Discrete strategies to reduce intake of discretionary food choices: a scoping review

Variety Predicts Discretionary Food and Beverage Intake of Australian Adults: A Cross-Sectional Analysis of an Online Food Intake Survey

BACKGROUND

Variety has been used as a strategy for increasing intakes of healthy foods, but has not been well explored with respect to discretionary food/beverages. The diverse sensory properties of these foods suggests that variety could play an important role in total intake.

OBJECTIVE

This study explored variety as a predictor of intake of discretionary food/beverages, and described the variety of these items consumed by Australian adults.

DESIGN

Secondary analyses of cross-sectional data from a validated, online survey that assesses participants' dietary intake using frequency and portion-based questions. Discretionary food/beverages are grouped into 11 categories.

PARTICIPANTS/SETTING

Participants included 235,203 Australian adults, aged 18 years or older, who provided data from May 2015 to November 2020.

OUTCOME MEASURES

Variety was the number of categories of discretionary food/beverages consumed. Servings were estimated from usual intake questions, and percent contribution summarized by category. Consumption prevalence was the proportion of the sample/subgroup consuming each category. Consumption was calculated as the mean of the sample and per capita in servings.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics were used to present variety and percent contribution to total intake across the sample and subgroups, and multiple regression was used to examine whether or not variety predicted intake of discretionary food/beverages.

RESULTS

Participants consumed a median of 8 categories of discretionary food/beverages, with every additional category associated wit h an increase in intake of half a serving of discretionary food/beverages per day (B = 0.48; P < 0.001). Alcohol, cakes and cookies, takeaway, and confectionary collectively contributed around two-thirds of total daily intake of discretionary food/beverages, with alcohol contributing the largest proportion (28.3% of total daily intake).

CONCLUSIONS

Variety is related to total intake of discretionary food/beverages. Intervention approaches targeting a reduction in variety, as an alternative to a focus on portion size or frequency of intake, would be a novel way of addressing overconsumption of discretionary food/beverages in future research.

Reduction in intake of discretionary foods and drinks among Danish schoolchildren: dietary results from the real-life cluster-randomised controlled trial 'Are You Too Sweet?'

OBJECTIVE

To evaluate the effectiveness of the multicomponent intervention trial 'Are You Too Sweet?' in reducing discretionary foods and drinks intake among young schoolchildren.

DESIGN

The study was a 3·5-month two-arm cluster-randomised controlled trial among primary schoolchildren and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilise at home. Dietary intake was assessed using a web-based 7-d dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups.

SETTING

Six schools from a Danish municipality were randomised to the intervention group (n 4) or the control group (n 2).

PARTICIPANTS

A total of 153 children aged 5-7 years.

RESULTS

No significant reduction in the children's intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40·9 % (P = 0·045) was observed compared with control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2·9 E% (P = 0·002).

CONCLUSION

The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.

Self-identified strategies to manage intake of tempting foods: cross-sectional and prospective associations with BMI and snack intake

OBJECTIVES

Individuals often use self-directed strategies to manage intake of tempting foods, but what these strategies are and whether they are effective is not well understood. This study assessed the frequency of use and subjective effectiveness of self-directed strategies in relation to BMI and snack intake.

DESIGN

A cross-sectional and prospective study with three time points (T1: baseline, T2: 3 months and T3: 3 years). At T1, demographics, frequency of use and subjective effectiveness of forty-one identified strategies were assessed. At T2 and T3, current weight was reported, and at T2 frequency of snack intake was also recorded.

SETTING

Online study in the UK.

PARTICIPANTS

Data from 368 participants (Mage = 34·41 years; MBMI = 25·06 kg/m2) were used for analysis at T1, n = 170 (46·20 % of the total sample) at T2 and n = 51 (13·59 %) at T3.

RESULTS

Two strategy factors were identified via principal axis factoring: (1) diet, exercise, reduction of temptations, and cognitive strategies, and (2) planning, preparation and eating style. For strategy 1, frequency of use, but not subjective effectiveness, was positively related to BMI at T1. Subjective effectiveness predicted an increase in BMI from T1 and T2 to T3. No relationship to snack intake was found. For strategy 2, frequency of use was negatively related to BMI at T1. Neither frequency of use nor subjective effectiveness were related to changes in BMI over time, but subjective effectiveness was negatively correlated with unhealthy snack intake.

CONCLUSION

Self-directed strategies to reduce the intake of tempting foods are not consistently related to BMI or snack intake.

Achieving high diet quality at eating occasions: findings from a nationally representative study of Australian adults

This study examined differences in food groups consumed at eating occasions by the level of adherence to dietary guidelines in Australian adults (≤19 years) and whether consumption differed with respect to age, sex and education levels. Secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey (n 9054) was performed, using one 24-h dietary recall with self-reported eating occasions. Dietary Guideline Index scores were used to assess adherence to the 2013 Australian Dietary Guidelines. Mean differences (95 % CI) in servings of the five food groups and discretionary foods at eating occasions were estimated for adults with higher and lower diet quality, stratified by sex, age group and education. Using survey-based t-tests, differences of at least half a serving with P values < 0·05 were considered meaningful. Compared with adults with lower diet quality, women and men aged 19-50 years with higher diet quality consumed more serves of vegetables at dinner (mean difference (95 % CI), women; 1·0; 95 % CI (0·7, 1·2); men: 0·9; 95 % CI (0·6, 1·3)) and fewer serves of discretionary foods at snacks (women: -0·7; 95 % CI (-0·9, -0·5); men: -1·0; 95 % CI (-1·4, -0·7). Other food groups, such as grains, dairy products and alternatives, meats and alternatives, were not significantly different between adults with lower and higher diet quality, across any eating occasions and age groups. Discretionary food intake at lunch, dinner and snacks was consistently greater among adults with lower diet quality, regardless of education level. Our findings identify dinner and snacks as opportunities to increase vegetable intake and reduce discretionary food intake, respectively.

