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Hughes JP, Weick M, Vasiljevic M. Can environmental traffic light warning labels reduce meat meal selection? A randomised experimental study with UK meat consumers. Appetite 2024; 200:107500. [PMID: 38763297 DOI: 10.1016/j.appet.2024.107500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/21/2024]
Abstract
An important area for tackling climate change and health improvement is reducing population meat consumption. Traffic light labelling has successfully been implemented to reduce the consumption of unhealthy foods and sugary drinks. The present research extends this work to meat selection. We tested 1,300 adult UK meat consumers (with quotas for age and gender to approximate a nationally representative sample). Participants were randomised into one of four experimental groups: (1) a red traffic light label with the text 'High Climate Impact' displayed on meat meal options only; (2) a green traffic light label with the text 'Low Climate Impact' displayed on vegetarian and vegan meal options only; (3) red/orange/green (ROG) traffic light labels displayed on relevant meals; and (4) control (no label present). Participants made meal selections within their randomised group across 20 meal trials. A beta-regression was performed to ascertain the change in primary outcome (proportion of meat meals selected across the 20 trials) across the different groups. The red-only label and ROG labels significantly reduced the proportion of meat meals selected compared to the unlabelled control group, by 9.2% and 9.8% respectively. The green-only label did not differ from control. Negatively framed traffic light labels seem to be effective at discouraging meat selection. The labels appeared to be moderately acceptable to meat eaters, who did not think the labels impacted the appeal of the products. These encouraging findings require replication in real-life settings.
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Affiliation(s)
- Jack P Hughes
- Department of Psychology, Durham University, Durham, UK.
| | - Mario Weick
- Department of Psychology, Durham University, Durham, UK
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Taillie LS, Wolfson JA, Prestemon CE, Bercholz M, Ewoldt L, Ruggles PR, Hall MG. The impact of an eco-score label on US consumers' perceptions of environmental sustainability and intentions to purchase food: A randomized experiment. PLoS One 2024; 19:e0306123. [PMID: 38935699 PMCID: PMC11210794 DOI: 10.1371/journal.pone.0306123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024] Open
Abstract
Front-of-package labels indicating a product's environmental footprint (i.e., eco-score labels) offer promise to shift consumers towards more sustainable food choices. This study aimed to understand whether eco-score labels impacted consumers' perceptions of environmental sustainability and intentions to purchase sustainable and unsustainable foods. US parents (n = 1,013) completed an online experiment in which they were shown 8 food products (4 sustainable and 4 unsustainable). Participants were randomized to a control (n = 503, barcode on product packaging) or eco-score label group (n = 510, eco-score label on product packaging). The eco-score label was color-coded with a grade of A-F based on the product's environmental footprint, where "A" indicates relative sustainability and "F" indicates relative unsustainability. Participants rated each product's environmental sustainability and their future likelihood of purchase. We used multilevel mixed-effects linear regression models and examined moderation by product category and sociodemographic characteristics. The eco-score label lowered perceived sustainability of unsustainable products by 13% in relative terms or -0.4 in absolute terms (95% CI -0.5, -0.3; p<0.001). The eco-score label increased perceived sustainability of sustainable products by 16% in relative terms or 0.6 in absolute terms (95% CI 0.5, 0.7, p<0.001). Effects on purchase intentions were smaller, with a 6% decrease for unsustainable products (p = 0.001) and an 8% increase for sustainable products (p<0.001). For unsustainable products, the effect of eco-score labels on sustainability perceptions was greater for older adults, men, participants with higher educational attainment, and participants with higher incomes. For sustainable products, the effect of ecolabels on sustainability perceptions was greater for those with higher educational attainment. Eco-score labels have the potential to direct consumers towards more sustainable products. Future studies should investigate eco-score label effectiveness on behavioral outcomes.
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Affiliation(s)
- Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Julia A. Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Carmen E. Prestemon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Maxime Bercholz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Laina Ewoldt
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Phoebe R. Ruggles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center,University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Marissa G. Hall
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center,University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Mora-Plazas M, Higgins ICA, Gomez LF, Hall MG, Parra MF, Bercholz M, Murukutla N, Taillie LS. Impact of nutrient warning labels on Colombian consumers' selection and identification of food and drinks high in sugar, sodium, and saturated fat: A randomized controlled trial. PLoS One 2024; 19:e0303514. [PMID: 38857209 PMCID: PMC11164358 DOI: 10.1371/journal.pone.0303514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/09/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE This study assessed the impact of nutrient warnings on product selection and ability to identify food products high in nutrients of concern in Colombia. METHODS In an online experiment (May-June 2023), Colombian adults were randomized to a nutrient warning, guideline daily amounts (GDA), Nutri-Score, or no-label condition (n = 8,004). Participants completed selection tasks between two fruit drinks labeled according to their condition, one high in sugar and one not. Next, participants answered questions about products high in sugar, sodium, and/or saturated fat ("high-in" product). Finally, they selected which label would most discourage them from consuming a high-in product. RESULTS Fewer participants (17%) exposed to the nutrient warning indicated they would purchase the high-sugar fruit drink compared to Nutri-Score (27%, Holm-adjusted (adj) p<0.001) and no label conditions (31%, adj p<0.001); there were no differences between the nutrient warning and GDA label (14%, adj p = 0.087). Compared to the nutrient warning, the GDA label was slightly more effective at helping consumers identify which drink was high in sugar (89% versus 92%, adj p<0.001), while the Nutri-Score and no-label conditions were less effective. Compared to all other conditions, nutrient warnings were more effective at helping participants identify that products were high in nutrients of concern, were more effective at decreasing intentions to purchase these high-in products and were perceived as more effective. Nutrient warnings were most often selected as the label that most discouraged consumption. CONCLUSIONS Nutrient warnings are a promising policy to help consumers identify and discourage consumption of products high in nutrients of concern. TRIAL REGISTRATION Trial Registration: NCT05783726.
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Affiliation(s)
- Mercedes Mora-Plazas
- Departamento de Nutrición Humana, Universidad Nacional de Colombia, Bogotá, Colombia, United States of America
| | - Isabella Carolyn Aida Higgins
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Luis Fernando Gomez
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia, United States of America
| | - Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Maria Fernanda Parra
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia, United States of America
| | - Maxime Bercholz
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Magriplis E, Marakis G, Panagiotakos DB, Samona A, Kotopoulou S, Kouretas D, Smiliotopoulos T, Chourdakis M, Zampelas A. The Relation between Consumer Perception and Objective Understanding of Front-of-Package Nutrition Labels (FOPNLs); Results from an Online Representative Survey. Nutrients 2024; 16:1751. [PMID: 38892684 PMCID: PMC11174983 DOI: 10.3390/nu16111751] [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: 04/19/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND This study investigates the efficacy of Front-of-Pack Nutrition Labels (FOPNLs) as a cost-effective tool for improving dietary choices among Greek consumers. The purpose of the study was to investigate Greek customers' preferences and comprehension of commonly used European FOPNL schemes. METHODS The Hellenic Food Authority and the Agricultural University of Athens performed a representative online survey in March 2022, titled "The Role of Nutritional Labelling in Public Perception and Food Procurement." Consumers responded to a questionnaire separated into two parts. Part one included (i) personal, sociodemographic information, and (ii) subjective opinions on the FOPNL schemes, and part two comprised (iii) an objective understanding of NutriScore and NutrInform Battery, using 15 different foods. Participants were randomly allocated to these groups, and general mixed models were used for analysis. RESULTS A total of 1389 adults completed the first part of the survey, and 74.8% completed the second part. The Multiple Traffic Lights scheme was the preferred FOPNL, chosen by 48.4% of respondents, compared to 19.7% for NutrInform Battery and 12.3% for NutriScore. However, the mean objective assessment score was highest for NutriScore (5.8 ± 2.3) compared to NutrInform Battery (5.4 ± 1.9). CONCLUSION The results highlight the necessity for comprehensive nutrition education programs by showing a considerable gap between subjective preferences and an objective understanding of nutrition labels.
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Affiliation(s)
- Emmanuella Magriplis
- Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece; (S.K.); (T.S.); (A.Z.)
| | - Georgios Marakis
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece; (G.M.); (A.S.)
| | - Demosthenes B. Panagiotakos
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, 17776 Athens, Greece;
| | - Aspasia Samona
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece; (G.M.); (A.S.)
| | - Sotiria Kotopoulou
- Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece; (S.K.); (T.S.); (A.Z.)
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece; (G.M.); (A.S.)
| | - Dimitris Kouretas
- Department of Biochemistry-Biotechnology, University of Thessaly, 41334 Larisa, Greece;
| | - Theodoros Smiliotopoulos
- Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece; (S.K.); (T.S.); (A.Z.)
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Antonis Zampelas
- Laboratory of Dietetics & Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece; (S.K.); (T.S.); (A.Z.)
- Hellenic Food Authority, Leoforos Kifissias 124 & Iatridou 2, 11526 Athens, Greece; (G.M.); (A.S.)
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Aronsen-Kongerud H, Bastien S, Klepp KI. The centrality of food in Norwegian adolescents' life; a photo elicitation study among Norwegian youth. Health Promot Int 2024; 39:daae043. [PMID: 38809235 PMCID: PMC11135210 DOI: 10.1093/heapro/daae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
The purpose of the study was to explore how adolescents from a high school in Viken county define and interact with food systems in their immediate environments to understand if and how health and sustainability affect their food choices. A qualitative case study design and a participatory approach were employed. Data were collected through photo elicitation combined with group interviews. Pictures were analyzed in collaboration with participants, and the group interview through systematic text condensation. Results indicate that adolescents perceive food systems as being a substantial part of their everyday life, that they care about their health and that of the planet, and they wish to take sustainability and health into consideration when making food choices. Their food choices are affected by aspects such as family, friends, marketing, price, time, availability and accessibility. They perceive that their agency to influence their own diet and food systems is limited. Adolescents hold unique and important knowledge of their food-related behaviors and value their autonomy to make food choices. Future research and policies aiming to help adolescents make healthy and sustainable food choices should therefore actively include adolescents.
