Food science challenge: translating the dietary guidelines for Americans to bring about real behavior change

What should I eat today? Evidence, guidelines, dietary patterns and consumer's behavior

Over the past century, dietary recommendations emphasizing food patterns as means to deliver essential nutrients have garnered widespread acceptance. The necessity for foods supplying vital nutrients and energy throughout various life stages requires the involvement of local resources and cultural practices to prevent nutrient deficiency diseases. Since the 1980s, dietary guidelines aimed at adverting chronic diseases have relied on epidemiological research to predict which dietary patterns correlate with reduced risk of chronic disease or links to health outcomes. Dietary guidelines have been broad, typically recommending avoiding excess or deficiency of single nutrients. Efforts to fine-tune these recommendations face challenges due to a scarcity of robust scientific data supporting more specific guidance across the life cycle. Consumers have become skeptical of dietary guidelines, because media coverage of new studies is often in conflict with accepted nutrition dogma. Indications to align individual and planet's health have been issued supporting the concept of sustainable dietary patterns. Whether we really have a science-based databank to support dietary guidelines is still a matter of ongoing debate, as presented in this paper.

Dynamic Changes in Dietary Guideline Adherence and Its Association with All-Cause Mortality among Middle-Aged Chinese: A Longitudinal Study from the China Health and Nutrition Survey

The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a "Dietary Non-Adherence Score (DNAS)" to assess the degree of similarity between subjects' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into mortality prediction. This study investigated the association between long-term changes in adherence to the CDG and all-cause mortality. This study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the food groups as DNAS. Mortality was assessed in 2015. Latent class trajectory modeling was used to identify three classes of participants with distinct longitudinal trajectories of DNAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the three classes of people. Risk factors for death and confounders for diets were sequentially adjusted in the models. There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DNAS levels (coefficient = -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DNAS levels (coefficient = 0.008). Those with moderate DNAS had an HR of 3.0 (95% CI: 1.1, 8.4). In summary, we find that people with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DNAS is a promising method to assess diet quality.

Considerations for the translation of nutrient recommendations as dietary plans for infants, children, and adolescents as reported in Italian Guidelines for healthy eating

Healthy eating in childhood and adolescence is important for proper growth and development and to establish a healthy foundation for future dietary habits. This paper aims to describe the elaboration of dietary plans for pediatric ages highlighting critical points related to the application of the Italian nutrient recommendations. National databases on food composition data were used to compile the dietary plans. Starting from the definition of serving size for adults, the suggested portion size for pediatric ages was shaped to produce appropriate dietary plans according to the different classes of age. Items from “cereals and derivatives,” “milk,” “fruit,” “vegetables,” “olive oil,” and “water” groups were included daily. Pizza was included once a week. Sweets and snacks were gradually introduced, once a week in infants and up to five times a week in adolescents. Legumes were provided three times a week, as a source of vegetable and sustainable proteins. The main critical aspect of the dietary plans was related to the monotony, especially for snacks and breakfasts. This work demonstrated the limits of the translation of Italian nutrient recommendations into dietary plans for pediatric age groups. Keeping the protein intake in the recommended range of 8–12% of daily energy resulted in inadequate provision of calcium and iron. Other critical points were the reference values for body weight and physical activity. The proposed dietary plans are adequate with regard to food composition, the intake of energy and several nutrients, and in terms of food selection. However, their implementations require action, information, and advocacy.

Implementation of food-based dietary guidelines: conceptual framework and analysis of the Brazilian case

OBJECTIVE

This study aimed to develop a conceptual framework of the process of food-based dietary guidelines (FBDG) implementation and analyse Brazil's employed measures to implement dietary guidelines for the Brazilian population (2014).

DESIGN

Qualitative research.

SETTING

Aiming to develop the conceptual framework, a literature review on FBDG implementation was carried out. Both documents scoped within the macropolitical sphere and scientific articles were reviewed. In the case study, measures took in Brazil were identified through a search on institutional websites and technical management reports of government sectors were responsible for FBDG implementation in the country.

PARTICIPANTS

This study does not involve humans.

RESULTS

The new conceptual framework frames FBDG implementation as a part of a larger set of intersectoral public policies to promote healthy eating and highlights two main implementation ways: educational materials and public policies. Brazil has a range of policies to promote healthy eating guided by the perspective of food as a right. Most of the implemented measures focussed on the concept of 'FBDG as educational materials,' although the recommendations have also been implemented in public policies.