Does cutting down on your food consumption lead to a net improvement in nutritional intake? A panel data approach using data from the UK Biobank

BACKGROUND

Food diets are complex and a policy targeting one item of a person's diet does not affect their nutritional intake in a solely additive or subtractive manner. Policies tackling unhealthy diets are more likely to be adopted by governments if there is robust evidence to support them. To evaluate dietary policies, it is important to understand the correlations and interdependencies between food groups, as these can lead to unintended negative consequences. We aimed to see whether reductions in consumption of a particular group is related to a net improvement in nutritional intake, after taking into account patterns of consumption and substitution across food groups.

METHODS

Detailed dietary data was collected using a 24-h online dietary assessment from the UK Biobank and Oxford Web Q (n = 185,611). We used panel data fixed effects methods to estimate changes in energy, saturated fat, total sugar, and fibre following a 100gram reduction across 44 food groups. We compare these estimates against the average nutritional value of that food group from the UK National Diet and Nutrition Survey.

RESULTS

We find evidence of variation in whether a food is compensated between the main confectionery products. Crisps, savoury snacks, and sugar confectionery are less likely to be compensated, whereas chocolate confectionery, biscuits, and buns/cakes/pastries and pies are compensated. The result is particularly striking for chocolate confectionery which shows that while chocolate confectionery often has a high energy content, eating less chocolate confectionery is not associated with an equal reduction in energy. Instead, we find individuals switch or compensate for their reduction in chocolate confectionery consumption with other high energy food items.

CONCLUSIONS

We find that sugar confectionery and crisps and savoury snacks are less likely to result in substitution than chocolate confectionery. This would suggest that food policies aiming to reduce the consumption of these food groups are more likely to result in overall lower consumption of unhealthy foods.

Evaluation of a state-wide intervention on salt intake in primary schoolchildren living in Victoria, Australia

OBJECTIVE

In 2015, the Victorian Salt Reduction Partnership launched a 4-year multifaceted salt reduction intervention designed to reduce salt intake by 1 g/d in children and adults living in Victoria, Australia. Child-relevant intervention strategies included a consumer awareness campaign targeting parents and food industry engagement seeking to reduce salt levels in processed foods. This study aimed to assess trends in salt intake, dietary sources of salt and discretionary salt use in primary schoolchildren pre- and post-delivery of the intervention.

DESIGN

Repeated cross-sectional surveys were completed at baseline (2010-2013) and follow-up (2018-2019). Salt intake was measured via 24-h urinary Na excretion, discretionary salt use behaviours by self-report and sources of salt by 24-h dietary recall. Data were analysed with multivariable-adjusted regression models.

SETTING

Victoria, Australia.

PARTICIPANTS

Children aged 4-12 years.

RESULTS

Complete 24-h urine samples were collected from 666 children at baseline and 161 at follow-up. Mean salt intake remained unchanged from baseline (6·0; se 0·1 g/d) to follow-up (6·1; 0·4 g/d) (P = 0·36), and there were no clear differences in the food sources of salt and at both time points approximately 70 % of children exceeded Na intake recommendations. At follow-up, 14 % more parents (P = 0·001) reported adding salt during cooking, but child use of table salt and inclusion of a saltshaker on the table remained unchanged.

CONCLUSION

These findings show no beneficial effect of the Victorian Salt Reduction Partnership intervention on children's salt intake. More intensive, sustained and coordinated efforts between state and federal stakeholders are required.

A Qualitative Process Evaluation of Participant Experiences in a Feasibility Randomised Controlled Trial to Reduce Indulgent Foods and Beverages

There is a growing interest in the effects of ultra-processed/energy-dense nutrient-poor foods on health outcomes, and few interventions to reduce their consumption have been tested. We tested a simple intervention to help people reduce the indulgences they consume (energy-dense nutrient-poor (EDNP) foods). Herein, we report the qualitative findings to understand how participants reduced their consumption by exploring intervention fidelity and the factors affecting consumption. We conducted a qualitative descriptive study of 23 adults who had taken part in a feasibility randomised controlled trial that asked participants to say no to seven indulgences/week and record what they said no to. Data were collected using face-to-face semi-structured interviews and analysed thematically. A total of 23 adults with an average BMI of 30.8 kg/m2 took part. Participants liked the term indulgence, as they could apply it to their normal dietary intake and make small changes. They found self-monitoring what they said no to helpful and reported that emotional eating and habits affected consumption. They had difficulty overcoming these. As most people are consuming too many foods that are EDNP, this simple intervention of “Say No” seven times/week has the potential to be developed as a public health campaign.

A Qualitative Evaluation of Social Aspects of Sugar-Rich Food and Drink Intake and Parental Strategies for Reductions

Danish children have a much larger intake of sugar-rich foods and drinks than recommended. This study aimed to (1) explore social aspects and practices of pre-school children's intake of sugar-rich foods and drinks and (2) evaluate barriers and parental strategies to reduce their children's intake of sugar-rich foods and drinks employed in connection with the 3.5-month family-centred intervention trial 'Are you too sweet?'. Intervention components included communication of the recommended maximum intake and reduction strategies, supported by resources encouraging and facilitating behavioural changes. A random sample of families (n = 24) from intervention schools participated in post-intervention semi-structured interviews. A thematic content analysis was conducted, revealing three main domains of social practices: (1) 'family treats', including the weekly Danish concept 'Friday sweets', (2) 'everyday treats', such as sweet snacks in lunch packs, between-meals snacks and soft drink habits and (3) 'socialized treats', including treats at special occasions. Parents employed several strategies, most often substitution and portion-size reduction, but also limiting home availability. Families most frequently made changes that were easily adoptable and close to existing routines at home. In conclusion, the intervention components provided families with knowledge and strategies that facilitated behavioural changes towards reducing the intake of sugar-rich foods and drinks.

Evaluation of Parental Acceptability and Use of Intervention Components to Reduce Pre-School Children's Intake of Sugar-Rich Food and Drinks

Knowledge is needed about effective tools that reach public health objectives focused on reducing the intake of sugar-rich foods and drinks. The purpose of this study was to assess the parental acceptability, use and motivational potential of intervention components developed in the randomized family-based trial ‘Are you too sweet?’ aimed at reducing the intake of sugar-rich foods and drinks among children (5–7 y). Intervention components included guidance on sugar-rich foods and drinks at a school health nurse consultation, a box with home-use materials and a digital platform. The methods used were a questionnaire among intervention families (n = 83) and semi-structured interviews with parents in selected intervention families (n = 24). Results showed the good acceptability and usefulness of the components, with reported frequencies of use of materials ranging from 48% to 94% and a high satisfaction rate with the school health nurse consultation. Personalized feedback and guidance from the school health nurse seemed to be a motivational trigger, and components that were compatible with existing practices were most frequently used. However, the components were not considered engaging by all families. Overall, intervention components were well received and hold the potential for enhancing parental knowledge and parenting practices regarding limiting the intake of sugar-rich foods and drinks.

