCLUSIONS Further research is urgently need to understand the ways in which the UK's post-Brexit trade strategy will impact on NCDs and policy responses to address these, including the openness of the trade policy architecture to health issues. The outcomes of this process will have wider systemic effects on the global trade regime with implications for health. Researchers must be cognizant of the ideological components of the policy debate which have been absent from previous analysis of Brexit, trade and health.
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Affiliation(s)
- Benjamin Hawkins
- MRC Epidemiology Unity, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Chris Holden
- School for Business and Society, University of York, York, UK
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Henney AE, Gillespie CS, Alam U, Hydes TJ, Cuthbertson DJ. Ultra-Processed Food Intake Is Associated with Non-Alcoholic Fatty Liver Disease in Adults: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15102266. [PMID: 37242149 DOI: 10.3390/nu15102266] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is associated with overweight/obesity, metabolic syndrome and type 2 diabetes (T2D) due to chronic caloric excess and physical inactivity. Previous meta-analyses have confirmed associations between ultra-processed food (UPF) intake and obesity and T2D. We aim to ascertain the contribution of UPF consumption to the risk of developing NAFLD. We performed a systematic review and meta-analysis (PROSPERO (CRD42022368763)). All records registered on Ovid Medline and Web of Science were searched from inception until December 2022. Studies that assessed UPF consumption in adults, determined according to the NOVA food classification system, and that reported NAFLD determined by surrogate (steatosis) scores, imaging or liver biopsy were included. The association between UPF consumption and NAFLD was assessed using random-effects meta-analysis methods. Study quality was assessed, and evidence credibility evaluated, using the Newcastle Ottawa Scale and NutriGrade systems, respectively. A total of 5454 records were screened, and 112 records underwent full text review. From these, 9 studies (3 cross-sectional, 3 case-control and 3 cohort), analysing 60,961 individuals, were included in the current review. Both moderate (vs. low) (pooled relative risk 1.03 (1.00-1.07) (p = 0.04) (I2 = 0%)) and high (vs. low) (1.42 (1.16-1.75) (<0.01) (I2 = 89%)) intake of UPF significantly increased the risk of NAFLD. Funnel plots demonstrate low risk of publication bias. Consumption of UPF is associated with NAFLD with a dose-response effect. Public health measures to reduce overconsumption of UPF are imperative to reduce the burden of NAFLD, and the related conditions, obesity and T2D.
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Affiliation(s)
- Alex E Henney
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool L3 5TR, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 1TN, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool L3 5TR, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Theresa J Hydes
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool L3 5TR, UK
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool L3 5TR, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
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Gebeltová Z, Hálová P, Malec K, Bartoňová K, Blažek V, Maitah M, Koželský R, Phiri J, Appiah-Kubi SNK, Tomšík K, Severová L, Marušiak J. Geopolitical risks for Egypt wheat supply and trade. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2023.1137526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
IntroductionSince 2005, Russia has established a stable position in Egypt's wheat imports, and after 2016, it became the largest global wheat exporter. The shift in Russian grain production has visibly affected wheat export destinations in favor of developing countries. This paper identifies the main determinants of wheat trade in Egypt concerning the primary risks associated with the war in Ukraine.MethodsThe paper utilizes time series analysis, index analysis, and an econometric model to define the statistical relationship between the quantity of wheat imported into Egypt and population development, wheat price, and wheat production.ResultsDespite increasing wheat production growth rates (1.9% p.a. over 2000–2020) and a growing population (2.01% p.a.), Egypt is unable to reduce its import dependence below 50% of total consumption. Undernourishment in Egypt remains at 5.2%–5.4% of the population. The econometric model shows that variables describing the evolution of production, population, and prices are statistically significant in relation to wheat imports. Egypt's wheat imports continue to increase even with rising prices, which is typical for developing countries. The war in Ukraine and associated commodity price increases have far-reaching implications for Africa's food security and supply systems.DiscussionEgypt's vulnerability to external influences, such as climate change, migration, rising commodity prices, and population growth, exacerbates the situation. Most African countries, including Egypt, struggle with the economic and social impacts of the COVID-19 pandemic. They also face rising food and energy prices, conflicts between the world's largest food producers, and increasing poverty rates. The research findings confirm that Egypt is among the highly vulnerable countries due to the war in Ukraine and the disruption of agricultural supply chains.
