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Young L, Kidd B, Shen S, Jiang Y, Eyles H, Marshall J, Schultz S, Chan J, Sacks G, Mhurchu CN. Trends in the healthiness and nutrient composition of packaged products sold by major food and beverage companies in New Zealand 2015 to 2019. BMC Med 2024; 22:372. [PMID: 39256836 PMCID: PMC11389062 DOI: 10.1186/s12916-024-03567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 08/19/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Dietary risk factors are the leading cause of death globally and in New Zealand (NZ). Processed packaged foods are prevalent in the food supply and contribute excess amounts of sodium, saturated fat, and sugar in diets. Improving the nutritional quality of these foods has the potential to reduce population chronic disease risk. We aimed to evaluate the healthiness using the Australasian Health Star Rating (HSR, from 0.5 to 5 stars, with 5 being the healthiest) and nutrient composition (sodium, saturated fat, and total sugar) of packaged products manufactured by the largest NZ-based food and beverage companies in NZ 2015-2019. This analysis relates to a larger study evaluating structured engagement with food companies to improve nutrition-related policies and actions. METHODS Data was sourced from Nutritrack, a NZ-branded supermarket-sourced food composition database. The largest NZ-based companies from annual retail sales revenue (n = 35) were identified using 2019 Euromonitor data. All relevant products of the selected companies were extracted for analysis. Products included totalled 17,795 with a yearly range of 3462-3672 products. The primary outcome was a nutrient profile score estimated using HSR. Healthiness was defined as ≥ 3.5 stars. Secondary outcomes were sodium, total sugar, and saturated fat per 100 g/100 mL. All outcomes were assessed overall, by food company, and food category. Change over time was tested using linear mixed models, adjusting for major food categories and cluster effects of food companies controlling for multiple comparisons. Model-adjusted mean differences between years were estimated with 95% confidence intervals. RESULTS There was a small statistically significant increase in mean HSR between 2015 and 2019 (0.08 [0.15,0.01], p = 0.024). Mean total sugar content decreased over the same period (0.78 g/100 g [0.08,1.47], p = 0.020), but there were no significant changes in mean sodium or saturated fat contents. Seven of the 13 categories showed small increases in mean HSR (0.1-0.2). Most categories (9/13) exhibited a reduction in mean total sugar content. CONCLUSIONS Between 2015 and 2019, there were slight improvements in the nutritional quality of selected packaged foods and drinks in NZ. Much more substantive changes are needed to address the health-related burden of unhealthy diets, supported by stronger government action and less reliance on voluntary industry initiatives.
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Affiliation(s)
- Leanne Young
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Bruce Kidd
- National Institute for Health Innovation, School of Population Health, The University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Stephanie Shen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Helen Eyles
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand
- The Centre for Translational Health Research: Informing Policy and Practice, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Josephine Marshall
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Sally Schultz
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Jasmine Chan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Cliona Ni Mhurchu
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand
- The George Institute for Global Health, Sydney, Australia
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Tremblay A, Gagné MP, Pérusse L, Fortier C, Provencher V, Corcuff R, Pomerleau S, Foti N, Drapeau V. Sodium and Human Health: What Can Be Done to Improve Sodium Balance beyond Food Processing? Nutrients 2024; 16:1199. [PMID: 38674889 PMCID: PMC11054196 DOI: 10.3390/nu16081199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Sodium plays a key role in the regulation of water balance and is also important in food formulation due to its contribution to the taste and use in the preservation of many foods. Excessive intake of any essential nutrient is problematic and this seems to be particularly the case for sodium since a high intake makes it the nutrient most strongly associated with mortality. Sodium intake has been the object of recommendations by public health agencies such as the WHO and this has resulted in efforts by the food industry to reduce the sodium content of packaged foods, although there is still room for improvement. The recent literature also emphasizes the need for other strategies, e.g., regulations and education, to promote adequate sodium intake. In the present paper, we also describe the potential benefits of a global healthy lifestyle that considers healthy eating but also physical activity habits that improve body functionality and may help to attenuate the detrimental effects of high sodium intake on body composition and cardiometabolic health. In conclusion, a reduction in sodium intake, an improvement in body functioning, and educational interventions promoting healthy eating behaviours seem to be essential for the optimal regulation of sodium balance.
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Affiliation(s)
- Angelo Tremblay
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada; (L.P.); (C.F.); (V.D.)
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Marie-Pascale Gagné
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
| | - Louis Pérusse
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada; (L.P.); (C.F.); (V.D.)
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Catherine Fortier
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada; (L.P.); (C.F.); (V.D.)
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Université Laval, Québec, QC G1V 0A6, Canada
| | - Véronique Provencher
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada;
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Ronan Corcuff
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
| | - Sonia Pomerleau
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
| | - Nicoletta Foti
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
| | - Vicky Drapeau
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada; (L.P.); (C.F.); (V.D.)
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada;
- Quebec Heart and Lung Institute Research Center, Quebec, QC G1V 4G5, Canada
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Jachimowicz-Rogowska K, Winiarska-Mieczan A. Initiatives to Reduce the Content of Sodium in Food Products and Meals and Improve the Population's Health. Nutrients 2023; 15:nu15102393. [PMID: 37242276 DOI: 10.3390/nu15102393] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Table salt is the main source of sodium (Na) in the human diet. Excessive supply of Na in a diet is strongly linked to many non-communicable human diseases, such as hypertension, obesity and stomach cancer. The World Health Organization recommends that daily intake of salt in adult diets should be kept below 5 g/person/day, which corresponds to 2 g Na/person/day. However, on average, adults consume about 9-10 g/person/day, and children and young people about 7-8 g/person/day. Initiatives to reduce salt intake include modifications of food composition in collaboration with the food industry, education of consumers, salt marking on foodstuff labels and taxation of salt. A need also exists to educate society so that they choose low-sodium products. In view of the food technology and amount of salt intake, the most important and the easiest change to make is to reduce the content of salt in baked goods. This paper analyses the results of surveys regarding strategies to reduce salt content in food products and considers multifaceted initiatives to reduce salt intake as a possible efficient method of improving the population's health status.
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Affiliation(s)
- Karolina Jachimowicz-Rogowska
- Department of Bromatology and Food Physiology, Institute of Animal Nutrition and Bromatology, University of Life Sciences in Lublin, Akademicka 13 St., 20-950 Lublin, Poland
| | - Anna Winiarska-Mieczan
- Department of Bromatology and Food Physiology, Institute of Animal Nutrition and Bromatology, University of Life Sciences in Lublin, Akademicka 13 St., 20-950 Lublin, Poland
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Zhou H, Wang S, Zhao C, He H. Effect of exercise on vascular function in hypertension patients: A meta-analysis of randomized controlled trials. Front Cardiovasc Med 2022; 9:1013490. [PMID: 36620631 PMCID: PMC9812646 DOI: 10.3389/fcvm.2022.1013490] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Objective The purpose of this study was to systematically evaluate the effect of exercise on vascular function in patients with pre- and hypertension. Methods A systematic review of articles retrieved via the PubMed, Embase, EBSCO, and Web of Science databases was conducted. All the randomized controlled trials published between the establishment of the databases and October 2022 were included. Studies that evaluated the effects of exercise intervention on vascular function in patients with pre- and hypertension were selected. Results A total of 717 subjects were included in 12 randomized controlled trials. The meta-analysis showed that in patients with pre- and hypertension, exercise can significantly reduce systolic blood pressure (SBP) (MD = -4.89; 95% CI, -7.05 to -2.73; P < 0.00001) and diastolic blood pressure (DBP) (MD = -3.74; 95% CI, -5.18 to -2.29; P < 0.00001) and can improve endothelium-dependent flow-mediated dilatation (MD = 2.14; 95% CI, 1.71-2.61; P < 0.00001), and exercise did not reduce pulse wave velocity (PWV) (MD = 0.03, 95% CI, -0.45-0.50; P = 0.92). Regression analysis showed that changes in exercise-related vascular function were independent of subject medication status, baseline SBP, age and duration of intervention. Conclusion Aerobic, resistance, and high-intensity intermittent exercise all significantly improved SBP, DBP, and FMD in pre- and hypertensive patients, however, they were not effective in reducing PWV, and this effect was independent of the subject's medication status, baseline SBP, age and duration of intervention. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022302646.
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Affiliation(s)
- Huayi Zhou
- College of Sport and Human Science, Beijing Sport University, Beijing, China
| | - Shengya Wang
- College of Sport and Human Science, Beijing Sport University, Beijing, China
| | - Changtao Zhao
- Department of Physical Health and Arts Education, Ministry of Education, Beijing, China
| | - Hui He
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China,*Correspondence: Hui He,
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Changes in the salt content of packaged foods sold in supermarkets between 2015-2020 in the United Kingdom: A repeated cross-sectional study. PLoS Med 2022; 19:e1004114. [PMID: 36197915 PMCID: PMC9581353 DOI: 10.1371/journal.pmed.1004114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/19/2022] [Accepted: 09/21/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Excess consumption of salt is linked to an increased risk of hypertension and cardiovascular disease. The United Kingdom has had a comprehensive salt reduction programme since 2003, setting a series of progressively lower, product-specific reformulation targets for the food industry, combined with advice to consumers to reduce salt. The aim of this study was to assess the changes in the sales-weighted mean salt content of grocery foods sold through retail between 2015 and 2020 by category and company. METHODS AND FINDINGS Information for products, including salt content (g/100 g), was collected online from retailer websites for 6 consecutive years (2015 to 2020) and was matched with brand-level retail sales data from Euromonitor for 395 brands. The sales-weighted mean salt content and total volume of salt sold were calculated by category and company. The mean salt content of included foods fell by 0.05 g/100 g, from 1.04 g/100 g in 2015 to 0.90 g/100 g in 2020, equivalent to -4.2% (p = 0.13). The categories with the highest salt content in 2020 were savoury snacks (1.6 g/100 g) and cheese (1.6 g/100 g), and the categories that saw the greatest reductions in mean salt content over time were breakfast cereals (-16.0%, p = 0.65); processed beans, potatoes, and vegetables (-10.6%, p = 0.11); and meat, seafood, and alternatives (-9.2%, p = 0.56). The total volume of salt sold fell from 2.41 g per person per day to 2.25 g per person per day, a reduction of 0.16 g or 6.7% (p = 0.54). The majority (63%) of this decrease was attributable to changes in mean salt content, with the remaining 37% accounted for by reductions in sales. Across the top 5 companies in each of 9 categories, the volume of salt sold decreased in 26 and increased in 19 cases. This study is limited by its exclusion of foods purchased out of the home, including at restaurants, cafes, and takeaways. It also does not include salt added at the table, or that naturally occurring in foods, meaning the findings underrepresent the population's total salt intake. The assumption was also made that the products matched with the sales data were entirely representative of the brand, which may not be the case if products are sold exclusively in convenience stores or markets, which are not included in this database. CONCLUSIONS There has been a small decline in the salt content of foods and total volume of salt sold between 2015 and 2020, but observed changes were not statistically significant so could be due to random variations over time. We suggest that mandatory reporting of salt sales by large food companies would increase the transparency of how individual businesses are progressing towards the salt reduction targets.