CONCLUSION

The FBDG implementation should be carried out in an integrated manner with multi-sector involvement. The Brazilian's case analysis can be helpful to decision makers in food policy across the globe be inspired by the Brazilian efforts, considering that the Brazilian FBDG was one of the firsts to have adopted a multidimensional paradigm of healthy eating, including diet sustainability.

Hedonic thresholds and ideal sodium content reduction of bread loaves

Global public policies have advocated strategies for reducing sodium consumption due to the high incidence of non-communicable chronic diseases (NCDs) worldwide. The objectives of this study were to identify the bread loaves sodium content considered as ideal by the consumers and determine hedonic thresholds. In this descriptive cross-sectional study, 114 consumers evaluated the ideal sodium content in bread loaves by the Just About Right (JAR) test, (first sensorial stage) studying four decreased levels of sodium (10%, 20%, 30%, 40%) from the mean values observed from bread in 11 food composition tables from various regions of the world, and Brazil. This ideal sodium content was used as the control in pairwise acceptance tests with five other reduced-sodium samples of bread loaves (10%, 30%, 50%, 70%, 100% of reduction from the control), and hedonic threshold tests were performed with 156 consumers (a second stage sensorial test of five sessions). The data from the JAR were analyzed by a regression analysis graph and correlated with the consumption of salt and family income range by a Principal Component Analysis with a 5% significance level. In the Hedonic Threshold tests, each paired session was analyzed by Student's t-test (test t), and an adjusted regression graph was built. The Compromised Acceptance Threshold (CAT) was performed, where the calculated t corresponded to the tabulated t. In the Hedonic Rejection Threshold (HRT), the hedonic scale five ("indifferent" term) was considered. The average sodium content of bread marketed in different regions of the world was 457 mg Na/100 g of bread, and the ideal sodium content observed was 395 mg Na/100 g of bread. The gender, age and income family rates as well as attitudes and knowledge regarding the salt consumption of the trial consumers were not directly related to the evaluations of the bread loaves in the JAR test, according to the Principal Components Analysis at p ≤ 0.05. From this ideal content, a 42% reduction was possible according to the CAT test (267 mg Na/100 g of bread), and more reductions were acceptable until an 85% (to 58 mg Na/100 g of bread) reduction, as the samples began to be rejected according to HRT test. These findings demonstrated that this methodology can be applied to sodium reduction product formulations and bread as a food matrix. With this kind of methodology, it is possible to provide to the bakery industry a methodology to know a safe region to work on food reformulations and subsidize the formulation of new products without compromising consumer acceptability, in addition to meeting the demand for safer food.

Social network characteristics are correlated with dietary patterns among middle aged and older South Asians living in the United States (U.S.)

Background

Social and cultural norms, operating through social networks, may influence an individual’s dietary choices. We examined correlations between social network characteristics and dietary patterns among South Asians in the United States (U.S.)

Methods

Data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Social Network study were analyzed among 756 participants (mean age = 59 y standard deviation [SD] = 9 y; 44% women). A culturally adapted, validated food frequency questionnaire was used for dietary assessment. A posteriori dietary patterns using principal component analysis were named 1) animal protein, 2) fried snacks, sweets and high-fat dairy, and 3) fruits, vegetables, nuts and legumes. Social network characteristics were assessed using a standard egocentric approach, where participants (egos) self-reported data on perceived dietary habits of their network members. Partial correlations between social network characteristics and egos’ dietary patterns were examined.

Results

The mean social network size of egos was 4.2 (SD = 1.1), with high proportion of network members being family (72%), South Asian ethnicity (89%), and half having daily contact. Animal protein pattern scores were negatively correlated with fruits and cooked vegetables consumption of network. Fried snacks, sweets and high-fat dairy pattern scores were positively correlated with sugar-sweetened beverages, South Asian sweets, fried/fast foods and ghee (clarified butter) consumption of network. Fruits, vegetables, nuts and legumes pattern scores were positively correlated with vegetables, fruits, and brown rice/quinoa consumption of network.

Conclusions

Network member characteristics and their perceived dietary behaviors were correlated with dietary patterns of egos. Dietary intervention studies among South Asians should consider social network characteristics as candidate components for dietary intervention.