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Barlow P, Sanap R, Garde A, Winters LA, Mabhala MA, Thow AM. Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016-20. Lancet Planet Health 2022; 6:e431-e438. [PMID: 35550082 DOI: 10.1016/s2542-5196(22)00047-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Abstract
To ensure a high level of health protection, governments must ensure that health and trade policy objectives are aligned. We conducted a systematic review of the health impacts of trade policies, including trade and investment agreements (TIAs), to provide a timely overview of this field. We systematically reviewed studies evaluating the health impacts of trade policies published between Jan 19, 2016, and July 10, 2020. Included studies were quantitative studies evaluating the impact of TIAs and trade policies on health determinants or outcomes. We evaluated methodological quality and performed a narrative synthesis. 21 of 28 067 articles identified via searches met our criteria. Methodologically strong studies found reduced child mortality, deteriorating worker health, rising supplies of sugar, ultra-processed food, tobacco, and alcohol supplies, and increased drug overdoses following trade reforms, compared with the time periods before trade reform. However, associations varied substantially across contexts and socioeconomic characteristics. Our findings show that trade policies, including TIAs, have diverse effects on health and health determinants. These effects vary substantially across contexts and socioeconomic groups. Governments seeking to adopt healthy trade policies should consider these updated findings to ensure that opportunities for health improvement are leveraged and widely shared, while harms are avoided, especially among vulnerable groups.
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Affiliation(s)
- Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Rujuta Sanap
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Amandine Garde
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - L Alan Winters
- Department of Economics, University of Sussex Business School, Brighton, UK
| | - Mzwandile A Mabhala
- Department of Public Health and Wellbeing, University of Chester, Chester, UK
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
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Chen H, Xu J, Liu J. Export Expansion May Increase Adult Illness and Injury: A Quasi-Natural Experiment on China's Accession to the World Trade Organization. Front Public Health 2022; 10:798686. [PMID: 35450119 PMCID: PMC9016144 DOI: 10.3389/fpubh.2022.798686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Exports can boost the economy, but may also cause harm to health through, for example, increased pollution and working hours. Although academic research extensively covers the impact of trade on health, few studies examine the mechanisms through which export expansion affects adult illness or injury within the past 4 weeks (illness/injury). Method We utilized China's entry into the World Trade Organization (WTO) as a quasi-natural experiment to investigate the relationship between export expansion and adult illness/injury. We explored the possible mechanisms and the heterogeneity of these associations. Our methodology was based on the analysis of China's Health and Nutrition Survey data, Chinese Customs databases, and China's Statistical Yearbook. Results Export expansion, induced by China's accession to the WTO, has a significantly positive effect on adult illness/injury [average effect (AE): 1.83%; 95% CI: 0.38–3.28%]. Our results remain robust following a series of robustness tests. Moreover, the effects of export expansion on adult illness/injury are more pronounced among urban residents (AE: 5.32%; 95% CI: 2.46–8.18%), women (AE: 2.68%; 95% CI: 0.57–4.80%), and higher-income groups (AE: 5.90%; 95% CI: 2.53–9.27%). Conclusions We find a statistically significant and positive effect of export expansion on adult illness/injury.