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Analysis of Sodium Content in 4082 Kinds of Commercial Foods in China. Nutrients 2022; 14:nu14142908. [PMID: 35889865 PMCID: PMC9322708 DOI: 10.3390/nu14142908] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
High-sodium intake is associated with the increased risk of hypertension and cardiovascular disease. Monitoring and analyzing the sodium content in commercial food is instructive for reducing sodium intake in the general population. The sodium content of 4082 commercial foods across 12 food groups and 41 food categories was collected and analyzed, including 4030 pre-packaged foods and 52 artisanal foods. The food group with the highest average sodium content (6888.6 mg/100 g) contained sauces, dressings, springs and dips, followed by bean products (1326.1 mg/100 g) and fish, meat and egg products (1302.1 mg/100 g). The average sodium content of all the collected commercial foods was 1018.6 mg/100 g. Meanwhile, the sodium content of non-alcoholic beverages (49.7 mg/100 g), confectionery (111.8 mg/100 g) and dairy products (164.1 mg/100 g) was much lower than the average sodium content of the 12 food groups. The sodium contents of different food groups and categories were significantly different. The proportion of high-sodium food (600 mg/100 g) was more than one-third of all the products. There are a few products marked with salt reduction on the package. Sixteen salt-reduced products were collected, which belong to the food category of soy sauce and account for 16% of all the soy sauce products. The average sodium content in salt-reduced soy sauce is 2022.8 mg/100 g lower than that of non-salt-reduced soy sauce products. These data provide a primary assessment with sodium content in commercial foods and potential improvements for the food industry to achievement the goal of sodium reduction.
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Matsumoto M, Tajima R, Fujiwara A, Yuan X, Okada E, Takimoto H. Trends in dietary salt sources in Japanese adults: data from the 2007-2019 National Health and Nutrition Survey. Br J Nutr 2022; 129:1-14. [PMID: 35506184 PMCID: PMC9899568 DOI: 10.1017/s0007114522001416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022]
Abstract
Identifying trends in dietary salt sources is essential for effectively reducing salt/Na intake. This study aimed to examine the trends in dietary salt sources among Japanese adults using the 2007-2019 National Health and Nutrition Survey data collected from 95 581 adults aged ≥ 20 years. Dietary intake was estimated using the 1-d household-based dietary record. Foods reported as potential sources of salt intake in Japan and other countries were categorised into twenty-one groups. Salt intake for each food group was adjusted using the density method based on the energy intake. Trends in dietary salt intake based on food sources by sex and age groups (20-39 years, 40-59 years and ≥ 60 years) were analysed using the Joinpoint Regression Program. Salt intake for each age group in both men and women decreased from 2007 (5·3 g/1000 kcal-6·4 g/1000 kcal) to 2019 (4·9 g/1000 kcal-5·6 g/1000 kcal). The major dietary source of salt continued to be seasonings such as soya sauce and soyabean paste (approximately 70 %). Salt intake from seasonings decreased over time in adults aged ≥ 40 years but did not change in those aged 20-39 years. Additionally, a decreasing salt intake from unprocessed fish and shellfish and an increasing salt intake from unprocessed meat were observed across all age categories for both sexes. This study demonstrated that a strategy targeting different age groups may be needed to reduce salt consumption from seasonings among the Japanese population. Further studies on salt content in seasonings and continued monitoring of trends in dietary salt sources are required.
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Affiliation(s)
- Mai Matsumoto
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
| | - Ryoko Tajima
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
| | - Aya Fujiwara
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Xiaoyi Yuan
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Emiko Okada
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
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Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Thies F, Tsabouri S, Vinceti M, Bresson JL, Siani A. Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. EFSA J 2022; 20:e07259. [PMID: 35464873 PMCID: PMC9016720 DOI: 10.2903/j.efsa.2022.7259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta‐analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food‐Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category‐based nutrient profiling models, total fat could replace energy in most food groups owing to its high‐energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.
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Bemfeito CM, Vilas Boas EVDB, de Angelis-Pereira MC, Souza NDO, Carneiro JDDS. Application of the nutrient profile model in the development of food bars with functional potential. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2021; 58:4313-4322. [PMID: 34538914 PMCID: PMC8405748 DOI: 10.1007/s13197-020-04909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 10/08/2020] [Accepted: 11/13/2020] [Indexed: 06/13/2023]
Abstract
In the present study, the nutrient profile model is used to develop functionally potential food bars prepared with pumpkin pulp flour (PuPF) and pequi peel flour (PePF). The control (0% PuPF, 0% PePF), and treatments T1 (0% PuPF, 2.5% PePF), T2 (5% PuPF, 2.5% PePF), T3 (10% PuPF, 2.5% PePF), and T4 (17.5% PuPF, 2.5% PePF) were defined using the nutrient profile model and subsequently evaluated for antioxidant activity, sensory acceptance, and nutrient profile. All treatments were nutritionally balanced but T3 and T4 were the best, containing, respectively, 35.11 and 59.85 μg g-1 of carotenoids, 230.60 and 261.14 mg gallic acid equivalents 100 g-1 of phenolics, and high antioxidant activity, as determined using ABTS (28.60 and 34.86 μM Trolox g-1), FRAP (67.13 and 80.09 μM ferrous sulfate g-1), and β-carotene/linoleic acid system (79.08 and 84.83% protection) methods. The nutrient profile model minimized time and resource expenditures throughout the development process.
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Affiliation(s)
- Carla Martino Bemfeito
- Department of Food Science, Federal University of Lavras, PO Box 3037, Lavras, MG 37200-900 Brazil
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Payne Riches S, Piernas C, Aveyard P, Sheppard JP, Rayner M, Albury C, Jebb SA. A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e26233. [PMID: 34673535 PMCID: PMC8569539 DOI: 10.2196/26233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/11/2021] [Accepted: 05/07/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs. OBJECTIVE The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention's effectiveness. METHODS This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated. RESULTS A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96%), intervention fidelity (25/31, 81%), and app use (27/31, 87%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors. CONCLUSIONS The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962.
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Affiliation(s)
- Sarah Payne Riches
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
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Song Y, Li Y, Guo C, Wang Y, Huang L, Tan M, He FJ, Harris T, MacGregor GA, Ding J, Dong L, Liu Y, Wang H, Zhang P, Ma Y. Cross-sectional comparisons of sodium content in processed meat and fish products among five countries: potential for feasible targets and reformulation. BMJ Open 2021; 11:e046412. [PMID: 34649844 PMCID: PMC8559105 DOI: 10.1136/bmjopen-2020-046412] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Reducing sodium intake has been identified as a highly cost-effective strategy to prevent and control high blood pressure and reduce cardiovascular mortality. This study aims to compare the sodium content in processed meat and fish products among five countries, which will contribute to the evidence-base for feasible strategies of sodium reduction in such products. METHODS Sodium content on product labels of 26 500 prepackaged products, 19 601 meat and 6899 fish, was collected in supermarkets from five countries using the FoodSwitch mobile application from 2012 to 2018. To be specific, it was 1898 products in China, 885 in the UK, 5673 in Australia, 946 in South Africa and 17 098 in the USA. Cross-sectional comparisons of sodium levels and proportions meeting 2017 UK sodium reduction targets were conducted using Kruskal-Wallis H and the χ2 test, respectively across the five countries. RESULTS The results showed that processed meat and fish products combined in China had the highest sodium level (median 1050 mg/100 g, IQR: 774-1473), followed by the USA, South Africa, Australia, with the lowest levels found in UK (432 mg/100 g, IQR: 236-786) (p<0.001). Similar variations, that is, a twofold to threefold difference of sodium content between the highest and the lowest countries were found among processed meat and fish products separately. Large sodium content variations were also found in certain specific food subcategories across the five countries, as well as across different food subcategories within each country. CONCLUSION Processed meat and fish products differ greatly in sodium content across different countries and across different food subcategories. This indicates great potential for food producers to reformulate the products in sodium content, as well as for consumers to select less salted food.
