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Pulker CE, Aberle LM, Butcher LM, Whitton C, Law KK, Large AL, Pollard CM, Trapp GSA. Development of the Menu Assessment Scoring Tool (MAST) to Assess the Nutritional Quality of Food Service Menus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3998. [PMID: 36901008 PMCID: PMC10001456 DOI: 10.3390/ijerph20053998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Preventing the rise in obesity is a global public health priority. Neighbourhood environments can help or undermine people's efforts to manage their weight, depending on availability of nutritious and nutrient-poor 'discretionary' foods. The proportion of household food budgets spent on eating outside the home is increasing. To inform nutrition policy at a local level, an objective assessment of the nutritional quality of foods and beverages on food service menus that is context-specific is needed. This study describes the development and piloting of the Menu Assessment Scoring Tool (MAST), used to assess the nutritional quality of food service menus in Australia. The MAST is a desk-based tool designed to objectively assess availability of nutrient-poor and absence of nutritious food and beverages on food service menus. A risk assessment approach was applied, using the best available evidence in an iterative way. MAST scores for 30 food service outlets in one Local Government Authority in Perth, Western Australia highlight opportunities for improvements. MAST is the first tool of its kind in Australia to assess the nutritional quality of food service menus. It was practical and feasible to use by public health nutritionists/dietitians and can be adapted to suit other settings or countries.
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Affiliation(s)
- Claire Elizabeth Pulker
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | | | - Lucy Meredith Butcher
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Clare Whitton
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Kristy Karying Law
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
- The George Institute for Global Health, Sydney, NSW 2042, Australia
| | - Amy Louise Large
- East Metropolitan Health Service, Kirkman House, Perth, WA 6000, Australia
| | - Christina Mary Pollard
- School of Population Health, Curtin University, Perth, WA 6845, Australia
- Enable Institute, Curtin University, Perth, WA 6845, Australia
| | - Georgina S. A. Trapp
- Telethon Kids Institute, Nedlands, WA 6009, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia
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Gislaine GM, Montserrat VR, Carrasco JA, Sáez KC, Bibiloni MDM, Tur JA. Adaption and reliability of the Nutrition Environment Measures for stores (NEMS-S) instrument for use in urban areas of Chile. BMC Public Health 2022; 22:224. [PMID: 35114954 PMCID: PMC8815185 DOI: 10.1186/s12889-022-12651-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To adapt and assess reliability of the Chilean version of Nutritional Environment Measurement for Stores (NEMS-S-CHILE) to measure the food environment of stores in urban areas. Design NEMS-S-CHILE was the NEMS-S tool adapted to the Chilean food patterns; foods were grouped according to level of processing in (a) unprocessed or minimally processed foods, (b) processed culinary ingredients, (c) processed foods, and (d) ultra-processed foods, and scored according to NEMS-S-CHILE tool. Reliability inter evaluators was measured. Setting City of Concepción, Bio-Bio region, Chile. Participants Seventeen of a total of 25 supermarkets, and 9 out of 10 street markets according to the municipal registry and the street market trade unions, representing 74.3% of both types of food premises in Concepción. Results Reliability inter evaluators was measured by the following aspects: product availability, price, quality, and variety, through the intraclass correlation coefficient (ICC), percent agreement, and Cohen’s kappa analysis. Reliability was high for availability, where the kappa index and ICC were acceptable, ranging from moderate to high (0.42 to 1.00 for the kappa coefficient and 0.65 to 1.00 for ICC), as well as for prices (ICC: 0.65-1.00 ), variety (kappa: 0.76-1.00) and quality (percent agreement: 68.2- 100%). Conclusions The adapted instrument, NEMS-S-CHILE, has a high reliability inter evaluators and can be useful to measure the availability of foods by the level of processing according to the prevalent food system in developing countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12651-w.