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Affiliation(s)
- Hongwen Chen
- Department of International Economics and Business, School of Economics, Xiamen University, Xiamen, China
| | - Junbing Xu
- New Huadu Business School, Minjiang University, Fuzhou, China
| | - Jianzheng Liu
- School of Public Affairs, Xiamen University, Xiamen, China
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Delpino FM, Figueiredo LM, Bielemann RM, da Silva BGC, Dos Santos FS, Mintem GC, Flores TR, Arcêncio RA, Nunes BP. Ultra-processed food and risk of type 2 diabetes: a systematic review and meta-analysis of longitudinal studies. Int J Epidemiol 2021; 51:1120-1141. [PMID: 34904160 DOI: 10.1093/ije/dyab247] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/26/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The consumption of some food groups is associated with the risk of diabetes. However, there is no evidence from meta-analysis which evaluates the consumption of ultra-processed products in the risk of diabetes. This study aimed to review the literature assessing longitudinally the association between consumption of ultra-processed food and the risk of type 2 diabetes and to quantify this risk through a meta-analysis. METHODS We conducted a systematic review and meta-analysis with records from PubMed, Latin American and Caribbean Literature in Health Sciences (LILACS), Scielo, Scopus, Embase, and Web of Science. We included longitudinal studies assessing ultra-processed foods and the risk of type 2 diabetes. The review process was conducted independently by two reviewers. The Newcastle Ottawa scale assessed the quality of the studies. A meta-analysis was conducted to assess the effect of moderate and high consumption of ultra-processed food on the risk of diabetes. RESULTS In total 2272 records were screened, of which 18 studies, including almost 1.1 million individuals, were included in this review and 72% showed a positive association between ultra-processed foods and the risk of diabetes. According to the studies included in the meta-analysis, compared with non-consumption, moderate intake of ultra-processed food increased the risk of diabetes by 12% [relative risk (RR): 1.12; 95% confidence interval (CI): 1.06-1.17, I2 = 24%], whereas high intake increased risk by 31% (RR: 1.31; 95% CI: 1.21-1.42, I2 = 60%). CONCLUSIONS The consumption of ultra-processed foods increased the risk for type 2 diabetes as dose-response effect, with moderate to high credibility of evidence.
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Affiliation(s)
- Felipe Mendes Delpino
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.,Postgraduate Program in Public Health Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Renata Moraes Bielemann
- Postgraduate Program in Nutrition and Food, Faculty of Nutrition, Federal University of Pelotas, Pelotas, Brazil
| | | | - Francine Silva Dos Santos
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.,Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Gicele Costa Mintem
- Postgraduate Program in Nutrition and Food, Faculty of Nutrition, Federal University of Pelotas, Pelotas, Brazil
| | - Thaynã Ramos Flores
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Bruno Pereira Nunes
- Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.,Faculty of Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Sarfo J, Pawelzik E, Keding GB. Dietary Patterns as Characterized by Food Processing Levels and Their Association with the Health Outcomes of Rural Women in East Africa. Nutrients 2021; 13:2866. [PMID: 34445024 PMCID: PMC8399242 DOI: 10.3390/nu13082866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 12/18/2022] Open
Abstract
Overweight and obesity are rapidly rising in Sub-Saharan Africa including in rural areas. However, most studies focus on urban centers, and have attributed this epidemic to the consumption of processed foods without their clear characterization. This study investigated food intake patterns defined by food processing levels and their association with overweight/obesity in rural areas. Four 24-h dietary recalls, anthropometric measurements, and socio-demographic characteristics were collected from 1152 women in Kenya, Tanzania, and Uganda. The PCA method was used to extract patterns characterized by food processing levels. The association between patterns and overweight/obesity was ascertained with regression models. The overweight/obesity rate was 47%, 42%, 26%, and 38% in Kenya, Tanzania, Uganda, and East Africa (as pooled data), respectively. Several patterns were identified, yet a "plant-based pattern" largely characterized by unprocessed and minimally processed foods and a "purchase pattern" mainly distinguished by highly processed foods were dominant. The "plant-based pattern" was inversely or not associated with overweight/obesity, while the "purchase pattern" had a positive association or no association. A clear distinction on processed foods as healthy and unhealthy should be made based on their nutrient provision to avoid their mischaracterization as unhealthy. Policies to reverse consumption of unhealthy processed foods while promoting healthy ones should be pursued.
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Affiliation(s)
- Jacob Sarfo
- Division Quality of Plant Products, Department of Crop Sciences, University of Goettingen, 37075 Göttingen, Germany; (E.P.); (G.B.K.)