Chemicals, cans and factories: how grade school children think about processed foods

OBJECTIVE

To determine how children interpret terms related to food processing; whether their categorisation of foods according to processing level is consistent with those used in research; and whether they associate the degree of processing with healthfulness.

DESIGN

Qualitative data were collected from ten focus groups. Focus groups were audio-recorded, transcribed verbatim, and thematic analysis was conducted.

SETTING

Four elementary and afterschool programmes in a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students.

PARTICIPANTS

Children, 9-12 years old, in the fourth-sixth grades (n 53).

RESULTS

The sample was 40 % male, 47 % Hispanic with a mean age of 10·4 ± 1·1 years. Children's understanding of unprocessed foods was well aligned with research classifications, while concordance of highly processed foods with research categorisations varied. Five primary themes regarding the way children categorised foods according to their processing level emerged: type and amount of added ingredients; preparation method; packaging and storage; change in physical state or sensory experience; and growing method. Most children associated processing level with healthfulness, describing unprocessed foods as healthier. The most common reason provided for the unhealthfulness of processed foods was added ingredients, including 'chemicals' and 'sugar'.

CONCLUSIONS

The current study demonstrated that children have a working knowledge of processing that could be leveraged to encourage healthier eating patterns; however, their understanding is not always consistent with the classification systems used in research. The vocabulary used by researchers and consumers to talk about processing must be reconciled to translate findings into actionable messages.

Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.

The Roles of Food Processing in Translation of Dietary Guidance for Whole Grains, Fruits, and Vegetables

The Dietary Guidelines for Americans (DGA) recommend the consumption of whole grains, fruits, and vegetables as part of a healthy diet. However, current consumption patterns suggest that most Americans are not meeting these recommendations. The challenge remains to align the DGA guidance with the food environment and consumers’ expectations for product quality, availability, and affordability. Currently, processed foods play an increasingly important role in American diets. Often characterized as unhealthy, processed foods are contributors to both food and nutritional security. When the alignment of processing strategies with DGA principles exists, achieving DGA goals is more likely, regardless of processing level. In this review, select processing strategies for whole grains, fruits, and vegetables are described to show how DGA principles can guide processing efforts to create healthier products. Although whole grains, supported by industry-wide innovation and guidance, have had some success with consumers, improving intake of fruit and vegetable products remains a challenge. Closing consumption gaps requires new innovations and products aligned with consumer preferences and DGA principles.

Best practices in nutrition science to earn and keep the public's trust

Public trust in nutrition science is the foundation on which nutrition and health progress is based, including sound public health. An ASN-commissioned, independent Advisory Committee comprehensively reviewed the literature and available public surveys about the public's trust in nutrition science and the factors that influence it and conducted stakeholder outreach regarding publicly available information. The Committee selected 7 overlapping domains projected to significantly influence public trust: 1) conflict of interest and objectivity; 2) public benefit; 3) standards of scientific rigor and reproducibility; 4) transparency; 5) equity; 6) information dissemination (education, communication, and marketing); and 7) accountability. The literature review comprehensively explored current practices and threats to public trust in nutrition science, including gaps that erode trust. Unfortunately, there is a paucity of peer-reviewed material specifically focused on nutrition science. Available material was examined, and its analysis informed the development of priority best practices. The Committee proposed best practices to support public trust, appropriate to ASN and other food and nutrition organizations motivated by the conviction that public trust remains key to the realization of the benefits of past, present, and future scientific advances. The adoption of the best practices by food and nutrition organizations, such as ASN, other stakeholder organizations, researchers, food and nutrition professionals, companies, government officials, and individuals working in the food and nutrition space would strengthen and help ensure earning and keeping the public's continued trust in nutrition science.