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Affiliation(s)
- Yuzhu Song
- Department of nutrition and food hygiene, Hebei Medical University, Shijiazhuang, China
| | - Yuan Li
- Peking University Health Science Centre, The George Institute for Global Health, Beijing, China
- Faculty of Medicine, University of New South Wales, Australia, Sydney, New South Wales, Australia
| | - Chunlei Guo
- Peking University Health Science Centre, The George Institute for Global Health, Beijing, China
| | | | - Liping Huang
- Food Policy, The George Institute for Global Heath, Sydney, New South Wales, Australia
| | - Monique Tan
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Terry Harris
- Discovery Vitality, Johannesburg, South Africa, South African, South Africa
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jingmin Ding
- Peking University Health Science Centre, The George Institute for Global Health, Beijing, China
| | - Le Dong
- Peking University Health Science Centre, The George Institute for Global Health, Beijing, China
| | - Yu Liu
- School of Computing, Beihang University, Beijing, China
| | - Huijun Wang
- Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Puhong Zhang
- Faculty of Medicine, University of New South Wales, Australia, Sydney, New South Wales, Australia
- Diabetes Program, The George Institute at Peking University Health Science Center, Beijing, China
| | - Yuxia Ma
- Department of nutrition and food hygiene, Hebei Medical University, Shijiazhuang, China
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12
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Gressier M, Sassi F, Frost G. Contribution of reformulation, product renewal, and changes in consumer behavior to the reduction of salt intakes in the UK population between 2008/2009 and 2016/2017. Am J Clin Nutr 2021; 114:1092-1099. [PMID: 33963735 PMCID: PMC8408870 DOI: 10.1093/ajcn/nqab130] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The UK salt reduction program started in 2003, consisting of education campaigns to raise awareness about the risks associated with a high-salt diet and of a reformulation strategy for food manufacturers. This program is often cited as an example of a successful public health program. OBJECTIVES This study aimed to assess: 1) the impacts of changes in food composition and changes in consumer behavior on sodium intakes; and 2) whether changes were similar across socioeconomic groups. METHODS Food intakes for the UK population were derived from food diaries in the UK National Diet and Nutrition Survey for 2008/09 (year 1; n = 1334) and 2016/17 (year 9; n = 995). Year-specific sodium densities of foods were used to calculate the average sodium density of all food and beverage consumed. Changes in sodium density between the 2 years were explained by changes in food composition (change in sodium density of products) and/or changes in behavior (type and quantity of food consumed) using a decomposition approach. RESULTS The program was linked to a 16% (95% CI: -21% to -12%) decrease in sodium intake between years 1 and 9, while the sodium density of foods consumed decreased by 17% (95% CI: -21% to -12%). This decrease was largely driven by reformulation (-12.0 mg/100 g). Changes in food choices reinforced the effects of the program, but had a smaller impact (-1.6 mg/100 g). These effects were similar across socioeconomic groups, whether stratified by education or income, with a consistent effect of reformulation across groups and no differences between groups in behavioral responses to the program. CONCLUSIONS A multi-component sodium reduction strategy deployed in the United Kingdom starting in 2003 corresponded to an important reduction in sodium intakes for the population. This reduction was mostly driven by changes in the food environment (reformulated food products to reduce the sodium density of foods) and, to a smaller extent, by changes in food choices. Impacts were consistent across socioeconomic groups.
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Affiliation(s)
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, Imperial College London, London, United Kingdom
| | - Gary Frost
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
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13
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Gressier M, Swinburn B, Frost G, Segal AB, Sassi F. What is the impact of food reformulation on individuals' behaviour, nutrient intakes and health status? A systematic review of empirical evidence. Obes Rev 2021; 22:e13139. [PMID: 33022095 DOI: 10.1111/obr.13139] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 01/22/2023]
Abstract
Food reformulation aimed at improving the nutritional properties of food products has long been viewed as a promising public health strategy to tackle poor nutrition and obesity. This paper presents a review of the empirical evidence (i.e., modelling studies were excluded) on the impact of food reformulation on food choices, nutrient intakes and health status, based on a systematic search of Medline, Embase, Global Health and sources of grey literature. Fifty-nine studies (in 35 papers) were included in the review. Most studies examined food choices (n = 27) and dietary intakes (n = 26). The nutrients most frequently studied were sodium (n = 32) and trans fatty acids (TFA, n = 13). Reformulated products were generally accepted and purchased by consumers, which led to improved nutrient intakes in 73% of studies. We also conducted two meta-analyses showing, respectively, a -0.57 g/day (95%CI, -0.89 to -0.25) reduction in salt intake and an effect size for TFA intake reduction of -1.2 (95% CI, -1.79 to -0.61). Only six studies examined effects on health outcomes, with studies on TFA reformulation showing overall improvement in cardiovascular risk factors. For other nutrients, it remains unclear whether observed improvements in food choices or nutrient intakes may have led to an improvement in health outcomes.
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Affiliation(s)
- Mathilde Gressier
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.,Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College London, London, UK
| | | | - Gary Frost
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Alexa B Segal
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College London, London, UK
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College London, London, UK
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14
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Nilson EAF, Spaniol AM, Santin RDC, Silva SA. Estratégias para redução do consumo de nutrientes críticos para a saúde: o caso do sódio. CAD SAUDE PUBLICA 2021; 37Suppl 1:e00145520. [DOI: 10.1590/0102-311x00145520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/04/2020] [Indexed: 11/22/2022] Open
Abstract
Doenças crônicas não transmissíveis correspondem à principal causa de morte no mundo e têm a alimentação inadequada como um de seus principais fatores de risco modificáveis, destacando-se o consumo excessivo de sódio e sua associação com doenças cardiovasculares, mediadas pela pressão arterial. Este estudo avaliou o impacto de diferentes cenários de políticas para a redução do consumo de sódio com base em alimentos processados e ultraprocessados na prevenção de mortes por desfechos cardiovasculares na população adulta no Brasil. Foram utilizados dados secundários, de relatórios e bases públicas do Sistema Único de Saúde e de inquéritos populacionais. Foram analisados os impactos, até 2027, de três cenários: manutenção das atuais metas voluntárias, e dois cenários mandatórios, considerando as menores metas nas Américas e as menores metas mundiais. Para a análise das mortes prevenidas ou adiadas com base no consumo de sódio em tais cenários foi utilizado o Preventable Risk Integrated ModEl (PRIME). Em 2027, mais de 72 mil mortes seriam atribuíveis ao excesso de sódio e as metas voluntárias resultariam na prevenção ou adiamento de até 4.001 (intervalos de 95% de incerteza - II95%: 1.611-6.563) mortes, e os cenários mandatórios resultariam na prevenção de 9.704 (II95%: 3.955-15.665) e 15.561 (II95%: 6.350-25.096) mortes por doenças cardiovasculares, considerando as menores metas regionais e internacionais, respectivamente. Os achados sugerem que a manutenção de metas voluntárias tem impacto limitado quando comparada a cenários possíveis e mais restritivos de redução do teor de sódio em alimentos processados e ultraprocessados, e reforçam a necessidade de adoção de medidas com maior efetividade no país.
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15
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Projected effects on salt purchases following implementation of a national salt reduction policy in South Africa. Public Health Nutr 2020; 24:4614-4621. [PMID: 33357250 DOI: 10.1017/s1368980020005273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with. DESIGN This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content. SETTING South Africa. PARTICIPANTS The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018. RESULTS Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %); meat and meat products (19 %); dairy (12·2 %); sauces, dressings, spreads and dips (11·8 %); and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels. CONCLUSIONS A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases.
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16
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Abstract
OBJECTIVE To describe the Na concentration of pre-packaged foods available in Hong Kong. DESIGN The Na concentrations (mg/100 g or mg/100 ml or per serving) of all pre-packaged foods available for sale in major supermarket chains in Hong Kong were obtained from the 2017 Hong Kong FoodSwitch database. Median and interquartile range (IQR) of Na concentration for different food groups and the proportion of foods and beverages considered low and high Na (<120 mg/100 g or mg/100 ml and >600 mg/100 g or mg/100 ml, respectively) were determined. SETTING Hong Kong. PARTICIPANTS Not applicable. RESULTS We analysed 11 518 pre-packaged products. 'Fruit and vegetables (including table salt)' had the highest variability in Na concentration ranging from 0 to 39 000 mg/100 g, followed by 'sauces, dressings, spreads and dips' ranging from 0 to 34 130. The latter also had the highest median Na concentration (mg/100 g or mg/100 ml) at 1180 (IQR 446-3520), followed by meat and meat products (median 800, IQR 632-1068) and snack foods (median 650, IQR 453-926). Fish and fish products (median 531, 364-791) and meat and meat products (median 444, IQR 351-593) had the highest Na concentration per serving. Overall, 46·7 and 26·7 % of products were low and high in Na, respectively. CONCLUSIONS Our results can serve as a baseline for food supply interventions in Hong Kong. We have identified several food groups as priority areas for reformulation, demonstrating the potential of such initiatives to improve the healthiness of the food supply in Hong Kong.
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17
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Impact of the announcement and implementation of the UK Soft Drinks Industry Levy on sugar content, price, product size and number of available soft drinks in the UK, 2015-19: A controlled interrupted time series analysis. PLoS Med 2020; 17:e1003025. [PMID: 32045418 PMCID: PMC7012398 DOI: 10.1371/journal.pmed.1003025] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dietary sugar, especially in liquid form, increases risk of dental caries, adiposity, and type 2 diabetes. The United Kingdom Soft Drinks Industry Levy (SDIL) was announced in March 2016 and implemented in April 2018 and charges manufacturers and importers at £0.24 per litre for drinks with over 8 g sugar per 100 mL (high levy category), £0.18 per litre for drinks with 5 to 8 g sugar per 100 mL (low levy category), and no charge for drinks with less than 5 g sugar per 100 mL (no levy category). Fruit juices and milk-based drinks are exempt. We measured the impact of the SDIL on price, product size, number of soft drinks on the marketplace, and the proportion of drinks over the lower levy threshold of 5 g sugar per 100 mL. METHODS AND FINDINGS We analysed data on a total of 209,637 observations of soft drinks over 85 time points between September 2015 and February 2019, collected from the websites of the leading supermarkets in the UK. The data set was structured as a repeat cross-sectional study. We used controlled interrupted time series to assess the impact of the SDIL on changes in level and slope for the 4 outcome variables. Equivalent models were run for potentially levy-eligible drink categories ('intervention' drinks) and levy-exempt fruit juices and milk-based drinks ('control' drinks). Observed results were compared with counterfactual scenarios based on extrapolation of pre-SDIL trends. We found that in February 2019, the proportion of intervention drinks over the lower levy sugar threshold had fallen by 33.8 percentage points (95% CI: 33.3-34.4, p < 0.001). The price of intervention drinks in the high levy category had risen by £0.075 (£0.037-0.115, p < 0.001) per litre-a 31% pass through rate-whilst prices of intervention drinks in the low levy category and no levy category had fallen and risen by smaller amounts, respectively. Whilst the product size of branded high levy and low levy drinks barely changed after implementation of the SDIL (-7 mL [-23 to 11 mL] and 16 mL [6-27ml], respectively), there were large changes to product size of own-brand drinks with an increase of 172 mL (133-214 mL) for high levy drinks and a decrease of 141 mL (111-170 mL) for low levy drinks. The number of available drinks that were in the high levy category when the SDIL was announced was reduced by 3 (-6 to 12) by the implementation of the SDIL. Equivalent models for control drinks provided little evidence of impact of the SDIL. These results are not sales weighted, so do not give an account of how sugar consumption from drinks may have changed over the time period. CONCLUSIONS The results suggest that the SDIL incentivised many manufacturers to reduce sugar in soft drinks. Some of the cost of the levy to manufacturers and importers was passed on to consumers as higher prices but not always on targeted drinks. These changes could reduce population exposure to liquid sugars and associated health risks.