A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study

BACKGROUND

Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited.

OBJECTIVE

This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM.

METHODS

The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability.

RESULTS

The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants' feedback to improve these aspects.

CONCLUSIONS

We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.

Energy-dense dietary patterns high in free sugars and saturated fat and associations with obesity in young adults

PURPOSE

To derive dietary patterns based on dietary energy density (DED), free sugars, SFA, and fiber and investigate association with odds of overweight/obesity in young adults.

METHODS

Cross-sectional data from 625 young Australian adults (18-30 years) were used. Dietary patterns were derived using reduced rank regression based on dietary data from a smartphone food diary using DED, free sugars, SFA, and fiber density as response variables. Multivariable logistic regression was used to investigate associations between dietary patterns and odds of self-reported overweight/obesity (BMI ≥ 25 kg/m2).

RESULTS

Two dietary patterns were identified (DP1 and DP2). DP-1 was positively correlated with DED, free sugars, and SFA, and inversely correlated with fiber density. It was characterized by higher sugar-sweetened beverages intake and lower vegetable intake, and associated with higher odds of overweight/obesity (OR: 1.22; 95% CI 1.05, 1.42). DP-2 was positively correlated with fiber density and free sugars, and inversely correlated with DED and SFA. It was characterized by higher sugar-sweetened beverages intake and lower non-lean red meat intake, and was not significantly associated with overweight/obesity.

CONCLUSION

An energy-dense dietary pattern high in free sugars and SFA and low in fiber was associated with higher odds of obesity in young adults. These findings support dietary interventions that target reductions in energy-dense foods and sugar-sweetened beverages.

Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF)

BACKGROUND

Recent lifestyle changes include increased consumption of highly processed foods (HPF), which has been associated with an increased risk of non-communicable diseases (NCDs). However, nutritional information relies on the estimation of HPF consumption from food-frequency questionnaires (FFQ) that are not explicitly developed for this purpose. We aimed to develop a short screening questionnaire of HPF consumption (sQ-HPF) that integrates criteria from the existing food classification systems.

METHODS

Data from 4400 participants (48.1% female and 51.9% male, 64.9 ± 4.9 years) of the Spanish PREDIMED-Plus ("PREvention with MEDiterranean DIet") trial were used for this analysis. Items from the FFQ were classified according to four main food processing-based classification systems (NOVA, IARC, IFIC and UNC). Participants were classified into tertiles of HPF consumption according to each system. Using binomial logistic regression, food groups associated with agreement in the highest tertile for at least two classification systems were chosen as items for the questionnaire. ROC analysis was used to determine cut-off points for the frequency of consumption of each item, from which a score was calculated. Internal consistency of the questionnaire was assessed through exploratory factor analysis (EFA) and Cronbach's analysis, and agreement with the four classifications was assessed with weighted kappa coefficients.

RESULTS

Regression analysis identified 14 food groups (items) associated with high HPF consumption for at least two classification systems. EFA showed that items were representative contributors of a single underlying factor, the "HPF dietary pattern" (factor loadings around 0.2). We constructed a questionnaire asking about the frequency of consumption of those items. The threshold frequency of consumption was selected using ROC analysis. Comparison of the four classification systems and the sQ-HPF showed a fair to high agreement. Significant changes in lifestyle characteristics were detected across tertiles of the sQ-HPF score. Longitudinal changes in HPF consumption were also detected by the sQ-HPF, concordantly with existing classification systems.

CONCLUSIONS

We developed a practical tool to measure HPF consumption, the sQ-HPF. This may be a valuable instrument to study its relationship with NCDs.

TRIAL REGISTRATION

Retrospectively registered at the International Standard Randomized Controlled Trial Registry ( ISRCTN89898870 ) on July 24, 2014.

The Effect of Downsizing Packages of Energy-Dense, Nutrient-Poor Snacks and Drinks on Consumption, Intentions, and Perceptions-A Scoping Review

The single-serve packaging of discretionary foods is becoming increasingly popular, but evidence is limited on whether smaller package sizes can reduce food intake. The aim of this scoping review is to assess the effect of reducing the package size of energy-dense, nutrient-poor (EDNP) snacks and drinks on consumption, intentions, and perception, and to examine the effects of potential moderators or mediators. The search was conducted in six selected databases and grey literature sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review process (PRISMA-ScR) guidelines. After screening 5562 articles, 30 articles comprising 47 intervention studies were included. Twelve of 15 studies found a significant effect in lowering the actual or intended consumption when a single smaller package was offered compared with a single larger package. When the total serving size was held constant between varying package conditions, such as a multipack, single package, or unpackaged, the results on the actual and intended consumption were inconsistent and varied according to the presence of moderators. Overall, these findings suggest that an overall reduction in the size of a single package is a more promising strategy than providing multipacks to reduce consumption. Changes to the current food environment to promote single smaller packages of EDNP snacks and drinks are necessary to support the better selection of appropriate portion sizes and reduce consumption.

Formative evaluation of a portion control and calorie reduction campaign: Insights from focus groups with target audience

Healthy eating campaigns can increase awareness of healthful foods and eating patterns and prompt behavior change. Portion control can be a useful strategy in weight management efforts, and new, innovative campaigns can help invigorate messages related to portion control and weight management. This qualitative study presents results of formative testing of portion control and calorie reduction messages and infographics for a proposed campaign. We conducted 17 focus groups with 113 adults ages 18-65 years in 3 US cities. We conducted separate focus groups by weight status (overweight/healthy weight) and gender (male/female) and analyzed coded data and categorized emerging themes. Participants, especially those with healthy weights, gravitated toward specific, and achievable messages to encourage portion control and calorie reduction. Men with overweight and women with healthy weights preferred messages that had a positive, supportive tone. Participants favored messages that addressed overeating and allowed for autonomy. In particular, women and those with healthy weights preferred messages that encouraged calorie budgeting. Many participants, in particular men, provided positive feedback on messages encouraging a "fresh start" on Mondays. Additionally, participants preferred messages that were colorful, informative, realistic, attractive, and relatable. With regard to message dissemination, participants suggested that messages and infographics be positioned in high-traffic areas and men generally suggested places where food decisions are made. Moreover, participants suggested message dissemination through trusted health professionals and credible research organizations. Health organizations planning a portion control or calorie reduction campaign should consider these factors early in the development process to help ensure acceptance and success.

