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Frank T, Ng SW, Lowery CM, Thow AM, Swart EC. Dietary intake of low-income adults in South Africa: ultra-processed food consumption a cause for concern. Public Health Nutr 2024; 27:e41. [PMID: 38204376 PMCID: PMC10882538 DOI: 10.1017/s1368980023002811] [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] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the Nova classification system and WHO and World Cancer Research Fund dietary guidelines. DESIGN Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017-2018. Foods consumed were classified according to the Nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated. SETTING Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included. PARTICIPANTS In total, 2521 participants (18-50 years) were included in the study. RESULTS Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall. CONCLUSIONS Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF.
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Affiliation(s)
- Tamryn Frank
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, Cape Town7535, South Africa
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina Chapel Hill, Chapel Hill, USA
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina Chapel Hill, Chapel Hill, USA
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa
- DSI/NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
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Liyanapathirana NN, Grech A, Li M, Malik A, Ribeiro R, Burykin T, Lenzen M, Raubenheimer D. Nutritional, environmental and economic impacts of ultra-processed food consumption in Australia. Public Health Nutr 2023; 26:3359-3369. [PMID: 37881877 PMCID: PMC10755453 DOI: 10.1017/s136898002300232x] [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: 02/17/2022] [Revised: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To quantify the full life cycle impacts of ultra-processed foods (UPF) for key environmental, economic and nutritional indicators to identify trade-offs between UPF contribution to broad-scope sustainability. DESIGN Using 24-h dietary recalls along with an input-output database for the Australian economy, dietary environmental and economic impacts were quantified in this national representative cross-sectional analysis. Food items were classified into non-UPF and UPF using the NOVA system, and dietary energy contribution from non-UPF and UPF fractions in diets was estimated. Thereafter, associations between nutritional, environmental and economic impacts of non-UPF and UPF fractions of diets were examined using a multi-dimensional nutritional geometry representation. SETTING National Nutrition and Physical Activity Survey 2011-2012 of Australia. PARTICIPANTS Respondents (n 5344) aged > 18 years with 1 d of 24-h dietary recall data excluding respondents with missing values and outlier data points and under reporters. RESULTS Australian diets rich in UPF were associated with reduced nutritional quality, high greenhouse gas emissions, energy use, and increased employment and income associated with the food supply chains. The environmental and economic impacts associated with the UPF portion of diets become more distinct when the diets are standardised to average protein recommendation. CONCLUSION Increased consumption of UPF has socio-economic benefits, but this comes with adverse effects on the environment and public health. Consideration of such trade-offs is important in identifying policy and other mechanisms regarding UPF for establishing healthy and sustainable food systems.
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Affiliation(s)
- Navoda Nirmani Liyanapathirana
- ISA, School of Physics A28, The University of Sydney, Sydney, NSW2006, Australia
- The School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Amanda Grech
- The School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mengyu Li
- ISA, School of Physics A28, The University of Sydney, Sydney, NSW2006, Australia
| | - Arunima Malik
- ISA, School of Physics A28, The University of Sydney, Sydney, NSW2006, Australia
- Discipline of Accounting, Business School, The University of Sydney, Sydney, NSW, Australia
| | - Rosilene Ribeiro
- The School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Timur Burykin
- The School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Manfred Lenzen
- ISA, School of Physics A28, The University of Sydney, Sydney, NSW2006, Australia
| | - David Raubenheimer
- The School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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3
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Fitzgerald M. It is time to appreciate the value of processed foods. Trends Food Sci Technol 2023. [DOI: 10.1016/j.tifs.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Whatnall M, Clarke E, Collins CE, Pursey K, Burrows T. Ultra-processed food intakes associated with ‘food addiction’ in young adults. Appetite 2022; 178:106260. [DOI: 10.1016/j.appet.2022.106260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/06/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
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The Association between Ultra-Processed Foods, Quality of Life and Insomnia among Adolescent Girls in Northeastern Iran. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106338. [PMID: 35627875 PMCID: PMC9141842 DOI: 10.3390/ijerph19106338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023]
Abstract
Ultra-processed foods have been associated with increased risk of chronic disease, poor overall health and psychological outcomes. This study explored the association of ultra-processed foods with quality of life in adolescent girls from northeastern Iran. In an interdisciplinary cross-sectional study, n = 733 adolescent girls were recruited by random cluster sampling. Assessments were completed for demographics, physical activity, anthropometric and biochemical parameters, psychological health and dietary intake. The participants were categorized into quartiles of ultra-processed food intake, and multivariable logistic regression was used in several models to investigate the association between ultra-processed food intake and psychological health. The mean age of the participants was 14 years. There were no significant differences in participant demographics for the quartiles of ultra-processed food intake including weight, waist-hip ratio, waist circumference, depression, insomnia and cardiometabolic markers related to cardiovascular disease risk. Adjusted logistic regression showed participants in the highest category of ultra-processed food consumption had an increased likelihood of reduced quality of life (OR: 1.87, 95% CI: 1.13-3.11), with a greater chance for insomnia (OR: 4.04, 95% CI: 1.83-8.94) across all models. However, no significant associations were observed between consumption of ultra-processed foods and daytime sleepiness. We highlight the association between ultra-processed food consumption and poor quality of life and insomnia amongst adolescent girls. Large longitudinal integrated public health studies in different ethnicities are needed to confirm these associations and evaluate their possible impact for optimizing health promotion programs.