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18
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Kanter R, Reyes M, Vandevijvere S, Swinburn B, Corvalán C. Anticipatory effects of the implementation of the Chilean Law of Food Labeling and Advertising on food and beverage product reformulation. Obes Rev 2019; 20 Suppl 2:129-140. [PMID: 31245920 DOI: 10.1111/obr.12870] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 12/15/2022]
Abstract
This study evaluated the anticipated food and beverage product reformulation by industry before the Chilean Law of Food Labeling and Advertising (Law 20.606) was implemented in June 2016 requiring a front-of-package (FOP) warning label for products high in sodium, total sugars, saturated fats, and/or total energy. Fieldworkers photographed a purposive sample of packaged food and beverage products in February 2015 (n = 5421) and February 2016 (n = 5479) from six different supermarkets in Santiago, Chile. The same products collected in both years (n = 2086) from 17 food and beverage categories with added critical nutrients (nutrients of concern: sodium, total sugars, and saturated fats) were included in this longitudinal study. The average change in energy and critical nutrient content was estimated by category. The number of warning labels potentially avoided because of reformulation was determined. Between February 2015 and February 2016, no category experienced reductions >5% average change in energy or critical nutrient content; and some increased in critical nutrient content. Few products (<2%) would have avoided at least one warning label with reformulation. In a diverse sample of food and beverage products, there was minimal reformulation by industry in anticipation of the implementation of the 2016 Chilean Law of Food Labeling and Advertising.
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Affiliation(s)
- Rebecca Kanter
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile.,Unit of Public Health, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Marcela Reyes
- Unit of Public Health, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Stefanie Vandevijvere
- Department of Epidemiology and Biostatistics, University of Auckland School of Population Health, Auckland, New Zealand
| | - Boyd Swinburn
- Department of Epidemiology and Biostatistics, University of Auckland School of Population Health, Auckland, New Zealand
| | - Camila Corvalán
- Unit of Public Health, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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19
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Turck D, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Aggett P, Fairweather-Tait S, Martin A, Przyrembel H, Ciccolallo L, de Sesmaisons-Lecarré A, Valtueña Martinez S, Martino L, Naska A. Dietary reference values for sodium. EFSA J 2019; 17:e05778. [PMID: 32626425 PMCID: PMC7009309 DOI: 10.2903/j.efsa.2019.5778] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) derived dietary reference values (DRVs) for sodium. Evidence from balance studies on sodium and on the relationship between sodium intake and health outcomes, in particular cardiovascular disease (CVD)-related endpoints and bone health, was reviewed. The data were not sufficient to enable an average requirement (AR) or population reference intake (PRI) to be derived. However, by integrating the available evidence and associated uncertainties, the Panel considers that a sodium intake of 2.0 g/day represents a level of sodium for which there is sufficient confidence in a reduced risk of CVD in the general adult population. In addition, a sodium intake of 2.0 g/day is likely to allow most of the general adult population to maintain sodium balance. Therefore, the Panel considers that 2.0 g sodium/day is a safe and adequate intake for the general EU population of adults. The same value applies to pregnant and lactating women. Sodium intakes that are considered safe and adequate for children are extrapolated from the value for adults, adjusting for their respective energy requirement and including a growth factor, and are as follows: 1.1 g/day for children aged 1-3 years, 1.3 g/day for children aged 4-6 years, 1.7 g/day for children aged 7-10 years and 2.0 g/day for children aged 11-17 years, respectively. For infants aged 7-11 months, an Adequate Intake (AI) of 0.2 g/day is proposed based on upwards extrapolation of the estimated sodium intake in exclusively breast-fed infants aged 0-6 months.
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20
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Berger N, Cummins S, Smith RD, Cornelsen L. Recent trends in energy and nutrient content of take-home food and beverage purchases in Great Britain: an analysis of 225 million food and beverage purchases over 6 years. BMJ Nutr Prev Health 2019; 2:63-71. [PMID: 33235959 PMCID: PMC7664498 DOI: 10.1136/bmjnph-2019-000036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/21/2019] [Accepted: 07/06/2019] [Indexed: 11/12/2022] Open
Abstract
Introduction In recent years, there has been an increased focus on developing a coherent obesity policy in the UK, which has led to various national policy initiatives aimed at improving population diet. We sought to determine whether there have been concurrent changes in trends in the nutrient content of take-home food and beverage purchases within this policy environment. Methods We used 2012–2017 data from the UK Kantar Fast-Moving Consumer Goods (FMCG) panel, a nationally representative panel study of food and beverages bought by British households and brought into the home (n≈32 000 per year). Households used hand-held barcode scanners to report over 225 million product-level purchases of food and beverages, for which nutritional information was obtained. We estimated daily per capita purchases of energy and nutrients from 32 healthier and less healthy food groups defined using the nutrient profiling model used by the UK Department of Health. Results From 2012 to 2017, daily purchases of energy from food and beverages taken home decreased by 35.4 kcal (95% CI 25.5 to 45.2) per capita. This is explained by moderate decreases in the purchase of products with high contents in carbohydrate (−13.1 g (−14.4 to –11.8)) and sugar (−4.4 g (−5.1 to –3.7)), despite small increases in protein (1.7 g (1.4 to 2.1)) and saturated fat (0.4 g (0.2 to 0.6)). Food and beverage purchases exceeded daily reference intake values in fat (on average +6%), saturated fat (+43%), sugar (+16%) and protein (+28%) across all years. Although substitutions between individual food groups were large in energy and nutrients purchased, the heterogeneity of these patterns resulted in modest overall changes. Conclusion There have been small declines in the purchase of less healthy food products, which translated to a small reduction of total energy and sugar purchases taken home. However, the rate of change needs to be accelerated in order to substantially reduce the health risks of poor diets, suggesting that more radical policies may be needed to attain larger population effects.
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Affiliation(s)
- Nicolas Berger
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard D Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Laura Cornelsen
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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21
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Santos JA, Sparks E, Thout SR, McKenzie B, Trieu K, Hoek A, Johnson C, McLean R, Arcand J, Campbell NRC, Webster J. The Science of Salt: A global review on changes in sodium levels in foods. J Clin Hypertens (Greenwich) 2019; 21:1043-1056. [PMID: 31301120 DOI: 10.1111/jch.13628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 12/21/2022]
Abstract
This review aims to summarize and synthesize studies reporting on changes in sodium levels in packaged food products, restaurant foods, and hospital or school meals, as a result of salt reduction interventions. Studies were extracted from those published in the Science of Salt Weekly between June 2013 and February 2018. Twenty-four studies were identified: 17 assessed the changes in packaged foods, four in restaurant foods, two in hospital or school meals, and one in both packaged and restaurant foods. Three types of interventions were evaluated as part of the studies: voluntary reductions (including targets), labeling, and interventions in institutional settings. Decreases in sodium were observed in all studies (n = 8) that included the same packaged foods matched at two time points, and in the studies carried out in hospitals and schools. However, there was little to no change in mean sodium levels in restaurant foods. The pooled analysis of change in sodium levels in packaged foods showed a decrease in sodium in unmatched food products (-36 mg/100 g, 95% CI -51 to -20 mg/100 g) and in five food categories-breakfast cereals, breads, processed meats, crisps and snacks, and soups. Twenty-two of the 24 studies were from high-income countries, limiting the applicability of the findings to lower resource settings.
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Affiliation(s)
- Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Emalie Sparks
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Briar McKenzie
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Annet Hoek
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachael McLean
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Norman R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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22
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Muth MK, Karns SA, Mancino L, Todd JE. How Much Can Product Reformulation Improve Diet Quality in Households with Children and Adolescents? Nutrients 2019; 11:nu11030618. [PMID: 30875736 PMCID: PMC6470779 DOI: 10.3390/nu11030618] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 12/21/2022] Open
Abstract
Improvements in the healthfulness of packaged foods and beverages through reformulation could help reduce the prevalence of obesity among children and adolescents through improved diet quality. This study assessed changes in calories and four nutrients (saturated fat, total sugars, sodium, and dietary fiber) from 2012 through 2014 for packaged products frequently consumed by children and adolescents, simulated effects of potential improvements in 12 frequently consumed product categories based on actual purchasing patterns, and compared differences in prices of healthier versus less healthy products. Analysis of trends showed limited evidence that healthfulness of foods improved over the years examined. Simulation results showed minimal changes for calories and sodium, but daily intake of saturated fat could decrease by 4%, sugar consumption could decrease by 5%, and dietary fiber consumption could increase by 11% if products were reformulated to meet an existing healthfulness standard. Using a higher standard, caloric intake could decline by 4%, saturated fat by 6%, sugar by 9%, and sodium by 4%, and dietary fiber could increase by 14%. Healthier versions of most products ranged from an average of 3 to 12 cents more per serving, but not all healthier versions were more costly. Overall, reformulation is a potential avenue for improving diet quality in households with children and adolescents, but price could be a barrier to purchasing healthier products for some households.
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Affiliation(s)
- Mary K Muth
- RTI International, Research Triangle Park, NC 27709, USA.
| | - Shawn A Karns
- RTI International, Research Triangle Park, NC 27709, USA.
| | - Lisa Mancino
- Economic Research Service, U.S. Department of Agriculture, Washington, DC 20024, USA.
| | - Jessica E Todd
- Economic Research Service, U.S. Department of Agriculture, Washington, DC 20024, USA.
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Abstract
Poor diets are a significant contributor to non-communicable diseases and obesity. Despite years of health promotion, change in dietary habits is slow and there is growing recognition of the need to provide greater support to individuals and to complement individual efforts with changes in the food environment to shift the default towards healthier diets. The present paper summarises opportunities for intervention at the individual and population level. It discusses the role of voluntary or mandatory approaches to drive change in the food industry and the need for improved methods to monitor and evaluate progress. It concludes with a call to action from all stakeholders to accelerate change towards a healthier diet.
