Comparison between household food purchase and individual food consumption in Brazil

Evolution of household availability of added sugars and their sources in Brazil: analysis of Household Budget Surveys from 2002 to 2017

The objective of this study was to describe the evolution of household purchase of added sugars and their main food sources in Brazil. Nationally representative data from the Household Budget Surveys from 2002-2003, 2008-2009 and 2017-2018 were used. Energy and added sugar quantities were estimated by means of per capita food quantities. The items considered as food sources were: (1) table sugar: refined sugar and other energetic sweeteners and (2) processed and ultra-processed foods with added sugar: soft drinks; other drinks; sweets, candies and chocolates; cookies; cakes and pies and other foods. The parameters estimated were: mean share of added sugar in total energy and, for food sources, the share of added sugar in total sugar intake and the impact of variations in sources of added sugar between 2008 and 2017. There was a regular share of energy from added sugar to total energy intake between 2002 and 2008 but a reduced share in 2017. Between 2008 and 2017, there was a decrease in the share of refined sugar and other sweeteners and soft drinks to total sugar intake and an increased share of all other items. High-income households had a lower share of refined sugar and other energetic sweeteners, but a higher share of soft drinks, sweets, candies and chocolates. The decrease in added sugar in 2017 was mainly due to the lower share of soft drinks. In conclusion, Brazilians' total intake of added sugar was decreased, mostly owing to reduced consumption of sugar from soft drinks.

Trends (2014-2018) in the healthiness of packaged food purchases of Australian consumers before and after the introduction of voluntary Health Star Rating nutrition labels

OBJECTIVE

To evaluate the trends in the healthiness of packaged food purchases of Australian consumers before and after the introduction of the Health Star Rating (HSR) nutrition labels.

DESIGN

Panel data analysis and difference-in-differences analysis.

SETTING

The Australian Government endorsed HSR nutrition labels for voluntary implementation on packaged foods in June 2014. We analyse the packaged food purchases of households across all major supermarkets before (January 2014 to June 2014) and after (June 2014-Dec 2018) the introduction of HSR.

PARTICIPANTS

6284 members of a panel of households across Australia reporting their grocery purchases to a market research company (Nielsen Homescan panel).

RESULTS

The healthiness of household food purchases exhibited a U-shaped trend - decreasing from 2014 to 2017, and then increasing from 2018, corresponding to the time when a higher proportion of products were HSR-labelled. Households that purchased a higher proportion of HSR-labelled products had healthier household purchases overall. Further, the healthiness of households' category-specific food purchases was positively associated with the proportion of HSR-labelled products in categories where HSR was adopted, relative to control categories where HSR was not adopted.

CONCLUSIONS

In Australia, once a substantial number of packaged food products adopted the voluntary HSR summary indicator, we observed an increasing trend in the healthiness of household food purchases. Widespread adoption of a nutrition summary indicator, such as HSR, on packaged food is likely to be beneficial for population health.

Sodium intake according to NOVA food classification in Brazil: trends from 2002 to 2018

Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the Brazilian Household Budgets Survey of 2002-2003, 2008-2009, and 2017-2018 were converted into nutrients using food composition tables and the mean availability was estimated per 2,000kcal/day. Mean daily sodium available for consumption in Brazilian households has increased from 3.9 to 4.7g per 2,000kcal, from 2002-2003 to 2017-2018, over twice the recommended levels of sodium intake. From 2002-2003 to 2017-2018, the processed culinary ingredients, including table salt, represented the largest dietary source of sodium, although their participation in dietary sodium was reduced by 17% (66.6% to 55%), while the percentage of dietary sodium from processed foods increased by 20.3% and from ultra-processed foods increased by 47.6% (11.3% to 13.6% and 17% to 25.1%, respectively). In conclusion, the total household sodium availability remains high and has increased over time in Brazil, yet the participation of different dietary sources of sodium have gradually changed.

Impact of aging on food consumption in rural China: Implications for dietary upgrading and health improvement

Background

The issue of population aging in rural China is getting profound; nevertheless, its impact on food consumption has not been well evaluated. This study aims to examine the relationship between rural aging and family food consumption in rural China.

Materials and methods

Using the statistical yearbook data and the nationally representative household-level data from the China Rural Fixed Observation Points, this study compares the evolution of food consumption between rural and urban residents from 1985 to 2020 and analyzes the structure of food consumption expenditure of rural residents. Next, this study further investigates the impact of aging on food consumption in rural households with ordinary least squares.