Balanced carbohydrate ratios are associated with improved diet quality in Australia: A nationally representative cross-sectional study

Background

Carbohydrate quality influences major health outcomes; however, the best criteria to assess carbohydrate quality remain unknown.

Objective

The objectives were to: i) evaluate whether a diet that meets a carbohydrate ratio (simple, modified or dual ratio) is associated with higher nutrient intakes and diet quality, and ii) model the impact of substituting carbohydrate foods that meet the proposed ratios in place of foods that do not, on nutrient intakes.

Design

A secondary analysis of cross-sectional data from the 2011–12 Australian National Nutrition and Physical Activity Survey.

Participants/Setting

National data from participants aged 2 years and older (n = 12,153).

Main outcome measures

Ratios were defined as (i) simple ratio, 10:1 (10g carbohydrate:≥1g dietary fiber); (ii) modified ratio, 10:1:2 (10g carbohydrate:≥1g dietary fiber:≤2g free sugars); and (iii) dual ratio, 10:1 & 1:2 (10g carbohydrate:≥1g dietary fiber & ≤2g free sugars per 1g dietary fiber). Ratios were compared to nutrient intakes obtained via automated multiple-pass 24-hour dietary recall and diet quality calculated using the Australian Healthy Eating Index.

Statistical analyses performed

Substitution dietary modelling was performed. Data were analyzed using paired and independent sample t-tests.

Results

Ratio adherence was highest for simple (50.2% adults; 28.6% children), followed by dual (40.6% adults; 21.7% children), then modified (32.7% adults; 18.6% children) ratios. Participants who met any ratio reported higher nutrient intake and diet quality compared to those who failed to meet the respective ratio (P < .001 for all), with the greatest nutrient intakes found for those who met modified or dual ratios. Dietary modelling improved nutrient intakes for all ratios, with the greatest improvement found for the dual ratio.

Conclusions

All carbohydrate ratios were associated with higher diet quality, with a free sugars constraint in the dual ratio providing the greatest improvements.

Personalised nutrition advice reduces intake of discretionary foods and beverages: findings from the Food4Me randomised controlled trial

BACKGROUND

The effect of personalised nutrition advice on discretionary foods intake is unknown. To date, two national classifications for discretionary foods have been derived. This study examined changes in intake of discretionary foods and beverages following a personalised nutrition intervention using these two classifications.

METHODS

Participants were recruited into a 6-month RCT across seven European countries (Food4Me) and were randomised to receive generalised dietary advice (control) or one of three levels of personalised nutrition advice (based on diet [L1], phenotype [L2] and genotype [L3]). Dietary intake was derived from an FFQ. An analysis of covariance was used to determine intervention effects at month 6 between personalised nutrition (overall and by levels) and control on i) percentage energy from discretionary items and ii) percentage contribution of total fat, SFA, total sugars and salt to discretionary intake, defined by Food Standards Scotland (FSS) and Australian Dietary Guidelines (ADG) classifications.

RESULTS

Of the 1607 adults at baseline, n = 1270 (57% female) completed the intervention. Percentage sugars from FSS discretionary items was lower in personalised nutrition vs control (19.0 ± 0.37 vs 21.1 ± 0.65; P = 0.005). Percentage energy (31.2 ± 0.59 vs 32.7 ± 0.59; P = 0.031), percentage total fat (31.5 ± 0.37 vs 33.3 ± 0.65; P = 0.021), SFA (36.0 ± 0.43 vs 37.8 ± 0.75; P = 0.034) and sugars (31.7 ± 0.44 vs 34.7 ± 0.78; P < 0.001) from ADG discretionary items were lower in personalised nutrition vs control. There were greater reductions in ADG percentage energy and percentage total fat, SFA and salt for those randomised to L3 vs L2.

CONCLUSIONS

Compared with generalised dietary advice, personalised nutrition advice achieved greater reductions in discretionary foods intake when the classification included all foods high in fat, added sugars and salt. Future personalised nutrition approaches may be used to target intake of discretionary foods.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01530139 . Registered 9 February 2012.

Strategies to Reduce Consumption of Unhealthy Foods and Beverages: Scenario Modeling to Estimate the Impact on the Australian Population's Energy and Nutrient Intakes

BACKGROUND

Overconsumption of energy-dense, nutrient-poor "discretionary" foods and beverages can indicate poor diet quality, which is a risk factor for obesity and chronic disease. With 60% of Australians exceeding the recommended intake of discretionary foods, there is a need for interventions to reduce their consumption.

OBJECTIVE

The objective was to model the impact of 26 specific scenarios to limit discretionary food intake on energy and nutrient intake.

DESIGN

The scenario modeling analysis was based on reduction strategies targeting portion size, frequency, or variety of discretionary food and beverage items consumed.

PARTICIPANTS/SETTING

Data from 12,153 respondents aged 2 to 85 years from the 2011-12 Australian National Nutrition and Physical Activity Survey were used.

OUTCOME MEASURES

The outcome measures were change in servings of discretionary foods and key nutrients (energy, total fat, saturated fat, sugar, alcohol, sodium, trans fat) for the population, and by sex, age group, weight status, and socioeconomic status.

STATISTICAL ANALYSES PERFORMED

Descriptive and inferential statistical analysis were conducted.