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Bandy L, Adhikari V, Jebb S, Rayner M. The use of commercial food purchase data for public health nutrition research: A systematic review. PLoS One 2019; 14:e0210192. [PMID: 30615664 PMCID: PMC6322827 DOI: 10.1371/journal.pone.0210192] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/17/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Traditional methods of dietary assessment have their limitations and commercial sources of food sales and purchase data are increasingly suggested as an additional source to measuring diet at the population level. However, the potential uses of food sales data are less well understood. The aim of this review is to establish how sales data on food and soft drink products from third-party companies have been used in public health nutrition research. METHODS A search of five electronic databases was conducted in February-March 2018 for studies published in peer-reviewed journals that had used food sales or purchase data from a commercial company to analyse trends and patterns in food purchases or in the nutritional composition of foods. Study quality was evaluated using the National Institutes of Health (NIH) Quality Assessment Tool for Cohort and Cross-Sectional Studies. RESULTS Of 2919 papers identified in the search, 68 were included. The selected studies used sales or purchase data from four companies: Euromonitor, GfK, Kantar and Nielsen. Sales and purchase data have been used to evaluate interventions, including the impact of the saturated fat tax in Denmark, the soft drink and junk food taxes in Mexico and supplemental nutrition programmes in the USA. They have also been used to identify trends in the nutrient composition of foods over time and patterns in food purchasing, including socio-demographic variations in purchasing. CONCLUSION Food sales and purchase data are a valuable tool for public health nutrition researchers and their use has increased markedly in the last four years, despite the cost of access, the lack of transparency on data-collection methods and restrictions on publication. The availability of product and brand-level sales data means they are particularly useful for assessing how changes by individual food companies can impact on diet and public health.
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Affiliation(s)
- Lauren Bandy
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Vyas Adhikari
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Sparks E, Farrand C, Santos JA, McKenzie B, Trieu K, Reimers J, Davidson C, Johnson C, Webster J. Sodium Levels of Processed Meat in Australia: Supermarket Survey Data from 2010 to 2017. Nutrients 2018; 10:E1686. [PMID: 30400649 PMCID: PMC6267163 DOI: 10.3390/nu10111686] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022] Open
Abstract
High sodium intake increases blood pressure and consequently increases the risk of cardiovascular diseases. In Australia, the best estimate of sodium intake is 3840 mg sodium/day, almost double the World Health Organization (WHO) guideline (2000 mg/day), and processed meats contribute approximately 10% of daily sodium intake to the diet. This study assessed the median sodium levels of 2510 processed meat products, including bacon and sausages, available in major Australian supermarkets in 2010, 2013, 2015 and 2017, and assessed changes over time. The median sodium content of processed meats in 2017 was 775 mg/100 g (interquartile range (IQR) 483⁻1080). There was an 11% reduction in the median sodium level of processed meats for which targets were set under the government's Food and Health Dialogue (p < 0.001). This includes bacon, ham/cured meat products, sliced luncheon meat and meat with pastry categories. There was no change in processed meats without a target (median difference 6%, p = 0.450). The new targets proposed by the current government's Healthy Food Partnership capture a larger proportion of products than the Food and Health Dialogue (66% compared to 35%) and a lower proportion of products are at or below the target (35% compared to 54%). These results demonstrate that voluntary government targets can drive nutrient reformulation. Future efforts will require strong government leadership and robust monitoring and evaluation systems.
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Affiliation(s)
- Emalie Sparks
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2006, Australia.
| | - Clare Farrand
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2006, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2006, Australia.
| | - Briar McKenzie
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2006, Australia.
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2006, Australia.
| | - Jenny Reimers
- Victorian Health Promotion Foundation (VicHealth), 15-31 Pelham Street, Carlton, VIC 3053, Australia.
| | - Chelsea Davidson
- Heart Foundation, Level 2, 850 Collins Street, Docklands, VIC 3008, Australia.
| | - Claire Johnson
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2006, Australia.
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2006, Australia.
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Measuring the Healthiness of the Packaged Food Supply in Australia. Nutrients 2018; 10:nu10060702. [PMID: 29857517 PMCID: PMC6024847 DOI: 10.3390/nu10060702] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 02/08/2023] Open
Abstract
The increasing availability of packaged foods plays a key role in nutritional transition. This study examined the healthiness of the Australian packaged food supply using a range of different metrics; 40,664 packaged products from The George Institute's FoodSwitch database were included. Median and interquartile range (IQR) were determined for each measure of nutrient composition; mean and standard deviation (SD) for the measure based upon Health Star Rating (HSR); and proportions (%) for the measures based upon products with a higher HSR, classification of foods as either core or discretionary, extent of processing and proportions of foods that met reformulation targets for sodium, saturated fat and total sugars. Overall median (IQR) values were 1093 (1256) kJ/100 g for energy, 1.7 (6.3) g/100 g for saturated fat, 5.3 (21.4) g/100 g for total sugars, 163 (423) g/100 g for sodium and 50 (100) g or mL for serving size. Overall mean (SD) HSR was 2.8 (1.4), proportion with HSR < 3.5 was 61.8%, proportion of foods defined as discretionary was 53.0% and proportion of foods defined as highly processed was 60.5%. There were sodium targets set for 21,382/40,664 (53%) foods and achieved for 14,126/40,664 (35%). Corresponding figures for saturated fat were 328/40,664 (0.8%) and 130/40,664 (0.3%). Nutrient profiling, dietary guidelines and the extent of food processing provided comparable assessments of the nutritional quality of Australia's packaged food supply. Individual measures of nutrient composition did not, but may be of value for identifying specific foods of concern.
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Spiteri SA, Olstad DL, Woods JL. Nutritional quality of new food products released into the Australian retail food market in 2015 - is the food industry part of the solution? BMC Public Health 2018; 18:222. [PMID: 29415698 PMCID: PMC5804078 DOI: 10.1186/s12889-018-5127-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food manufacturers have made public statements and voluntary commitments, such as the Healthier Australia Commitment (HAC), to improve the nutritional quality of foods. However, limited information about the nutritional quality or healthfulness of new products makes it difficult to determine if manufacturers are doing this. The purpose of this study was to assess the healthfulness of new food products released into the Australian retail market in 2015, and whether those companies who were HAC members released healthier food options compared to non-HAC members. METHODS This cross-sectional study assessed the healthfulness of all new retail food products launched in Australia in 2015 as indexed in Mintel's Global New Products Database. Healthfulness was assessed using three classification schemes: Healthy Choices Framework Victoria, Australian Dietary Guidelines and NOVA Food Classification System. Descriptive statistics and chi-squared tests described and compared the number and proportions of new foods falling within each of the food classification schemes' categories for companies that were and were not HAC members. RESULTS In 2015, 4143 new food products were launched into the Australian market. The majority of new products were classified in each schemes' least healthy category (i.e. red, discretionary and ultra-processed). Fruits and vegetables represented just 3% of new products. HAC members launched a significantly greater proportion of foods classified as red (59% vs 51% for members and non-members, respectively) discretionary (79% vs 61%), and ultra-processed (94% vs 81%), and significantly fewer were classified as green (8% vs 15%), core foods (18% vs 36%) and minimally processed (0% vs 6%) (all p < 0.001). CONCLUSIONS This study found that the majority of new products released into the Australian retail food market in 2015 were classified in each of three schemes' least healthy categories. A greater proportion of new products launched by companies that publicly committed to improve the nutritional quality of their products were unhealthy, and a lower proportion were healthy, compared with new products launched by companies that did not so commit. Greater monitoring of industry progress in improving the healthfulness of the food supply may be warranted, with public accountability if the necessary changes are not seen.
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Affiliation(s)
- Sheree A. Spiteri
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Dana Lee Olstad
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Julie L. Woods
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
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28
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Food reformulation and nutritional quality of food consumption: an analysis based on households panel data in France. Eur J Clin Nutr 2017; 72:228-235. [PMID: 29269888 PMCID: PMC5842885 DOI: 10.1038/s41430-017-0044-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/12/2017] [Accepted: 10/08/2017] [Indexed: 12/03/2022]
Abstract
Background/objectives We aimed to quantify the contribution of food reformulation to changes in the nutritional quality of consumers’ food purchases, and compare it with the impact of substitutions made by consumers. Subjects/methods Using a brand-specific data set in France, we considered the changes in the nutrient content of food products in four food sectors over a 3-year period. These data were matched with data on consumers’ purchases to estimate the change in the nutritional quality of consumers’ purchases. This change was divided into three components: the reformulation of food products, the launching of new products and the consumers’ substitutions between products. Key nutrients were selected for each food group: breakfast cereals (sugar, fats, SFA, fiber, and sodium), biscuits and cakes (sugar, fats, SFA, and fiber), potato chips (fats, SFA, and sodium) and soft drinks (sugar). Results Product reformulation initiatives have improved existing products for most food group-nutrient pairs. In particular, the contribution of food reformulation to the change in nutritional quality of food purchases was strong in potato chips (the sales-weighted mean SFA and sodium contents decreased by 31.4% to 52.1% and 6.7% to 11.1%, respectively), and breakfast cereals (the sales-weighted mean sodium content decreased by 7.3% to 9.7%). Regarding the launching of new products, the results were ambiguous. Consumers’ substitutions between food items were not generally associated to an improvement in the nutritional quality of the food purchases. Conclusions Policies aiming to promote food reformulation may have greater impact than those promoting changes in consumer behavior.
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Levi R, Probst Y, Crino M, Dunford E. Evaluation of Australian soup manufacturer compliance with national sodium reduction targets. Nutr Diet 2017; 75:200-205. [PMID: 29083119 DOI: 10.1111/1747-0080.12392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 08/15/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Abstract
AIM Packaged foods dominate Australia's food supply and are important contributors to nutrition-related disease. To help address this problem, the Food and Health Dialogue (FHD) was launched in 2009, setting voluntary sodium reduction targets for various categories of packaged foods. The aim of this study was to examine the food industry's progress and compliance with the FHD sodium reduction targets for soup products. METHODS Nutritional information was collected from product labels of all soup products available from four major Australian supermarkets annually between 2011 and 2014. Products were assigned to categories in line with those in the FHD. The proportion of soup products meeting sodium reduction targets was examined by (i) soup category; (ii) FHD participant status; and (iii) manufacturer. RESULTS A 6% reduction in sodium levels in soups overall was found from 2011 to 2014 (P = 0.002). Significant reductions were observed for FHD participants (P < 0.05 for all) but not for non-participants. In 2014, 67% dry soups and 76% of wet soups met national sodium reduction targets. CONCLUSIONS Despite the majority of soup products meeting the sodium reduction targets specified by the FHD, re-evaluation of the targets may be required to further reduce sodium levels in soups. Manufacturers participating in the FHD are likely to be driving sodium reductions in the Australian soup market, further highlighting the need for continued government leadership in this area to ensure all manufacturers are actively involved in the process.