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Chauhan H, Belski R, Bryant E, Cooke M. Dietary Assessment Tools and Metabolic Syndrome: Is It Time to Change the Focus? Nutrients 2022; 14:1557. [PMID: 35458121 PMCID: PMC9032662 DOI: 10.3390/nu14081557] [Citation(s) in RCA: 3] [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: 03/15/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 12/16/2022] Open
Abstract
Metabolic syndrome (MS) is associated with a range of chronic diseases, for which lifestyle interventions are considered the cornerstone of treatment. Dietary interventions have primarily focused on weight reduction, usually via energy restricted diets. While this strategy can improve insulin sensitivity and other health markers, weight loss alone is not always effective in addressing all risk factors associated with MS. Previous studies have identified diet quality as a key factor in reducing the risk of MS independent of weight loss. Additionally, supporting evidence for the use of novel strategies such as carbohydrate restriction and modifying the frequency and timing of meals is growing. It is well established that dietary assessment tools capable of identifying dietary patterns known to increase the risk of MS are essential for the development of personalised, targeted diet and lifestyle advice. The American Heart Association (AHA) recently evaluated the latest in a variety of assessment tools, recommending three that demonstrate the highest evidence-based and clinical relevance. However, such tools may not assess and thus identify all dietary and eating patterns associated with MS development and treatment, especially those which are new and emerging. This paper offers a review of current dietary assessment tools recommended for use by the AHA to assess dietary and eating patterns associated with MS development. We discuss how these recommendations align with recent and novel evidence on the benefits of restricting ultra-processed food and refined carbohydrates and modifying timing and frequency of meals. Finally, we provide recommendations for future redevelopment of these tools to be deployed in health care settings.
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Affiliation(s)
- Helen Chauhan
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Regina Belski
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Eleanor Bryant
- Division of Psychology, University of Bradford, Bradford BD7 1DP, UK
| | - Matthew Cooke
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
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Habibi N, Leemaqz SYL, Grieger JA. Modelling the Impact of Reducing Ultra-Processed Foods Based on the NOVA Classification in Australian Women of Reproductive Age. Nutrients 2022; 14:1518. [PMID: 35406131 PMCID: PMC9003044 DOI: 10.3390/nu14071518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 02/05/2023] Open
Abstract
Women of reproductive age have a high proportion of overweight/obesity and an overall poor nutritional intake and diet quality. Nutritional modelling is a method to forecast potential changes in nutrition composition that may offer feasible and realistic changes to dietary intake. This study uses simulation modelling to estimate feasible population improvements in dietary profile by reducing ultra-processed food (UPF) consumption in Australian women of reproductive age. The simulation used weighted data from the most recent 2011-2012 National Nutrition and Physical Activity Survey. A total of 2749 women aged 19-50 years was included, and 5740 foods were examined. The highest daily energy, saturated fat, and added sugar and sodium came from UPF. Reducing UPF by 50% decreased energy intake by 22%, and saturated fat, added sugar, sodium, and alcohol by 10-39%. Reducing UPF by 50% and increasing unprocessed or minimally processed foods by 25% led to a lower estimated reduction in energy and greater estimated reductions in saturated fat and sodium. Replacement of 50% UPF with 75% of unprocessed or minimally processed foods led to smaller estimated reductions in energy and nutrients. Our results provide insight as to the potential impact of population reductions in UPF, but also increasing intake of unprocessed or minimally processed foods, which may be the most feasible strategy for improved nutritional intake.