RESULTS

Scenarios reduced total energy intake by up to 26% across the population as a whole. The removal of discretionary foods (not beverages) resulted in the greatest reduction in servings and energy (74.8% and 25.6%, respectively), followed by the removal of discretionary items in portions greater than 143 kcal (59.1% and 24.3%) and not consuming discretionary items at main meals (51.2% and 17.8%). Targeting single categories of discretionary foods reduced energy intake by an average of 5.6% for the removal of cakes and biscuits, 4.4% for alcohol, and 3.9% for sugar-sweetened beverages. Strategies reduced total fat, saturated fat, and sugar by up to 35%, 38%, and 40% respectively.

CONCLUSIONS

Strategies that are specific to discretionary food and beverage intake targeting reductions in portion size, frequency, or variety have the potential to reduce energy intake and improve diet quality. These findings have implications for designing interventions with potential to tailor messages to current dietary habits. Exploration of how these strategies could be effectively implemented will be the focus of further research.

Strategies for Healthy Eating Promotion and Behavioral Change Perceived as Effective by Nutrition Professionals: A Mixed-Methods Study

Nutrition professionals may recognize ways to improve diet among their clients/patients. This study aimed to survey strategies and foods that nutrition professionals in Puerto Rico perceive as most effective for healthy eating promotion and behavioral change. The study was a cross-sectional online mixed-methods survey conducted among registered members of the College of Nutritionists and Dietitians of Puerto Rico. Using close-ended questions, nutrition professionals identified foods that they considered as easy to include or difficult to control in the diet of their clients/patients, and strategies that may work best for healthy eating. Frequencies of responses were analyzed. Open-ended questions were qualitatively analyzed in NVivo v11. The response rate was 33.2% (n = 414). The foods deemed as easy to include in the diet were root vegetables (66%), fruit (66%), legumes (57%), water (38%), and yogurt/dairy (37%). The foods deemed as more difficult to control were sugary beverages (63%), sweets and desserts (57%), fats and fried foods (56%), salt (50%), and white rice (44%). The strategies for healthy eating deemed effective were personalized orientation (79%), setting short-term goals (61%), making gradual dietary changes (53%), and setting health-oriented (41%), and personal (37%) goals. Emerging themes from qualitative analysis included the intuited key role of nutrition professionals, the need for policy changes, emphasizing prevention, cultural sensitivity, and practical issues. Respondents suggested potential strategies across levels of the socioecological model. In conclusion, healthy eating strategies and foods perceived by nutrition professionals as effective may shape optimal nutritional counseling and population-wide approaches to improve healthy eating in Puerto Rico.

Which strategies to manage problem foods were related to weight loss in a randomized clinical trial?

Individuals managing their weight are often faced with problem foods that are difficult to resist eating. In the context of a weight-loss intervention, we characterized the most commonly reported problem foods and the behavioral strategies used to manage them, and examined which strategies were related to weight loss. Women with overweight and obesity (N = 186) participated in a one-year randomized trial of three interventions (NCT01474759): standard advice to eat less food, choosing portions based on energy density, and using pre-portioned foods. At Months 0, 6, and 12 of the trial, participants listed the foods they found most problematic and reported the frequency of using eight behavioral strategies to control intake of these foods, including three practices for avoiding exposure to problem foods and three for consuming them but limiting intake. The responses showed that 82% of the top three problem foods were in the categories of sweet baked items, salty snacks, starchy side dishes, chocolate and candy, and ice cream. After one year, women who reported more frequently using the strategy of limiting portions of problem foods had a greater rate of weight loss (kg/week), regardless of their intervention group (p < 0.0001). Among women who limited portions of problem foods less frequently, those using pre-portioned foods had greater initial weight loss compared to the other two groups, but then regained weight at a greater rate (p < 0.0001). The three avoidance strategies for problem foods were reported to be frequently used but were not found to be related to weight loss. These results suggest that adopting and maintaining strategies to manage portions of problem foods, rather than avoiding exposure to them, can be a more useful approach for weight loss.

The Modelled Population Obesity-Related Health Benefits of Reducing Consumption of Discretionary Foods in Australia

Over one third of Australians' daily energy intake is from discretionary foods and drinks. While many health promotion efforts seek to limit discretionary food intake, the population health impact of reductions in the consumption of different types of discretionary foods (e.g., sugar-sweetened beverages (SSBs), confectionery, sweet biscuits) has not been quantified. This study estimated the potential reductions in body weight, obesity-related disease incidence, and healthcare cost savings associated with consumption of one less serving per week of different discretionary foods. Reductions in the different types of discretionary food were modelled individually to estimate the impact on energy consumption and population body weight by 5-year age and sex groups. It was assumed that one serving of discretionary food each week was replaced with either a serving of fruit or popcorn, and a serving (375 mL) of SSBs was replaced with coffee, tea, or milk. Proportional multi-state multiple-cohort Markov modelling estimated likely resultant health adjusted life years (HALYs) gained and healthcare costs saved over the lifetime of the 2010 Australian population. A reduction of one serving of SSBs (375 mL) had the greatest potential impact in terms of weight reduction, particularly in ages 19-24 years (mean 0.31 kg, 95% UI: 0.23 kg to 0.37 kg) and overall healthcare cost savings of AUD 793.4 million (95% UI: 589.1 M to 976.1 M). A decrease of one serving of sweet biscuits had the second largest potential impact on weight change overall, with healthcare cost savings of $640.7 M (95% CI: $402.6 M to $885.8 M) and the largest potential weight reduction amongst those aged 75 years and over (mean 0.21 kg, 95% UI: 0.14 kg to 0.27 kg). The results demonstrate that small reductions in discretionary food consumption are likely to have substantial health benefits at the population level. Moreover, the study highlights that policy responses to improve population diets may need to be tailored to target different types of foods for different population groups.

Factors influencing user's adherence to physical activity applications: A scoping literature review and future directions

BACKGROUND

Although mobile app-delivered physical activity (PA) interventions have the potential to promote exercise, poor adherence to these apps is a common issue impeding their effectiveness. Gaining insights into the factors that influence PA app adherence is an important priority for app developers and intervention designers.

OBJECTIVE

The objective of this study is to perform a literature review to synthesize the factors influencing PA app adherence and to identify directions for future research in this area.