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Affiliation(s)
- Rebecca Levi
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yasmine Probst
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle Crino
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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30
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Swanepoel B, Malan L, Myburgh PH, Schutte AE, Steyn K, Wentzel-Viljoen E. Sodium content of foodstuffs included in the sodium reduction regulation of South Africa. J Food Compost Anal 2017. [DOI: 10.1016/j.jfca.2017.07.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Applying a Consumer Behavior Lens to Salt Reduction Initiatives. Nutrients 2017; 9:nu9080901. [PMID: 28820449 PMCID: PMC5579694 DOI: 10.3390/nu9080901] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 01/31/2023] Open
Abstract
Reformulation of food products to reduce salt content has been a central strategy for achieving population level salt reduction. In this paper, we reflect on current reformulation strategies and consider how consumer behavior determines the ultimate success of these strategies. We consider the merits of adopting a ‘health by stealth’, silent approach to reformulation compared to implementing a communications strategy which draws on labeling initiatives in tandem with reformulation efforts. We end this paper by calling for a multi-actor approach which utilizes co-design, participatory tools to facilitate the involvement of all stakeholders, including, and especially, consumers, in making decisions around how best to achieve population-level salt reduction.
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32
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Peters SAE, Dunford E, Ware LJ, Harris T, Walker A, Wicks M, van Zyl T, Swanepoel B, Charlton KE, Woodward M, Webster J, Neal B. The Sodium Content of Processed Foods in South Africa during the Introduction of Mandatory Sodium Limits. Nutrients 2017; 9:nu9040404. [PMID: 28425938 PMCID: PMC5409743 DOI: 10.3390/nu9040404] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/07/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background: In June 2016, the Republic of South Africa introduced legislation for mandatory limits for the upper sodium content permitted in a wide range of processed foods. We assessed the sodium levels of packaged foods in South Africa during the one-year period leading up to the mandatory implementation date of the legislation. Methods: Data on the nutritional composition of packaged foods was obtained from nutrition information panels on food labels through both in-store surveys and crowdsourcing by users of the HealthyFood Switch mobile phone app between June 2015 and August 2016. Summary sodium levels were calculated for 15 food categories, including the 13 categories covered by the sodium legislation. The percentage of foods that met the government’s 2016 sodium limits was also calculated. Results: 11,065 processed food items were included in the analyses; 1851 of these were subject to the sodium legislation. Overall, 67% of targeted foods had a sodium level at or below the legislated limit. Categories with the lowest percentage of foods that met legislated limits were bread (27%), potato crisps (41%), salt and vinegar flavoured snacks (42%), and raw processed sausages (45%). About half (49%) of targeted foods not meeting the legislated limits were less than 25% above the maximum sodium level. Conclusion: Sodium levels in two-thirds of foods covered by the South African sodium legislation were at or below the permitted upper levels at the mandatory implementation date of the legislation and many more were close to the limit. The South African food industry has an excellent opportunity to rapidly meet the legislated requirements.
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Affiliation(s)
- Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford OX1 3QX, UK.
| | - Elizabeth Dunford
- Carolina Population Center, University of North Carolina, Chapel Hill, NC 27516, USA.
- The George Institute for Global Health, University of Sydney, Sydney, NSW 2050, Australia.
| | - Lisa J Ware
- Hypertension in Africa Research Team, North West University, Potchefstroom 2520, South Africa.
| | | | | | - Mariaan Wicks
- Center of Excellence for Nutrition, North West University, Potchefstroom 2520, South Africa.
| | - Tertia van Zyl
- Center of Excellence for Nutrition, North West University, Potchefstroom 2520, South Africa.
| | - Bianca Swanepoel
- Center of Excellence for Nutrition, North West University, Potchefstroom 2520, South Africa.
| | - Karen E Charlton
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford OX1 3QX, UK.
- The George Institute for Global Health, University of Sydney, Sydney, NSW 2050, Australia.
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21218, USA.
| | - Jacqui Webster
- The George Institute for Global Health, University of Sydney, Sydney, NSW 2050, Australia.
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney, Sydney, NSW 2050, Australia.
- The Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
- Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
- Imperial College London, London SW7 2AZ, UK.
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Nutrient profiling for product reformulation: public health impact and benefits for the consumer. Proc Nutr Soc 2017; 76:255-264. [PMID: 28420455 DOI: 10.1017/s0029665117000301] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The food industry holds great potential for driving consumers to adopt healthy food choices as (re)formulation of foods can improve the nutritional quality of these foods. Reformulation has been identified as a cost-effective intervention in addressing non-communicable diseases as it does not require significant alterations of consumer behaviour and dietary habits. Nutrient profiling (NP), the science of categorizing foods based on their nutrient composition, has emerged as an essential tool and is implemented through many different profiling systems to guide reformulation and other nutrition policies. NP systems should be adapted to their specific purposes as it is not possible to design one system that can equally address all policies and purposes, e.g. reformulation and labelling. The present paper discusses some of the key principles and specificities that underlie a NP system designed for reformulation with the example of the Nestlé nutritional profiling system. Furthermore, the impact of reformulation at the level of the food product, dietary intakes and public health are reviewed. Several studies showed that food and beverage reformulation, guided by a NP system, may be effective in improving population nutritional intakes and thereby its health status. In order to achieve its maximum potential and modify the food environment in a beneficial manner, reformulation should be implemented by the entire food sector. Multi-stakeholder partnerships including governments, food industry, retailers and consumer associations that will state concrete time-bound objectives accompanied by an independent monitoring system are the potential solution.
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34
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Huang L, Neal B, Dunford E, Ma G, Wu JH, Crino M, Trevena H. Completeness of nutrient declarations and the average nutritional composition of pre-packaged foods in Beijing, China. Prev Med Rep 2016; 4:397-403. [PMID: 27570732 PMCID: PMC4992038 DOI: 10.1016/j.pmedr.2016.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 07/04/2016] [Accepted: 08/02/2016] [Indexed: 01/13/2023] Open
Abstract
Increasing consumption of pre-packaged foods is likely an important driver of diet-related diseases in China. From January 2013 it became mandatory to provide a standardised nutrient declaration on pre-packaged foods in China. We collected data on pre-packaged foods from large chain supermarkets in Beijing in 2013, examined the completeness of the nutrient declaration of core required nutrients and summarised the average nutritional composition of 14 different major food groups. We also illustrated the potential use of the data by comparing sodium levels. Photos of 14,279 pre-packaged foods were collected from 16 chain supermarkets in Beijing. Data for 11,489 products were included in the evaluation of nutrient declarations and data for 10,048 in the summary analysis of average nutritional composition. Compliant nutrient declarations were displayed by 87% of products with 88% of foods displaying data for each of energy, protein, total fat, carbohydrate and sodium. Nutrients not required by the Chinese regulation were infrequently reported: saturated fat (12%), trans fat (17%) and sugars (11%). Mean sodium levels were higher in Chinese products compared to UK products for 8 of 11 major food categories, often markedly so (e.g. 1417 mg/100 g vs. 304 mg/100 g for convenience foods). There has been substantial uptake of the recently introduced Chinese nutrition labelling regulation which should help consumers to choose healthier foods. As the comparison against corresponding data about sodium from the United Kingdom shows, the nutrient data can also be used to identify broader opportunities for improvement of the food supply.
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Affiliation(s)
- Liping Huang
- The George Institute for Global Health at Peking University Health Science Centre, B1801, Horizon Tower, No. 6 Zhichun Rd, Haidian, Beijing 100088, China
| | - Bruce Neal
- The George Institute for Global Health, The University of Sydney, PO Box M201 Missenden Rd Camperdown, NSW 2050, Australia
| | - Elizabeth Dunford
- The George Institute for Global Health, The University of Sydney, PO Box M201 Missenden Rd Camperdown, NSW 2050, Australia
- Carolina Population Center, The University of North Carolina at Chapel Hill, USA
| | - Guansheng Ma
- Department of Nutrition and Food Hygien, School of Public Health, Peking University, No. 38 Xueyuan Rd., Haidian District, Beijing 100191, China
| | - Jason H.Y. Wu
- The George Institute for Global Health, The University of Sydney, PO Box M201 Missenden Rd Camperdown, NSW 2050, Australia
| | - Michelle Crino
- The George Institute for Global Health, The University of Sydney, PO Box M201 Missenden Rd Camperdown, NSW 2050, Australia
| | - Helen Trevena
- The George Institute for Global Health, The University of Sydney, PO Box M201 Missenden Rd Camperdown, NSW 2050, Australia
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Curtis CJ, Clapp J, Niederman SA, Ng SW, Angell SY. US Food Industry Progress During the National Salt Reduction Initiative: 2009-2014. Am J Public Health 2016; 106:1815-9. [PMID: 27552265 DOI: 10.2105/ajph.2016.303397] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the US packaged food industry's progress from 2009 to 2014, when the National Salt Reduction Initiative had voluntary, category-specific sodium targets with the goal of reducing sodium in packaged and restaurant foods by 25% over 5 years. METHODS Using the National Salt Reduction Initiative Packaged Food Database, we assessed target achievement and change in sales-weighted mean sodium density in top-selling products in 61 food categories in 2009 (n = 6336), 2012 (n = 6898), and 2014 (n = 7396). RESULTS In 2009, when the targets were established, no categories met National Salt Reduction Initiative 2012 or 2014 targets. By 2014, 26% of categories met 2012 targets and 3% met 2014 targets. From 2009 to 2014, the sales-weighted mean sodium density declined significantly in almost half of all food categories (43%; 26/61 categories). Overall, sales-weighted mean sodium density declined significantly (by 6.8%; P < .001). CONCLUSIONS National target setting with monitoring through a partnership of local, state, and national health organizations proved feasible, but industry progress was modest. PUBLIC HEALTH IMPLICATIONS The US Food and Drug Administration's proposed voluntary targets will be an important step in achieving more substantial sodium reductions.