Study Protocol for a Randomized Double Blind, Placebo Controlled Trial Exploring the Effectiveness of a Micronutrient Formula in Improving Symptoms of Anxiety and Depression

Background: Anxiety and depression are conferring an increasing burden on society. Although treatments exist for both conditions, side effects, and difficulties accessing treatment prevent many people from receiving adequate assistance. Nutritional approaches have demonstrated some success in treating anxiety and depression. We plan to investigate whether a micronutrient formula, Daily Essential Nutrients, improves symptoms of anxiety and depression compared to a placebo in a community recruited sample. Methods: This will be a randomized, double blind placebo controlled study (RCT). Two hundred adults will be assigned to either a placebo or micronutrient group (placebo or Daily Essential Nutrients (DEN)) in a 1:1 ratio. Baseline data will be collected for 2 weeks, followed by 10 weeks of placebo or micronutrient intervention. Psychometrics will be used to measure progress and participant safety will be monitored weekly. Results: The primary outcome measures will be total scores on three measures of symptom severity at 10 weeks. Linear mixed modelling will be used to measure between group differences and effect sizes will be calculated using pooled mean scores and standard deviations over the course of the trial. Conclusions: If effective, micronutrients could provide an alternative treatment, with fewer barriers and adverse events than currently available treatments.

Do Lower Calorie or Lower Fat Foods Have More Sodium Than Their Regular Counterparts?

The objective of this study was to compare the sodium content of a regular food and its lower calorie/fat counterpart. Four food categories, among the top 20 contributing the most sodium to the US diet, met the criteria of having the most matches between regular foods and their lower calorie/fat counterparts. A protocol was used to search websites to create a list of "matches", a regular and comparable lower calorie/fat food(s) under each brand. Nutrient information was recorded and analyzed for matches. In total, 283 matches were identified across four food categories: savory snacks (N = 44), cheese (N = 105), salad dressings (N = 90), and soups (N = 44). As expected, foods modified from their regular versions had significantly reduced average fat (total fat and saturated fat) and caloric profiles. Mean sodium content among modified salad dressings and cheeses was on average 8%-12% higher, while sodium content did not change with modification of savory snacks. Modified soups had significantly lower mean sodium content than their regular versions (28%-38%). Consumers trying to maintain a healthy diet should consider that sodium content may vary in foods modified to be lower in calories/fat.

Overcoming consumer inertia to dietary guidance

Despite 35 y of dietary guidance, there has been no substantial shift in consumer compliance. Consumers report that they seek information on nutrition and healthy eating, but most are not paying attention to dietary recommendations. For guidance to be effective, it must be realistic. Even with increasingly detailed nutrition information and evidence that diet affects health outcomes, convenience and taste remain the strongest determinants of food choices. It is up to health educators to clear up confusion and give consumers control with nutrition messages that are realistic, positive, easy to understand, and actionable without an expectation that consumers will surrender foods they love.

Interpreting the Australian dietary guideline to "limit" into practical and personalised advice

Food-based dietary guidelines shift the focus from single nutrients to whole diet. Guideline 3 of the Australian Dietary Guidelines (ADG) recommends “limiting” discretionary foods and beverages (DF)—Those high in saturated fat, added sugars, salt, and/or alcohol. In Australia, DF contribute 35% of total energy intake. Using the ADG supporting documents, the aim of this study was to develop a food‑based educational toolkit to help translate guideline 3 and interpret portion size. The methodology used to produce the toolkit is presented here. “Additional energy allowance” is specific to gender, age, height and physical activity level, and can be met from core foods, unsaturated fats/oils/spreads and/or DF. To develop the toolkit, additional energy allowance was converted to serves equaling 600 kJ. Common DF were selected and serves were determined based on nutrient profile. Portion sizes were used to calculate number of DF serves. A consumer brochure consisting of DF, portion sizes and equivalent number of DF serves was developed. A healthcare professional guide outlines the methodology used. The toolkit was designed to assist dietitians and consumers to translate guideline 3 of the ADF and develop a personalized approach to include DF as part of the diet.

Nutrition Troubles

This conversation is part of a special issue on “Critical Nutrition” in which multiple authors weigh in on various themes related to the origins, character, and consequences of contemporary American nutrition discourses and practices, as well as how nutrition might be known and done differently. In this section one author calls into question the validity and efficacy of the 1977 Dietary Goals for the United States that are still widely used in official nutrition information. A second author considers whether official dietary recommendations are commonly known, let alone followed, and therefore questions their effectiveness at shaping actual dietary practice.

The Baltic Sea Diet Score: a tool for assessing healthy eating in Nordic countries

OBJECTIVE

The health-related effects of the Nordic diet remain mostly unidentified. We created a Baltic Sea Diet Score (BSDS) for epidemiological research to indicate adherence to a healthy Nordic diet. We examined associations between the score and nutrient intakes that are considered important in promoting public health. We also examined the performance of the BSDS under two different cut-off strategies.