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Affiliation(s)
- Helene Aronsen-Kongerud
- Department of Public Health Sciences, Norwegian University of Life Sciences, Post Box 5003, 1432 Ås, Norway
| | - Sheri Bastien
- Department of Public Health Sciences, Norwegian University of Life Sciences, Post Box 5003, 1432 Ås, Norway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW Calgary, Alberta, T2N 4Z6 Canada
| | - Knut-Inge Klepp
- Department of Nutrition, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
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Gitungwa H, Gustafson CR, Rose DJ. Comparing the impact of simple and educational point-of-decision messages on nutritional choice outcomes. Appetite 2024; 197:107301. [PMID: 38493871 DOI: 10.1016/j.appet.2024.107301] [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: 10/05/2023] [Revised: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
Emerging evidence suggests that point-of-decision messages may be an effective way to promote healthy food choices. Previous studies show improvements in overall nutritional quality, as well as increases in underconsumed food categories, such as fruits and vegetables, and underconsumed nutrients of public health concern, like dietary fiber. However, there have been multiple approaches used for delivering point-of-decision messages, including very brief messages that remind individuals to consider health during choice, as well as longer messages providing educational information about health benefits. While both approaches have demonstrated positive impacts on outcomes, there is no comparative evidence of the messages' effectiveness. In this study, we examine the impact of four messages on two nutritional attributes of cereals selected in a two-round pre- and post-message breakfast cereal choice exercise with numerous (n = 33) breakfast cereals available. Data were collected via an online survey of adult US residents recruited from the Prolific consumer panel. Three of the messages were simple reminder messages (taste, health, fiber), while there was additionally a longer fiber-focused messaging detailing the health benefits of fiber. Findings show that the simple messages outperformed the longer educational message, though there were some trade-offs between general health and fiber messages. The simple dietary fiber-focused message resulted in significantly higher dietary fiber content in cereals chosen than in any other messaging condition, while the general health message did not result in significantly higher measures of nutritional quality than the simple fiber message. The results of the study suggest that simpler messages may be more effective at increasing the nutritional quality of food choices. Additionally, messages focused on specific nutrients lead to significantly greater increases in the content of those nutrients.
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Affiliation(s)
- Henriette Gitungwa
- Department of Agricultural Economics, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Devin J Rose
- Department of Food Science & Technology, Department of Agronomy & Horticulture, University of Nebraska-Lincoln, Lincoln, NE, USA.
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Matthews ED, Kurnat-Thoma EL. U.S. food policy to address diet-related chronic disease. Front Public Health 2024; 12:1339859. [PMID: 38827626 PMCID: PMC11141542 DOI: 10.3389/fpubh.2024.1339859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/18/2024] [Indexed: 06/04/2024] Open
Abstract
Poor diet is the leading cause of mortality in the U.S. due to the direct relationship with diet-related chronic diseases, disproportionally affects underserved communities, and exacerbates health disparities. Evidence-based policy solutions are greatly needed to foster an equitable and climate-smart food system that improves health, nutrition and reduces chronic disease healthcare costs. To directly address epidemic levels of U.S. diet-related chronic diseases and nutritional health disparities, we conducted a policy analysis, prioritized policy options and implementation strategies, and issued final recommendations for bipartisan consideration in the 2023-24 Farm Bill Reauthorization. Actional recommendations include: sugar-sweetened beverage taxation, Supplemental Nutrition Assistance Program (SNAP) fruit and vegetable subsidy expansion, replacement of ultra-processed foods (UPF) with sustainable, diverse, climate-smart agriculture and food purchasing options, and implementing "food is medicine."
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Affiliation(s)
- Emily D. Matthews
- Emergency Department, Holy Cross Hospital, Holy Cross Health, Silver Spring, MD, United States
| | - Emma L. Kurnat-Thoma
- Georgetown Institute for Women, Peace and Security, Walsh School of Foreign Service, Georgetown University, Washington, DC, United States
- Precision Policy Solutions, LLC, Bethesda, MD, United States
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Gibson LA, Stephens-Shields AJ, Hua SV, Orr JA, Lawman HG, Bleich SN, Volpp KG, Bleakley A, Thorndike AN, Roberto CA. Comparison of Sales From Vending Machines With 4 Different Food and Beverage Messages: A Randomized Trial. JAMA Netw Open 2024; 7:e249438. [PMID: 38717775 PMCID: PMC11079689 DOI: 10.1001/jamanetworkopen.2024.9438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/27/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Point-of-sale food messaging can encourage healthier purchases, but no studies have directly compared multiple interventions in the field. Objective To examine which of 4 food and beverage messages would increase healthier vending machine purchases. Design, Setting, and Participants This randomized trial assessed 13 months (February 1, 2019, to February 29, 2020) of vending sales data from 267 machines and 1065 customer purchase assessments from vending machines on government property in Philadelphia, Pennsylvania. Data analysis was performed from March 5, 2020, to November 8, 2022. Interventions Study interventions were 4 food and beverage messaging systems: (1) beverage tax posters encouraging healthy choices because of the Philadelphia tax on sweetened drinks; (2) green labels for healthy products; (3) traffic light labels: green (healthy), yellow (moderately healthy), or red (unhealthy); or (4) physical activity equivalent labels (minutes of activity to metabolize product calories). Main Outcomes and Measures Sales data were analyzed separately for beverages and snacks. The main outcomes analyzed at the transaction level were calories sold and the health status (using traffic light criteria) of each item sold. Additional outcomes were analyzed at the monthly machine level: total units sold, calories sold, and units of each health status sold. The customer purchase assessment outcome was calories purchased per vending trip. Results Monthly sales data came from 150 beverage and 117 snack vending machines, whereas 1065 customers (558 [52%] male) contributed purchase assessment data. Traffic light labels led to a 30% decrease in the mean monthly number of unhealthy beverages sold (mean ratio [MR], 0.70; 95% CI, 0.55-0.88) compared with beverage tax posters. Physical activity labels led to a 34% (MR, 0.66; 95% CI, 0.51-0.87) reduction in the number of unhealthy beverages sold at the machine level and 35% (MR, 0.65; 95% CI, 0.50-0.86) reduction in mean calories sold. Traffic light labels also led to a 30-calorie reduction (b = -30.46; 95% CI, -49.36 to -11.56) per customer trip in the customer purchase analyses compared to physical activity labels. There were very few significant differences for snack machines. Conclusions and Relevance In this 13-month randomized trial of 267 vending machines, the traffic light and physical activity labels encouraged healthier beverage purchases, but no change in snack sales, compared with a beverage tax poster. Corporations and governments should consider such labeling approaches to promote healthier beverage choices. Trial Registration ClinicalTrials.gov Identifier: NCT06260176.
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Affiliation(s)
- Laura A. Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Alisa J. Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Jennifer A. Orr
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Hannah G. Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
- Now with Novo Nordisk Inc, Plainsboro Township, New Jersey
| | - Sara N. Bleich
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
- Department of Health Care Management, University of Pennsylvania Wharton School, Philadelphia
| | - Amy Bleakley
- Department of Communication, University of Delaware, Newark
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
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Miller C, Ettridge K, Pettigrew S, Wittert G, Coveney J, Wakefield M, Roder D, Durkin S, Martin J, Kay E, Dono J. Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency. Public Health 2024; 230:138-148. [PMID: 38547760 DOI: 10.1016/j.puhe.2024.01.026] [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: 08/15/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.
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Affiliation(s)
- C Miller
- School of Public Health, The University of Adelaide, Adelaide, Australia; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
| | - S Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - G Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Food for Health Alliance, Cancer Council Victoria, Melbourne, Australia
| | - E Kay
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; College of Education Psychology and Social Work, Flinders University, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
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Calabro R, Kemps E, Prichard I, Tiggemann M. Effects of traffic light labelling and increased healthy range on beverage choices from vending machines. Public Health Nutr 2024; 27:e113. [PMID: 38587000 PMCID: PMC11036432 DOI: 10.1017/s1368980024000843] [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: 08/31/2023] [Revised: 01/28/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To test whether traffic light labels and an increased range of healthy beverages, individually and in combination, can increase healthy beverage choices from vending machines. DESIGN Two studies (n 558, 420) tested whether the provision of traffic light labels (green, amber and red) and an increased range of healthy beverages (from 20 % to 50 % green options), individually and in combination, could increase healthy beverage choices from a digital vending machine display. The studies used a between-subjects experimental design, and a hypothetical beverage choice, a limitation when considering real-world applicability. SETTING Both studies utilised an online Qualtrics survey that featured a digital vending machine display. PARTICIPANTS Both studies (n 558, 420) consisted of university students from Flinders University and individuals from a survey recruitment service. RESULTS Featuring traffic lights did not significantly influence beverage choices (P = 0·074), while increasing the healthy range (P = 0·003, OR = 3·27), and the combination of both, did significantly increase healthier beverage choices (P < 0·001, OR = 4·83). CONCLUSIONS The results suggest that the traffic light system and increased healthy range are not maximally effective when used on their own, and benefit greatly when combined, to increase healthy beverage choices. It was suggested that the provision of traffic light labels supplied the necessary nutritional information, and the increased healthy range offered greater opportunity to act in accordance with that information. In so doing, the present findings offer a promising pathway for reducing unhealthy beverage consumption.
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Affiliation(s)
- Ryan Calabro
- Psychology, College of Education, Psychology and Social Work, Flinders University, Adelaide, SA5001, Australia
| | - Eva Kemps
- Psychology, College of Education, Psychology and Social Work, Flinders University, Adelaide, SA5001, Australia
| | - Ivanka Prichard
- Health & Exercise Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Marika Tiggemann
- Psychology, College of Education, Psychology and Social Work, Flinders University, Adelaide, SA5001, Australia
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11
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D’Angelo Campos A, Ng SW, McNeel K, Hall MG. How Promising Are "Ultraprocessed" Front-of-Package Labels? A Formative Study with US Adults. Nutrients 2024; 16:1072. [PMID: 38613105 PMCID: PMC11013171 DOI: 10.3390/nu16071072] [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: 03/05/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
High levels of food processing can have detrimental health effects independent of nutrient content. Experts and advocates have proposed adding information about food processing status to front-of-package labeling schemes, which currently exclusively focus on nutrient content. How consumers would perceive "ultraprocessed" labels has not yet been examined. To address this gap, we conducted a within-subjects online experiment with a convenience sample of 600 US adults. Participants viewed a product under three labeling conditions (control, "ultraprocessed" label, and "ultraprocessed" plus "high in sugar" label) in random order for a single product. The "ultraprocessed" label led participants to report thinking more about the risks of eating the product and discouraging them from wanting to buy the product more than the control, despite not grabbing more attention than the control. The "ultraprocessed" plus "high in sugar" labels grabbed more attention, led participants to think more about the risks of eating the product, and discouraged them from wanting to buy the product more than the "ultraprocessed" label alone. "Ultraprocessed" labels may constitute promising messages that could work in tandem with nutrient labels, and further research should examine how they would influence consumers' actual intentions and behaviors.