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Affiliation(s)
- Christine J Curtis
- At the time of the study, Christine J. Curtis, Jenifer Clapp, Sarah A. Niederman, and Sonia Y. Angell were with the New York City Department of Health and Mental Hygiene, New York, NY. Shu Wen Ng is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Jenifer Clapp
- At the time of the study, Christine J. Curtis, Jenifer Clapp, Sarah A. Niederman, and Sonia Y. Angell were with the New York City Department of Health and Mental Hygiene, New York, NY. Shu Wen Ng is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Sarah A Niederman
- At the time of the study, Christine J. Curtis, Jenifer Clapp, Sarah A. Niederman, and Sonia Y. Angell were with the New York City Department of Health and Mental Hygiene, New York, NY. Shu Wen Ng is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Shu Wen Ng
- At the time of the study, Christine J. Curtis, Jenifer Clapp, Sarah A. Niederman, and Sonia Y. Angell were with the New York City Department of Health and Mental Hygiene, New York, NY. Shu Wen Ng is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Sonia Y Angell
- At the time of the study, Christine J. Curtis, Jenifer Clapp, Sarah A. Niederman, and Sonia Y. Angell were with the New York City Department of Health and Mental Hygiene, New York, NY. Shu Wen Ng is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
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Eyles H, Shields E, Webster J, Ni Mhurchu C. Achieving the WHO sodium target: estimation of reductions required in the sodium content of packaged foods and other sources of dietary sodium. Am J Clin Nutr 2016; 104:470-9. [PMID: 27385612 DOI: 10.3945/ajcn.115.125146] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 06/02/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Excess sodium intake is one of the top 2 dietary risk factors contributing to the global burden of disease. As such, many countries are now developing national sodium reduction strategies, a key component of which is a sodium reduction model that includes sodium targets for packaged foods and other sources of dietary sodium. OBJECTIVE We sought to develop a sodium reduction model to determine the reductions required in the sodium content of packaged foods and other dietary sources of sodium to reduce adult population salt intake by ∼30% toward the optimal WHO target of 5 g/d. DESIGN Nationally representative household food-purchasing data for New Zealand were linked with branded food composition information to determine the mean contribution of major packaged food categories to total population sodium consumption. Discretionary salt use and the contribution of sodium from fresh foods and foods consumed away from the home were estimated with the use of national nutrition survey data. Reductions required in the sodium content of packaged foods and other dietary sources of sodium to achieve a 30% reduction in dietary sodium intakes were estimated. RESULTS A 36% reduction (1.6 g salt or 628 mg Na) in the sodium content of packaged foods in conjunction with a 40% reduction in discretionary salt use and the sodium content of foods consumed away from the home would reduce total population salt intake in New Zealand by 35% (from 8.4 to 5.5 g/d) and thus meet the WHO 2025 30% relative reduction target. Key reductions required include a decrease of 21% in the sodium content of white bread, 27% for hard cheese, 42% for sausages, and 54% for ready-to-eat breakfast cereals. CONCLUSIONS Achieving the WHO sodium target in New Zealand will take considerable efforts by both food manufacturers and consumers and will likely require a national government-led sodium reduction strategy.
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Affiliation(s)
- Helen Eyles
- National Institute for Health Innovation and Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand; and
| | | | - Jacqui Webster
- George Institute for Global Health, University of Sydney, Sydney, Australia
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Wilson N, Nghiem N, Eyles H, Mhurchu CN, Shields E, Cobiac LJ, Cleghorn CL, Blakely T. Modeling health gains and cost savings for ten dietary salt reduction targets. Nutr J 2016; 15:44. [PMID: 27118548 PMCID: PMC4847342 DOI: 10.1186/s12937-016-0161-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/15/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Dietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. We therefore aimed to identify health gain and cost impacts of achieving a national target for sodium reduction, along with component targets in different food groups. METHODS We used an established dietary sodium intervention model to study 10 interventions to achieve sodium reduction targets. The 2011 New Zealand (NZ) adult population (2.3 million aged 35+ years) was simulated over the remainder of their lifetime in a Markov model with a 3 % discount rate. RESULTS Achieving an overall 35 % reduction in dietary salt intake via implementation of mandatory maximum levels of sodium in packaged foods along with reduced sodium from fast foods/restaurant food and discretionary intake (the "full target"), was estimated to gain 235,000 QALYs over the lifetime of the cohort (95 % uncertainty interval [UI]: 176,000 to 298,000). For specific target components the range was from 122,000 QALYs gained (for the packaged foods target) down to the snack foods target (6100 QALYs; and representing a 34-48 % sodium reduction in such products). All ten target interventions studied were cost-saving, with the greatest costs saved for the mandatory "full target" at NZ$1260 million (US$820 million). There were relatively greater health gains per adult for men and for Māori (indigenous population). CONCLUSIONS This work provides modeling-level evidence that achieving dietary sodium reduction targets (including specific food category targets) could generate large health gains and cost savings for a national health sector. Demographic groups with the highest cardiovascular disease rates stand to gain most, assisting in reducing health inequalities between sex and ethnic groups.
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Affiliation(s)
- Nick Wilson
- Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand.
| | - Nhung Nghiem
- Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand
| | - Helen Eyles
- National Institute for Health Innovation and Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Linda J Cobiac
- British Heart Foundation Centre on Population Approaches to NCD Prevention, Oxford University, Oxford, UK
| | - Christine L Cleghorn
- Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand
| | - Tony Blakely
- Department of Public Health (BODE3 Programme), Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand
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Estimating population food and nutrient exposure: a comparison of store survey data with household panel food purchases. Br J Nutr 2016; 115:1835-42. [DOI: 10.1017/s000711451600088x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractPopulation exposure to food and nutrients can be estimated from household food purchases, but store surveys of foods and their composition are more available, less costly and might provide similar information. Our aim was to compare estimates of nutrient exposure from a store survey of packaged food with those from household panel food purchases. A cross-sectional store survey of all packaged foods for sale in two major supermarkets was undertaken in Auckland, New Zealand, between February and May 2012. Longitudinal household food purchase data (November 2011 to October 2012) were obtained from the nationally representative, population-weighted New Zealand Nielsen HomeScan® panel. Data on 8440 packaged food and non-alcoholic beverage products were collected in the store survey. Food purchase data were available for 1229 households and 16 812 products. Store survey data alone produced higher estimates of exposure to Na and sugar compared with estimates from household panel food purchases. The estimated mean difference in exposure to Na was 94 (95 % CI 72, 115) mg/100 g (20 % relative difference; P<0·01), to sugar 1·6 (95 % CI 0·8, 2·5) g/100 g (11 %; P<0·01), to SFA −0·3 (95 % CI −0·8, 0·3) g/100 g (6 %; P=0·3) and to energy −18 (−71, 35) kJ/100 g (2 %; P=0·51). Compared with household panel food purchases, store survey data provided a reasonable estimate of average population exposure to key nutrients from packaged foods. However, caution should be exercised in using such data to estimate population exposure to Na and sugar and in generalising these findings to other countries, as well as over time.
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Leroy P, Réquillart V, Soler LG, Enderli G. An assessment of the potential health impacts of food reformulation. Eur J Clin Nutr 2015; 70:694-9. [PMID: 26669572 DOI: 10.1038/ejcn.2015.201] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/31/2015] [Accepted: 09/29/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Policies focused on food quality are intended to facilitate healthy choices by consumers, even those who are not fully informed about the links between food consumption and health. The goal of this paper is to evaluate the potential impact of such a food reformulation scenario on health outcomes. SUBJECTS/METHODS We first created reformulation scenarios adapted to the French characteristics of foods. After computing the changes in the nutrient intakes of representative consumers, we determined the health effects of these changes. To do so, we used the DIETRON health assessment model, which calculates the number of deaths avoided by changes in food and nutrient intakes. RESULTS Depending on the reformulation scenario, the total impact of reformulation varies between 2408 and 3597 avoided deaths per year, which amounts to a 3.7-5.5% reduction in mortality linked to diseases considered in the DIETRON model. The impacts are much higher for men than for women and much higher for low-income categories than for high-income categories. These differences result from the differences in consumption patterns and initial disease prevalence among the various income categories. CONCLUSIONS Even without any changes in consumers' behaviors, realistic food reformulation may have significant health outcomes.
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Affiliation(s)
- P Leroy
- INRA Aliss UR 1303, Ivry sur Seine, France
| | - V Réquillart
- Toulouse School of Economics (GREMAQ-INRA), Toulouse, France
| | - L-G Soler
- INRA Aliss UR 1303, Ivry sur Seine, France
| | - G Enderli
- INRA Aliss UR 1303, Ivry sur Seine, France
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Ahuja JK, Wasswa-Kintu S, Haytowitz DB, Daniel M, Thomas R, Showell B, Nickle M, Roseland JM, Gunn J, Cogswell M, Pehrsson PR. Sodium content of popular commercially processed and restaurant foods in the United States. Prev Med Rep 2015; 2:962-7. [PMID: 26844175 PMCID: PMC4721398 DOI: 10.1016/j.pmedr.2015.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to provide baseline estimates of sodium levels in 125 popular, sodium-contributing, commercially processed and restaurant foods in the U.S., to assess future changes as manufacturers reformulate foods. METHODS In 2010-2013, we obtained ~ 5200 sample units from up to 12 locations and analyzed 1654 composites for sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar), as part of the U.S. Department of Agriculture-led sodium-monitoring program. We determined sodium content as mg/100 g, mg/serving, and mg/kcal and compared them against U.S. Food and Drug Administration's (FDA) sodium limits for "low" and "healthy" claims and to the optimal sodium level of < 1.1 mg/kcal, extrapolating from the Healthy Eating Index-2010. RESULTS Results from this study represent the baseline nutrient values to use in assessing future changes as foods are reformulated for sodium reduction. Sodium levels in over half (69 of 125) of the foods, including all main dishes and most Sentinel Foods from fast-food outlets or restaurants (29 of 33 foods), exceeded the FDA sodium limit for using the claim "healthy". Only 13 of 125 foods had sodium values below 1.1 mg/kcal. We observed a wide range of sodium content among similar food types and brands. CONCLUSIONS Current sodium levels in commercially processed and restaurant foods in the U.S. are high and variable. Targeted benchmarks and increased awareness of high sodium content and variability in foods would support reduction of sodium intakes in the U.S.