METHODS

A scoping review of prior research was conducted to uncover the factors influencing PA app adherence. Seven online journal databases were searched for relevant articles published from January 1, 2014, to December 31, 2018. The initial search identified 5,572 articles. After a screening and eligibility check based on inclusion criteria, 24 articles were finally selected. The definition of PA app adherence in this review could be categorized along four dimensions derived from previous studies: i.e., frequency of PA app usage, intention/motivation to sustain use of the PA app, degree of function use within the PA app, and the duration of PA app usage.

RESULTS

Of the 24 included studies (both qualitative and quantitative), 12 studies were conducted in the U.S. The methods and study designs varied considerably, with the study durations ranging from 2 weeks to 24 months. The synthesized evidence indicates that 89 distinct factors influenced PA app adherence, and these could be classified into three categories: Personal Factors (n = 28), Technology Features (n = 53), and Contextual Factors (n = 8). Nine more detailed sub-categories were also compiled. Factors in sub-categories, such as psychological factors, health-related factors and predefined goals, are essential for physical activity behavior change experts to implement interventions. Factors in technology features, including PA tracking, PA goal setting and customization of exercise, are specifically useful for PA app developers or PA intervention designers. Overall, evidence of causal factors was limited. Only 5 of the 24 articles explored causal factors that affect PA app adherence. Furthermore, longitudinal studies with long durations were also limited.

CONCLUSIONS

Uncovering the factors influencing PA app adherence is critical as it can expand our current knowledge and provide guidance for app-delivered PA interventions, as well as the design of PA apps. This scoping review identified and categorized factors that influence PA app adherence in prior studies. Based on the evidence synthesized, users are paying more attention to the "playfulness" and personalized features of PA apps, in addition to basic functional requirements. Also, app glitches are the most common factors found to negatively influence app adherence. Several important directions for future research are highlighted in this review, especially the design of studies to explore causality.

5-2-1-0 Lifestyle risk factors predict obesity in Millennials

The Making Effective Nutritional Choices Generation Y (MENU GenY) study is a web-based intervention trial aimed at improving food choices in those aged 21-30 years. We report baseline levels of the 5-2-1-0 healthy lifestyle patterns to predict a body mass index (BMI) ≥30 vs <30 kg m^-2 . Overall, 1674 young adults (69% female) from two large health systems enroled and completed an online survey asking questions about lifestyle habits. A multivariable binary logistic regression model was utilized to predict a BMI ≥30 while controlling for known predictors of obesity. Consuming >3 daily servings of fruits/vegetables (odds ratio, OR = 0.90, 95% confidence interval, CI = 0.81, 0.99), and reporting >2.5 hours/week of vigorous physical activity (OR = 0.93, 95% CI = 0.89-0.96, P < 0.001) was associated with a BMI <30. Conversely, time sitting (OR = 1.07, 95% CI = 1.04, 1.11) and consuming sugar-sweetened beverages (OR = 1.08, 95% CI = 1.00, 1.15) were related to a BMI ≥30. In this cohort of 20-30-year-olds, we observed a consistent relationship between obesity and the 5-2-1-0 healthy lifestyle patterns previously reported among children and adolescents.

Reducing Retail Merchandising of Discretionary Food and Beverages in Remote Indigenous Community Stores: Protocol for a Randomized Controlled Trial

Background

Discretionary food and beverages (products high in saturated fat, added sugars, and salt) are detrimental to a healthy diet. Nevertheless, they provide 42% of total energy and account for 53% of food and beverage expenditure for remote living Aboriginal and Torres Strait Islander Australians, contributing to the excessive burden of chronic diseases experienced by this population group.

Objective

The aim of this study is to test an intervention to reduce sales of discretionary products, in collaboration with the Arnhem Land Progress Aboriginal Corporation (ALPA), which operates 25 stores in very remote Australia, by reducing their merchandising and substituting with core products in remote Australian communities.

Methods

We will use a community-level randomized controlled pragmatic trial design. Stores randomized to the intervention group will be supported by ALPA to reduce merchandising of 4 food categories (sugar, sugar-sweetened beverages, sweet biscuits, and confectionery) that together provide 64% of energy from discretionary foods and 87% of total free sugars in very remote community stores. The remaining stores (50% of total) will serve as controls and conduct business as usual. Electronic store sales data will be collected at baseline, 12-weeks intervention, and 24-weeks postintervention to objectively assess the primary outcome of percent change in purchases of free sugars (g/megajoule) and secondary business- and diet-related outcomes. Critical to ensuring translation to improved store policies and healthier diets in remote Indigenous Australia, we will conduct (1) an in-depth implementation evaluation to assess fidelity, (2) a customer intercept survey to investigate the relationship between customer characteristics and discretionary food purchasing, and (3) a qualitative study to identify policy supports for scale-up of health-enabling policy action in stores.

Results

As of August 2018, 20 stores consented to participate and were randomized to receive the intervention or continue usual business. The 12-week strategy ended in December 2018. The 24-week postintervention follow-up will occur in May 2019. Trial results are expected for 2019.

Conclusions

Novel pragmatic research approaches are needed to inform policy for healthy retail food environments. This research will greatly advance our understanding of how the retail food environment can be used to improve population-level diet in the remote Australian Aboriginal and Torres Strait Islander context and retail settings globally.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12618001588280; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375933 (Archived by WebCite at http://www.webcitation.org/76dbQEmwN)

International Registered Report Identifier (IRRID)

DERR1-10.2196/12646

Discretionary intake among Australian adults: prevalence of intake, top food groups, time of consumption and its association with sociodemographic, lifestyle and adiposity measures

OBJECTIVE

To profile discretionary food and beverage (DF) consumption among Australian adults.

DESIGN

Cross-sectional analysis. Dietary and sociodemographic data were used to profile DF intake. Prevalence of DF consumption, DF servings (1 serving=600 kJ), nutrient contribution from DF and top DF food groups by self-reported eating occasions were determined. DF consumers (&gt;0 g) were classified according to quartile of DF intake and general linear models adjusted for age and sex were used to determine associations.

SETTING

2011-12 National Nutrition and Physical Activity Survey (NNPAS).ParticipantsAdults aged ≥19 years (n 9341) who participated in the NNPAS 2011-12.