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Affiliation(s)
- Aline D’Angelo Campos
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Katherine McNeel
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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12
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Moja L, Zanichelli V, Mertz D, Gandra S, Cappello B, Cooke GS, Chuki P, Harbarth S, Pulcini C, Mendelson M, Tacconelli E, Ombajo LA, Chitatanga R, Zeng M, Imi M, Elias C, Ashorn P, Marata A, Paulin S, Muller A, Aidara-Kane A, Wi TE, Were WM, Tayler E, Figueras A, Da Silva CP, Van Weezenbeek C, Magrini N, Sharland M, Huttner B, Loeb M. WHO's essential medicines and AWaRe: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections. Clin Microbiol Infect 2024; 30 Suppl 2:S1-S51. [PMID: 38342438 DOI: 10.1016/j.cmi.2024.02.003] [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: 10/23/2023] [Revised: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
The WHO Model List of Essential Medicines (EML) prioritizes medicines that have significant global public health value. The EML can also deliver important messages on appropriate medicine use. Since 2017, in response to the growing challenge of antimicrobial resistance, antibiotics on the EML have been reviewed and categorized into three groups: Access, Watch, and Reserve, leading to a new categorization called AWaRe. These categories were developed taking into account the impact of different antibiotics and classes on antimicrobial resistance and the implications for their appropriate use. The 2023 AWaRe classification provides empirical guidance on 41 essential antibiotics for over 30 clinical infections targeting both the primary health care and hospital facility setting. A further 257 antibiotics not included on the EML have been allocated an AWaRe group for stewardship and monitoring purposes. This article describes the development of AWaRe, focussing on the clinical evidence base that guided the selection of Access, Watch, or Reserve antibiotics as first and second choices for each infection. The overarching objective was to offer a tool for optimizing the quality of global antibiotic prescribing and reduce inappropriate use by encouraging the use of Access antibiotics (or no antibiotics) where appropriate. This clinical evidence evaluation and subsequent EML recommendations are the basis for the AWaRe antibiotic book and related smartphone applications. By providing guidance on antibiotic prioritization, AWaRe aims to facilitate the revision of national lists of essential medicines, update national prescribing guidelines, and supervise antibiotic use. Adherence to AWaRe would extend the effectiveness of current antibiotics while helping countries expand access to these life-saving medicines for the benefit of current and future patients, health professionals, and the environment.
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Affiliation(s)
- Lorenzo Moja
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland.
| | - Veronica Zanichelli
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; World Health Organization Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Canada
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Bernadette Cappello
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Graham S Cooke
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Pem Chuki
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; World Health Organization Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva, Switzerland
| | - Celine Pulcini
- APEMAC, and Centre régional en antibiothérapie du Grand Est AntibioEst, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Evelina Tacconelli
- Infectious Diseases Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Loice Achieng Ombajo
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Ronald Chitatanga
- Antimicrobial Resistance National Coordinating Centre, Public Health Institute of Malawi, Blantyre, Malawi
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | | | - Christelle Elias
- Service Hygiène et Epidémiologie, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | | | - Sarah Paulin
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Arno Muller
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | | | - Teodora Elvira Wi
- Department of Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland
| | - Wilson Milton Were
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Elizabeth Tayler
- WHO Regional Office for the Eastern Mediterranean (EMRO), World Health Organisation, Cairo, Egypt
| | | | - Carmem Pessoa Da Silva
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Nicola Magrini
- NHS Clinical Governance, Romagna Health Authority, Ravenna, Italy; World Health Organization Collaborating Centre for Evidence Synthesis and Guideline Development, Bologna, Italy
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infections, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Benedikt Huttner
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; World Health Organization Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Canada
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13
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Hall MG, Ruggles PR, McNeel K, Prestemon CE, Lee CJY, Lowery CM, Campos AD, Taillie LS. Understanding Whether Price Tag Messaging Can Amplify the Benefits of Taxes: An Online Experiment. Am J Prev Med 2024; 66:609-618. [PMID: 38189693 PMCID: PMC10957315 DOI: 10.1016/j.amepre.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Excise taxes on unhealthy products like sugary drinks and tobacco can reduce purchases of these products. However, little research has investigated whether messages at the point of purchase, such as enhanced price tags, can increase the effects of taxes by heightening psychological reactions. This study aimed to examine whether including messages about taxes on price tags could amplify the benefits of excise taxes on unhealthy products. METHODS In 2022, an online study recruited 1,013 U.S. parents to view seven price tag messages (e.g., "includes a 19% sugary drink tax") and a control (i.e., standard price tag with the tax included in the price) displayed in random order alongside sugary drinks. Participants were randomly assigned to view a caution-symbol icon or no icon on price tags. Analyses were conducted in 2023. RESULTS All seven messages discouraged parents from buying sugary drinks for their children compared to control (average differential effects [ADEs] ranged from 0.28 to 0.48, all p<0.001). All messages led to greater attention to the price tag (ADEs ranged from 0.24 to 0.41, all p<0.001) and greater consideration of the cost of sugary drinks (ADEs ranged from 0.31 to 0.50, all p<0.001). Icons elicited higher cost consideration than text-only price tags (ADE=0.15, p<0.010), but not discouragement (p=0.061) or attention (p=0.079). CONCLUSIONS Messaging on price tags could make excise taxes more effective. Policymakers should consider requiring messaging on price tags when implementing taxes.
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Affiliation(s)
- Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Phoebe R Ruggles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine McNeel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Carmen E Prestemon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cristina J Y Lee
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aline D'Angelo Campos
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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14
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Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A Narrative Review of Public Health Interventions for Childhood Obesity. Curr Obes Rep 2024; 13:87-97. [PMID: 38172483 DOI: 10.1007/s13679-023-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). RECENT FINDINGS Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Erica Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, The Greater Boston Food Bank, Boston, USA
| | - Ellen McMahon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Lauren Kruse
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, USA
| | - Emma K Edmondson
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
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15
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Montericcio A, Bonaccio M, Ghulam A, Di Castelnuovo A, Gianfagna F, de Gaetano G, Iacoviello L. Dietary indices underpinning front-of-pack nutrition labels and health outcomes: a systematic review and meta-analysis of prospective cohort studies. Am J Clin Nutr 2024; 119:756-768. [PMID: 38145705 DOI: 10.1016/j.ajcnut.2023.12.017] [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: 06/14/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Nutrient profiling systems are increasingly used to characterize the healthfulness of foods for front-of-package (FOP) labeling, which have been proposed as an effective public health strategy to help people make healthier food choices. OBJECTIVE This study aimed to review available evidence from cohort studies that evaluated the association of dietary indices underpinning FOP nutrition labels with all-cause mortality and incidence of cardiovascular diseases (CVDs) or cancer. METHODS PubMed, Web of Science, and Scopus were systematically searched up to October 2023. We included articles if they were prospective cohort studies, if the exposure was any dietary index underpinning FOP nutrition labels [e.g., the modified Food Standard Agency-Nutrient Profiling System (FSAm-NPS) and the Health Star Rating System], and if outcomes were all-cause mortality or incidence of or mortality due to CVD and cancer. Random-effects models were used to calculate the pooled hazard ratios (HRs) and 95% CIs. RESULTS We identified 11 records (7 unique prospective studies), which were included in the systematic review. The meta-analysis comprised 8 studies analyzing the FSAm-NPS dietary index (DI) as exposure. The pooled HRs associated with a 2-unit increase in the FSAm-NPS DI of all-cause mortality, CVD, and cancer risk were 1.06 (95% confidence interval [CI]: 0.99, 1.13; I2: 80%), 1.08 (95% CI: 1.00, 1.18; I2: 70%), and 1.09 (95% CI: 1.00, 1.19; I2: 77%), respectively. The Chilean Warning Label score and the Health Star Rating systems were examined by 1 study each and were significantly associated with the outcomes. CONCLUSIONS DIs underpinning most common FOP nutrition labels and reflecting nutrient-poor diets show a tendency toward an increased incidence of CVD and cancer, but the observed effects are quite modest in magnitude. Further studies at the population level are needed to support the widely shared hypothesis that FOP labels, possibly in conjunction with other interventions, may contribute to reduce noncommunicable disease risk. This meta-analysis was registered at PROSPERO as CRD42021292625.
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Affiliation(s)
- Alberto Montericcio
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese-Como, Italy
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy.
| | - Anwal Ghulam
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
| | | | - Francesco Gianfagna
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese-Como, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy; Department of Medicine and Surgery LUM University "Giuseppe Degennaro," Casamassima (BA), Italy
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16
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Ding X, Lv W, Liu Y, Lu Y, Liu Y, Li H, Cai B, Han J, Yang Y, Gao C, Wang Z. Evaluation of the Nutritional Quality of Chinese Processed Meat Products: Comparison of Two Nutrient Profile Models. Nutrients 2024; 16:578. [PMID: 38474707 DOI: 10.3390/nu16050578] [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: 01/07/2024] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Processed meat products are one of the most consumed pre-packaged foods in China. They are also group-1 carcinogens, whose consumption has proved to be positively associated with the risk of noncommunicable diseases (NCDs). The purpose of this study is to analyze the nutrient content on the food label of processed meat products based on the China Standardized Database for the Composition of Pre-packaged Food and the National Open Database of the UK and France. The Chilean front-of-pack warning label (FOPWL) and the Chinese Healthier Choice Logo were used to compare the nutrient content of processed meat products from the three countries. It was found that cured meat products have the highest median energy (483 kcal/100 g), total fat content (38.7 g/100 g), and sodium content (2076 mg/100 g) and dried meat products have the highest median protein content (30.2 g/100 g) and carbohydrate content (38.2 g/100 g). In addition, there were significant differences in energy content and contents of total fat, protein, and carbohydrate across different products of the three countries (p < 0.001). A large number of processed meat products currently collected did not meet the criteria of the Chilean FOPWL and the Chinese Healthier Choice Logo. This study provided information on the healthiness of Chinese processed meat products and provided data for improving food formulations for different categories of processed meat products.