DESIGN

The cross-sectional study included two phases of the National FINRISK 2007 Study. Diet was assessed using a validated FFQ. Food and nutrient intakes were calculated using in-house software. Nine components were selected for the score. Each component was scored according to both sex-specific consumption quartiles (BSDS-Q) and medians (BSDS-M), and summed to give the final score values.

SETTING

A large representative sample of the Finnish population.

SUBJECTS

Men (n 2217) and women (n 2493) aged 25 to 74 years.

RESULTS

In the age- and energy-adjusted model, adherence to the diet was associated with a higher intake of carbohydrates (E%), and lower intakes of SFA (E%) and alcohol (E%, where E% is percentage of total energy intake; P < 0·01). Furthermore, the intakes of fibre, Fe, vitamins A, C and D, and folate were higher among participants who adhered to the diet (P < 0·05). After further adjustments, the results remained significant (P < 0·05) and did not differ remarkably between BSDS-Q and BSDS-M.

CONCLUSIONS

The BSDS can be used as a measure of a healthy Nordic diet to assess diet-health relationships in public health surveys in Nordic countries.

[Evaluation of the usability of a mobile Digital Food Guide based on user perception]

The use of digital technology in the form of health care apps has been on the increase. In the nutrition area, apps are now available with a view to lead to behavior change, helping individuals to reflect on their food choices and identify weak points in their dietary routine. The article seeks to evaluate user perception regarding the usability of the Digital Food Guide (DFG), which is a mobile smartphone app with guidelines on healthy eating. A cross-sectional study evaluated the user perception of the app using the Likert scale, built with 24 assertions organized in three dimensions of analysis: the DFG as an intuitive and self-explanatory tool; the DFG as a promoter of healthy food choices; and the DFG as a promoter of the transition to the appropriate weight. The instrument was assessed regarding its reliability through the split-half and validity method in two stages. The 22 assertions were validated; the reliability was 0.93; the average of the assertions in each dimension was 3.10; of the 80 respondents, 58.75% considered the implementation of the DFG to be positive. The application has good usability as perceived by users, considering analysis of the dimensions relating to its performance.

Whole grains and health: from theory to practice--highlights of The Grains for Health Foundation's Whole Grains Summit 2012

The Grains for Health Foundation's Whole Grains Summit, held May 19-22, 2012 in Minneapolis, was the first meeting of its kind to convene >300 scientists, educators, food technologists, grain breeders, food manufacturers, marketers, health professionals, and regulators from around the world. Its goals were to identify potential avenues for collaborative efforts and formulate new approaches to whole-grains research and health communications that support global public health and business. This paper summarizes some of the challenges and opportunities that researchers and nutrition educators face in expanding the knowledge base on whole grains and health and in translating and disseminating that knowledge to consumers. The consensus of the summit was that effective, long-term, public-private partnerships are needed to reach across the globe and galvanize the whole-grains community to collaborate effectively in translating whole-grains science into strategies that increase the availability and affordability of more healthful, grain-based food products. A prerequisite of that is the need to build trust among diverse multidisciplinary professionals involved in the growing, producing, marketing, and regulating of whole-grain products and between the grain and public health communities.

Is "processed" a four-letter word? The role of processed foods in achieving dietary guidelines and nutrient recommendations

This paper, based on the symposium "Is 'Processed' a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations in the U.S." describes ongoing efforts and challenges at the nutrition-food science interface and public health; addresses misinformation about processed foods by showing that processed fruits and vegetables made important dietary contributions (e.g., fiber, folate, potassium, vitamins A and C) to nutrient intake among NHANES 2003-2006 participants, that major sources of vitamins (except vitamin K) were provided by enrichment and fortification and that enrichment and fortification helped decrease the percentage of the population below the Estimated Average Requirement for vitamin A, thiamin, folate, and iron; describes how negative consumer perceptions and consumer confusion about processed foods led to the development of science-based information on food processing and technology that aligns with health objectives; and examines challenges and opportunities faced by food scientists who must balance consumer preferences, federal regulations, and issues surrounding food safety, cost, unintended consequences, and sustainability when developing healthful foods that align with dietary guidelines.