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Affiliation(s)
- Granfeldt M Gislaine
- Department of Nutrition and Dietetics, Faculty of Pharmacy, University of Concepción, Concepción, Chile
| | - Victoriano R Montserrat
- Department of Nutrition and Dietetics, Faculty of Pharmacy, University of Concepción, Concepción, Chile
| | - Juan Antonio Carrasco
- Department of Civil Engineering, Faculty of Engineering, University of Concepción, Concepción, Chile
| | - Katia C Sáez
- Faculty of Physical Sciences and Mathematics, Department of Statistics, University of Concepción, Concepción, Chile
| | - Maria Del Mar Bibiloni
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, E-07122, Palma de Mallorca, Spain.,Institute of Health Carlos III, CIBEROBN (Physiopathology of Obesity and Nutrition, CB12/03/30038), E-28029, Madrid, Spain.,Health Research Institute of the Balearic Islands (IDISBA), E-07120, Palma de Mallorca, Spain
| | - Josep A Tur
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, E-07122, Palma de Mallorca, Spain. .,Institute of Health Carlos III, CIBEROBN (Physiopathology of Obesity and Nutrition, CB12/03/30038), E-28029, Madrid, Spain. .,Health Research Institute of the Balearic Islands (IDISBA), E-07120, Palma de Mallorca, Spain. .,Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands, IDISBA & CIBEROBN, Guillem Colom Bldg, Campus, E-07122, Palma de Mallorca, Spain.
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Tavares LF, Perez PMP, dos Passos MEA, de Castro Junior PCP, da Silva Franco A, de Oliveira Cardoso L, de Castro IRR. Development and Application of Healthiness Indicators for Commercial Establishments That Sell Foods for Immediate Consumption. Foods 2021; 10:1434. [PMID: 34205645 PMCID: PMC8235135 DOI: 10.3390/foods10061434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022] Open
Abstract
Studies of food environments lack easy-to-apply indicators for their characterization and monitoring. This study aimed to create and assess the applicability of an a priori classification of establishments that sell foods for immediate consumption and to develop and apply indicators for assessment of the establishments' healthiness. The indicators were grouped by the types of foods sold most frequently at these establishments, according to the extent and purpose of the foods' industrial processing. Four indicators were developed, based on the availability of unprocessed/minimally processed foods (MPF) and ultra-processed foods (UPF) in the establishments. The classification and indicators were applied to commercial food establishments at two Brazilian universities. Descriptive analyses were performed to characterize the food environment for all the establishments and by university. Two proportion indicators assess the relative availability of subgroups of MPF and UPF. The UPF/MPF ratio expresses the relative advantage/disadvantage of the availability of MPF compared to that of UPF. The Healthiness Index or summary score expresses the availability of MPF and the unavailability of UPF. The classification and indicators present good discriminatory power and are easy to operationalize, interpret, and adapt.
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Affiliation(s)
- Letícia Ferreira Tavares
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.F.T.); (M.E.A.d.P.); (P.C.P.d.C.J.)
| | - Patrícia Maria Périco Perez
- Institute of Nutrition, State University of Rio de Janeiro, Rio de Janeiro 20559-900, Brazil; (P.M.P.P.); (I.R.R.d.C.)
| | - Maria Eliza Assis dos Passos
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.F.T.); (M.E.A.d.P.); (P.C.P.d.C.J.)
| | - Paulo Cesar Pereira de Castro Junior
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.F.T.); (M.E.A.d.P.); (P.C.P.d.C.J.)
| | - Amanda da Silva Franco
- Nutrition Coordination, Health Sciences Center, Centro Universitário Serra dos Órgãos (UNIFESO), Rio de Janeiro 25964-000, Brazil;
| | | | - Inês Rugani Ribeiro de Castro
- Institute of Nutrition, State University of Rio de Janeiro, Rio de Janeiro 20559-900, Brazil; (P.M.P.P.); (I.R.R.d.C.)