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Affiliation(s)
- Xin Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China
| | - Wanting Lv
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yang Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Ying Lu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yajun Liu
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China
| | - Hanning Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Beilei Cai
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Junhua Han
- Chinese Nutrition Society, Beijing 100053, China
| | - Yuexin Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China
- Chinese Nutrition Society, Beijing 100053, China
| | - Chao Gao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition of National Health Commission, Beijing 100050, China
| | - Zhu Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition of National Health Commission, Beijing 100050, China
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17
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Yang Y, Charlebois S, Music J. Front-of-Package-Label-Style Health Logos on Menus-Do Canadian Consumers Really Care about Menu Health Logos? Nutrients 2024; 16:545. [PMID: 38398868 PMCID: PMC10892900 DOI: 10.3390/nu16040545] [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: 01/23/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Public health policies have been widely utilized to improve population nutrition, such as the newly announced front-of-pack labels (FOPLs) that will be applied to Canadian prepackaged foods to help consumers make healthier selections. However, research on similar health logos in the food service sector has been limited. This study explores the potential application of FOPL-style health logos in the food service sector and its impact on consumer behaviors. A survey was conducted among 1070 Canadians to assess their awareness, perception, and support for health logos on restaurant menus. The results indicate that while participants value healthy food options when dining out, taste, price, and convenience remain the primary factors influencing their choices. Most participants were unaware of existing FOPL policies and demonstrated mixed responses regarding the influence of similar health logos on their restaurant selection. However, a majority expressed a desire to see FOPL-style health logos on menus, and nutrient profile ratings and logos indicating nutrient limitations or encouragements were listed as preferred health logos. Notably, females indicated higher supportiveness for FOPL-style health logos on menus and individuals with food allergies exhibited higher agreement in the likelihood of eating at a restaurant displaying labels. Additionally, findings revealed that FOPL-style health logos alone may not significantly deter consumers from purchasing labelled menu items, especially if price is affected. Overall, this study highlights the need for further understanding consumer perceptions to effectively develop and implement FOPL initiatives in the food service sector.
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Affiliation(s)
- Yahan Yang
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Sylvain Charlebois
- Agri-Food Analytics Lab, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Janet Music
- Faculty of Arts & Social Sciences, Dalhousie University, Kenneth C. Rowe Management Building, Halifax, NS B3H 4R2, Canada
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18
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Kelly M, McCann JR, Chapple CI, Woods J, Russell CG. Visual communication design: a neglected factor in nutrition promotion via packaged food labels. Front Public Health 2024; 12:1296704. [PMID: 38420036 PMCID: PMC10899386 DOI: 10.3389/fpubh.2024.1296704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Packaging design is a communication device and a critical component in branding strategy, and has relevance for food policy. Presently, packaging-related nutrition policy initiatives focus on the role of regulated claims, nutrition information panels and front-of-pack nutrition labels to help guide consumer food choices and address high prevalences of discretionary and ultra-processed food consumption in many countries. However, these nutrition labelling systems are not optimized as public health policy tools as many consumers do not use them to inform their food choices. Visual communication design theory posits that a designer orders the elements and principles of design into hierarchies that prioritize certain elements over others, and that some of these elements are more dominant and given more emphasis than others. The overall design of the package thereby directs consumer attention to some aspects of pack design (e.g., characters, contents of the package) and away from others (e.g., nutrition details). Dual processing frameworks propose that food decisions are made with the interplay between automatic and rational thinking processes. Packaging designs affect whether consumers rely predominantly on automatic or rational thinking to select a food. This narrative review outlines the role of food packaging design and how it impacts the clear communication of nutrition aspects of food products and how the use of nutrition information by consumers to make decisions may depend upon design structures in packaging. This article attests that nutrition scientists and policy makers should incorporate visual communication design into research on the food packaging as a public health promotion tool. A stronger focus on the communication of regulated front-of-pack nutrition information can be made with a re-evaluation of the hierarchy of elements in the front-of-pack design enabling consumers to make healthier decisions.
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Affiliation(s)
- Meghan Kelly
- School of Communication and Creative Arts, Faculty of Arts and Education, Deakin University, Geelong, VIC, Australia
| | - Jennifer R. McCann
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Celeste I. Chapple
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Julie Woods
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Catherine G. Russell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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19
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Chen J, Fan Y, Zhang M, Wu S, Li H. The neural model of front-of-package label processing. Nutr Rev 2024; 82:374-388. [PMID: 37604108 DOI: 10.1093/nutrit/nuad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
Front-of-package (FOP) labels have been adopted in many countries to battle the obesity pandemic and its serious health consequences by providing clearer and easier-to-understand nutrition and health information. The effectiveness of FOP labels has been generally confirmed, with some contextual and individual factors modifying their effectiveness. Existing theories (eg, the dual-process theory) and shifting priorities for self-control, provide some explanations for the FOP label effect. However, the cognitive and neural mechanisms underlying the processing of FOP labels remain unknown. Here, a new model, namely, the neural model of FOP label processing, has been proposed to fill this gap by providing an integrated account of FOP label processing while simultaneously considering multiple important situational and individual factors in the same framework. This neural model is built on the core eating network (ie, the ventral reward pathway and the dorsal control pathway) for food cue processing and actual food consumption. The new model explains how FOP labels may facilitate attention, influence the core eating network, and thus alter food choices. It also demonstrates how motivation may modify FOP label processing in 2 ways: affecting attention (the indirect way) and changing the process of evaluating the food (the direct way). It further explains how some contextual and individual factors (eg, ego depletion, time pressure, and health knowledge) influence the process. Thus, the neural model integrates evidence from behavioral, eye-tracking, and neuroimaging studies into a single, integrated account, deepening understanding of the cognitive and neural mechanisms of FOP label processing. This model might facilitate consensus on the most successful FOP label. Moreover, it could provide insights for consumers, food industries, and policy makers and encourage healthy eating behaviors.
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Affiliation(s)
- Jing Chen
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Yixuan Fan
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Manlu Zhang
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Shuhuan Wu
- School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Huiyan Li
- School of Psychology, Beijing Sport University, Beijing 100084, China
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20
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Nkhoma DE, Mumba WK, Banda KJ, Sakala M, Panyani D, Muwalo B, Mbeye NM. Prevalence and determinants of adult consumer use and comprehension of food labels in sub-Saharan Africa: a systematic review and meta-analysis. Nutr Rev 2024; 82:318-331. [PMID: 37330669 DOI: 10.1093/nutrit/nuad064] [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] [Indexed: 06/19/2023] Open
Abstract
CONTEXT Food labelling is a global strategy recommended to reduce noncommunicable diseases. Few reviews, however, have focused on food label use in sub-Saharan Africa (SSA). OBJECTIVE To determine the prevalence of food label use and describe determinants of food label use and purchasing decisions of adult consumers in SSA. DATA SOURCE PubMed (Medline), Web of Science, Cochrane Central, and Google Scholar databases. DATA EXTRACTION Search criteria included adults (aged ≥18 years), conducted in SSA, focusing on food label use or understanding and their determinants or determinants of food-purchasing decisions, and articles published in English. STUDY QUALITY AND DATA ANALYSIS Risk-of-bias assessment of included studies was done using the Joann Briggs Institute checklist for prevalence studies. Publication bias was assessed using funnel plots and Egger's test. Analysis included narrative synthesis and moderator and meta-analyses of food label use. RESULTS A total of 124 articles were found, of which 21 were included in the review. Of participants in the selected studies, 58% were female. About 80% reported food label use (either used sometimes or always) (70%-88%) (I2 = 97%; n = 6223), and regular use was estimated at 36% (28%-45%) (I2 = 97%; n = 5147). Food label use was influenced by level of income, education, employment status, and household size. Food-purchasing decisions were influenced by attributes such as expiry dates, price, and taste. Major recommendations reported were tailored education campaigns and reducing barriers to food label use. CONCLUSION Most (80%) of adults in SSA reported using food labels; however, only about one-third used them consistently. Demographic and situation factors determined patterns in food label use, whereas product attributes influenced food purchasing decisions. Complexity of these determinants requires adopting tailored, multisectoral, theory-driven programs to improve food label use. SYSTEMATIC REVIEW REGISTRATION Open Science Framework (https://osf.io/kc562).
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Affiliation(s)
- Dumisani E Nkhoma
- Nkhata Bay District Hospital, Nkhata Bay District Health Office, Nkhata Bay, Malawi
| | - Wongani K Mumba
- Nkhata Bay District Hospital, Nkhata Bay District Health Office, Nkhata Bay, Malawi
| | - Kondwani J Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Melody Sakala
- Policy Engagement Unit, Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - David Panyani
- Nkhata Bay District Hospital, Nkhata Bay District Health Office, Nkhata Bay, Malawi
| | - Blessings Muwalo
- Department of Nutrition, HIV & AIDS, Ministry of Health, Lilongwe, Malawi
| | - Nyanyiwe Masingi Mbeye
- Evidence Informed Decision Making Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Epidemiology and Biostatistics, Kamuzu University of Health Sciences, Blantyre, Malawi
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21
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Denis F, Savard G. Propositions pour la prévention et la promotion de la santé bucco-dentaire chez les enfants. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2024; 36:91-94. [PMID: 38834529 DOI: 10.3917/spub.242.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
At the last congress of the Association Dentaire Française (ADF) (French Dental Association), the minister of health and prevention, François Braun, stressed the importance he attached to oral health prevention. He also emphasized his desire to roll out and extend prevention campaigns, targeting young people in particular. With this in mind, we are working to lay the political foundations for the mass, free distribution of single-use toothbrushes with fluoride toothpaste in schools. This oral health promotion campaign would aim to debunk any myths or misinformation spread by manufacturers and to encourage a profound cultural change in the way children and their parents learn about oral hygiene. The "cavity-score," which is still under development, could help to reinforce the idea, both among the general public and among healthcare professionals, that oral health is not isolated from the rest of the body, and that this health issue cannot be dealt with in isolation, but in conjunction with all healthcare professionals.