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Affiliation(s)
- Nahal Habibi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia;
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Shalem Yiner-Lee Leemaqz
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5042, Australia;
| | - Jessica Anne Grieger
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia;
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
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Ivancovsky-Wajcman D, Fliss-Isakov N, Webb M, Bentov I, Shibolet O, Kariv R, Zelber-Sagi S. Ultra-processed food is associated with features of metabolic syndrome and non-alcoholic fatty liver disease. Liver Int 2021; 41:2635-2645. [PMID: 34174011 DOI: 10.1111/liv.14996] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS High consumption of ultra-processed food (UPF) is associated with mortality and chronic morbidity but has not been studied concerning to non-alcoholic fatty liver disease (NAFLD). We aimed to test the association of UPF consumption with metabolic syndrome, NAFLD and related-liver damage. METHODS A cross-sectional study among volunteers who underwent abdominal ultrasound (AUS), anthropometrics, blood pressure measurements, and fasting blood tests including FibroMax for non-invasive assessment of NASH and significant fibrosis. A food-frequency questionnaire was used to evaluate UPF consumption using the NOVA classification. RESULTS A total of 789 subjects were included in the total sample (mean age 58.83 ± 6.58 years, 52.60% men), a reliable FibroMax test was obtained from 714 subjects, 305 subjects were diagnosed with NAFLD. High consumption of UPF was associated with higher odds for metabolic syndrome (OR = 1.88, 95% CI 1.31-2.71, P = .001) and its components; hypertension, hypertriglyceridemia, and low HDL, among the entire sample (OR = 1.53, 1.07-2.19, P = .026; OR = 1.51, 1.08-2.11, P = .017; OR = 1.55, 1.05-2.29, P = .028). In addition, it was associated with higher odds for NASH and hypertension (OR = 1.89, 1.07-3.38, P = .030; OR = 2.26, 1.20-4.26, P = .012 respectively) among subjects with NAFLD. Stratification by smoking status revealed an association between high UPF consumption and significant fibrosis among ever smokers in the entire sample and among subjects with NAFLD (OR = 1.89, 95% CI 1.03-3.45, P = .039; OR = 2.85, 1.14-7.14, P = .026 respectively). CONCLUSIONS High UPF consumption is associated with metabolic syndrome in the general population, and among those with NAFLD it is associated with NASH marker. Ever-smoking may act synergistically with UPF to amplify the risk for fibrosis.
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Affiliation(s)
| | - Naomi Fliss-Isakov
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Muriel Webb
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Oren Shibolet
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Kariv
- Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa, Israel.,Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
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10
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Dinu M, Bonaccio M, Martini D, Madarena MP, Vitale M, Pagliai G, Esposito S, Ferraris C, Guglielmetti M, Rosi A, Angelino D. Reproducibility and validity of a food-frequency questionnaire (NFFQ) to assess food consumption based on the NOVA classification in adults. Int J Food Sci Nutr 2021; 72:861-869. [PMID: 33550856 DOI: 10.1080/09637486.2021.1880552] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
NOVA is a classification that divides foods into four groups according to processing. Since no questionnaires have been validated to assess the consumption of foods with different levels of processing in the general adult population, we tested the reliability and validity of a 94-item Food Frequency Questionnaire (NFFQ) designed to estimate the intake (g/day) and the weight ratio (%) of the NOVA food groups in Italian adults. Time reliability and validity were tested by administrating the NFFQ to 110 subjects on two different occasions and comparing it with a weighed dietary record (WDR). Strong correlations between NFFQs (r > 0.7, p < 0.001) and intraclass correlation coefficients (ICC) of 0.851-0.940 indicated good test-retest reliability. Moderate correlations between the NFFQ and the WDR (0.6<r < 0.7), ICC of 0.536-0.741, and consistent agreement for intake percentages as revealed by Bland-Altman plots indicated moderate to good validity. The NFFQ could be useful for future investigations in this research field.
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Affiliation(s)
- Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Daniela Martini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Maria Pia Madarena
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | - Giuditta Pagliai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simona Esposito
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.,Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Alice Rosi
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - Donato Angelino
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
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Lopes Pinto S, da Silva DCG, Bressan J. Absolute and Relative Changes in Ultra-processed Food Consumption and Dietary Antioxidants in Severely Obese Adults 3 Months After Roux-en-Y Gastric Bypass. Obes Surg 2020; 29:1810-1815. [PMID: 30719649 DOI: 10.1007/s11695-019-03749-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Patients that undergo Roux-en-Y gastric bypass (RYGB) experience a dramatic change in food consumption; however, it is unknown whether food consumption changes in relation to the level of food processing. OBJECTIVE The aim of this work was to evaluate the relationship between ultra-processed food intake, dietary antioxidant capacity, and cardiometabolic risk factors in patients who underwent RYGB. METHODS This study included 58 obese patients who underwent RYGB bariatric surgery. Data collection was done pre-operatively and at 3 months post-surgery. The foods consumed were documented using a 3-day 24-h dietary recall, and food intake was classified based on NOVA and dietary total antioxidant capacity (TAC). Anthropometric and biochemical data as well as information on body composition were also collected. Metabolic syndrome (MS) was classified in accordance with the International Diabetes Federation. RESULTS Ultra-processed foods amounted to 27.2% and 19.7% of the total calories consumed during pre- and post-surgery periods, respectively. Regarding post-surgery, the caloric contribution of unprocessed or minimally processed foods increased, from 55.7 to 70.2% (p = 0.000). The TAC of foods consumed is inversely proportional to that of ultra-processed foods. Obvious changes were observed in all the anthropometric variables, lipid profile, glycemia, insulin resistance, and MS. CONCLUSION Our results indicate that bariatric surgery is able to promote improvement in the diet quality of patients, reducing the consumption of ultra-processed foods and increasing the intake of unprocessed foods. The TAC of foods consumed is inversely proportional to that of ultra-processed ones.
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Affiliation(s)
- Sônia Lopes Pinto
- Federal University of Tocantins, Quadra 806 South, Alameda 02, HM 1, Apt 202, Block C, Palmas, Tocantins, Brazil. .,Department of Nutrition and Health, Federal University of Viçosa, University Campus, Viçosa, Minas Gerais, 36570-900, Brazil.
| | - Danielle Cristina Guimarães da Silva
- Department of Nutrition and Health, Federal University of Viçosa, University Campus, Viçosa, Minas Gerais, 36570-900, Brazil.,Federal University of the West of Bahia, Rua Professor José Seabra de Lemos, 316, Recanto dos Pássaros, Barreiras, Bahia, 47808-021, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Federal University of Viçosa, University Campus, Viçosa, Minas Gerais, 36570-900, Brazil
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Magriplis E, Panagiotakos D, Kyrou I, Tsioufis C, Mitsopoulou AV, Karageorgou D, Dimakopoulos I, Bakogianni I, Chourdakis M, Micha R, Michas G, Ntouroupi T, Tsaniklidou SM, Argyri K, Zampelas A. Presence of Hypertension Is Reduced by Mediterranean Diet Adherence in All Individuals with a More Pronounced Effect in the Obese: The Hellenic National Nutrition and Health Survey (HNNHS). Nutrients 2020; 12:nu12030853. [PMID: 32209978 PMCID: PMC7146360 DOI: 10.3390/nu12030853] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/22/2022] Open
Abstract
Hypertension is a major risk of cardiovascular diseases. This study’s aim was to examine associations between hypertension and a priori known lifestyle risk factors, including weight status and Mediterranean diet adherence. The study included a representative sample of the adult population (N = 3775 (40.8% males)), from the Hellenic National Nutrition and Health Survey (HNNHS), which took place from September 2013 to May 2015. Demographic and anthropometric data were collected using validated questionnaires, and blood pressure (BP) measurements were performed for the two main metropolitan areas (N = 1040; 41.1%). Hypertension diagnosis was according to the International Classification of Diseases (ICD-10) guidelines. Weighted proportions, extended Mantel–Haenszel (M–H) analyses, and multiple logistic regressions (for the survey data) were performed. Mean systolic BP (SBP) and diastolic BP (DBP) were 118.6 mmHg and 72.2 mmHg respectively, with both values being higher in males compared to females in all age groups (p < 0.001). Study participants with hyperlipidemia or diabetes, and those overweight, were almost twice as likely to be hypertensives, with the odds increasing to 4 for those obese (p for all, < 0.05). Stricter Mediterranean diet adherence significantly decreased the likelihood of hypertension by 36% (OR: 0.64; 95% CI: 0.439, 0.943), and a significant interaction was found between Mediterranean diet adherence and weight status on hypertension. The presence of hypertension is clustered with comorbidities, but is significantly associated with modifiable risk factors, including Mediterranean diet and weight status, underlining the need for personalized medical nutritional treatment.
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Affiliation(s)
- Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Eleftheriou Venizelou 70, 176 76 Athens, Greece; (D.P.); (I.K.)
| | - Ioannis Kyrou
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Eleftheriou Venizelou 70, 176 76 Athens, Greece; (D.P.); (I.K.)
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B4 7ET, UK
- WISDEM, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Costas Tsioufis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 115 27 Athens, Greece;
| | - Anastasia-Vasiliki Mitsopoulou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
| | - Dimitra Karageorgou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02110, USA
| | - Ioannis Dimakopoulos
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
| | - Ioanna Bakogianni
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
| | - Michalis Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54 124 Thessaloniki, Greece;
| | - Renata Micha
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02110, USA
| | - George Michas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
- Department of Cardiology, “Elpis” General Hospital of Athens, 106 75 Athens, Greece
| | - Triantafyllia Ntouroupi
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
| | - Sophia-Maria Tsaniklidou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
| | - Kostantina Argyri
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece; (E.M.); (A.-V.M.); (D.K.); (I.D.); (I.B.); (R.M.); (G.M.); (T.N.); (S.-M.T.); (K.A.)
- Correspondence: ; Tel.: +30-210-5294701
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Bleiweiss-Sande R, Chui K, Evans EW, Goldberg J, Amin S, Sacheck J. Robustness of Food Processing Classification Systems. Nutrients 2019; 11:E1344. [PMID: 31208000 PMCID: PMC6627649 DOI: 10.3390/nu11061344] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
Discrepancies exist among food processing classification systems and in the relationship between processed food intake and dietary quality of children. This study compared inter-rater reliability, food processing category, and the relationship between processing category and nutrient concentration among three systems (Nova, International Food Information Council (IFIC), and University of North Carolina at Chapel Hill (UNC)). Processing categories for the top 100 most commonly consumed foods children consume (NHANES 2013-2014) were independently coded and compared using Spearman's rank correlation coefficient. Relative ability of nutrient concentration to predict processing category was investigated using linear discriminant analysis and multinomial logistic regression and compared between systems using Cohen's kappa coefficient. UNC had the highest inter-rater reliability (ρ = 0.97), followed by IFIC (ρ = 0.78) and Nova (ρ = 0.76). UNC and Nova had the highest agreement (80%). Lower potassium was predictive of IFIC's classification of foods as moderately compared to minimally processed (p = 0.01); lower vitamin D was predictive of UNC's classification of foods as highly compared to minimally processed (p = 0.04). Sodium and added sugars were predictive of all systems' classification of highly compared to minimally processed foods (p < 0.05). Current classification systems may not sufficiently identify foods with high nutrient quality commonly consumed by children in the U.S.
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Affiliation(s)
- Rachel Bleiweiss-Sande
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Kenneth Chui
- Tufts University School of Medicine, Tufts University, Boston, MA 02111, USA.
| | - E Whitney Evans
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
| | - Jeanne Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Sarah Amin
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA.
| | - Jennifer Sacheck
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20037, USA.
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Relative Validity and Reproducibility of a Food Frequency Questionnaire to Assess Energy Intake from Minimally Processed and Ultra-Processed Foods in Young Children. Nutrients 2019; 11:nu11061290. [PMID: 31181631 PMCID: PMC6627316 DOI: 10.3390/nu11061290] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023] Open
Abstract
NOVA is a food classification system that categorises food items into one of four categories according to the extent and purpose of their processing: minimally processed food (MPF), processed culinary ingredient (PCI), processed food (PF), or ultra-processed food (UPF). The aim of this study was to determine the relative validity and reproducibility of a food frequency questionnaire (EAT5 FFQ) for measuring daily energy intake (EI kJ) and percentage of daily energy intake (EI%) from each NOVA group in New Zealand children. One hundred parents of five year old children completed the 123 item EAT5 FFQ on two occasions four weeks apart. A 3 day weighed diet record (WDR) was completed on non-consecutive randomly assigned days between FFQ appointments. The FFQ overestimated EI (both as kJ and %) from MPF and UPF, and underestimated intakes from PCI and PF, compared with the WDR. Bland–Altman plots indicated reasonably consistent agreement between FFQ and WDR for MPF and UPF but not PCI or PF. Correlation coefficients between the FFQ and WDR were acceptable for EI (%) for MPF (r = 0.31) and UPF (r = 0.30). The FFQ differentiated between the highest and lowest quartiles for EI (%) from MPF and UPF foods (p-values for the trends were 0.006 and 0.009 respectively), and for EI (kJ) from UPF foods (p-value for trend 0.003). Bland–Altman plots indicated consistent agreement between repeat administrations of FFQ for MPF and UPF only, while intra-class correlations suggested good reproducibility for EI (kJ and %) for all four NOVA categories (range 0.51–0.76). The EAT5 FFQ has acceptable relative validity for ranking EI (%) from MPF and UPF. It has good reproducibility for measuring EI from all four NOVA categories, in young children.
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15
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Davis KA, Esslinger K, Elvidge Munene LA, St-Pierre S. International approaches to developing healthy eating patterns for national dietary guidelines. Nutr Rev 2019; 77:388-403. [PMID: 31222369 PMCID: PMC6519442 DOI: 10.1093/nutrit/nuy058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
As part of the revision of the 2007 Eating Well with Canada's Food Guide, a literature scan on statistical modeling approaches used in developing healthy eating patterns for national food guides was conducted. The scan included relevant literature and online searches, primarily since the 2007 Canada's Food Guide was released. Eight countries were identified as utilizing a statistical model or analysis to help inform their healthy eating pattern, defined as the amounts and types of food recommended, with many common characteristics noted. Detail on international modeling approaches is presented, highlighting similarities and differences as well as strengths and challenges.
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Affiliation(s)
- Karelyn A Davis
- Office of Nutrition Policy and Promotion, Health Canada, Ottawa, Ontario, Canada
- Bureau of Food Surveillance and Science Integration, Health Canada, Ottawa Ontario, Canada
| | - Krista Esslinger
- Office of Nutrition Policy and Promotion, Health Canada, Ottawa, Ontario, Canada
| | | | - Sylvie St-Pierre
- Office of Nutrition Policy and Promotion, Health Canada, Ottawa, Ontario, Canada
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16
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Dickie S, Woods JL, Lawrence M. Analysing the use of the Australian Health Star Rating system by level of food processing. Int J Behav Nutr Phys Act 2018; 15:128. [PMID: 30545373 PMCID: PMC6293654 DOI: 10.1186/s12966-018-0760-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 12/05/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The consumption of ultra-processed foods is associated with diminished dietary quality and adverse health outcomes. The Australian Health Star Rating (HSR) is a nutrient-based front-of-pack (FOP) labelling system that assesses the 'healthiness' of foods on a scale of 0.5 to 5 stars based on their content of 'risk' and 'positive' nutrients. This study aimed to analyse the use of health stars on new packaged food products entering the Australian marketplace by level of food processing. METHODS The Mintel Global New Product Database (GNPD) was searched to identify the number of stars displayed on the labels of all new packaged food products participating in the HSR system released into the Australian retail food supply between 27 June 2014 (the endorsement date) and 30 June 2017. Products were categorised by the four NOVA food processing categories: unprocessed and minimally processed (MP), processed culinary ingredients (PCI), processed (P), and ultra-processed (UP), and the distribution of the star ratings within each category was compared and analysed. RESULTS The majority of new food products displaying an HSR were UP (74.4%), followed by MP (12.5%), P (11.6%), and PCI (1.5%). The median HSR of MP products (4.5) was significantly higher than the median of P (4) and UP products (3.5) (all p < 0.05). In all NOVA categories HSR profiles were distributed towards higher star ratings, and the majority (77%) of UP products displayed an HSR ≥ 2.5. CONCLUSIONS The HSR is being displayed on a substantial proportion of newly released UP foods. Technical weaknesses, design flaws and governance limitations with the HSR system are resulting in 3 out of 4 instances of these UP foods displaying at least 2.5 so-called 'health' stars. These findings add further evidence to concerns that the HSR system, in its current form, is misrepresenting the healthiness of new packaged food products and creating a risk for behavioural nutrition.
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Affiliation(s)
- Sarah Dickie
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Julie L. Woods
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
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17
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Pulker CE, Trapp GSA, Scott JA, Pollard CM. Alignment of Supermarket Own Brand Foods' Front-of-Pack Nutrition Labelling with Measures of Nutritional Quality: An Australian Perspective. Nutrients 2018; 10:E1465. [PMID: 30304807 PMCID: PMC6213021 DOI: 10.3390/nu10101465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022] Open
Abstract
Two voluntary front-of-pack nutrition labels (FOPNL) are present in Australia: the government-led Health Star Ratings (HSR) and food industry-led Daily Intake Guide (DIG). Australia's two largest supermarkets are key supporters of HSR, pledging uptake on all supermarket own brand foods (SOBF). This study aimed to examine prevalence of FOPNL on SOBF, and alignment with patterns of nutritional quality. Photographic audits of all SOBF present in three large supermarkets were conducted in Perth, Western Australia, in 2017. Foods were classified as nutritious or nutrient-poor based on the Australian Guide to Healthy Eating (AGTHE), NOVA level of food processing, and HSR score. Most (81.5%) SOBF featured FOPNL, with only 55.1% displaying HSR. HSR was present on 69.2% of Coles, 54.0% of Woolworths, and none of IGA SOBF. Half (51.3%) of SOBF were classified as nutritious using the AGTHE, but using NOVA, 56.9% were ultra-processed foods. Nutrient-poor and ultra-processed SOBF were more likely than nutritious foods to include HSR, yet many of these foods achieved HSR scores of 2.5 stars or above, implying they were a healthy choice. Supermarkets have a powerful position in the Australian food system, and they could do more to support healthy food selection through responsible FOPNL.
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Affiliation(s)
- Claire Elizabeth Pulker
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Western Australia, Australia.
| | - Georgina S A Trapp
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth 6872, Western Australia, Australia.
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Western Australia, Australia.
| | - Jane Anne Scott
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Western Australia, Australia.
| | - Christina Mary Pollard
- School of Public Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Western Australia, Australia.
- East Metropolitan Health Service, Kirkman House, 20 Murray Street, East Perth 6004, Western Australia, Australia.
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18
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Hasenegger V, Rust P, König J, Purtscher AE, Erler J, Ekmekcioglu C. Main Sources, Socio-Demographic and Anthropometric Correlates of Salt Intake in Austria. Nutrients 2018; 10:E311. [PMID: 29509671 PMCID: PMC5872729 DOI: 10.3390/nu10030311] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 01/11/2023] Open
Abstract
Excessive salt intake is known to increase blood pressure and cardiovascular risk. Nevertheless, salt intake exceeds the recommendations in most countries. To face this problem, it is important to identify high consumers as well as the main contributors of salt intake. Overall, data of 2018 adults between 18 and 64 years were analysed to determine the main sources, socio-demographic and anthropometric correlates of salt intake. Dietary intake was assessed from 24-h-recalls, information on socio-demographic characteristics was obtained using a questionnaire and anthropometric data were measured. Salt intake was significantly higher in males than in females. There was a significant positive association between salt intake and body mass index. No significant differences in salt intake were observed for other variables including affluence, educational level, smoking status and physical activity. The main contributor to salt intake were condiments including table salt (32.6%), followed by cereals and cereal products (27.0%), meat and meat products (16.1%) and dairy products (14.0%). These results highlight that specific population groups need to be targeted by public health initiatives and that a reduction in salt intake can only be achieved in tandem with the food producers by the reduction of salt in processed foods.
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Affiliation(s)
- Verena Hasenegger
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria.