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Pulker CE, Trapp GSA, Fallows M, Hooper P, McKee H, Pollard CM. Food Outlets Dietary Risk (FODR) assessment tool: study protocol for assessing the public health nutrition risks of community food environments. Nutr J 2020; 19:122. [PMID: 33183279 PMCID: PMC7663896 DOI: 10.1186/s12937-020-00641-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/02/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Availability and accessibility of nutritious foods can vary according to the food outlets present within a neighbourhood or community. There is increasing evidence that community food environments influence food choice, diet and the risk of diet-related chronic disease, however contemporary community food environments assessments (e.g. unhealthy fast food outlets versus healthy supermarkets or fruit and vegetable shops) may be too simplistic to accurately summarise the complexities of their impacts on food choice. This study protocol describes the development of the Food Outlets Dietary Risk (FODR) assessment tool for use by local government in Perth, Western Australia. METHODS Similar to food safety risk assessment, the FODR assessment tool rates the potential harmful public health nutrition impact of food outlets by identifying and characterising the issues, and assessing the risk of exposure. Scores are attributed to six public health nutrition attributes: 1) availability of nutrient-poor foods; 2) availability of nutritious foods; 3) acceptability and appeal; 4) accessibility; 5) type of business operation; and 6) complex food outlet considerations. Food retail outlets are then classified as having a low, medium, high or very high dietary risk based on their total score. DISCUSSION A local government administered tool to rate the public health nutrition risk of food outlets requires data which can be collected during routine assessments or sourced from the internet. The ongoing categorical classification of foods available within food outlets as either unhealthy or nutritious will require nutrition scientists' input. An objective risk assessment of the dietary impact of food retail outlets can guide local government planning, policies and interventions to create supportive community food environments. It is intended that locally relevant data can be sourced throughout Australia and in other countries to apply the local context to the FODR assessment tool. Utility and acceptability of the tool will be tested, and consultation with environmental health officers and public health practitioners will inform future iterations.
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Affiliation(s)
- Claire Elizabeth Pulker
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth, Western Australia 6845 Australia
- East Metropolitan Health Service, Kirkman House, 20 Murray Street, East Perth, Perth, Western Australia 6004 Australia
| | - Georgina S. A. Trapp
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia 6872 Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009 Australia
| | - Mark Fallows
- Department of Health of Western Australia, Perth, Western Australia 6004 Australia
| | - Paula Hooper
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009 Australia
| | - Heather McKee
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia 6872 Australia
| | - Christina Mary Pollard
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth, Western Australia 6845 Australia
- East Metropolitan Health Service, Kirkman House, 20 Murray Street, East Perth, Perth, Western Australia 6004 Australia
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Martínez-García A, Díez J, Fernández-Escobar C, Trescastro-López EM, Pereyra-Zamora P, Ariza C, Bilal U, Franco M. Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7031. [PMID: 32992984 PMCID: PMC7579010 DOI: 10.3390/ijerph17197031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool's ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability.
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Affiliation(s)
- Alba Martínez-García
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Universidad de Alicante, 03690 Alicante, Spain; (A.M.-G.); (E.M.T.-L.); (P.P.-Z.)
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (C.F.-E.); (U.B.); (M.F.)
| | - Carlos Fernández-Escobar
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (C.F.-E.); (U.B.); (M.F.)
- National School of Public Health, Carlos III Health Institute, 28029 Madrid, Spain
| | - Eva María Trescastro-López
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Universidad de Alicante, 03690 Alicante, Spain; (A.M.-G.); (E.M.T.-L.); (P.P.-Z.)
| | - Pamela Pereyra-Zamora
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Universidad de Alicante, 03690 Alicante, Spain; (A.M.-G.); (E.M.T.-L.); (P.P.-Z.)
| | - Carles Ariza
- Agència de Salut Pública de Barcelona (Public Health Agency Barcelona), 08023 Barcelona, Spain;
- Ciber de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Usama Bilal
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (C.F.-E.); (U.B.); (M.F.)
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA 19104, USA
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (C.F.-E.); (U.B.); (M.F.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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