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Pettigrew S, Jongenelis M, Maganja D, Hercberg S, Julia C. The Ability of Nutrition Warning Labels to Improve Understanding and Choice Outcomes Among Consumers Demonstrating Preferences for Unhealthy Foods. J Acad Nutr Diet 2024; 124:58-64.e1. [PMID: 37673335 DOI: 10.1016/j.jand.2023.08.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/04/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Given growing interest in warning labels as a form of front-of-pack nutrition label, it is important to better understand the mechanisms via which these labels may exert their effects, especially among those making suboptimal food choices. OBJECTIVE The study aim was to assess the extent to which consumers with the weakest outcomes for objective understanding and choice in no-label conditions were able to improve their understanding and choices after exposure to warning labels on food product options. DESIGN Post-hoc analyses of the cross-sectional FOP-ICE (Front-of-Pack International Comparative Experimental) study data generated from an online survey that included simulated food choice and nutritional quality ranking scenarios. PARTICIPANTS/SETTING Participants included 3,680 adults from the following 18 countries: Argentina, Australia, Belgium, Bulgaria, Canada, Denmark, France, Germany, Italy, Mexico, Netherlands, Poland, Portugal, Singapore, Spain, Switzerland, United Kingdom, and United States. INTERVENTION Survey respondents selected their preferred product options and ranked foods according to their healthiness before and after exposure to mock breakfast cereal, cake, and pizza products displaying warning labels. MAIN OUTCOME MEASURES Objective understanding and food choice were measured. STATISTICAL ANALYSES PERFORMED Within each product category, analyses were conducted on respondents who initially incorrectly identified the healthiest option and/or selected the unhealthiest option as their preferred choice. Significant differences between proportions selecting each understanding and choice response option were assessed using 2-sample z tests for proportions. RESULTS Salience of the warning labels was low; 46% reported noticing the labels while completing the survey. Just over one-third of those aware of the presence of warning labels were able to identify the least healthy option in the post-exposure condition. Approximately one-half reselected the least healthy option post exposure and just over one-fourth switched to the healthiest option. CONCLUSIONS The results indicated that warning labels can assist some consumers to improve their food quality assessments and choices. However, design improvements could enhance the salience and interpretability of this label format.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Michelle Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Damian Maganja
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Serge Hercberg
- Sorbonne Paris Nord University, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center, Universite Paris Cite, Paris, France; Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center, Universite Paris Cite, Paris, France; Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France
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23
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Rogers NT, Conway DI, Mytton O, Roberts CH, Rutter H, Sherriff A, White M, Adams J. Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis. BMJ Nutr Prev Health 2023; 6:243-252. [PMID: 38264366 PMCID: PMC10800259 DOI: 10.1136/bmjnph-2023-000714] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/18/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Tooth extraction due to dental caries is associated with socioeconomic deprivation and is a major reason for elective childhood hospital admissions in England. Consumption of sugar-sweetened beverages is a risk factor for dental caries. We examined whether the soft drinks industry levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in incidence rates of hospital admissions for carious tooth extraction in children, 22 months post-SDIL implementation. Methods Changes in incidence rates of monthly National Health Service hospital admissions for extraction of teeth due to a primary diagnosis of dental caries (International Classification of Diseases; ICD-10 code: K02) in England, between January 2012 and February 2020, were estimated using interrupted time series and compared with a counterfactual scenario where SDIL was not announced or implemented. Periodical changes in admissions, autocorrelation and population structure were accounted for. Estimates were calculated overall, by Index of Multiple Deprivation (IMD) fifths and by age group (0-4 years, 5-9 years, 10-14 years, 15-18 years). Results Compared with the counterfactual scenario, there was a relative reduction of 12.1% (95% CI 17.0% to 7.2%) in hospital admissions for carious tooth extractions in all children (0-18 years). Children aged 0-4 years and 5-9 years had relative reductions of 28.6% (95% CI 35.6% to 21.5%) and 5.5% (95% CI 10.5% to 0.5%), respectively; no change was observed for older children. Reductions were observed in children living in most IMD areas regardless of deprivation. Conclusion The UK SDIL was associated with reductions in incidence rates of childhood hospital admissions for carious tooth extractions, across most areas regardless of deprivation status and especially in younger children. Trial registration number ISRCTN18042742.
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Affiliation(s)
- Nina Trivedy Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - David I Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Oliver Mytton
- Institute of Child Health, University College London, London, UK
| | - Chrissy H Roberts
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Andrea Sherriff
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
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Ikeda N, Yamashita H, Hattori J, Kato H, Nishi N. Economic effects of dietary salt reduction policies for cardiovascular disease prevention in Japan: a simulation study of hypothetical scenarios. Front Nutr 2023; 10:1227303. [PMID: 38024379 PMCID: PMC10665469 DOI: 10.3389/fnut.2023.1227303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Reducing dietary salt intake is an essential population strategy for cardiovascular disease (CVD) prevention, but evidence on healthcare costs and outcomes is limited in Japan. We aimed to conduct a pilot economic evaluation under hypothetical scenarios of applying the salt reduction policies of England to Japan. Methods We examined salt reduction policies in England: media health promotion campaigns, front-of-pack labeling, and voluntary and mandatory reformulation with best-case and worst-case policy cost scenarios. We assumed that these policies were conducted in Japan for 10 years from 2019. We used published data on epidemiology and healthcare expenditures in Japan and the costs and effects of salt reduction policies in England, and defined the benefits as a decrease in national medical expenditures on CVD. We developed a Markov cohort simulation model of the Japanese population. To estimate the annual net benefits of each policy over 10 years, we subtracted monitoring and policy costs from the benefits. We adopted a health sector perspective and a 2% discount rate. Results The cumulative net benefit over 10 years was largest for mandatory reformulation (best case) at 2,015.1 million USD (with costs of USD 48.3 million and benefits of USD 2063.5 million), followed by voluntary reformulation (net benefit: USD 1,895.1 million, cost: USD 48.1 million, benefit: USD 1,943.2 million), mandatory reformulation (worst case, net benefit: USD 1,447.9 million, cost: USD 1,174.5 million, benefit: USD 2,622.3 million), labeling (net benefit: USD 159.5 million, cost: USD 91.6 million, benefit: USD 251.0 million), and a media campaign (net benefit: USD 140.5 million, cost: USD 110.5 million, benefit: USD 251.0 million). There was no change in the superiority or inferiority of policies when the uncertainty of model parameters was considered. Conclusion Mandatory reformulation with the best-case cost scenario might be economically preferable to the other alternatives in Japan. In future research, domestic data on costs and effects of salt reduction policies should be incorporated for model refinement.
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Affiliation(s)
- Nayu Ikeda
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Settsu, Osaka, Japan
| | - Hitomi Yamashita
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Settsu, Osaka, Japan
| | - Jun Hattori
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Settsu, Osaka, Japan
| | - Hiroki Kato
- Department of Healthcare Information Management, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Nobuo Nishi
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Settsu, Osaka, Japan
- Graduate School of Public Health, St. Luke’s International University, Chuo-ku, Tokyo, Japan
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25
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Barbe C, Boiteux-Chabrier M, Bouazzi L, El-Adib O, Pham BN, Lourdelle A, Hurtaud A. Does the use of color coding facilitate parents' understanding of body mass index curves? Arch Pediatr 2023; 30:458-465. [PMID: 37336698 DOI: 10.1016/j.arcped.2023.06.005] [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: 12/14/2022] [Revised: 03/21/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND In France, national guidelines recommend early detection and management of overweight and obesity in children, with multi-year systematic generation of children's body mass index (BMI) curves in primary care. It is important for the parents to understand the BMI curves displayed in the child's health notebook and to become involved in the care with health professionals. OBJECTIVE The aim of the current study was to compare parents' understanding of a BMI curve displayed using color coding versus their understanding of the same curve displayed without color coding. METHODS An observational, cross-sectional, comparative study was performed between February 1, 2021 and November 15, 2021. Adult parents with at least one child attending primary school were included. Two questionnaires testing parents' understanding were completed: one showing BMI curves without color coding (five questions) and one showing BMI curve with color coding (five questions). The primary endpoint was the proportion of parents achieving fully correct answers. Comparisons of endpoints between the color-coded and non-color-coded curve were performed using the McNemar test. Factors associated with the primary endpoint were investigated by mixed logistic regression models with the subject as a random effect. RESULTS The 109 participants (45.4% response rate) had an average age of 39.4 ± 6.6 years; 81.7% were women. A total of 214 complete questionnaires were compared: The proportion of participants with fully correct responses was significantly higher using the BMI curve with color coding compared to the curve without color coding (86.0% vs. 54.2%, p<0.0001). In multivariate analysis, the use of color coding was significantly associated with a higher likelihood of achieving fully correct responses (odds ratio: 5.9, 95% CI: 3.0-11.2, p<0.0001). CONCLUSION The use of color coding improved parents' understanding of BMI curves. Further research should explore equally the benefits and risks associated with weight loss and mental health when using a colored BMI curve for the detection and management of overweight and obese children.
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Affiliation(s)
- Coralie Barbe
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne UFR Médecine, 51 rue Cognacq Jay, 51100, REIMS, France; Laboratoire C2S (Cognition, Santé, Société), EA 6291, Université de Reims Champagne-Ardenne, France.
| | - Marie Boiteux-Chabrier
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, REIMS, France
| | - Leïla Bouazzi
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne UFR Médecine, 51 rue Cognacq Jay, 51100, REIMS, France
| | - Omar El-Adib
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, REIMS, France
| | - Bach-Nga Pham
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne UFR Médecine, 51 rue Cognacq Jay, 51100, REIMS, France
| | - Alexandre Lourdelle
- American Memorial Hospital, CHU de Reims, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Aline Hurtaud
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq Jay, 51100, REIMS, France
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Mehlhose C, Risius A. Effects of immediate and distant health consequences: different types of health warning messages on sweets affect the purchase probability. BMC Public Health 2023; 23:1892. [PMID: 37777719 PMCID: PMC10544146 DOI: 10.1186/s12889-023-16760-y] [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: 03/10/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Several health control policies have been discussed as a regulatory approach to tackle the increasing prevalence of obesity and other health risks related to sugar consumption. Health warnings, like the ones used in tobacco control worldwide, are one of the most promising approaches. However, in the case of health warning messages for food products, it is much more complicated and involves much more consumer involvement than tobacco guidance. Therefore, it is important to better understand the efficacy, evaluation, and reactance of health warning labels in the food sector regarding consumers' behavior, persuasion, and perceptions. The aim of this study was to examine how different types (design and message) of health warning messages in combination with graphical applications affect consumer behavior. METHODS In a 3 × 3 × 3 symmetrical design, 1,040 German participants completed an online discrete choice experiment including various text-only and image-and-text health warning labels on sweets. An accompanying questionnaire assessed socio-demographic variables as well as psychometric scales to understand the relationship between fear, control, reactance, and shocking/inhibiting/mediating health-related warnings. RESULTS Our results suggest that especially emotional graphical images combined with text health warning labels might be more influential. The health effects of immediate (caries) and more distant health consequences (diabetes/obesity) differ in their impact. Further, results show that especially when consumers engage in a danger control process for overweight, warning messages have a negative impact on their choices. CONCLUSION Hence, warning labels on sweets can potentially be a decisive factor when communicating health threats related to excessive sugar consumption. In the context of a targeted health policy, we see the need for further research, especially concerning the perception and understanding of noncommunicable diseases (NCDs) in the population.