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Hansen A. Negotiating Unsustainable Food Transformations: Development, Middle Classes and Everyday Food Practices in Vietnam. THE EUROPEAN JOURNAL OF DEVELOPMENT RESEARCH 2021; 34:1441-1459. [PMID: 34248300 PMCID: PMC8261804 DOI: 10.1057/s41287-021-00429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Amidst calls for making food systems more sustainable, new unsustainable food transformations unfold alongside economic development. Explanations for unsustainable food transformations in emerging economies vary greatly, but there is widespread agreement that demand from new middle classes play a crucial role. Yet this demand is to a large extent co-created by systems of provision, and middle-class consumers are constantly navigating food transformations in a search for healthy and safe food. Focusing on Vietnam's dramatic food transformations, and combining attention to the political economy of food with a social practice approach to consumption, the paper zooms in on the how middle-class households in Hanoi negotiate the rapid transformations of food systems and food environments. The paper concludes that new thinking on sustainable food systems is urgently needed and argues that vital insights can be gained by studying food practices and their interaction with everyday geographies of consumption.
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Affiliation(s)
- Arve Hansen
- Centre for Development and the Environment, University of Oslo, Blindern, P.O. Box 1116, 0317 Oslo, Norway
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12
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Webb P, Danaei G, Masters WA, Rosettie KL, Leech AA, Cohen J, Blakstad M, Kranz S, Mozaffarian D. Modelling the potential cost-effectiveness of food-based programs to reduce malnutrition. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2021; 29:100550. [PMID: 34164258 PMCID: PMC8202230 DOI: 10.1016/j.gfs.2021.100550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 01/24/2023]
Abstract
Poor quality diets contribute to malnutrition globally, but evidence is weak on the cost-effectiveness of food-based interventions that shift diets. This study assessed 11 candidate interventions developed through Delphi techniques to improve diets in India, Nigeria, and Ethiopia. A Markov simulation model incorporated time, individual-level, nutrition, and policy parameters to estimate health impacts and cost-effectiveness for reducing stunting, anaemia, diarrhea, and mortality in preschool children. At an assumed 80% coverage, interventions considered would potentially save between 0·16 and 3·20 years of life per child. The average cost-effectiveness ratio ranged from US$9 to US$2000 per life year saved. This approach, linking expert knowledge, known costs, and modelling, offers potential for estimating cost-effective investments for better informed policy choice where empirical evidence is limited. Few studies estimate the potential cost-effectiveness of programs for improving health through diets. Expert knowledge linked to modelling offers a basis for assessing potential alternatives where data are lacking. Our analysis assessed 11 candidate interventions for Ethiopia, India, and Nigeria derived from local expert opinion. Modelling demonstrates these programs' potential health impacts and cost-effectiveness. The modelling of estimated benefits can support best-buy policy and program choices.
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Affiliation(s)
- Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Goodarz Danaei
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Katherine L Rosettie
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Ashley A Leech
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joshua Cohen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mia Blakstad
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Kranz
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Role of Sensory Appeal, Nutritional Quality, Safety, and Health Determinants on Convenience Food Choice in an Academic Environment. Foods 2021; 10:foods10020345. [PMID: 33562836 PMCID: PMC7916031 DOI: 10.3390/foods10020345] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
The present research aims to investigate the extent to which sensory appeal, nutritional quality, safety, and health determinants influence purchase intention, consumption, and satisfaction of consumers towards convenience food. The non-probability purposive sampling approach was adopted for the recruitment of consumers. A pre-tested questionnaire was used to collect data from 501 consumers. Descriptive statistics, confirmatory factor analysis, and structural equation modeling were adopted to analyze the data. Factor loading, Cronbach’s alpha, composite reliability, average variance extracted, and correlations estimate of constructs revealed good internal consistency and reliability of scale items as well as convergent and discriminant validity of the constructs. The path analysis of structural model demonstrated positive relationship between sensory appeal, nutritional quality, safety attributes, healthiness, and purchase intention of convenience food. Further, the path analysis of structural model revealed that purchase intention with consumption as well as consumption with satisfaction were positively associated for convenience food. Sensory appeal was the key determinant influencing purchase intention, consumption, and satisfaction of consumers towards convenience food. The good taste, pleasant appearance, nice smell, and appealing texture within sensory appeal were the most important factors influencing purchase intention, consumption, and satisfaction of consumers towards convenience food. Further, the consumers in emerging economies such as India focus more on sensory appeal in convenience food choice.
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