Results

(1) The principal foods consumed by rural residents in 2020 are meat and meat products (36.8%), grain (24.5%), and vegetables (10.9%). (2) An increase in older adults has decreased the absolute consumption of all foods, while it increased relative consumption of meat and meat products, aquatic products, edible oil and fats, poultry, eggs, and sugar. (3) Due to differences in the structure of young adults' food consumption, older adults would increase their consumption of fruits and vegetables if they lived with younger adults.

Conclusion

The findings of this study suggest that rural older adults may increase their consumption of fruits and vegetables by advocating intergenerational cohabitation while maintaining their intake of protein to achieve a balanced dietary structure and improve their health condition.

Do we eat what we buy? Relative validity of grocery purchase data as an indicator of food consumption in the LoCard study

The validity of grocery purchase data as an indicator of food consumption is uncertain. This paper investigated (1) the associations between food consumption and grocery purchases using automatically accumulated purchase data and (2) whether the strength of the associations differed in certain sub-populations. The participants filled in a FFQ, and a major Finnish retailer issued us with their loyalty-card holders' grocery purchase data covering the 1- and 12-month periods preceding the FFQ. We used gamma statistics to study the association between thirds/quarters of FFQ and grocery purchase data (frequency/amount) separately for eighteen food groups among the 11 983 participants. Stratified analyses were conducted for subgroups based on sex, family structure, educational level, household income and self-estimated share of purchases from the retailer. We also examined the proportion of participants classified into the same, adjacent, subsequent and opposite categories using the FFQ and purchase data. The gammas ranged from 0·12 (cooked vegetables) to 0·75 (margarines). Single households had stronger gammas than two-adult families, and participants with > 60 % of purchases from the retailer had stronger gammas. For most food groups, the proportion of participants classified into the same or adjacent category was > 70 %. Most discrepancies were observed for fresh/cooked vegetables, berries and vegetable oils. Even though the two methods did not categorise all food groups similarly, we conclude that grocery purchase data are able to describe food consumption in an adult population, and future studies should consider purchase data as a resource-saving and moderately valid measure in large samples.

Inequalities in food acquisition according to the social profiles of the head of households in Brazil

Abstract Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family.

Update on Analytical Methods and Research Gaps in the Use of Household Consumption and Expenditure Survey Data to Inform the Design of Food-Fortification Programs

The lack of nationally representative, individual-level dietary intake data has led researchers to increasingly turn to household-level data on food acquisitions and/or consumption to inform the design of food-fortification programs in low- and middle-income countries (LMICs). These nationally representative, household-level data come from household consumption and expenditure surveys (HCESs), which are collected regularly in many LMICs and are often made publicly available. Our objectives were to examine the utility of HCES data to inform the design of food-fortification programs and to identify best-practice methods for analyzing HCES data for this purpose. To this end, we summarized information needed to design fortification programs and assessed the extent to which HCES data can provide corresponding indicators. We concluded that HCES data are well suited to guide the selection of appropriate food vehicles, but because individual-level estimates of apparent nutrient intakes rely on assumptions about the intrahousehold distribution of food, more caution is advised when using HCES data to select the target micronutrient content of fortified foods. We also developed a checklist to guide analysts through the use of HCES data and, where possible, identified research-based, best-practice analytical methods for analyzing HCES data, including selecting the number of days of recall data to include in the analysis and converting reported units to standard units. More research is needed on how best to deal with composite foods, foods consumed away from home, and extreme values, as well as the best methods for assessing the adequacy of apparent intakes. Ultimately, we recommend sensitivity analyses around key model parameters, and the continual triangulation of HCES-based results with other national and subnational data on food availability, dietary intake, and nutritional status when designing food-fortification programs.

Food consumption markers and associated factors in Brazil: distribution and evolution, Brazilian National Health Survey, 2013 and 2019

This study objective was to describe the distribution of food consumption markers in Brazil per sociodemographic characteristics and its evolution from 2013 to 2019. Healthy food consumption markers (regular consumption of beans, fruits, vegetables, and fish, recommended consumption of red meat, and never replacing meals with snacks) and unhealthy food consumption markers (regular consumption of sweetened beverages and confectionery and excessive salt intake) were studied for adult participants of the Brazilian National Health Survey. The prevalence of food consumption markers was estimated according to sociodemographic characteristics and compared to data of 2013 and 2019. Most of the population regularly consumes beans, fruits, and vegetables, they also follows the recommendation to limit red meat consumption, and never replaces meals with snacks. The percentage of people who regularly consume sweetened beverages and perceive their salt intake as excessive is relatively low. The distribution of food consumption markers was associated with sex, age, income, race/skin color, area of dwelling, and schooling level. From 2013 to 2019, the prevalence of most food consumption markers declined, except for the regular consumption of fruits and recommended consumption of red meat, that increased 8.5% and 18.5%, respectively, and the regular consumption of vegetables, which did not vary. Healthy and unhealthy food consumption markers should be monitored to evaluate the effect of healthy eating policies implemented in the country.

Comparing estimated cost-effectiveness of micronutrient intervention programs using primary and secondary data: evidence from Cameroon

Designing a cost-effective portfolio of micronutrient intervention programs is complex and generally undertaken with limited data. We developed the MINIMOD-Secondary Data (MINIMOD-SD) tool, which uses household consumption and expenditure survey data and other secondary data to estimate apparent nutrient intakes and model the effectiveness and cost-effectiveness of micronutrient intervention programs. We present the SD tool methodology and results in the context of Cameroon, with a particular focus on vitamin A (VA) for children and folate for women of reproductive age (WRA). We compared the MINIMOD-SD tool estimates with those of the full MINIMOD tool, which uses 24-h dietary recall data. The SD tool consistently underestimated folate intake among women (median (IQR): 230 (143,352) versus 303 (244,367) μg dietary folate equivalents (DFEs)/day) and especially VA among children (141 (64,279) versus 227 (102,369)). Qualitatively, however, the two tools were generally consistent in predicted subnational patterns of micronutrient adequacy and identification of effective and cost-effective (cost per child/WRA moving from inadequate to adequate intake) interventions. Secondary data and the MINIMOD-SD tool can provide policymakers with information to qualitatively assess deficiency risks and identify cost-effective interventions. However, accurately quantifying individual-level deficiency or dietary inadequacy and intervention effectiveness and cost-effectiveness will likely require individual-level dietary data and biomarker measurements.

Reducing ultra-processed foods and increasing diet quality in affordable and culturally acceptable diets: a study case from Brazil using linear programming

The aim was to design culturally acceptable and healthy diets with reduced energetic share of ultra-processed foods (UPF%) at no cost increment and to evaluate the impact of the change in the UPF% on diet quality. Food consumption and price data were obtained from the Household Budget Survey (n 55 970 households) and National Dietary Survey (n 32 749 individuals). Linear programming models were performed to design diets in which the mean population UPF% was reduced up to 5 % with no cost increment relative to the observed costs. The models were isoenergetic or allowed the energy content to vary according to the UPF%, and they were not constrained to nutritional goals (nutrient-free models) or maximised the compliance with dietary recommendations (nutrient-constrained models). Constraints regarding food preference were introduced in the models to obtain culturally acceptable diets. The mean population UPF% was 23·8 %. The lowest UPF% attained was approximately 10 %. The optimised diet cost was up to 20 % cheaper than the observed cost, depending on the model and the income level. In the optimised diets, the reduction in the UPF% was followed by an increase in fruits, vegetables, beans, tubers, dairy products, nuts, fibre, K, Mg, vitamin A and vitamin C in the nutrient-constrained models, compared with the observed consumption in the population. There was little variation in most nutrients across the UPF% reduction. The UPF% reduction in the nutrient-free models impacted only trans-fat and added sugar content. UPF% reduction and increase in diet quality are possible at no cost increment.

Household availability of dietary fats and cardiovascular disease and mortality: prospective evidence from Russia

Background

The aim of this analysis was to examine the prospective association between household availability of lard, butter, margarine and vegetable oil with all-cause mortality and cardiovascular disease (CVD) incidence in a general population sample in Russia.

Methods

Data from the Russian Longitudinal Monitoring Survey were used. 6618 adult individuals with no previous CVD who were recruited for the study in 1994 and followed-up in subsequent years were included in the analysis. Household availability of lard, butter, margarine and vegetable oil were assessed at baseline with questions on whether these food items were purchased by the participants’ family. Self-reported information on heart attack or stroke (CVD) and death reported by another household member were used as outcome.

Results

Over the median follow-up of 11 years, 1787 participants died or reported incident CVD. In the multivariable adjusted survival models, household availability of lard was significantly associated with the combined outcome of CVD incidence and/or death (OR in the high vs. no availability categories: 1.31; 95% CI: 1.05–1.62). The associations with butter (1.06; 0.93–1.20), margarine (1.18; 0.94–1.47) and vegetable oil (0.92; 0.80–1.06) were not statistically significant. When self-reported CVD and mortality were examined separately, the association regarding lard was particularly strong for CVD (1.52; 1.11–2.09).

Conclusion

Our results suggest that lard, a dietary fat of animal origin traditionally used in Eastern European cooking, is of a particular concern regarding CVD risk. Replacing it with plant-based oils in cooking practices is strongly recommended.

The cost of eating more sustainable diets: A nutritional and environmental diet optimisation study

We aim to identify the dietary changes to improve nutrition and reduce diet-related greenhouse gas emission (GHGE) simultaneously in Brazil, taking into account the heterogeneity in food habits and prices across the country. Food consumption and prices were obtained from two nationwide surveys (n = 55,970 households and 34,003 individuals). Linear programming models were performed to design optimised diets most resembling the observed diets, and meeting different sets of constraints: (i) nutritional, for preventing chronic diseases and meeting nutrient adequacy; (ii) socio-cultural: by respecting food preferences; and (iii) environmental: by reducing GHGE by steps of 10%. Moving toward a diet that meets nutritional recommendations led to a 14% to 24% cost increase and 10% to 27% GHGE reduction, depending on the stringency of the acceptability constraints. Stronger GHGE reductions were achievable (up to about 70%), with greater departure from the current diet, but not achieving calcium and potassium goals. Diet cost increment tended to be mitigated with GHGE reduction in most models, along with reductions in red meat, chicken, eggs, rice, and high-fat sugar sodium foods.

Reaching culturally acceptable and adequate diets at the lowest cost increment according to income level in Brazilian households

OBJECTIVE

To identify food choices allowing the fulfillment of nutritionally adequate diets resembling actual food patterns at the lowest cost achievable for the Brazilian population, stratified by income level.

METHODS

Food consumption and prices were obtained from the Household Budget Survey (n = 55,970 households) and National Dietary Survey (n = 32,749 individuals). The sample was stratified into capitals of the states and further by income levels according to the official minimum wage (totaling 108 geographic-economic strata, or GES). Linear programming models were performed for each GES in order to find the lowest cost of diets that meet a set of nutritional constraints. In order to find realistic diets, constraints referring to preferences were introduced in the models allowing optimized food quantities to depart progressively from the current intake for each food and food group. The impact of meeting each target nutrient was assessed by performing models removing each nutrient at the time.

RESULTS

The observed and optimized diet costs were US$2.16 and US$2.58 per capita/day. The highest cost increment and the greatest food shifts were observed in the lowest income level. The nutrient adequacy was reached by mainly increasing fruits and vegetables, beans, fish and seafood, dairy, nuts, and eggs; and reducing red and processed meat, chicken, margarine and butter, cookies, cakes, sugar-sweetened beverages, and sauces. As the departure from the current intakes increase, the optimized healthy diet cost reduced. In the lowest income, the lowest cost increment was about US$ 0.10; in the higher income levels, it tended to be cheaper than the observed cost. Calcium was the most expensive nutrient to meet adequacy.

CONCLUSION

Nutritionally adequate diets are possible but costlier than the observed.

Planning dietary improvements without additional costs for low-income individuals in Brazil: linear programming optimization as a tool for public policy in nutrition and health

BACKGROUND

Meeting nutrient intake recommendations may demand substantial modifications in dietary patterns, and may increase diet cost. Incentives for modifying one's dietary intake that disregard prices are unlikely to be effective in the general population, especially among low-income strata, due to the high percentage of income committed to food purchases. The aim of this study is to evaluate how much the nutrient content can be increased through a modeled diet, without any cost increase, for low-income Brazilian households.

METHODS

Low-income households were selected from the Household Budget Survey (24,688 households) and National Dietary Survey (6,032 households, 16,962 individuals), from where we obtained food prices and consumption data. Food quantities were modeled using linear programming to find diets that meet nutritional recommendations in two sets of models: cost-constrained (the cost should not be higher than the observed diet cost) and cost-free. Minimum and maximum amounts of each food in the modelled diets were allowed at three levels of food acceptability: rigorous (least deviance from the current observed diets), moderate, and flexible (higher deviance from the current observed diets).

RESULTS

We found no feasible solution that would accommodate all the nutritional targets. The most frequent limiting nutrients were calcium; vitamins D, E, and A; zinc; fiber; sodium; and saturated and trans-fats. However, increases in nutrient contents were observed, especially for fiber, calcium, copper, magnesium, vitamin A, vitamin C, and vitamin E. In general, the best achievement was obtained with cost-free models. Fruits and beans increased in all models; large increase in whole cereals was observed only in the flexible models; large increase in vegetables was observed only in the cost-free models; and fish increased only in the cost-free models. Reductions were observed for rice, red and processed meats, sugar-sweetened beverages, and sweets. The mean observed cost was US$2.16 per person/day. The mean cost in the cost-free models was US$2.90 (moderate), US$2.70 (rigorous), and US$2.60 (flexible).

CONCLUSION

The complete nutritional adequacy is unattainable, although feasible changes would substantially improve diet quality by improving nutrient content without additional costs.