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Affiliation(s)
- Clara Mehlhose
- Marketing of Agricultural and Food Products, Department of Agricultural Economics and Rural Development, University of Göttingen, Platz Der Göttinger Sieben 5, 37073, Göttingen, Germany.
| | - Antje Risius
- Marketing of Agricultural and Food Products, Department of Agricultural Economics and Rural Development, University of Göttingen, Platz Der Göttinger Sieben 5, 37073, Göttingen, Germany
- University of Education Schwäbisch Gmünd, Institute for Health Sciences, Oberbettringer Str. 200, 73525, Schwäbisch Gmünd, Germany
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Grummon AH, Gibson LA, Musicus AA, Stephens-Shields AJ, Hua SV, Roberto CA. Effects of 4 Interpretive Front-of-Package Labeling Systems on Hypothetical Beverage and Snack Selections: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2333515. [PMID: 37703015 PMCID: PMC10500374 DOI: 10.1001/jamanetworkopen.2023.33515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023] Open
Abstract
Importance Policymakers and researchers have proposed a variety of interpretative front-of-package food labeling systems, but it remains unclear which is most effective at encouraging people to choose healthier foods and beverages, including among people with less education. Objective To test the effects of 4 interpretative front-of-package food labeling systems on the healthfulness of beverage and snack selections, overall and by education level. Design, Setting, and Participants This randomized clinical trial of a national sample of US adults 18 years and older was conducted online from November 16 to December 3, 2022. Intervention Participants were randomized to view products with 1 of 5 food labeling systems, including control (calorie labels only) or 1 of 4 interpretative labeling systems: green ("choose often") labels added to healthy foods; single traffic light labels added to healthy, moderately healthy, and unhealthy foods; physical activity calorie equivalent labels added to all products; and nutrient warning labels added to products high in calories, sugar, saturated fat, or sodium. All conditions had calorie labels on all products. Main Outcomes and Measures Participants selected 1 of 16 beverages and 1 of 16 snacks that they wanted to hypothetically purchase. The primary outcomes were calories selected from beverages and from snacks. Secondary outcomes included label reactions and perceptions. Results A total of 7945 participants completed the experiment and were included in analyses (4078 [51%] female, 3779 [48%] male, and 88 [1%] nonbinary or another gender; mean [SD] age, 47.5 [17.9 years]). Compared with the control arm, exposure to the green (average differential effect [ADE], -34.2; 95% CI, -42.2 to -26.1), traffic light (ADE, -31.5; 95% CI, -39.5 to -23.4), physical activity (ADE, -39.0; 95% CI, -47.0 to -31.1), or nutrient warning labels (ADE, -28.2; 95% CI, -36.2 to -20.2) led participants to select fewer calories from beverages (all P < .001). Similarly, compared with the control label, exposure to the green (ADE, -12.7; 95% CI, -17.3 to -8.2), traffic light (ADE, -13.7; 95% CI, -18.2 to -9.1), physical activity (ADE, -18.5; 95% CI, -23.1 to -13.9), or nutrient warning labels (ADE, -14.2; 95% CI, -18.8 to -9.6) led participants to select fewer calories from snacks (all P < .001). These effects did not differ by education level. The green labels were rated as less stigmatizing than the other interpretative systems but otherwise generally received the least favorable label reactions and perceptions (eg, elicited less attention, were perceived as less trustworthy), while the nutrient warnings and physical activity labels received the most favorable ratings. Conclusions and Relevance In this randomized clinical trial of front-of-package food labeling systems, all 4 interpretative labeling systems reduced calories selected from beverages and from snacks compared with calorie labels, with no differences by education level. Trial Registration ClinicalTrials.gov Identifier: NCT05432271.
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Affiliation(s)
- Anna H. Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Laura A. Gibson
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Aviva A. Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Now with Center for Science in the Public Interest, Washington, DC
| | - Alisa J. Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christina A. Roberto
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Kolber A, Meixner O. Effects of Multi-Level Eco-Labels on the Product Evaluation of Meat and Meat Alternatives-A Discrete Choice Experiment. Foods 2023; 12:2941. [PMID: 37569210 PMCID: PMC10418589 DOI: 10.3390/foods12152941] [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: 06/14/2023] [Revised: 07/13/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Eco-labels are an instrument for enabling informed food choices and supporting a demand-sided change towards an urgently needed sustainable food system. Lately, novel eco-labels that depict a product's environmental life cycle assessment on a multi-level scale are being tested across Europe's retailers. This study elicits consumers' preferences and willingness to pay (WTP) for a multi-level eco-label. A Discrete Choice Experiment was conducted; a representative sample (n = 536) for the Austrian population was targeted via an online survey. Individual partworth utilities were estimated by means of the Hierarchical Bayes. The results show higher WTP for a positively evaluated multi-level label, revealing consumers' perceived benefits of colorful multi-level labels over binary black-and-white designs. Even a negatively evaluated multi-level label was associated with a higher WTP compared to one with no label, pointing towards the limited effectiveness of eco-labels. Respondents' preferences for eco-labels were independent from their subjective eco-label knowledge, health consciousness, and environmental concern. The attribute "protein source" was most important, and preference for an animal-based protein source (beef) was strongly correlated with consumers' meat attachment, implying that a shift towards more sustainable protein sources is challenging, and sustainability labels have only a small impact on the meat product choice of average consumers.
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Affiliation(s)
| | - Oliver Meixner
- Institute of Marketing & Innovation, Department of Economics and Social Sciences, University of Natural Resources and Life Sciences, Feistmantelstraße 4, A-1180 Vienna, Austria;
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Machín L, Alcaire F, Antúnez L, Giménez A, Curutchet MR, Ares G. Use of nutritional warning labels at the point of purchase: An exploratory study using self-reported measures and eye-tracking. Appetite 2023:106634. [PMID: 37356578 DOI: 10.1016/j.appet.2023.106634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
Nutritional warning labels are gaining relevance in the region of the Americas as a policy tool to reduce information asymmetry and encourage healthier food choices. However, empirical evidence about consumer experiences with warning labels after implementation is still scarce. In this context, the aim of the present work was to explore the use of nutritional warning labels after policy implementation in Uruguay, using a combination of eye-tracking and self-reported data. The study was conducted in three supermarkets, in two regional capitals, 19 months after the entry into force of the policy. A total of 224 participants were intercepted while entering the facilities of the supermarket and asked to wear a mobile eye-tracker while making their food purchases. Then, they were asked a series of questions about their awareness and use of warning labels. Although participants reported high awareness and understanding of the labels, active search and use at the point of purchase was low. Only 6% of the consumers declared having actively searched for the warning labels and 7% fixated their gaze on the labels. The majority of the participants (72%) who declared having seen the warnings on a product, purchased it anyway. However, 56% declared having changed their food choice decisions as a consequence of the implementation of the policy. Participants' accounts about reasons for (not) taking into account the warning labels provide relevant insights for the development of strategies to encourage citizens to increase policy effectiveness and encourage healthier food choices.
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Affiliation(s)
- Leandro Machín
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Uruguay
| | - Florencia Alcaire
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | - Lucía Antúnez
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | - Ana Giménez
- Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay
| | | | - Gastón Ares
- Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la República, Uruguay; Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Uruguay.
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Ganderats-Fuentes M, Morgan S. Front-of-Package Nutrition Labeling and Its Impact on Food Industry Practices: A Systematic Review of the Evidence. Nutrients 2023; 15:nu15112630. [PMID: 37299593 DOI: 10.3390/nu15112630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
The obesity epidemic has become a major public health concern globally, and the food supply is a significant driver of this trend. Front-of-package (FOP) labels have been implemented in many countries to encourage healthier food choices. This systematic review aimed to examine the effect of FOP label implementation on food manufacturers' practices. A comprehensive search of multiple databases was conducted following PRISMA guidelines, identifying 39 relevant articles from 1990 to 2021. The studies indicated that FOP labels conveying intuitive information influenced product reformulation, whereas those with numerical information without specific guidance had no impact on reducing unhealthy nutrients. The most common outcomes were sodium, sugar, and calorie reduction. Mandatory policies reported higher and more consistent effects on product reformulation compared to voluntary approaches. Voluntary FOP labeling resulted in low uptake and tended to be applied to healthier products. Food manufacturers responded to FOP labeling heterogeneously, depending on the label design and type of enforcement. FOP label implementation can reduce nutrients of concern but food manufacturers behave strategically by labeling healthier choices. This review provides recommendations for maximizing the benefits of using FOP labels to prevent obesity, and findings can inform future public health research and policymaking.
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Affiliation(s)
| | - Sherry Morgan
- Holman Biotech Commons, University of Pennsylvania, Philadelphia, PA 19104, USA
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Jachimowicz-Rogowska K, Winiarska-Mieczan A. Initiatives to Reduce the Content of Sodium in Food Products and Meals and Improve the Population's Health. Nutrients 2023; 15:nu15102393. [PMID: 37242276 DOI: 10.3390/nu15102393] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Table salt is the main source of sodium (Na) in the human diet. Excessive supply of Na in a diet is strongly linked to many non-communicable human diseases, such as hypertension, obesity and stomach cancer. The World Health Organization recommends that daily intake of salt in adult diets should be kept below 5 g/person/day, which corresponds to 2 g Na/person/day. However, on average, adults consume about 9-10 g/person/day, and children and young people about 7-8 g/person/day. Initiatives to reduce salt intake include modifications of food composition in collaboration with the food industry, education of consumers, salt marking on foodstuff labels and taxation of salt. A need also exists to educate society so that they choose low-sodium products. In view of the food technology and amount of salt intake, the most important and the easiest change to make is to reduce the content of salt in baked goods. This paper analyses the results of surveys regarding strategies to reduce salt content in food products and considers multifaceted initiatives to reduce salt intake as a possible efficient method of improving the population's health status.