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Affiliation(s)
- Jaspreet K.C. Ahuja
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
| | - Shirley Wasswa-Kintu
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
| | - David B. Haytowitz
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
| | - Marlon Daniel
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
| | - Robin Thomas
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
| | - Bethany Showell
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
| | - Melissa Nickle
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
| | - Janet M. Roseland
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
| | - Janelle Gunn
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, 4770 Buford Highway, NE, Mailstop F-72, Atlanta, GA 30341, USA
| | - Mary Cogswell
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, 4770 Buford Highway, NE, Mailstop F-72, Atlanta, GA 30341, USA
| | - Pamela R. Pehrsson
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, Room 205 BARC-WEST, Beltsville, MD 20705, USA
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Hardy ST, Loehr LR, Butler KR, Chakladar S, Chang PP, Folsom AR, Heiss G, MacLehose RF, Matsushita K, Avery CL. Reducing the Blood Pressure-Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control. J Am Heart Assoc 2015; 4:e002276. [PMID: 26508742 PMCID: PMC4845128 DOI: 10.1161/jaha.115.002276] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions. METHODS AND RESULTS We used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population-wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987-1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of "428." A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100,000 person-years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person-years, respectively, in whites. In contrast, a 1 mm Hg population-wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person-years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population-wide and targeted interventions. CONCLUSIONS Modest population-wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.
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Affiliation(s)
- Shakia T. Hardy
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
| | - Laura R. Loehr
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
| | - Kenneth R. Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Sujatro Chakladar
- Department of BiostatisticsUniversity of North CarolinaChapel HillNC
| | - Patricia P. Chang
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
- Department of MedicineUniversity of North CarolinaChapel HillNC
| | - Aaron R. Folsom
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMSMN
| | - Gerardo Heiss
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
| | - Richard F. MacLehose
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMSMN
| | | | - Christy L. Avery
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
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Eyles H, Mhurchu CN, Gorton D, Jiang Y, Monro D. Response to a Letter to the Editor from Katherine Rich. Nutrients 2015; 7:5965-8. [PMID: 26205162 PMCID: PMC4517041 DOI: 10.3390/nu7075264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/14/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Helen Eyles
- National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
- Epidemiology and Biostatistics, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Delvina Gorton
- Heart Foundation of New Zealand, P.O. Box 17160, Greenlane, Auckland 1546, New Zealand.
| | - Yannan Jiang
- National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - David Monro
- Heart Foundation of New Zealand, P.O. Box 17160, Greenlane, Auckland 1546, New Zealand.
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Gillespie DOS, Allen K, Guzman-Castillo M, Bandosz P, Moreira P, McGill R, Anwar E, Lloyd-Williams F, Bromley H, Diggle PJ, Capewell S, O’Flaherty M. The Health Equity and Effectiveness of Policy Options to Reduce Dietary Salt Intake in England: Policy Forecast. PLoS One 2015; 10:e0127927. [PMID: 26131981 PMCID: PMC4488881 DOI: 10.1371/journal.pone.0127927] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/20/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Public health action to reduce dietary salt intake has driven substantial reductions in coronary heart disease (CHD) over the past decade, but avoidable socio-economic differentials remain. We therefore forecast how further intervention to reduce dietary salt intake might affect the overall level and inequality of CHD mortality. METHODS We considered English adults, with socio-economic circumstances (SEC) stratified by quintiles of the Index of Multiple Deprivation. We used IMPACTSEC, a validated CHD policy model, to link policy implementation to salt intake, systolic blood pressure and CHD mortality. We forecast the effects of mandatory and voluntary product reformulation, nutrition labelling and social marketing (e.g., health promotion, education). To inform our forecasts, we elicited experts' predictions on further policy implementation up to 2020. We then modelled the effects on CHD mortality up to 2025 and simultaneously assessed the socio-economic differentials of effect. RESULTS Mandatory reformulation might prevent or postpone 4,500 (2,900-6,100) CHD deaths in total, with the effect greater by 500 (300-700) deaths or 85% in the most deprived than in the most affluent. Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200-5,000) CHD deaths in total, with the effect greater by 100 (-100-600) deaths or 49% in the most deprived than in the most affluent. Further social marketing and improvements to labelling might each prevent or postpone 400-500 CHD deaths, but minimally affect inequality. CONCLUSIONS Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option. For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction. We therefore encourage planners to prioritise equity.
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Affiliation(s)
- Duncan O. S. Gillespie
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Kirk Allen
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, United Kingdom
| | - Maria Guzman-Castillo
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Patricia Moreira
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Rory McGill
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Helen Bromley
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Peter J. Diggle
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, United Kingdom
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
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Sodium intake and its reduction by food reformulation in the European Union — A review. NFS JOURNAL 2015. [DOI: 10.1016/j.nfs.2015.03.001] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Monro D, Mhurchu CN, Jiang Y, Gorton D, Eyles H. Changes in the sodium content of New Zealand processed foods: 2003-2013. Nutrients 2015; 7:4054-67. [PMID: 26024294 PMCID: PMC4488772 DOI: 10.3390/nu7064054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/12/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022] Open
Abstract
Decreasing population sodium intake has been identified as a “best buy” for reducing non-communicable disease. The aim of this study was to explore 10-year changes in the sodium content of New Zealand processed foods. Nutrient data for nine key food groups were collected in supermarkets in 2003 (n = 323) and 2013 (n = 885). Mean (SD) and median (min, max) sodium content were calculated by food group, year and label type (private/branded). Paired t-tests explored changes in sodium content for all products available for sale in both years (matched; n = 182). The mean (SD) sodium content of all foods was 436 (263) mg (100 g)−1 in 2003 and 433 (304) mg (100 g)−1 in 2013, with no significant difference in matched products over time (mean (SD) difference, −56 (122) mg (100 g)−1, 12%; p = 0.22). The largest percentage reductions in sodium (for matched products) were observed for Breakfast Cereals (28%; −123 (125) mg (100 g)−1), Canned Spaghetti (15%; −76 (111) mg (100 g)−1) and Bread (14%; −68 (69) mg (100 g)−1). The reduction in sodium was greater for matched private vs. branded foods (−69 vs. −50 mg (100 g)−1, both p < 0.001). There has been modest progress with sodium reduction in some New Zealand food categories over the past 10 years. A renewed focus across the whole food supply is needed if New Zealand is to meet its global commitment to reducing population sodium intake.
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Affiliation(s)
- David Monro
- Heart Foundation of New Zealand, PO Box 17160, Greenlane, Auckand 1546, New Zealand.
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Yannan Jiang
- National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Delvina Gorton
- Heart Foundation of New Zealand, PO Box 17160, Greenlane, Auckand 1546, New Zealand.
| | - Helen Eyles
- National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
- Epidemiology and Biostatistics, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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Korošec Ž, Pravst I. Assessing the average sodium content of prepacked foods with nutrition declarations: the importance of sales data. Nutrients 2014; 6:3501-15. [PMID: 25192028 PMCID: PMC4179173 DOI: 10.3390/nu6093501] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/18/2014] [Accepted: 08/22/2014] [Indexed: 11/16/2022] Open
Abstract
Processed foods are recognized as a major contributor to high dietary sodium intake, associated with increased risk of cardiovascular disease. Different public health actions are being introduced to reduce sodium content in processed foods and sodium intake in general. A gradual reduction of sodium content in processed foods was proposed in Slovenia, but monitoring sodium content in the food supply is essential to evaluate the progress. Our primary objective was to test a new approach for assessing the sales-weighted average sodium content of prepacked foods on the market. We show that a combination of 12-month food sales data provided by food retailers covering the majority of the national market and a comprehensive food composition database compiled using food labelling data represent a robust and cost-effective approach to assessing the sales-weighted average sodium content of prepacked foods. Food categories with the highest sodium content were processed meats (particularly dry cured meat), ready meals (especially frozen pizza) and cheese. The reported results show that in most investigated food categories, market leaders in the Slovenian market have lower sodium contents than the category average. The proposed method represents an excellent tool for monitoring sodium content in the food supply.
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Affiliation(s)
- Živa Korošec
- Nutrition Institute, Tržaška cesta 40, Ljubljana 1000, Slovenia.
| | - Igor Pravst
- Nutrition Institute, Tržaška cesta 40, Ljubljana 1000, Slovenia.
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Gray KL, Petersen KS, Clifton PM, Keogh JB. Attitudes and beliefs of health risks associated with sodium intake in diabetes. Appetite 2014; 83:97-103. [PMID: 25128832 DOI: 10.1016/j.appet.2014.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/31/2014] [Accepted: 08/04/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite good evidence that reducing sodium intake can reduce blood pressure (BP), salt intake in people with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) remains high. The purpose of this study was to describe the knowledge and beliefs of health risks associated with a high salt diet in adults with diabetes. METHODS Men and women with T1DM (n = 27; age 38 ± 16 years) or T2DM (n = 124; age 60 ± 11 years) were recruited. RESULTS Nine (6.0%) respondents knew the correct maximum daily recommended upper limit for salt intake. Thirty-six (23.9%) participants were not concerned with the amount of salt in their diet. Most participants knew that a diet high in salt was related to high BP (88.1%) and stroke (78.1%) and that foods such as pizza (80.8%) and bacon (84.8%) were high in salt. Fewer than 30% of people knew that foods such as white bread, cheese and breakfast cereals are high in salt (white bread 28.5%, cheese 29.1%, breakfast cereals 19.9%) and 51.0% correctly ranked three different nutrition information panels based on the sodium content. Label reading and purchase of low salt products was used by 60-80% of the group. Estimated average 24 hour urinary sodium excretion was 169 ± 32 mmol/24 h in men and 115 ± 27 mmol/24 h in women. CONCLUSION Label reading and purchase of low salt products was used by the majority of the group but their salt excretion was still high. Men who used label reading had a lower salt intake. Other strategies to promote a lower sodium intake such as reducing sodium in staple foods such as bread need investigation.
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Affiliation(s)
- Kristy L Gray
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
| | - Kristina S Petersen
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
| | - Peter M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
| | - Jennifer B Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Australia.
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