RESULTS

Most adults consumed DF (98 %) and over 60 % exceeded 3 DF servings/d, with a mean of 5·0 (se 0·0) DF servings/d. Cakes, muffins, scones, cake-type desserts contributed the most DF energy (8·4 %) of all food groups, followed by wines (8·1 %), pastries (8·0 %) and beers (6·1 %), with all these food groups consumed in large portions (2·3-3·0 DF servings). Lunch and dinner together contributed 45 % of total DF energy intake. High DF consumers had an average of 10 DF servings, and this group contained more younger adults, males, low socio-economic status, lower usual fruit intake and higher mean waist circumference, but not higher BMI.

CONCLUSIONS

A focus on DF consumed in large portions at lunch and dinner may help improve interventions aimed at reducing DF intake and addressing negative adiposity-related measures found in high DF consumers.

Intake of Sugar-Sweetened Beverages in Adolescents from Troms, Norway-The Tromsø Study: Fit Futures

High intake of sugar-sweetened beverages (SSB) has been associated with weight gain and chronic disease. The objective of this paper was to study the intake of SSB and characteristics associated with SSB intake in adolescents from Troms, Norway. We present results from a cross-sectional analysis from the Tromsø Study: Fit Futures, with 426 female and 444 male students aged 15⁻17 years (93% participation rate). Descriptive statistics and logistic regression analyses were performed. Among females, 31.8% drank at least one glass of SSB per day on average, compared to 61.0% among males. The adjusted OR (odds ratio) of daily SSB drinking for males vs. females was 3.74 (95% CI (confidence interval) 2.68⁻5.22). Other dietary habits such as eating snacks, drinking artificially sweetened beverages, fruit juice, and seldom eating breakfast were associated with higher odds for daily SSB drinking, as was daily snuffing. Weight class was not associated with daily SSB drinking. Students in vocational studies, particularly males tended to be more likely to be daily SSB drinkers. The prevalence of participants who on average were daily drinkers was higher than in national studies. We have identified several possible targets for interventions. Clustering of unhealthy behaviours and tendencies to socioeconomic differences are of particular concern.

Understanding everyday strategies used to manage indulgent food consumption: A mixed-methods design

To maintain a healthy body weight or support weight loss efforts, dietary self-management must allow for the limitation of tempting high energy-dense foods. We were interested in people's implementation of day-to-day strategies in order to successfully manage their indulgent food and beverage consumption. Participants from the Swansea area, UK (N = 25; M_age = 37; 68% male) were divided into four focus groups. The average BMI was within the healthy range (23 kg/m²). Each group discussed the approaches that they used to manage their consumption of indulgent foods and drinks. Group discussions were then transcribed, thematically analysed and independently reviewed by a second researcher. In a follow-up phase, participants were asked to rate how often they used the identified strategies and to rate the perceived effectiveness of any that applied to them. The thematic analysis revealed four major themes: Exercise, Cognitive Strategies, Availability and Meal Formation. Variability in the frequency with which strategies were used and perceived as effective was evident. Notably, participants tended to use multiple strategies and even lean participants who did not identify themselves as 'dieters' none-the-less employed a variety of strategies to successfully manage their exposure to and consumption of tempting foods. The findings suggest that dietary advice could be improved by taking into account the strategies for managing indulgent food consumption that are frequently used by individuals, as well as those that are perceived as effective.

Sources of Dietary Sodium in Food and Beverages Consumed by Spanish Schoolchildren between 7 and 11 Years Old by the Degree of Processing and the Nutritional Profile

Excessive salt intake has negative effects on health and persists as a dietary problem in Spanish children. However, the analysis of dietary sodium sources has not been extensively studied. A group of 321 children between 7 and 11 years old from five Spanish regional communities was studied. A three-day dietary record was used to determine the contribution of food and beverages to dietary sodium intake. The food consumed was classified based on the level of processing (NOVA classification) and the nutritional profile. Boys consumed more dietary sodium and sodium from ultra-processed food (UPF) than girls (p < 0.05). The main sources of dietary sodium from discretionary food were meat and meat products (25.1%), some ready-to-eat and pre-cooked dishes (7.4%) and sugars and sweets (6.3%). More than 4/5 of the total dietary sodium consumed came from processed foods (PF) and UPF. Ready-to-eat and pre-cooked dishes (14.4%), meat and meat products (10.6%), and cereals (10.2%) were the most relevant UPF. These results demonstrate that a key point for Spanish children is a reduction in the sodium content in PF and UPF, whether these foods are for basic or discretionary consumption. Furthermore, a decrease in the frequency and the quantity of discretionary food consumption should be encouraged.

High-risk environments for eating foods surplus to requirements: a multilevel analysis of adolescents' non-core food intake in the National Diet and Nutrition Survey (NDNS)

OBJECTIVE

Interventions to reduce adolescents' non-core food intake (i.e. foods high in fat and sugar) could target specific people or specific environments, but the relative importance of environmental contexts v. individual characteristics is unknown.

DESIGN

Cross-sectional.

SETTING

Data from 4d food diaries in the UK National Diet and Nutrition Survey (NDNS) 2008-2012 were analysed. NDNS food items were classified as 'non-core' based on fat and sugar cut-off points per 100g of food. Linear multilevel models investigated associations between 'where' (home, school, etc.) and 'with whom' (parents, friends, etc.) eating contexts and non-core food energy (kcal) per eating occasion (EO), adjusting for variables at the EO (e.g. time of day) and adolescent level (e.g. gender).ParticipantsAdolescents (n 884) aged 11-18 years.

RESULTS

Only 11 % of variation in non-core energy intake was attributed to differences between adolescents. In adjusted models, non-core food intake was 151 % higher (ratio; 95 % CI) in EO at 'Eateries' (2·51; 2·14, 2·95) and 88 % higher at 'School' (1·88; 1·65, 2·13) compared with 'Home'. EO with 'Friends' (1·16; CI 1·03, 1·31) and 'Family &amp; friends' (1·21; 1·07, 1·37) contained 16-21 % more non-core food compared with eating 'Alone'. At the individual level, total energy intake and BMI, but not social class, gender or age, were weakly associated with more non-core energy intake.

CONCLUSIONS

Regardless of individual characteristics, adolescents' non-core food consumption was higher outside the home, especially at eateries. Targeting specific eating contexts, not individuals, may contribute to more effective public health interventions.