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Affiliation(s)
- Karolina Jachimowicz-Rogowska
- Department of Bromatology and Food Physiology, Institute of Animal Nutrition and Bromatology, University of Life Sciences in Lublin, Akademicka 13 St., 20-950 Lublin, Poland
| | - Anna Winiarska-Mieczan
- Department of Bromatology and Food Physiology, Institute of Animal Nutrition and Bromatology, University of Life Sciences in Lublin, Akademicka 13 St., 20-950 Lublin, Poland
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Flexner N, Ng AP, Ahmed M, Khandpur N, Acton RB, Lee JJ, L’Abbe MR. Estimating the dietary and health impact of implementing front-of-pack nutrition labeling in Canada: A macrosimulation modeling study. Front Nutr 2023; 10:1098231. [PMID: 37006927 PMCID: PMC10065472 DOI: 10.3389/fnut.2023.1098231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Background Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy diets. Health Canada has recently published FOPL regulations that will require food and beverages that meet or exceed set thresholds for sodium, sugars, or saturated fat to display a 'high in' symbol on the front of the package. Although a promising measure, its potential impact on dietary intakes and health have not yet been estimated in Canada. Objective This study aims to estimate (1) the potential dietary impact of implementing a mandatory FOPL among Canadian adults; and (2) the number of diet-related non-communicable disease (NCD) deaths that could be averted or delayed due to these estimated dietary changes. Methods Baseline and counterfactual usual intakes of sodium, total sugars, saturated fats, and calories were estimated among Canadian adults (n = 11,992) using both available days of 24 h recalls from the 2015 Canadian Community Health Survey-Nutrition. The National Cancer Institute method was used to estimate usual intakes, and adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall. Estimated counterfactual dietary intakes were modeled from reductions observed in experimental and observational studies that examined changes in sodium, sugars, saturated fat, and calorie content of food purchases in the presence of a 'high in' FOPL (four counterfactual scenarios). The Preventable Risk Integrated ModEl was used to estimate potential health impacts. Results Estimated mean dietary reductions were between 31 and 212 mg/day of sodium, 2.3 and 8.7 g/day of total sugars, 0.8 and 3.7 g/day of saturated fats, and 16 and 59 kcal/day of calories. Between 2,183 (95% UI 2,008-2,361) and 8,907 (95% UI 8,095-9,667) deaths due to diet-related NCDs, mostly from cardiovascular diseases (~70%), could potentially be averted or delayed by implementing a 'high in' FOPL in Canada. This estimation represents between 2.4 and 9.6% of the total number of diet-related NCD deaths in Canada. Conclusion Results suggest that implementing a FOPL could significantly reduce sodium, total sugar, and saturated fat intakes among Canadian adults and subsequently prevent or postpone a substantial number of diet-related NCD deaths in Canada. These results provide critical evidence to inform policy decisions related to implementing FOPL in Canada.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alena P. Ng
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Neha Khandpur
- Department of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
- Center for Epidemiological Research in Nutrition and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Rachel B. Acton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mary R. L’Abbe
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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A Diet Profiling Algorithm (DPA) to Rank Diet Quality Suitable to Implement in Digital Tools—A Test Study in a Cohort of Lactating Women. Nutrients 2023; 15:nu15061337. [PMID: 36986066 PMCID: PMC10051632 DOI: 10.3390/nu15061337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Although nutrient profiling systems can empower consumers towards healthier food choices, there is still a need to assess diet quality to obtain an overall perspective. The purpose of this study was to develop a diet profiling algorithm (DPA) to evaluate nutritional diet quality, which gives a final score from 1 to 3 with an associated color (green-yellow-orange). It ranks the total carbohydrate/total fiber ratio, and energy from saturated fats and sodium as potentially negative inputs, while fiber and protein are assumed as positive items. Then, the total fat/total carbohydrate ratio is calculated to evaluate the macronutrient distribution, as well as a food group analysis. To test the DPA performance, diets of a lactating women cohort were analyzed, and a correlation analysis between DPA and breast milk leptin levels was performed. Diets classified as low quality showed a higher intake of negative inputs, along with higher energy and fat intakes. This was reflected in body mass index (BMI) and food groups, indicating that women with the worst scores tended to choose tastier and less satiating foods. In conclusion, the DPA was developed and tested in a sample population. This tool can be easily implemented in digital nutrition platforms, contributing to real-time dietary follow-up of patients and progress monitoring, leading to further dietary adjustment.
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Dufault RJ, Crider RA, Deth RC, Schnoll R, Gilbert SG, Lukiw WJ, Hitt AL. Higher rates of autism and attention deficit/hyperactivity disorder in American children: Are food quality issues impacting epigenetic inheritance? World J Clin Pediatr 2023; 12:25-37. [PMID: 37034430 PMCID: PMC10075020 DOI: 10.5409/wjcp.v12.i2.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/25/2022] [Accepted: 01/10/2023] [Indexed: 03/06/2023] Open
Abstract
In the United States, schools offer special education services to children who are diagnosed with a learning or neurodevelopmental disorder and have difficulty meeting their learning goals. Pediatricians may play a key role in helping children access special education services. The number of children ages 6-21 in the United States receiving special education services increased 10.4% from 2006 to 2021. Children receiving special education services under the autism category increased 242% during the same period. The demand for special education services for children under the developmental delay and other health impaired categories increased by 184% and 83% respectively. Although student enrollment in American schools has remained stable since 2006, the percentage distribution of children receiving special education services nearly tripled for the autism category and quadrupled for the developmental delay category by 2021. Allowable heavy metal residues remain persistent in the American food supply due to food ingredient manufacturing processes. Numerous clinical trial data indicate heavy metal exposures and poor diet are the primary epigenetic factors responsible for the autism and attention deficit hyperactivity disorder epidemics. Dietary heavy metal exposures, especially inorganic mercury and lead may impact gene behavior across generations. In 2021, the United States Congress found heavy metal residues problematic in the American food supply but took no legislative action. Mandatory health warning labels on select foods may be the only way to reduce dietary heavy metal exposures and improve child learning across generations.
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Affiliation(s)
- Renee J Dufault
- Department of Research, Food Ingredient and Health Research Institute, Naalehu, HI 96772, United States
- College of Graduate Health Studies, A.T. Still University, Kirksville, MO 63501, United States
| | - Raquel A Crider
- Department of Research, Food Ingredient and Health Research Institute, Naalehu, HI 96772, United States
| | - Richard C Deth
- Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, FL 33314, United States
| | - Roseanne Schnoll
- Department of Research, Food Ingredient and Health Research Institute, Naalehu, HI 96772, United States
- Department of Health and Nutrition Sciences, Brooklyn College of CUNY, Brooklyn, NY 11210, United States
| | - Steven G Gilbert
- Department of Research, Food Ingredient and Health Research Institute, Naalehu, HI 96772, United States
- Department of Research, Institute of Neurotoxicology and Neurological Disorders, Seattle, WA 98105, United States
| | - Walter J Lukiw
- LSU Neuroscience Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United States
| | - Amanda L Hitt
- Food Integrity Campaign, Government Accountability Project, Columbia, WA 20006, United States
- Department of Legal, Food Ingredient and Health Research Institute, Naalehu, HI 96772, United States
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A randomized trial to evaluate the impact of Singapore's forthcoming Nutri-grade front-of-pack beverage label on food and beverage purchases. Int J Behav Nutr Phys Act 2023; 20:18. [PMID: 36793058 PMCID: PMC9930047 DOI: 10.1186/s12966-023-01422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The epidemic of non-communicable diseases (NCDs) is a growing concern worldwide and Singapore is no exception to this global trend. As part of measures to address this concern, the Singapore government will implement a mandatory color-coded front-of-package (FOP) nutrition label for beverages, called Nutri-Grade (NG), which will complement the existing FOP label, Healthier Choice Symbol (HCS) logos, currently displayed on select food and beverage items. NG grades beverages on a four-point scale, A (healthiest) to D (least healthy), in terms of sugar and saturated fat levels. This study aimed to evaluate the effectiveness of the NG label on nutritional quality of pre-packaged beverages using a fully functional online grocery store. METHODS We conducted a 2-arm crossover trial involving actual purchases with 138 participants randomly exposed to: 1) Control with HCS logos displayed on qualifying items; 2) Similar to Control except that all beverages displayed the NG label. The effects of the NG label were estimated using a linear mixed-effects model that addresses correlations between repeated measures and accommodates missing data. RESULTS We found that the NG label encouraged consumers to choose beverages with higher ratings. This led to a reduction in sugar from beverages purchased by 1.51 g [95% CI: - 2.68, - 0.34] per serving but was not effective at reducing saturated fat purchased (- 0.009 g [95% CI: - 0.22, 0.20]) per serving or improvements in overall diet quality, measured by the weighted (by the number of servings) average Nutri-Score value ranging from 1 to 5 (- 0.024 [95% CI: - 0.13, 0.08]). CONCLUSIONS Results suggest that the Nutri-Grade label is likely to reduce sugar purchased from beverages. However, to improve overall diet quality in Singapore, additional measures will be needed. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov under the identifier: NCT05018026 on 24th August 2021.
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Ares G, Antúnez L, Curutchet MR, Giménez A. Warning labels as a policy tool to encourage healthier eating habits. Curr Opin Food Sci 2023. [DOI: 10.1016/j.cofs.2023.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Pettigrew S, Jongenelis MI, Talati Z, Dana LM, Hercberg S, Julia C. The ability of five different front-of-pack labels to assist Australian consumers to identify healthy versus unhealthy foods. Aust N Z J Public Health 2023; 47:100017. [PMID: 36641957 DOI: 10.1016/j.anzjph.2022.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the relative ability of different interpretive front-of-pack food labels to alert consumers to both healthier and unhealthier options to inform their food choices. METHODS One thousand Australians completed an online experiment where they rated the nutritional quality of sets of fictional products pre- and post-randomisation to one of five front-of-pack labels: Health Star Rating, Multiple Traffic Lights, Nutri-Score, Reference Intakes and Warning Label. Two sample z-tests were used to assess the ability of each label to facilitate the correct identification of the least and most healthy product options. RESULTS The Nutri-Score was superior in assisting respondents to identify both the healthiest and unhealthiest options. The Health Star Rating ranked second for both outcomes, followed by the Multiple Traffic Lights. CONCLUSIONS Results reinforce the role of interpretive front-of-pack labels in assisting consumers to understand the nutritional quality of food products and suggest spectrum labels may provide superior utility in assisting consumers to identify both the most and least nutritious products from among available product options. IMPLICATIONS FOR PUBLIC HEALTH The strongest performance of a highly interpretive front-of-pack label (Nutri-Score) featuring colour in a summary indicator suggests potential strategies for enhancing the performance of the Health Star Rating.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Australia.
| | - Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Zenobia Talati
- School of Population Health, Curtin University, Western Australia, Australia
| | - Liyuwork M Dana
- School of Population Health, Curtin University, Western Australia, Australia
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris-Cité (CRESS), Bobigny, France; Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris-Cité (CRESS), Bobigny, France; Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
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Mais LA, Mialon M, Hassan BK, Peres JMD, dos Santos MG, Martins APB, Coutinho JG, de Carvalho CMP. Do they really support "your freedom of choice"? FoPNL and the food industry in Brazil. Front Nutr 2023; 9:921498. [PMID: 36741995 PMCID: PMC9892853 DOI: 10.3389/fnut.2022.921498] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/24/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction In 2020, Brazil approved the introduction of a new front-of-package nutrition labeling (FoPNL) in the format of a magnifying glass (MG) after years of discussion. There is currently a lack of understanding of the role of the food industry in that process. This study aimed to describe the corporate political activity (CPA) of the food industry and conflicts of interest situations, as they happened during the development and approval of a new FoPNL system in Brazil. Materials and methods We undertook bibliographical and documentary searches using material from food companies, trade associations and front groups involved in the regulatory process. We (1) collected information about the case study context, (2) collected data from documentary sources, and (3) prepared a synthesis of the results and a timeline of key events. Results/Discussion During the FoPNL regulatory process in Brazil, the food industry opposed the introduction of warning labels, a model supported by health authorities and implemented with success in other countries in Latin America. The food industry rather promoted a traffic-light labeling system, known to be less effective at guiding individuals to make healthier food choices. Later in the process, when it was evident that its preferred model would not be used, and a MG would rather be introduced, the food industry argued for the use of a different version of this FoPNL model. We found that the food industry, all along the process, was directly involved in and influenced the development of the FoPNL, by providing technical support, advising and lobbying policymakers. The food industry also established relationships with a consumer non-governmental organization and nutrition professional societies. The food industry also produced and disseminated information supporting its position in order to influence public opinion and high-level decision makers, and used the legal system to delay the process. Conclusion The FoPNL in Brazil is neither aligned with the recommendations of international health organizations nor with existing independent scientific evidence. The new FoPNL, as adopted in Brazil, reflects some of the preferences of the industry; it is likely that the influence of that sector during the legislative process was pivotal, even if its initial proposal was not adopted.
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Affiliation(s)
- Laís Amaral Mais
- Instituto Brasileiro de Defesa do Consumidor (IDEC), São Paulo, Brazil
| | - Mélissa Mialon
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), Universidade de São Paulo (USP), São Paulo, Brazil
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Bruna Kulik Hassan
- ACT Promoção da Saúde, São Paulo, Brazil
- Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil
| | | | | | - Ana Paula Bortoletto Martins
- Instituto Brasileiro de Defesa do Consumidor (IDEC), São Paulo, Brazil
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), Universidade de São Paulo (USP), São Paulo, Brazil
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Mertens E, Peñalvo JL. Mapping the nutritional value of diets across Europe according to the Nutri-Score front-of-pack label. Front Nutr 2023; 9:1080858. [PMID: 36712540 PMCID: PMC9880413 DOI: 10.3389/fnut.2022.1080858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background Front-of-pack labels, such as Nutri-Score, aim to offer clear information on the overall nutritional quality of foods and beverages to consumers, allowing them to make healthier food choices. Using the European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database, the present study aims to map out European food consumption patterns by applying the Nutri-Score as a benchmark for nutritional value. Methods Country-specific food consumption data, collected by multiple 24-h dietary recalls or food records available from EFSA, were linked to the Dutch Food Composition Database (NEVO). Foods and beverages consumed by adolescents (10-17 years), adults (18-64 years), and the elderly (65-74 years) were graded following the modified Food Standard Agency Nutrient Profiling System (FSAm-NPS) and classified according to Nutri-Score grading, from A to E. Subsequently, a dietary index score (FSAm-NPS-DI) was calculated for each country-specific diet by age-groups and sex as an energy-weighted mean of the FSAm-NPS score of all foods and beverages consumed, with lower scores for a diet of greater overall nutritional quality. Results On average, the daily energy intake of adults across the European countries studied is distributed in 27.6% of A-, 12.9% of B-, 17% of C-, 30.0% of D-, and 12.5% of E-classified foods and beverages. This energy distribution, according to the Nutri-Score, corresponded to a median FSAm-NPS-DI score of 6.34 (interquartile range: 5.92, 7.19). For both adult males and females, Estonia reported the highest energy share from A-classified products, scoring the lowest on the FSAm-NPS-DI. On the other hand, Latvia reported the highest energy share from E-classified products, along with the highest FSAm-NPS-DI. Females and the elderly group reported, in general, a greater energy share from A- and a lower share from E-classified products, and had the lowest FSAm-NPS-DI scores. No sex-related difference was observed for adolescents whose share of energy was predominantly from A- and D-classified products, such as for adults and the elderly. Conclusion Our analyses leveraging the secondary use of country-specific databases on dietary intakes found considerable variation in the nutritional value of European diets, with an overall agreement across all countries on a modestly healthier dietary profile for the elderly and among females.
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Caballero S, Moënne-Loccoz C, Delgado M, Luarte L, Jimenez Y, Galgani JE, Perez-Leighton CE. Eating contexts determine the efficacy of nutrient warning labels to promote healthy food choices. Front Nutr 2023; 9:1026623. [PMID: 36687700 PMCID: PMC9852898 DOI: 10.3389/fnut.2022.1026623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Unhealthy food choices increase the risk of obesity and its co-morbidities. Nutrition labels are a public health policy that aims to drive individuals toward healthier food choices. Chile has been an example of this policy, where mandatory nutrient warning labels (NWL) identify processed foods high in calories and critical nutrients. Eating contexts influence individual food choices, but whether eating contexts also influence how NWL alter the decision process and selection during food choice is unknown. Methods In an online mouse-tracking study, participants prompted to health, typical, or unrestricted eating contexts were instructed to choose between pairs of foods in the presence or absence of NWL. Conflict during choices was analyzed using mouse paths and reaction times. Results NWL increased conflict during unhealthy food choices and reduced conflict during healthy choices in all contexts. However, the probability that NWL reversed an unhealthy choice was 80% in a healthy, 37% in a typical, and 19% in an unrestricted context. A drift-diffusion model analysis showed the effects of NWL on choice were associated with an increased bias toward healthier foods in the healthy and typical but not in the unrestricted context. Discussion These data suggest that the efficacy of NWL to drive healthy food choices increases in a healthy eating context, whereas NWL are less effective in typical or unrestricted eating contexts.
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Affiliation(s)
- Sara Caballero
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile,Programa de Magister en Nutrición, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Moënne-Loccoz
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Delgado
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Luarte
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile,Programa Interdisciplinario de Neurociencia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yanireth Jimenez
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José E. Galgani
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile,Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio E. Perez-Leighton
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile,Programa Interdisciplinario de Neurociencia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile,*Correspondence: Claudio E. Perez-Leighton,
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Are Front-of-Pack Nutrition Labels Influencing Food Choices and Purchases, Diet Quality, and Modeled Health Outcomes? A Narrative Review of Four Systems. Nutrients 2023; 15:nu15010205. [PMID: 36615862 PMCID: PMC9824714 DOI: 10.3390/nu15010205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Front-of-Pack Nutrition labels (FOPNLs) aim to improve consumers' food purchases and prompt product reformulation by the food and beverage industry. Despite their widespread use, the effectiveness of FOPNL in achieving these goals is still a matter of debate. This review has gathered 65 original studies exploring the performances of four widely used FOPNLs (Multiple Traffic Light, Warning signs, Nutri-Score and Health Star Rating). Although FOPNLs have been associated with healthier food purchases, the magnitude of improvements was small and dependent on study settings. Any associated health effects were modeled rather than observed. None of the four FOPNLs clearly outperformed the other ones on any outcome. Few studies dealt with the impact of FOPNL on product reformulation. Some of those studies, but not all, found small reductions in energy, sodium, sugar and saturated fat content of foods in some food categories. Although global trends point to a small favorable effect of FOPNL, this conclusion is subject to caution since the evidence is inconsistent and comes from a wide variety of contexts and study designs. There remain numerous research gaps, notably with regard to the optimal characteristics of FOPNLs, the durability of FOPNL effects on consumer behaviors, and any possible unexpected consequences.
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Ong WY, Satish RL, Herr DR. ACE2, Circumventricular Organs and the Hypothalamus, and COVID-19. Neuromolecular Med 2022; 24:363-373. [PMID: 35451691 PMCID: PMC9023728 DOI: 10.1007/s12017-022-08706-1] [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: 12/22/2021] [Accepted: 03/01/2022] [Indexed: 12/29/2022]
Abstract
The SARS-CoV-2 virus gains entry to cells by binding to angiotensin-converting enzyme 2 (ACE2). Since circumventricular organs and parts of the hypothalamus lack a blood-brain barrier, and immunohistochemical studies demonstrate that ACE2 is highly expressed in circumventricular organs which are intimately connected to the hypothalamus, and the hypothalamus itself, these might be easy entry points for SARS-CoV-2 into the brain via the circulation. High ACE2 protein expression is found in the subfornical organ, area postrema, and the paraventricular nucleus of the hypothalamus (PVH). The subfornical organ and PVH are parts of a circuit to regulate osmolarity in the blood, through the secretion of anti-diuretic hormone into the posterior pituitary. The PVH is also the stress response centre in the brain. It controls not only pre-ganglionic sympathetic neurons, but is also a source of corticotropin-releasing hormone, that induces the secretion of adrenocorticotropic hormone from the anterior pituitary. It is proposed that the function of ACE2 in the circumventricular organs and the PVH could be diminished by binding with SARS-CoV-2, thus leading to a reduction in the ACE2/Ang (1-7)/Mas receptor (MasR) signalling axis, that modulates ACE/Ang II/AT1R signalling. This could result in increased presympathetic activity/neuroendocrine secretion from the PVH, and effects on the hypothalamic-pituitary-adrenal axis activity. Besides the bloodstream, the hypothalamus might also be affected by SARS-CoV-2 via transneuronal spread along the olfactory/limbic pathways. Exploring potential therapeutic pathways to prevent or attenuate neurological symptoms of COVID-19, including drugs which modulate ACE signalling, remains an important area of unmet medical need.
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Affiliation(s)
- Wei-Yi Ong
- Department of Anatomy, National University of Singapore, Singapore, 119260, Singapore.
- Neurobiology Research Programme, Life Sciences Institute, National University of Singapore, Singapore, 119260, Singapore.
| | - R L Satish
- Department of Anatomy, National University of Singapore, Singapore, 119260, Singapore
| | - Deron R Herr
- Department of Pharmacology, National University of Singapore, Singapore, 119260, Singapore
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Muacevic A, Adler JR, Kotsiou OS, Fradelos EC, Papathanasiou IV, Malli F, