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Kiosia A, Dagbasi A, Berkley JA, Wilding JPH, Prendergast AJ, Li JV, Swann J, Mathers JC, Kerac M, Morrison D, Drake L, Briend A, Maitland K, Frost G. The double burden of malnutrition in individuals: Identifying key challenges and re-thinking research focus. NUTR BULL 2024; 49:132-145. [PMID: 38576109 DOI: 10.1111/nbu.12670] [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: 10/30/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
The 'double burden of malnutrition' is a global health challenge that increasingly affects populations in both low- and middle-income countries (LMICs). This phenomenon refers to the coexistence of undernutrition and overweight or obesity, as well as other diet-related non-communicable diseases, in the same population, household or even individual. While noteworthy progress has been made in reducing undernutrition in some parts of the world, in many of these areas, the prevalence of overweight and obesity is increasing, particularly in urban areas, resulting in greater numbers of people who were undernourished in childhood and have overweight or obesity in adulthood. This creates a complex and challenging situation for research experts and policymakers who must simultaneously address the public health burdens of undernutrition and overweight/obesity. This review identifies key challenges and limitations in the current research on the double burden of malnutrition in individuals, including the need for a more comprehensive and nuanced understanding of the drivers of malnutrition, the importance of context-specific interventions and the need for greater attention to the food environment and food systems. We advocate for the re-evaluation of research strategies and focus, with a greater emphasis on multidisciplinary and systems approaches and greater attention to the synergistic relationship between the biological, environmental, commercial and socio-economic determinants of malnutrition. Addressing these key challenges can enable us to better comprehend and tackle the multifaceted and dynamic issues of the double burden of malnutrition, particularly in individuals and work towards more effective and sustainable solutions.
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Affiliation(s)
- Agklinta Kiosia
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Health Data Research Global, HDR UK, London, UK
| | - Aygul Dagbasi
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - James A Berkley
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Clinical Sciences Centre, Aintree University Hospital, Liverpool, UK
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jia V Li
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Jon Swann
- School of Human Development and Health, University of Southampton Faculty of Medicine, Southampton, UK
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, William Leech Building, Newcastle University, Newcastle upon Tyne, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Douglas Morrison
- Scottish Universities Environmental Research Centre, East Kilbride, UK
| | - Lesley Drake
- Partnership for Child Development, School of Public Health, Imperial College London, London, UK
| | - Andre Briend
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Kathryn Maitland
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Gary Frost
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
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Polden M, Jones A, Essman M, Adams J, Bishop T, Burgoine T, Donohue A, Sharp S, White M, Smith R, Robinson E. Point-of-choice kilocalorie labelling practices in large, out-of-home food businesses: a preobservational versus post observational study of labelling practices following implementation of The Calorie Labelling (Out of Home Sector) (England) Regulations 2021. BMJ Open 2024; 14:e080405. [PMID: 38604637 PMCID: PMC11015320 DOI: 10.1136/bmjopen-2023-080405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES On 6 April 2022, the UK government implemented mandatory kilocalorie (kcal) labelling regulations for food and drink products sold in the out-of-home food sector (OHFS) in England. Previous assessments of kcal labelling practices in the UK OHFS found a low prevalence of voluntary implementation and poor compliance with labelling recommendations. This study aimed to examine changes in labelling practices preimplementation versus post implementation of mandatory labelling regulations in 2022. METHODS In August-December 2021 (preimplementation) and August-November 2022 (post implementation), large OHFS businesses (250 or more employees) subject to labelling regulations were visited. At two time points, a researcher visited the same 117 food outlets (belonging to 90 unique businesses) across four local authorities in England. Outlets were rated for compliance with government regulations for whether kcal labelling was provided at any or all point of choice, provided for all eligible food and drink items, provided per portion for sharing items, if labelling was clear and legible and if kcal reference information was displayed. RESULTS There was a significant increase (21% preimplementation vs 80% post implementation, OR=40.98 (95% CI 8.08 to 207.74), p<0.001) in the proportion of outlets providing any kcal labelling at point-of-choice post implementation. Only 15% of outlets met all labelling compliance criteria post implementation, with a minority of outlets not presenting labelling in a clear (33%) or legible (29%) way. CONCLUSION The number of large businesses in the OHFS providing kcal labelling increased following the implementation of mandatory labelling regulations. However, around one-fifth of eligible outlets sampled were not providing kcal labelling 4-8 months after the regulations came into force, and the majority of businesses only partially complied with government guidance. More effective enforcement may be required to further improve kcal labelling practices in the OHFS in England. PREREGISTRATION Study protocol and analysis strategy preregistered on Open Science Framework (https://osf.io/pfnm6/).
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Affiliation(s)
- Megan Polden
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Lancaster University, Lancaster, UK
| | | | - Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tom Bishop
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Stephen Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Richard Smith
- Institute of Health Research, University of Exeter Medical School, Exeter, Devon, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK
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Rantala E, Vanhatalo S, Valtanen M, Lindström J, Pihlajamäki J, Poutanen K, Absetz P, Karhunen L. Effectiveness of workplace choice architecture modification for healthy eating and daily physical activity. BMC Public Health 2024; 24:939. [PMID: 38561724 PMCID: PMC10986070 DOI: 10.1186/s12889-024-18482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Modifying the choice architecture of behavioural contexts can facilitate health behaviour change, but existing evidence builds mostly on small-scale interventions limited in duration, targets, strategies, and settings. We evaluated the effectiveness of a one-year hybrid type 2 implementation-effectiveness trial aimed at promoting healthy eating and daily physical activity with subtle modifications to the choice architecture of heterogeneous worksites. The intervention was contextualised to and integrated into the routine operations of each worksite. Effectiveness was evaluated in a quasi-experimental pre-post design. METHODS Intervention sites (n = 21) implemented a median of two (range 1-9) intervention strategies for healthy eating and one (range 1-5) for physical activity. Questionnaires pre (n = 1126) and post (n = 943) intervention surveyed employees' behavioural patterns at work (food consumption: vegetables/roots, fruit/berries, nuts/almonds/seeds, sweet treats, fast food, water; physical activity: restorative movement, exercise equipment use, stair use). The post-intervention questionnaire also measured employees' perception of and response to three intervention strategies: a packed lunch recipe campaign, a fruit crew-strategy, and movement prompts. Multi- and single-level regression models evaluated effectiveness, treating intervention as a continuous predictor formed of the site-specific dose (n intervention strategies employed) and mean quality (three-point rating per strategy halfway and at the end of the intervention) of implementation relevant to each outcome. RESULTS Multinomial logistic regression models found the intervention significantly associated with a favourable change in employees' fruit and berry consumption (interaction effect of time and implementation p = 0.006) and with an unfavourable change in sweet treat consumption (p = 0.048). The evidence was strongest for the finding concerning fruit/berry consumption-an outcome that sites with greater dose and quality of implementation targeted by using strategies that reduced the physical effort required to have fruit/berries at work and by covering multiple eating-related contexts at the worksite. The quality of implementation was positively associated with the perception of (p = 0.044) and response to (p = 0.017) the packed lunch recipes, and with response to the fruit crew-strategy (p < 0.001). CONCLUSIONS The results suggest that a contextualised, multicomponent choice architecture intervention can positively influence eating behaviour in diverse real-world settings over a one-year period, and that higher implementation quality can enhance intervention perception and response. However, outcomes may depend on the type of intervention strategies used and the extent of their delivery.
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Affiliation(s)
- Eeva Rantala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland.