'Say no': a feasibility trial of a brief intervention to reduce instances of indulgent energy-intake episodes

The aim of this study is to examine the feasibility of a brief intervention to reduce instances of indulgent energy intake. Forty-five participants with a body mass index (BMI) ≥25 kg m-² were randomized to one of three groups for 8 weeks. The control group was asked to complete a questionnaire every 4 days, the self-monitoring group was given the same instructions but also asked to 'say no' to indulgences. The self-monitoring and feedback group was asked to do the same but in addition to send a photograph or description of that to which they had 'said no' and were then provided with feedback. All participants reported on indulgences for 7 days prospectively at baseline and 8-week follow-up. The follow-up rate was 80%; completion of questionnaires was 63% and 87 text messages were sent. The control group reduced their indulgences by 4.1 (SD 10.0), the self-monitoring group by 13.8 (SD 16.8) and self-monitoring and feedback group by 9.0 (SD 11.7) per week. All bar one, feasibility progression criteria were met and this was the return of the indulgence diaries during the intervention period. The study demonstrates the feasibility of a brief intervention to reduce the number of indulgences people ate. The progression criteria were met and areas of improvement are highlighted.

The effect of a portion size intervention on French fries consumption, plate waste, satiety and compensatory caloric intake: an on-campus restaurant experiment

Background

One of the driving factors of dietary overconsumption throughout the last decennia is the increase of food portion sizes. Larger portions induce higher daily energy intake, so reducing portion size may reduce intake of excess calories. However, real-life studies about the effects of portion size reduction are lacking. Therefore, this study examined the effect of a French fries portion size reduction on French fries consumption, French fries plate waste, satiety and caloric intake during the subsequent afternoon among university students and employees in a Belgian on-campus restaurant setting. Moreover, this study evaluated consumers’ perception about the portion size reduction.

Methods

The study took place over a two-time (i.e. baseline and intervention week) 4-day period (Tuesday–Friday) in the on-campus restaurant where ±1200 meals are served every day. French fries’ portions were reduced by 20% by replacing the usual porcelain bowl served during the baseline week (±200 g) with smaller volume paper bags during the intervention week (±159 g) in a pre-post real-life experiment. French fries consumption and plate waste were measured in 2056 consumers at baseline and 2175 consumers at intervention. Additionally, interviews were conducted directly after lunch and again between 4 and 6 p.m. on the same day to assess satiety and caloric intake at pre and post in a small subsample of both French fries consumers (n = 19) and non-French fries consumers (n = 14). Post-intervention, the same subsample was interviewed about their perception of the portion size reduction (n = 28).

Results

Total French fries intake decreased by 9.1%, and total plate waste decreased by 66.4%. No differences were found in satiety or caloric intake between baseline and intervention week among the French fries’ consumers. The majority (n = 24, 86%) of French fries consumers noticed the reduction in portion size during the intervention. Although most participants (n = 19, 68%) perceived the reduced portion size as sufficient, only a minority of participants (n = 9, 32%) indicated post-intervention that they would agree with a permanent implementation.

Conclusions

Reducing portion size may lead to reduced caloric intake, without changing perceived levels of satiety.

Comparing the Nutritional Impact of Dietary Strategies to Reduce Discretionary Choice Intake in the Australian Adult Population: A Simulation Modelling Study

Dietary strategies to reduce discretionary choice intake are commonly utilized in practice, but evidence on their relative efficacy is lacking. The aim was to compare the potential impact on nutritional intake of three strategies to reducing discretionary choices intake in the Australian adult (19-90 years) population. Dietary simulation modelling using data from the National Nutrition and Physical Activity Survey 2011-2012 was conducted (n = 9341; one 24 h dietary recall). Strategies modelled were: moderation (reduce discretionary choices by 50%, with 0%, 25% or 75% energy compensation); substitution (replace 50% of discretionary choices with core choices); reformulation (replace 50% SFA with unsaturated fats, reduce added sugars by 25%, and reduce sodium by 20%). Compared to the base case (observed) intake, modelled intakes in the moderation scenario showed: -17.3% lower energy (sensitivity analyses, 25% energy compensation -14.2%; 75% energy compensation -8.0%), -20.9% lower SFA (-17.4%; -10.5%), -43.3% lower added sugars (-41.1%; -36.7%) and 17.7% lower sodium (-14.3%; -7.5%). Substitution with a range of core items, or with fruits, vegetables and core beverages only, resulted in similar changes in energy intake (-13.5% and -15.4%), SFA (-17.7% and -20.1%), added sugars (-42.6% and -43%) and sodium (-13.7% and -16.5%), respectively. Reformulating discretionary choices had minimal impact on reducing energy intake but reduced SFA (-10.3% to -30.9%), added sugars (-9.3% to -52.9%), and alcohol (-25.0% to -49.9%) and sodium (-3.3% to -13.2%). The substitution and reformulation scenarios minimized negative changes in fiber, protein and micronutrient intakes. While each strategy has strengths and limitations, substitution of discretionary choices with core foods and beverages may optimize the nutritional impact.

The CSIRO Healthy Diet Score: An Online Survey to Estimate Compliance with the Australian Dietary Guidelines

There are few dietary assessment tools that are scientifically developed and freely available online. The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Healthy Diet Score survey asks questions about the quantity, quality, and variety of foods consumed. On completion, individuals receive a personalised Diet Score—reflecting their overall compliance with the Australian Dietary Guidelines. Over 145,000 Australians have completed the survey since it was launched in May 2015. The average Diet Score was 58.8 out of a possible 100 (SD = 12.9). Women scored higher than men; older adults higher than younger adults; and normal weight adults higher than obese adults. It was most common to receive feedback about discretionary foods (73.8% of the sample), followed by dairy foods (55.5%) and healthy fats (47.0%). Results suggest that Australians’ diets are not consistent with the recommendations in the guidelines. The combination of using technology and providing the tool free of charge has attracted a lot of traffic to the website, providing valuable insights into what Australians’ report to be eating. The use of technology has also enhanced the user experience, with individuals receiving immediate and personalised feedback. This survey tool will be useful to monitor population diet quality and understand the degree to Australians’ diets comply with dietary guidelines.