- Department of Environmental Health, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
| | - Petra Rust
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria.
| | - Jürgen König
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria.
| | - Anna Elisabeth Purtscher
- Health University of Applied Sciences, Tyrol, Bachelor Programm Dietetics, Innrain 98, 6020 Innsbruck, Austria.
| | - Judith Erler
- Health University of Applied Sciences, Tyrol, Bachelor Programm Dietetics, Innrain 98, 6020 Innsbruck, Austria.
| | - Cem Ekmekcioglu
- Department of Environmental Health, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
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Poti JM, Braga B, Qin B. Ultra-processed Food Intake and Obesity: What Really Matters for Health-Processing or Nutrient Content? Curr Obes Rep 2017; 6:420-431. [PMID: 29071481 PMCID: PMC5787353 DOI: 10.1007/s13679-017-0285-4] [Citation(s) in RCA: 237] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this narrative review was to summarize and critique recent evidence evaluating the association between ultra-processed food intake and obesity. RECENT FINDINGS Four of five studies found that higher purchases or consumption of ultra-processed food was associated with overweight/obesity. Additional studies reported relationships between ultra-processed food intake and higher fasting glucose, metabolic syndrome, increases in total and LDL cholesterol, and risk of hypertension. It remains unclear whether associations can be attributed to processing itself or the nutrient content of ultra-processed foods. Only three of nine studies used a prospective design, and the potential for residual confounding was high. Recent research provides fairly consistent support for the association of ultra-processed food intake with obesity and related cardiometabolic outcomes. There is a clear need for further studies, particularly those using longitudinal designs and with sufficient control for confounding, to potentially confirm these findings in different populations and to determine whether ultra-processed food consumption is associated with obesity independent of nutrient content.
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Affiliation(s)
- Jennifer M Poti
- Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, Campus Box #7461, Chapel Hill, NC, 27599, USA.
| | - Bianca Braga
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of International Studies, Universidad Torcuato Di Tella, Buenos Aires, Argentina
| | - Bo Qin
- Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Abstract
Objective To objectively evaluate voluntary nutrition and health claims and marketing techniques present on packaging of high-market-share ultra-processed foods (UPF) in Australia for their potential impact on public health. Design Cross-sectional. Setting Packaging information from five high-market-share food manufacturers and one retailer were obtained from supermarket and manufacturers’ websites. Subjects Ingredients lists for 215 UPF were examined for presence of added sugar. Packaging information was categorised using a taxonomy of nutrition and health information which included nutrition and health claims and five common food marketing techniques. Compliance of statements and claims with the Australia New Zealand Food Standards Code and with Health Star Ratings (HSR) were assessed for all products. Results Almost all UPF (95 %) contained added sugars described in thirty-four different ways; 55 % of UPF displayed a HSR; 56 % had nutrition claims (18 % were compliant with regulations); 25 % had health claims (79 % were compliant); and 97 % employed common food marketing techniques. Packaging of 47 % of UPF was designed to appeal to children. UPF carried a mean of 1·5 health and nutrition claims (range 0–10) and 2·6 marketing techniques (range 0–5), and 45 % had HSR≤3·0/5·0. Conclusions Most UPF packaging featured nutrition and health statements or claims despite the high prevalence of added sugars and moderate HSR. The degree of inappropriate or inaccurate statements and claims present is concerning, particularly on packaging designed to appeal to children. Public policies to assist parents to select healthy family foods should address the quality and accuracy of information provided on UPF packaging.
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The provision of ultra-processed foods and their contribution to sodium availability in Australian long day care centres. Public Health Nutr 2017; 21:134-141. [DOI: 10.1017/s136898001700132x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivesTo categorize and assess all foods, beverages and ingredients provided over one week at Australian long day care (LDC) centres according to four levels of food processing and to assess the contribution of Na from each level of processing.DesignCross-sectional.SettingMenus for lunch, morning and afternoon snacks were collected from LDC centres. The level of food processing of all foods, beverages and ingredients was assessed utilizing a four-level food processing classification system: minimally processed (MP), processed culinary ingredients (PCI), processed (P) and ultra-processed (ULP).ResultsA total of thirty-five menus (lunch, n 35; snacks, n 70) provided to 1–5-year-old children were collected from seven LDC centres. Proportions of foodstuffs classified as MP, PCI, P and ULP were 54, 10, 15 and 21 %, respectively. All lunches were classified as MP. ULP foods accounted for 6 % of morning snacks; 41 % of afternoon snacks. Mean daily amount of Na provided per child across all centres was 633 (sd 151) mg. ULP foods provided 40 % of Na, followed by P (35 %), MP (23 %) and PCI (2 %).ConclusionsCentres provided foods resulting in a mean total daily Na content that represented 63 % of the recommended Upper Level of Intake for Na in this age group. A significant proportion of ULP snack foods were included, which were the major contributor to total daily Na intake. Replacement of ULP snack foods with MP lower-Na alternatives is recommended.
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