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland.
| | - Saara Vanhatalo
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | - Mikko Valtanen
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland
- Department of Mathematics and Statistics, University of Turku, 20014, Turku, Finland
| | - Jaana Lindström
- Finnish Institute for Health and Welfare (THL), 00271, Helsinki, Finland
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 KYS, Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044, Espoo, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520, Tampere, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
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Awudi DA, Walker AN, Weeto MM, Priddy CB, Akan OD, Baduweh CA, Arthur BA, Yakubu S, Bafei SEC, Olagunju TM, Zaitoun M, Zhong Y, Feng Y, Zhang Y, Wei T, Feng Q. Unhealthy diets increase the likelihood of being overweight or obese among African migrant students in China, but not among African non-migrant students: a cross-sectional study. Front Nutr 2024; 11:1291360. [PMID: 38562488 PMCID: PMC10984215 DOI: 10.3389/fnut.2024.1291360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/12/2024] [Indexed: 04/04/2024] Open
Abstract
Background The impact of non-communicable diseases (NCDs) is disproportionately felt by immigrants from low- to medium-income countries (LMICs), partly due to their dietary habits. To thrive in their new environment, migrants either omit or consume certain food items, which could lead to nutritional deficits. As a result, most migrants experience more NCDs than their compatriots in their native countries. Therefore, we evaluated the difference in dietary habits, quality, and the influencing factors of overweight or obesity among African migrant students in Nanjing (China) and non-migrant students in Africa using cross-sectional data. Methods The researchers used the food frequency questionnaire and the global diet quality score metrics to assess food intake and quality, respectively. Then, cross-tabulation was employed to explore the differences between the groups in meal skipping, eating habits, and diet quality. Finally, the factors associated with overweight or obesity were assessed with binary logistic regression stratified by African students in Nanjing and students in their native countries. Results Approximately 678 responses were received, mainly between 18-25 years (46.7%) and 26-36 years (45.4 %). The majority of them (52.3%) were international students. The non-migrant African students' diets lacked citrus fruits (22.2%), deep orange fruits (15.4%), deep orange vegetables (18%), cruciferous vegetables (24.6%), and dark leafy vegetables (26.5%). While the African migrant students consumed more high-fat dairy (50.7%), processed meats (23.9%), sweets and ice creams (51.3%), sugar-sweetened beverages (40.5%), and juice (61.5%), p < 0.001. Furthermore, consuming late-night meals constantly [Exp (B) = 39.607, p = 0.049], eating twice a day [Exp (B) = 6.527, p = 0.036], consuming red meat [Exp (B) = 29.287, p = 0.001], processed meats [Exp (B) = 719.979, p = 0.0011], refined grains and baked foods [Exp (B) = 15.752, p = 0.013], and sweets and ice cream [Exp (B) = 193.633, p = 0.006] were factors inducing overweight or obesity among only African migrant students. Conclusion Controlling the what (Western diet and nature of late-night meals) and the when of eating can drastically reduce their influence on obesogenic condition formation in African migrant students in China and elsewhere.
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Affiliation(s)
- Doris Abra Awudi
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Anita Nyarkoa Walker
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mary Makhala Weeto
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
| | | | - Otobong Donald Akan
- Microbiology Department, Akwa-Ibom State University, Uyo, Akwa-Ibom State, Nigeria
- Food Science and Engineering, Central South University of Forestry and Technology, Hunan, China
| | | | | | - Salimata Yakubu
- Department of Epidemiology and Health Statistics, Nanjing Medical University, Nanjing, Jiangsu, China
| | | | - Timothy Mobolaji Olagunju
- Department of Epidemiology and Health Statistics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Margaret Zaitoun
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuxia Zhong
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yucong Feng
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuandie Zhang
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Wei
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qing Feng
- Department of Nutrition and Food Hygiene, Nanjing Medical University, Nanjing, Jiangsu, China
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Fong M, Scott S, Albani V, Brown H. The Impact of COVID-19 Restrictions and Changes to Takeaway Regulations in England on Consumers' Intake and Methods of Accessing Out-of-Home Foods: A Longitudinal, Mixed-Methods Study. Nutrients 2023; 15:3636. [PMID: 37630827 PMCID: PMC10459227 DOI: 10.3390/nu15163636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND COVID-19 restrictions significantly impacted the operations of fast food and full-service retailers. Full-service retailers were permitted to operate as takeaway outlets without needing to seek formal changes in planning permissions. We conducted a study to determine consumers' intake and modes of accessing foods from fast food and full-service retailers during various COVID-19 restrictions and changes to takeaway/delivery regulations, as well as their experiences. METHODS We conducted a longitudinal, mixed-methods study comprising three surveys, which examined the intake frequency and modes of accessing retailers, and two rounds of qualitative focus groups, which explored their related experiences. The data were collected at three timepoints (T) from May 2021-March 2022. The participants were adults living in Northern England (n = 701 at T1); a sub-sample participated in the focus groups (n = 22). The intake data were presented descriptively; an ordered logit regression explored the factors associated with the intake frequency. The focus group data were analysed using a framework analysis. RESULTS The mean weekly intake frequency from fast food retailers at T1, T2, and T3 was 0.96 (SD 1.05), 1.08 (SD 1.16), and 1.06 times (SD 1.12), respectively. For full-service retailers, this was 0.36 (SD 0.69), 0.75 (1.06), and 0.71 (SD 0.99) times, respectively. Food access issues (OR (SE): T1 = 1.65 (0.40), T2 = 2.60 (0.66), T = 2.1 (0.62)) and obesity (T1 = 1.61 (0.31), T2 = 2.21 (0.46), T3 = 1.85 (0.42)) were positively associated with intake from fast food, but not full-service retailers. Delivery services were commonly used to access fast food (30-34% participants), but not full-service retailers (6-10% participants). As COVID-19 restrictions eased, participants were eager to socialise on-premises at full-service retailers. CONCLUSIONS Takeaway/delivery services were seldom used to access full-service retailers, but the use of delivery services to access fast food was high. Policymakers must recognise delivery services as a growing part of the food environment, and the challenges they pose to planning policies for obesity prevention.
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Affiliation(s)
- Mackenzie Fong
- National Institute for Health and Care Research Applied Research Collaboration (North East and North Cumbria), Newcastle-upon-Tyne NE3 3XT, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Steph Scott
- National Institute for Health and Care Research Applied Research Collaboration (North East and North Cumbria), Newcastle-upon-Tyne NE3 3XT, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Viviana Albani
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Heather Brown
- Division Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4AT, UK
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Polden M, Jones A, Adams J, Bishop T, Burgoine T, Essman M, Sharp SJ, Smith R, White M, Robinson E. Kilocalorie labelling in the out-of-home sector: an observational study of business practices and consumer behaviour prior to implementation of the mandatory calorie labelling policy in England, 2022. BMC Public Health 2023; 23:1088. [PMID: 37280640 DOI: 10.1186/s12889-023-16033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Regulations mandating kilocalorie (kcal) labelling for large businesses in the out-of-home food sector (OHFS) came into force on 6th April 2022 as a policy to reduce obesity in England. To provide indicators of potential reach and impact, kcal labelling practices were studied in the OHFS, and customer purchasing and consumption behaviours prior to implementation of the mandatory kcal labelling policy in England. METHODS From August-December 2021, large OHFS businesses subject to the kcal labelling regulations were visited prior to regulations coming into force on 6th April 2022. 3308 customers were recruited from 330 outlets and collected survey information on the number of kcal purchased and consumed by customers, customers' knowledge of the kcal content of their purchases, and customers noticing and use of kcal labelling. In a subset of 117 outlets, data was collected on nine recommended kcal labelling practices. RESULTS The average number of kcals purchased (1013 kcal, SD = 632 kcal) was high with 69% of purchases exceeding the recommendation of a maximum of 600 kcal per meal. Participants underestimated the energy content of their purchased meals by on average 253 kcal (SD = 644 kcals). In outlets providing kcal labelling in which customer survey data was collected, a minority of customers reported noticing (21%) or using (20%) kcal labelling. Out of the 117 outlets assessed for kcal labelling practices, 24 (21%) provided any in-store kcal labelling. None of the outlets met all nine aspects of recommended labelling practices. CONCLUSIONS Prior to implementation of 2022 kcal labelling policy, the majority of sampled OHFS large business outlets in England did not provide kcal labelling. Few customers noticed or used the labels and on average customers purchased and consumed substantially more energy than recommended in public health guidelines. The findings suggest that reliance on voluntary action for kcal labelling implementation failed to produce widespread, consistent, and adequate kcal labelling practices.
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Affiliation(s)
- Megan Polden
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.
| | | | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tom Bishop
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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Du M, Griecci CF, Cudhea F, Eom H, Wong JB, Wilde P, Kim DD, Michaud DS, Wang YC, Mozaffarian D, Zhang FF. What is the cost-effectiveness of menu calorie labelling on reducing obesity-associated cancer burdens? An economic evaluation of a federal policy intervention among 235 million adults in the USA. BMJ Open 2023; 13:e063614. [PMID: 37072239 DOI: 10.1136/bmjopen-2022-063614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE To assess the impact of menu calorie labelling on reducing obesity-associated cancer burdens in the USA. DESIGN Cost-effectiveness analysis using a Markov cohort state-transition model. SETTING Policy intervention. PARTICIPANTS A modelled population of 235 million adults aged ≥20 years in 2015-2016. INTERVENTIONS The impact of menu calorie labelling on reducing 13 obesity-associated cancers among US adults over a lifetime was evaluated for: (1) effects on consumer behaviours; and (2) additional effects on industry reformulation. The model integrated nationally representative demographics, calorie intake from restaurants, cancer statistics and estimates on associations of policy with calorie intake, dietary change with body mass index (BMI) change, BMI with cancer rates, and policy and healthcare costs from published literature. MAIN OUTCOME MEASURES Averted new cancer cases and cancer deaths and net costs (in 2015 US$) among the total population and demographic subgroups were determined. Incremental cost-effectiveness ratios from societal and healthcare perspectives were assessed and compared with the threshold of US$150 000 per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analyses incorporated uncertainty in input parameters and generated 95% uncertainty intervals (UIs). RESULTS Considering consumer behaviour alone, this policy was associated with 28 000 (95% UI 16 300 to 39 100) new cancer cases and 16 700 (9610 to 23 600) cancer deaths averted, 111 000 (64 800 to 158 000) QALYs gained, and US$1480 (884 to 2080) million saved in cancer-related medical costs among US adults. The policy was associated with net cost savings of US$1460 (864 to 2060) million and US$1350 (486 to 2260) million from healthcare and societal perspectives, respectively. Additional industry reformulation would substantially increase policy impact. Greater health gains and cost savings were predicted among young adults, Hispanic and non-Hispanic Black individuals. CONCLUSIONS Study findings suggest that menu calorie labelling is associated with lower obesity-related cancer burdens and reduced healthcare costs. Policymakers may prioritise nutrition policies for cancer prevention in the USA.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Christina F Griecci
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Heesun Eom
- New York Academy of Medicine, New York, New York, USA
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts, USA
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, School of Medicine, Tuft University, Boston, Massachusetts, USA
| | - Y Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Robinson E, Boyland E, Christiansen P, Haynos AF, Jones A, Masic U, Robertson D, Tapper K, Marty L. Is the effect of menu energy labelling on consumer behaviour equitable? A pooled analysis of twelve randomized control experiments. Appetite 2023; 182:106451. [PMID: 36610541 PMCID: PMC10082393 DOI: 10.1016/j.appet.2023.106451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/18/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023]
Abstract
Menu energy labelling has been implemented as a public health policy to promote healthier dietary choices and reduce obesity. However, it is unclear whether the influence energy labelling has on consumer behaviour differs based on individuals' demographics or characteristics and may therefore produce inequalities in diet. Data were analysed from 12 randomized control trials (N = 8508) evaluating the effect of food and drink energy labelling (vs. labelling absent) on total energy content of food and drink selections (predominantly hypothetical) in European and US adults. Analyses examined the moderating effects of participant age, sex, ethnicity/race, education, household income, body mass index, dieting status, food choice motives and current hunger on total energy content of selections. Energy labelling was associated with a small reduction (f2 = 0.004, -50 kcal, p < 0.001) in total energy selected compared to the absence of energy labelling. Participants who were female, younger, white, university educated, of a higher income status, dieting, motivated by health and weight control when making food choices, and less hungry, tended to select menu items of lower energy content. However, there was no evidence that the effect of energy labelling on the amount of energy selected was moderated by any of the participants' demographics or characteristics. Energy labelling was associated with a small reduction in energy content of food selections and this effect was similar across a range of participants' demographics and characteristics. These preliminary findings suggest that energy labelling policies may not widen existing inequalities in diet.
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Affiliation(s)
- Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK.
| | - Emma Boyland
- Department of Psychology, University of Liverpool, Liverpool, UK
| | | | - Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Jones
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
| | - Deirdre Robertson
- Behavioural Research Unit, Economic and Social Research Institute, Ireland & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Katy Tapper
- Department of Psychology, City, University of London, UK
| | - Lucile Marty
- Centre des Sciences Du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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Yang Y, Weippert M, Ahmed M, L'Abbé MR. Cross-Sectional Nutritional Information and Quality of Canadian Chain Restaurant Menu Items in 2020. Am J Prev Med 2023; 64:42-50. [PMID: 36155709 DOI: 10.1016/j.amepre.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION More than 50% of Canadians report regularly eating foods prepared at restaurants. The literature shows poor nutritional quality of restaurant foods. No federal policy on improving the nutritional quality of restaurant food is available except for a provincial regulation that mandates Ontario chain restaurants to display the energy content of items on menus. There is limited information on the nutrition information reporting and nutritional quality of restaurant foods. This study aimed to examine the nutrition information reporting and nutritional quality of menu items of Canadian chain restaurants in 2020. METHODS Nutrition information for menu items (n=18,760) was collected and analyzed from Canadian restaurants with ≥20 outlets nationally between 2020 and 2021. Menu items were categorized into 5 categories. Descriptive statistics were calculated for serving size, energy, and saturated fat, sodium, and sugar. Percentage daily values of energy and nutrient levels were calculated following the Canadian labeling guidelines. RESULTS Of the 201 eligible chain restaurants, 141 (70%) provided some nutrition information, of which 70 (50%) voluntarily provided the complete nutrition information that is required on prepackaged foods. Overall, menu items were high per serving in energy (mean kcal=483; 95% CI=477, 489), saturated fat (mean=7.4 g; 95% CI=7.2, 7.5), sodium (mean=867 mg; 95% CI=853, 881), and total sugars (mean=17 g; 95% CI=17, 17), and all exceeded the recommended 15% percentage daily values threshold. CONCLUSIONS Although most chain restaurants provided nutrition information, the lack of regulations regarding reporting format and provision of serving size and other nutrients challenges the assessment of the nutritional quality of menu items. Interventions to standardize nutrition information reporting and improve nutritional quality are needed in the restaurant sector.
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Affiliation(s)
- Yahan Yang
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madyson Weippert
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary R L'Abbé
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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10
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Robinson E, Boyland E, Evans R, Finlay A, Halsall L, Humphreys G, Langfield T, McFarland‐Lesser I, Patel Z, Jones A. Energy labelling of alcoholic drinks: An important or inconsequential obesity policy? Obes Sci Pract 2022; 9:75-86. [PMID: 37034571 PMCID: PMC10073822 DOI: 10.1002/osp4.638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behavior are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behavior, suggest alcohol energy labelling may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity.
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Affiliation(s)
- Eric Robinson
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Emma Boyland
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Rebecca Evans
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Amy Finlay
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Lauren Halsall
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Gabrielle Humphreys
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Tess Langfield
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - India McFarland‐Lesser
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Zina Patel
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
| | - Andrew Jones
- Department of Psychology Eleanor Rathbone Building, University of Liverpool LiverpoolL69 7ZA UK
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11
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Rantala E, Järvelä-Reijonen E, Pettersson K, Laine J, Vartiainen P, Närväinen J, Pihlajamäki J, Poutanen K, Absetz P, Karhunen L. Sensory Appeal and Routines Beat Health Messages and Visibility Enhancements: Mixed-Methods Analysis of a Choice-Architecture Intervention in a Workplace Cafeteria. Nutrients 2022; 14:nu14183731. [PMID: 36145107 PMCID: PMC9505513 DOI: 10.3390/nu14183731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Easier recognition and enhanced visibility of healthy options supposedly increase healthy choices, but real-world evidence remains scarce. Addressing this knowledge gap, we promoted nutritionally favourable foods in a workplace cafeteria with three choice-architectural strategies-priming posters, point-of-choice nutrition labels, and improved product placement-and assessed their effects on visual attention, food choices, and food consumption. Additionally, we developed a method for analysing real-world eye-tracking data. The study followed a pretest-posttest design whereby control and intervention condition lasted five days each. We monitored visual attention (i.e., total number and duration of fixations) and food choices with eye tracking, interviewed customers about perceived influences on food choices, and measured cafeteria-level food consumption (g). Individual-level data represents 22 control and 19 intervention participants recruited at the cafeteria entrance. Cafeteria-level data represents food consumption during the trial (556/589 meals sold). Results indicated that the posters and labels captured participants' visual attention (~13% of fixations on defined areas of interest before food choices), but the intervention had insignificant effects on visual attention to foods, on food choices, and on food consumption. Interviews revealed 17 perceived influences on food choices, the most common being sensory appeal, healthiness, and familiarity. To conclude, the intervention appeared capable of attracting visual attention, yet ineffective in increasing healthier eating. The developed method enabled a rigorous analysis of visual attention and food choices in a natural choice setting. We discuss ways to boost the impact of the intervention on behaviour, considering target groups' motives. The work contributes with a unique, mixed-methods approach and a real-world setting that enabled a multi-dimensional effects evaluation with high external validity.
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Affiliation(s)
- Eeva Rantala
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Correspondence:
| | - Elina Järvelä-Reijonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Kati Pettersson
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Janne Laine
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Paula Vartiainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | | | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, 02044 Espoo, Finland
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33520 Tampere, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
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12
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Flynn AN, Hall KD, Courville AB, Rogers PJ, Brunstrom JM. Time to revisit the passive overconsumption hypothesis? Humans show sensitivity to calories in energy-rich meals. Am J Clin Nutr 2022; 116:581-588. [PMID: 35488870 PMCID: PMC9348985 DOI: 10.1093/ajcn/nqac112] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A possible driver of obesity is insensitivity (passive overconsumption) to food energy density (ED, kcal/g); however, it is unclear whether this insensitivity applies to all meals. OBJECTIVES We assessed the influence of ED on energy intake (kcal) across a broad and continuous range of EDs comprised of noncovertly manipulated, real-world meals. We also allowed for the possibility that the association between energy intake and ED is nonlinear. METHODS We completed a secondary analysis of 1519 meals which occurred in a controlled environment as part of a study conducted by Hall and colleagues to assess the effects of food ultra-processing on energy intake. To establish the generalizability of the findings, the analyses were repeated in 32,162 meals collected from free-living humans using data from the UK National Diet and Nutrition Survey (NDNS). Segmented regressions were performed to establish ED "breakpoints" at which the association between consumed meal ED and mean centered meal caloric intake (kcal) changed. RESULTS Significant breakpoints were found in both the Hall et al. data set (1.41 kcal/g) and the NDNS data set (1.75 and 2.94 kcal/g). Centered meal caloric intake did not increase linearly with consumed meal ED, and this pattern was captured by a 2-component ("volume" and "calorie content" [biologically derived from the sensing of fat, carbohydrate, and protein]) model of physical meal size (g), in which volume is the dominant signal with lower energy-dense foods and calorie content is the dominant signal with higher energy-dense foods. CONCLUSIONS These analyses reveal that, on some level, humans are sensitive to the energy content of meals and adjust meal size to minimize the acute aversive effects of overconsumption. Future research should consider the relative importance of volume and calorie-content signals, and how individual differences impact everyday dietary behavior and energy balance.
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Affiliation(s)
- Annika N Flynn
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Amber B Courville
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Peter J Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre: Nutrition Theme, University of Bristol, University Hospitals Bristol Education & Research Centre, Bristol, United Kingdom
| | - Jeffrey M Brunstrom
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, United Kingdom
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre: Nutrition Theme, University of Bristol, University Hospitals Bristol Education & Research Centre, Bristol, United Kingdom
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13
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Huang Y, Burgoine T, Theis DRZ, Adams J. Differences in energy and nutrient content of menu items served by large chain restaurants in the USA and the UK in 2018. Public Health Nutr 2022; 25:1-9. [PMID: 35642073 PMCID: PMC9991847 DOI: 10.1017/s1368980022001379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/25/2022] [Accepted: 05/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the sector-wide energy and nutritional differences of both adult and children's restaurant menu items in the UK and the USA in 2018. DESIGN Cross-sectional study. SETTING Energy and nutritional information provided on restaurant websites. PARTICIPANTS Menu items (n 40 902) served by forty-two large UK chains and ninety-six large USA chains. RESULTS Mean absolute energy, fat and saturated fat values were higher in USA menu items. For example, the mean adjusted per-item differences of adult menu items between the USA and the UK were 45·6 kcal for energy and 3·2 g for fat. Comparable figures for children's menu items were 43·7 kcal and 4 g. Compared with UK menu items, USA adult menu items also had higher sugar content (3·2 g, 95 % CI (0·5, 6)), and children's menu items had higher Na content (181·1 mg, 95 % CI (108·4, 253·7)). Overall, 96·8 % of UK and 95·8 % of USA menu items exceeded recommended levels for at least one of Na, fat, saturated fat or sugars. CONCLUSIONS Menu items served by large chain restaurants had higher mean absolute levels of energy, fat and saturated fat in the USA compared with the UK. UK adult menu items were also lower in sugars compared with the USA ones and children's items lower in Na. As more than 95 % of all items were considered to have high levels of at least one nutrient of public health concern in the USA and the UK, improvements in restaurant menu items are needed in both countries.
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Affiliation(s)
- Yuru Huang
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Dolly RZ Theis
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
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14
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Akamatsu R, Tonsho N, Saiki M, Komatsu M. Restaurant managers' readiness to maintain people's healthy weight and minimise food waste in Japan. BMC Public Health 2022; 22:831. [PMID: 35468794 PMCID: PMC9040262 DOI: 10.1186/s12889-022-13274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People who consume high amounts of ready-to-eat meals have a higher body mass index than those who do not. However, if customers adhere to eating proper amounts without restaurants reducing the portions, plate waste may occur. It is therefore incumbent upon restaurants to serve suitable meal portions to customers in the interests of their health and the environment. This study examined whether restaurants support Japan's national goals of minimising food loss and waste and maintaining healthy body weight. Additionally, the characteristics of restaurant managers who display a willingness to meet these goals, were identified. METHODS An internet-based nationwide cross-sectional survey was conducted among restaurant managers in Japan in May 2019. The main outcome measured was readiness to take action toward maintaining healthy weight and minimising food loss and waste. Chi-square tests were performed to examine the characteristics of three groups, divided on the basis of their readiness to take action toward achieving these two goals. The group that displayed a higher readiness toward attaining both goals was examined using logistic regression analyses. RESULTS Of the 412 restaurant managers who responded, 387 (93.9%) were analysed. Few managers reported taking action toward maintaining healthy weight (n = 13, 3.4%) and minimising food loss and waste (n = 45, 11.6%). Two variables, 'medium- or big-sized company' and 'referring to the United Nations' Sustainable Development Goals for running their business', were related to both higher readiness for maintaining healthy weight and minimising food loss and waste (odds ratio [OR] = 2.27, confidence interval [CI]: 1.11-4.62; OR = 4.06, CI: 2.39-6.88, respectively). CONCLUSIONS Increasing recognition of the Sustainable Development Goals among restaurant managers is needed to increase their cooperation toward meeting Japan's national goals.
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Affiliation(s)
- Rie Akamatsu
- Faculty of Core Research, Natural Science Division, Ochanomizu University, Tokyo, Japan.
| | - Nozomi Tonsho
- Former Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
| | - Mika Saiki
- Former Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
| | - Mihono Komatsu
- Former Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
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15
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Gesteiro E, García-Carro A, Aparicio-Ugarriza R, González-Gross M. Eating out of Home: Influence on Nutrition, Health, and Policies: A Scoping Review. Nutrients 2022; 14:1265. [PMID: 35334920 PMCID: PMC8953831 DOI: 10.3390/nu14061265] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 12/13/2022] Open
Abstract
Eating out of home (EOH) is a common practice worldwide but research gaps have been identified. The aims of this review were (a) to find a common definition for EOH, (b) to determine the nutritional contribution of EOH, and (c) to analyze the relationship of EOH with health parameters in adults. Fifty-seven articles were finally selected. The definition of EOH was not harmonized between researchers and the comparison between studies was quite difficult. Restaurant and fast food were the terms most used, followed by chain restaurant, à la carte, sit-down restaurant, eating at table, full service, ready to eat, takeaway, buffet and buffet by weight, bar, cafes, and cafeterias, either alone or attached to at least one of the above. The profile of the main EOH participant was a highly educated, high-income, and unmarried young man. EOH was related to a body mass index (BMI) or being overweight in a different way depending on age, sex, or EOH frequency. A high rate of EOH led to poorer diet quality, characterized by higher intakes of energy, total and saturated fats, sugar, and sodium, as well as lower intakes of fiber, dairy, fruit, vegetables, and micronutrients. Regarding beverages, a higher intake of soft drinks, sugar-sweetened beverages, fruit juices, beer, and other alcohol was observed when EOH. There is a need for a methodological consensus for analyzing the impact of EOH on dietary intake and health to avoid bias. Additionally, measures and policies should be utilized to help consumers to make healthier choices when EOH is compatible with business regarding those running EOH establishments.
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Affiliation(s)
- Eva Gesteiro
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, E-28040 Madrid, Spain; (A.G.-C.); (R.A.-U.); (M.G.-G.)
| | - Alberto García-Carro
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, E-28040 Madrid, Spain; (A.G.-C.); (R.A.-U.); (M.G.-G.)
| | - Raquel Aparicio-Ugarriza
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, E-28040 Madrid, Spain; (A.G.-C.); (R.A.-U.); (M.G.-G.)
| | - Marcela González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, E-28040 Madrid, Spain; (A.G.-C.); (R.A.-U.); (M.G.-G.)
- Institute of Health Carlos III, CIBEROBN (Physiopathology of Obesity and Nutrition, CB12/03/30038), E-28029 Madrid, Spain
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16
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Yaacoub S, Truppa C, Pedersen TI, Abdo H, Rossi R. Antibiotic resistance among bacteria isolated from war-wounded patients at the Weapon Traumatology Training Center of the International Committee of the Red Cross from 2016 to 2019: a secondary analysis of WHONET surveillance data. BMC Infect Dis 2022; 22:257. [PMID: 35287597 PMCID: PMC8922823 DOI: 10.1186/s12879-022-07253-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background A substantial body of evidence has recently emphasized the risks associated with antibiotic resistance (ABR) in conflicts in the Middle East. War-related, and more specifically weapon-related wounds can be an important breeding ground for multidrug resistant (MDR) organisms. However, the majority of available evidence comes from the military literature focused on risks and patterns of ABR in infections from combat-related injuries among military personnel. The overall aim of this study is to contribute to the scarce existing evidence on the burden of ABR among patients, including civilians with war-related wounds in the Middle East, in order to help inform the revision of empirical antibiotic prophylaxis and treatment protocols adopted in these settings. The primary objectives of this study are to: 1) describe the microbiology and the corresponding resistance profiles of the clinically relevant bacteria most commonly isolated from skin, soft tissue and bone biopsies in patients admitted to the WTTC; and 2) describe the association of the identified bacteria and corresponding resistance profiles with sociodemographic and specimen characteristics. Methods We retrospectively evaluated the antibiograms of all consecutive, non-duplicate isolates from samples taken from patients admitted to the ICRC WTTC between 2016 and 2019, limited to skin and soft tissue samples and bone biopsies. We collected data on socio-demographic characteristics from patient files and data on specimens from the WHONET database. We ran univariate and multivariable logistic regression models to test the association between bacterial and resistance profiles with sociodemographic and specimen characteristics. Results Patients who were admitted with war-related trauma to the ICRC reconstructive surgical project in Tripoli, Lebanon, from 2016 to 2019, presented with high proportion of MDR in the samples taken from skin and soft tissues and bones, particularly Enterobacterales (44.6%), MRSA (44.6%) and P. aeruginosa (7.6%). The multivariable analysis shows that the odds of MDR isolates were higher in Iraqi patients (compared to Syrian patients) and in Enterobacterales isolates (compared to S. aureus isolates). Conclusions Our findings stress the importance of regularly screening patients who present with complex war-related injuries for colonization with MDR bacteria, and of ensuring an antibiotic-sensitivity testing-guided antimicrobial therapeutic approach. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07253-1.
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Affiliation(s)
- Sally Yaacoub
- International Committee of the Red Cross (ICRC), Geneva, Switzerland. .,International Committee of the Red Cross (ICRC), Beirut, Lebanon.
| | - Claudia Truppa
- International Committee of the Red Cross (ICRC), Beirut, Lebanon
| | | | | | - Rodolfo Rossi
- International Committee of the Red Cross (ICRC), Geneva, Switzerland
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17
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Mandracchia F, Tarro L, Llauradó E, Valls RM, Solà R. The “Healthy Meals” web app for the assessment of nutritional content and food allergens in restaurant meals: Development, evaluation and validation. Digit Health 2022; 8:20552076221081690. [PMID: 35251681 PMCID: PMC8891920 DOI: 10.1177/20552076221081690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/30/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The development and the evaluation of the Healthy Meals web app designed for professionals from different disciplines related to food, aimed to assess the nutritional and food allergen content of restaurant meals, was described. Methods App evaluation concerned: (1) usability, scored on a 7-point scale by 6 restaurateurs and 10 nutritionists through the Computer System Usability Questionnaire; (2) quality, scored on a 5-point scale by 10 nutritionists through the Mobile App Rating Scale; (3) validation, by two nutritionists through differences in entered nutrient contents. Ratings reliability was assessed by the interclass correlation coefficient. Results Users agreed with the web app usability (mean 5.6/7 points, SD 0.9), with moderate reliability among ratings (interclass correlation coefficient = 0.57; 95% CI, 0.18 to 0.82). The web app showed good objective quality (mean 4.0/5 points, SD 0.4), with excellent reliability among nutritionists (interclass correlation coefficient = 0.91; 95% CI, 0.85 to 0.96). For web app validation, no significant differences were observed between the two nutritionists’ data, with excellent reliability (interclass correlation coefficient = 0.98; 95% CI, 0.97 to 0.99). App data entry was identified as a point to improve. Conclusions The Healthy Meals web app designed for professionals related to food, such as restaurateurs, demonstrated to be usable, of good quality and valid for dishes nutritional assessment and food allergen identification. Points to improve were identified, while app effectiveness should be tested in trials.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Spain
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Rosa M. Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Spain
- Hospital Universitari Sant Joan de Reus, Spain
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18
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Trends in energy and nutrient content of menu items served by large UK chain restaurants from 2018 to 2020: an observational study. BMJ Open 2021. [PMCID: PMC8718418 DOI: 10.1136/bmjopen-2021-054804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The objective of this study was to evaluate the change in energy and nutrient content of menu items sold in large UK chain restaurants (eg, fast food, full service) from 2018 to 2020. Design Observational study. Setting Energy and nutritional information of menu items served by 29 large UK chain restaurants that consistently provided this information online in all three years. Data were collected in 2018 (March–April), 2019 (April) and 2020 (October–November) from restaurant websites. Primary and secondary outcome measures The per-item energy and nutrient (saturated fat, sugar and salt) changes in all items available on menus (‘all menu items’) and recurring items that were consistently available on menus in all three years (‘core menu items’), overall and in 12 different food categories. Results Our study included 7770, 9213 and 6928 menu items served by 29 large UK chain restaurants in 2018, 2019 and 2020, respectively. Our results showed that sugar content declined from 2018 to 2020 among all menu items (per-item: −0.43 g/year, 95% CI −0.66 to –0.21). This reduction in sugar was evident in beverages, sandwiches and desserts. Among core menu items (N=1855), sugar content reduced significantly from 2018 to 2020 (per-item: −0.31 g/year, 95% CI −0.45 to –0.17), especially in beverages. Energy, salt and saturated fat content in menu items remained constant overall, in both all menu items and core menu items. Fewer food categories had significant changes in energy, sugar, salt and saturated fat content among core menu items than among all menu items. Conclusions From 2018 to 2020, sugar content declined in restaurant menu items, which may reflect a response to the sugar reduction strategy and the effects of the soft drinks industry levy. In contrast, there was little change in other nutrients. Future policies addressing the overall nutritional quality of restaurant foods, rather than single nutrients, may help the restaurant sector move towards offering healthier foods.
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19
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Kerins C, Kelly C, Reardon CM, Houghton C, Toomey E, Hayes CB, Geaney F, Perry IJ, McSharry J, McHugh S. Factors Influencing Fidelity to a Calorie Posting Policy in Public Hospitals: A Mixed Methods Study. Front Public Health 2021; 9:707668. [PMID: 34485232 PMCID: PMC8414889 DOI: 10.3389/fpubh.2021.707668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Labelling menus with nutrition information has increasingly become an important obesity policy option. While much research to-date has focused on determining its effectiveness, few studies report the extent to which menu labelling is implemented as designed. The aim of this study was to explore factors influencing fidelity to a calorie posting policy in Irish acute public hospitals. Methods: A mixed methods sequential explanatory study design was employed, with a nested case study for the qualitative component. Quantitative data on implementation fidelity at hospitals were analysed first and informed case sampling in the follow-on qualitative phase. Maximum variation sampling was used to select four hospitals with high and low levels of implementation and variation in terms of geographic location, hospital size, complexity of care provided and hospital type. Data were collected using structured observations, unstructured non-participant observations and in-depth semi-structured interviews. The Consolidated Framework for Implementation Research guided qualitative data collection and analysis. Using framework analysis, factors influencing implementation were identified. A triangulation protocol was used to integrate fidelity findings from multiple sources. Data on influencing factors and fidelity were then combined using joint displays for within and cross-case analysis. Results: Quantitative fidelity data showed seven hospitals were categorised as low implementers and 28 hospitals were high implementers of the policy. Across the four hospitals selected as cases, qualitative analysis revealed factors influencing implementation and fidelity were multiple, and operated independently and in combination. Factors were related to the internal hospital environment (e.g., leadership support, access to knowledge and information, perceived importance of calorie posting implementation), external hospital environment (e.g., national policy, monitoring), features of the calorie posting policy (e.g., availability of supporting materials), and the implementation process (e.g., engaging relevant stakeholders). Integrated analysis of fidelity indicated a pattern of partial adherence to the calorie posting policy across the four hospitals. Across all hospitals, there was a consistent pattern of low adherence to calorie posting across all menu items on sale, low adherence to calorie information displayed per standard portion or per meal, low adherence to standardised recipes/portions, and inaccurate calorie information. Conclusion: Efforts to maximise fidelity require multi-level, multi-component strategies in order to reduce or mitigate barriers and to leverage facilitators. Future research should examine the relative importance of calorie posting determinants and the association between implementation strategies and shifts in fidelity to intervention core components.
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Affiliation(s)
- Claire Kerins
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- Faculty of Education and Health Sciences, School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fiona Geaney
- School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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Increasing availability of lower energy meals vs. energy labelling in virtual full-service restaurants: two randomized controlled trials in participants of higher and lower socioeconomic position. BMC Public Health 2021; 21:975. [PMID: 34034699 PMCID: PMC8147368 DOI: 10.1186/s12889-021-11007-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are a range of interventions designed to promote healthier food choices in full-service restaurants. However, it is unclear how these interventions affect dietary choices in people of lower and higher socioeconomic position (SEP). Methods A total of 2091 US participants recruited online completed Study 1 (n = 1001) and Study 2 (n = 1090). Recruitment was stratified by participant highest education level, resulting in higher SEP and lower SEP groups. In a between-subjects design, participants made hypothetical food choices (main dish, plus optional sides and desserts) from six restaurants menus in the absence vs. presence of menu energy labelling and from menus with baseline (10%) vs. increased availability (50%) of lower energy main dishes. Data were collected and analysed in 2019. Two studies were conducted in order to examine replicability and generalisability of findings across different restaurant menu types. Results Across both studies, increasing the availability of lower energy main menu options decreased the average energy content of the ordered main dish (− 129 kcal, 95% CI [− 139; − 119]) and total energy ordered (− 117 kcal, 95% CI [− 138; − 95]) in both higher and lower SEP participants. Energy labelling significantly reduced the energy content of ordered main dishes in higher SEP participants (− 41 kcal, 95% CI [− 54; − 29]), but not lower SEP participants (− 5 kcal, 95% CI [− 22; 11]). However, energy labelling reduced total energy ordered (− 83 kcal, 95% CI [− 105; − 60]) irrespective of SEP. Conclusions In two virtual experiments, increasing the availability of lower energy restaurant main menu options impacted on main menu dish choice and decreased total energy ordered irrespective of SEP. Energy labelling had a less pronounced effect on total energy ordered and had a larger impact on the energy content of main menu dish choice in higher as opposed to lower SEP participants. Trial registration Clinicaltrials.gov NCT04336540 retrospectively registered (7 April, 2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11007-0.
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21
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Redox regulation of the insulin signalling pathway. Redox Biol 2021; 42:101964. [PMID: 33893069 PMCID: PMC8113030 DOI: 10.1016/j.redox.2021.101964] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
The peptide hormone insulin is a key regulator of energy metabolism, proliferation and survival. Binding of insulin to its receptor activates the PI3K/AKT signalling pathway, which mediates fundamental cellular responses. Oxidants, in particular H2O2, have been recognised as insulin-mimetics. Treatment of cells with insulin leads to increased intracellular H2O2 levels affecting the activity of downstream signalling components, thereby amplifying insulin-mediated signal transduction. Specific molecular targets of insulin-stimulated H2O2 include phosphatases and kinases, whose activity can be altered via redox modifications of critical cysteine residues. Over the past decades, several of these redox-sensitive cysteines have been identified and their impact on insulin signalling evaluated. The aim of this review is to summarise the current knowledge on the redox regulation of the insulin signalling pathway.
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Wellard-Cole L, Davies A, Allman-Farinelli M. Contribution of foods prepared away from home to intakes of energy and nutrients of public health concern in adults: a systematic review. Crit Rev Food Sci Nutr 2021; 62:5511-5522. [PMID: 33596740 DOI: 10.1080/10408398.2021.1887075] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A 2011 review associated eating out with increased energy intake. Popular outlets, nutrient composition, and menus may have changed since 2011. This study aimed to investigate relative contributions of foods prepared outside of home to total energy, total and saturated fat, sugars, and sodium intakes. Studies were included if they were observational cohort or cross-sectional, investigated the contributions that foods prepared out of home made to energy, nutrient intakes and/or nutrient densities of adults aged 18-64 years, published between 2009 and 2019. Socio-demographic differences were explored. Data were extracted guided by the STROBE Statement for cohort and cross-sectional studies. A descriptive, qualitative synthesis was conducted. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists for Analytical Cross-sectional and Cohort Studies. Evidence strength was assessed using GRADE. Twenty-six studies were included. Higher consumption of foods purchased outside home increased intakes of energy and nutrients of public health concern, particularly in males and younger adults. Heterogeneity of definitions of foods prepared outside of home made comparison difficult. Studies frequently used self-reported consumption data, prone to misreporting. Foods prepared outside of home are associated with poorer diets. Policy and practice initiatives are required to address this.
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Affiliation(s)
- Lyndal Wellard-Cole
- Charles Perkins Centre, The University of Sydney, University Drive, Sydney, Australia.,Cancer Prevention and Advocacy Division, Cancer Council NSW, Woolloomooloo, Australia
| | - Alyse Davies
- Charles Perkins Centre, The University of Sydney, University Drive, Sydney, Australia
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Abstract
OBJECTIVE To estimate the daily dietary energy intake for me to maintain a constant body weight. How hard can it be? DESIGN Very introspective study. SETTING At home. In lockdown. (Except every Tuesday afternoon and Saturday morning, when I went for a run.) PARTICIPANTS: Me. n=1. MAIN OUTCOME MEASURES My weight, measured each day. RESULTS Sleeping, I shed about a kilogram each night (1.07 (SD 0.25) kg). Running 5 km, I shed about half a kilogram (0.57 (SD 0.15) kg). My daily equilibrium energy intake is about 10 000 kJ (10 286 (SD 201) kJ). Every kJ above (or below) 10 000 kJ adds (or subtracts) about 40 mg (35.4 (SD 3.2) mg). CONCLUSIONS Body weight data show persistent variability, even when the screws of control are tightened and tightened.
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Affiliation(s)
- R A Lewis
- School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong NSW 2522, Australia
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Abstract
OBJECTIVE To compare the sugar content of items at four multinational fast-food chains, across three countries. DESIGN Total sugar (g)/per serving was extracted from online nutrition information, and sugar/100 g serving was calculated. Foods were categorised as: breakfast sandwiches, burgers, sandwiches, desserts and condiments. Beverages were categorised as fountain, frozen or pre-packaged. Sugar (g) was compared across countries using linear mixed-effects models. Pairwise comparisons were performed with Tukey-Kramer adjustments. SETTING USA, Germany and Australia. PARTICIPANTS Burger King™ (Hungry Jack's™), Kentucky Fried Chicken™, McDonald's™ and Subway™. RESULTS Differences in total sugar/100 g or ml were observed across countries for burgers (n 104), desserts (n 110), sandwiches (n 178), pre-packaged beverages (n 36) and frozen beverages (n 72). Comparing identical items across countries (e.g. BigMacTM from McDonalds in USA, Germany and Australia), burgers (n 10 available in all three countries) had lower sugar content in Australia (3·4 g/100 g) compared with the USA (4·7 g/100 g, P = 0·02) or Germany (4·6 g/100 g, P = 0·04), yet no differences were observed in other food categories. Comparing the same beverages across countries (e.g. chocolate shake from Burger King), frozen beverages (n 4 available in all three countries) had lower sugar content in Australia (14·2 g/100 ml), compared with the USA (20·3 g/100 ml, P = 0·0005) or Germany (17·8 g/100 ml, P = 0·0148), yet no differences were observed in other beverage categories. CONCLUSIONS Heterogeneity in fast-food sugar content across countries suggests that reductions are possible and should be implemented to reduce health risks associated with excess added sugar intake.
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25
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Murphy SA, Weippert MV, Dickinson KM, Scourboutakos MJ, L'Abbé MR. Cross-Sectional Analysis of Calories and Nutrients of Concern in Canadian Chain Restaurant Menu Items in 2016. Am J Prev Med 2020; 59:e149-e159. [PMID: 32828587 DOI: 10.1016/j.amepre.2020.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/14/2020] [Accepted: 05/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The nutritional quality of restaurant foods in Canada is not monitored by government and limited research has evaluated the nutrient content of these foods. Given the increasing proportion of foods consumed outside the home, this study aims to assess levels of nutrients of public health concern in Canadian fast-food and sit-down restaurant menu items. METHODS Levels of calories, saturated fat, sodium, and sugar of 10,285 menu items from 90 national chain restaurants in Canada were assessed. Data were collected in 2016, extracted and analyzed between 2018 and 2020, and presented overall and by category. Levels in fast-food and sit-down restaurant establishments were compared. RESULTS Overall mean levels of saturated fat, sodium, and sugar were high. Entrées contained on average 52% of the total daily value for sodium (1,256 mg/serving) and 45% of the daily value for saturated fat (8.9 g/serving). Beverages and desserts had high levels of total sugar (mean=44 g and 32 g/serving, respectively) but tended to be low in sodium. Sit-down restaurant items had significantly (p≤0.0001) higher levels of calories, saturated fat, and sodium overall, although fast-food restaurant items had higher average sugar levels because of the higher number of beverage and dessert items. CONCLUSIONS Levels of nutrients of concern in Canadian menu items are excessive among most food categories. As the frequency of eating out in restaurants rises, government policies to promote reformulation and increase transparency of the nutritional content of these items are required to reduce their negative impact on public health.
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Affiliation(s)
- Sarah A Murphy
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madyson V Weippert
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kacie M Dickinson
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mary J Scourboutakos
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary R L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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26
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Elliston KG, Schüz B, Albion T, Ferguson SG. Comparison of Geographic Information System and Subjective Assessments of Momentary Food Environments as Predictors of Food Intake: An Ecological Momentary Assessment Study. JMIR Mhealth Uhealth 2020; 8:e15948. [PMID: 32706728 PMCID: PMC7407250 DOI: 10.2196/15948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/18/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background It has been observed that eating is influenced by the presence and availability of food. Being aware of the presence of food in the environment may enable mobile health (mHealth) apps to use geofencing techniques to determine the most appropriate time to proactively deliver interventions. To date, however, studies on eating typically rely on self-reports of environmental contexts, which may not be accurate or feasible for issuing mHealth interventions. Objective This study aimed to compare the subjective and geographic information system (GIS) assessments of the momentary food environment to explore the feasibility of using GIS data to predict eating behavior and inform geofenced interventions. Methods In total, 72 participants recorded their food intake in real-time for 14 days using an ecological momentary assessment approach. Participants logged their food intake and responded to approximately 5 randomly timed assessments each day. During each assessment, the participants reported the number and type of food outlets nearby. Their electronic diaries simultaneously recorded their GPS coordinates. The GPS data were later overlaid with a GIS map of food outlets to produce an objective count of the number of food outlets within 50 m of the participant. Results Correlations between self-reported and GIS counts of food outlets within 50 m were only of a small size (r=0.17; P<.001). Logistic regression analyses revealed that the GIS count significantly predicted eating similar to the self-reported counts (area under the curve for the receiver operating characteristic curve [AUC-ROC] self-report=0.53, SE 0.00 versus AUC-ROC 50 m GIS=0.53, SE 0.00; P=.41). However, there was a significant difference between the GIS-derived and self-reported counts of food outlets and the self-reported type of food outlets (AUC-ROC self-reported outlet type=0.56, SE 0.01; P<.001). Conclusions The subjective food environment appears to predict eating better than objectively measured food environments via GIS. mHealth apps may need to consider the type of food outlets rather than the raw number of outlets in an individual’s environment.
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Affiliation(s)
| | - Benjamin Schüz
- Institute of Public Health and Nursing Science, University of Bremen, Bremen, Germany.,Leibniz Science Campus, Digital Public Health, Bremen, Germany
| | - Tim Albion
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Stuart G Ferguson
- College of Health and Medicine, University of Tasmania, Hobart, Australia
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27
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Dashti HS, Hivert MF, Levy DE, McCurley JL, Saxena R, Thorndike AN. Polygenic risk score for obesity and the quality, quantity, and timing of workplace food purchases: A secondary analysis from the ChooseWell 365 randomized trial. PLoS Med 2020; 17:e1003219. [PMID: 32692747 PMCID: PMC7373257 DOI: 10.1371/journal.pmed.1003219] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/18/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The influence of genetic risk for obesity on food choice behaviors is unknown and may be in the causal pathway between genetic risk and weight gain. The aim of this study was to examine associations between genetic risk for obesity and food choice behaviors using objectively assessed workplace food purchases. METHODS AND FINDINGS This study is a secondary analysis of baseline data collected prior to the start of the "ChooseWell 365" health-promotion intervention randomized control trial. Participants were employees of a large hospital in Boston, MA, who enrolled in the study between September 2016 and February 2018. Cafeteria sales data, collected retrospectively for 3 months prior to enrollment, were used to track the quantity (number of items per 3 months) and timing (median time of day) of purchases, and participant surveys provided self-reported behaviors, including skipping meals and preparing meals at home. A previously validated Healthy Purchasing Score was calculated using the cafeteria traffic-light labeling system (i.e., green = healthy, yellow = less healthy, red = unhealthy) to estimate the healthfulness (quality) of employees' purchases (range, 0%-100% healthy). DNA was extracted and genotyped from blood samples. A body mass index (BMI) genome-wide polygenic score (BMIGPS) was generated by summing BMI-increasing risk alleles across the genome. Additionally, 3 polygenic risk scores (PRSs) were generated with 97 BMI variants previously identified at the genome-wide significance level (P < 5 × 10-8): (1) BMI97 (97 loci), (2) BMICNS (54 loci near genes related to central nervous system [CNS]), and (3) BMInon-CNS (43 loci not related to CNS). Multivariable linear and logistic regression tested associations of genetic risk score quartiles with workplace purchases, adjusted for age, sex, seasonality, and population structure. Associations were considered significant at P < 0.05. In 397 participants, mean age was 44.9 years, and 80.9% were female. Higher genetic risk scores were associated with higher BMI. The highest quartile of BMIGPS was associated with lower Healthy Purchasing Score (-4.8 percentage points [95% CI -8.6 to -1.0]; P = 0.02), higher quantity of food purchases (14.4 more items [95% CI -0.1 to 29.0]; P = 0.03), later time of breakfast purchases (15.0 minutes later [95% CI 1.5-28.5]; P = 0.03), and lower likelihood of preparing dinner at home (Q4 odds ratio [OR] = 0.3 [95% CI 0.1-0.9]; P = 0.03) relative to the lowest BMIGPS quartile. Compared with the lowest quartile, the highest BMICNS quartile was associated with fewer items purchased (P = 0.04), and the highest BMInon-CNS quartile was associated with purchasing breakfast at a later time (P = 0.01), skipping breakfast (P = 0.03), and not preparing breakfast (P = 0.04) or lunch (P = 0.01) at home. A limitation of this study is our data come from a relatively small sample of healthy working adults of European ancestry who volunteered to enroll in a health-promotion study, which may limit generalizability. CONCLUSIONS In this study, genetic risk for obesity was associated with the quality, quantity, and timing of objectively measured workplace food purchases. These findings suggest that genetic risk for obesity may influence eating behaviors that contribute to weight and could be targeted in personalized workplace wellness programs in the future. TRIAL REGISTRATION Clinicaltrials.gov NCT02660086.
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Affiliation(s)
- Hassan S. Dashti
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute, Cambridge, Massachusetts, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Douglas E. Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jessica L. McCurley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Broad Institute, Cambridge, Massachusetts, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anne N. Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Cortés-Rojo C, Vargas-Vargas MA, Olmos-Orizaba BE, Rodríguez-Orozco AR, Calderón-Cortés E. Interplay between NADH oxidation by complex I, glutathione redox state and sirtuin-3, and its role in the development of insulin resistance. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165801. [PMID: 32305451 DOI: 10.1016/j.bbadis.2020.165801] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/16/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
Metabolic diseases are characterized by high NADH/NAD+ ratios due to excessive electron supply, causing defective mitochondrial function and impaired sirtuin-3 (SIRT-3) activity, the latter driving to oxidative stress and altered fatty acid β-oxidation. NADH is oxidized by the complex I in the electron transport chain, thereby factors inhibiting complex I like acetylation, cardiolipin peroxidation, and glutathionylation by low GSH/GSSG ratios affects SIRT3 function by increasing the NADH/NAD+ ratio. In this review, we summarized the evidence supporting a role of the above events in the development of insulin resistance, which is relevant in the pathogenesis of obesity and diabetes. We propose that maintenance of proper NADH/NAD+ and GSH/GSSG ratios are central to ameliorate insulin resistance, as alterations in these redox couples lead to complex I dysfunction, disruption of SIRT-3 activity, ROS production and impaired β-oxidation, the latter two being key effectors of insulin resistance.
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Affiliation(s)
- Christian Cortés-Rojo
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mich 58030, México.
| | - Manuel Alejandro Vargas-Vargas
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mich 58030, México
| | - Berenice Eridani Olmos-Orizaba
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mich 58030, México
| | - Alain Raimundo Rodríguez-Orozco
- Facultad de Ciencias Médicas y Biológicas "Dr. Ignacio Chávez", Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mich 58020, México
| | - Elizabeth Calderón-Cortés
- Facultad de Enfermería, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mich 58260, México
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Kerins C, McHugh S, McSharry J, Reardon CM, Hayes C, Perry IJ, Geaney F, Seery S, Kelly C. Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review. Int J Behav Nutr Phys Act 2020; 17:48. [PMID: 32295647 PMCID: PMC7161210 DOI: 10.1186/s12966-020-00948-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 03/23/2020] [Indexed: 02/05/2023] Open
Abstract
Background Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. Methods Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the ‘best fit’ framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). Results Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs ‘Consumer Needs & Resources’ (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and ‘Compatibility’ with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs ‘Relative Advantage’ of menu labelling (e.g. improved business image/reputation) and ‘Consumer Needs & Resources’ (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. Conclusion This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. Trial registration Systematic review registration: PROSPERO CRD42017083306.
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Affiliation(s)
- Claire Kerins
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Sheena McHugh
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland
| | - Caitlin M Reardon
- Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Catherine Hayes
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin Russell Centre, Tallaght Cross, Dublin 24, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Fiona Geaney
- School of Public Health, University College Cork, College Road, Cork, Ireland
| | - Suzanne Seery
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, University Road, Galway, Ireland
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White M, Aguirre E, Finegood DT, Holmes C, Sacks G, Smith R. What role should the commercial food system play in promoting health through better diet? BMJ 2020; 368:m545. [PMID: 32184211 PMCID: PMC7190369 DOI: 10.1136/bmj.m545] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Martin White and coauthors consider that the commercial food system has the potential to show leadership and support for dietary public health, but systemic change is needed first and this is likely to require governmental action
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Affiliation(s)
- Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, Institute of Metabolic Sciences, University of Cambridge, UK
| | - Emilie Aguirre
- University of Chicago Law School, Chicago, IL, USA
- Harvard Business School, Boston, MA, USA
| | - Diane T Finegood
- Morris J Wosk Centre for Dialogue, Simon Fraser University, Vancouver, BC, Canada
| | | | - Gary Sacks
- Global Obesity Centre, Deakin University, Burwood, VIC 3125, Australia
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
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Dayong N, Mikhaylov A, Bratanovsky S, Shaikh ZA, Stepanova D. Mathematical modeling of the technological processes of catering products production. J FOOD PROCESS ENG 2019. [DOI: 10.1111/jfpe.13340] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nie Dayong
- Yellow River Conservancy Technical Institute Kaifeng Henan China
| | - Alexey Mikhaylov
- Financial University under the Government of the Russian Federation Moscow Russian Federation
| | - Sergey Bratanovsky
- Plekhanov Russian University of Economics Moscow Russian Federation
- Institute of State and Law of the Russian Academy of Sciences Moscow Russian Federation
| | | | - Diana Stepanova
- Plekhanov Russian University of Economics Moscow Russian Federation
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Chai LK, Yoong SL, Bucher T, Collins CE, Shrewsbury VA. Children's Intake of Food from Non-Fast-Food Outlets and Child-Specific Menus: A Survey of Parents. CHILDREN-BASEL 2019; 6:children6110123. [PMID: 31683781 PMCID: PMC6915613 DOI: 10.3390/children6110123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/25/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
Eating out-of-home is associated with higher energy intakes in children. The continued high prevalence of childhood obesity requires a greater understanding of child menu options and eating out frequency to inform appropriate regulatory initiatives. The majority of studies to date have focused on menus from fast-food outlets with few focused on non-fast-food outlets. This study aimed to describe parents’ reports of their child(ren)’s (aged up to 6 years) frequency of consuming foods at non-fast-food outlets, observations of child menus at these outlets, and their purchasing behaviours and future preferences regarding these menus; and if their responses were influenced by sociodemographic characteristics. Ninety-five parents completed a 15-item cross-sectional survey. Overall, children from 54% of families consumed food from non-fast-food outlets at least monthly. Of the 87 parents who reported that their child eats at a non-fast-food restaurant, 71 had children who ordered from child menus every time (7%, n = 5), often (29%, n = 22), sometimes (42%, n = 32) or rarely (16%, n = 12), with a further 7% (n = 5) never ordering from these menus. All parents indicated that they would like to see a higher proportion of healthy child menu items than is currently offered. Parents’ responses were not influenced by sociodemographic characteristics. Parents’ views support implementation of initiatives to increase availability of healthy options on child menus at non-fast-food outlets.
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Affiliation(s)
- Li Kheng Chai
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
| | - Tamara Bucher
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- School of Environmental and Life Science, Faculty of Science, University of Newcastle, Ourimbah, New South Wales 2258, Australia.
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Vanessa A Shrewsbury
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308, Australia.
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Kraak V, Rincón-Gallardo Patiño S, Renukuntla D, Kim E. Progress Evaluation for Transnational Restaurant Chains to Reformulate Products and Standardize Portions to Meet Healthy Dietary Guidelines and Reduce Obesity and Non-Communicable Disease Risks, 2000-2018: A Scoping and Systematic Review to Inform Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2732. [PMID: 31370229 PMCID: PMC6695776 DOI: 10.3390/ijerph16152732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 11/16/2022]
Abstract
Transnational restaurant chains sell food and beverage products in 75 to 139 countries worldwide linked to obesity and non-communicable diseases (NCDs). This study examined whether transnational restaurant chains reformulated products and standardized portions aligned with healthy dietary guidelines and criteria. Firstly, we describe the transnational restaurant industry structure and eating trends. Secondly, we summarize results from a scoping review of healthy dietary guidelines for restaurants. Thirdly, we describe a systematic review of five electronic databases (2000-2018) to identify studies on nutrient profile and portion size changes made by transnational restaurants over 18 years. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, identified 179 records, and included 50 studies conducted in 30 countries across six regions. The scoping review found a few expert-recommended targets for restaurants to improve offerings, but no internationally accepted standard for portions or serving sizes. The systematic review results showed no standardized assessment methods or metrics to evaluate transnational chain restaurants' practices to improve menu offerings. There was wide variation within and across countries, regions, firms, and chains to reduce energy, saturated and trans fats, sodium, and standardized portions. These results may inform future research and encourage transnational chain restaurants to offer healthy product profiles and standardized portions to reduce obesity and NCD risks worldwide.
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Affiliation(s)
- Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA.
| | | | | | - Eojina Kim
- Department of Hospitality and Tourism Management, Pamplin College of Business, Virginia Tech, Blacksburg, VA 24061, USA
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Adams J. Bringing harmony to public health debates about food. BMJ 2018; 363:k5028. [PMID: 30541824 DOI: 10.1136/bmj.k5028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jean Adams
- Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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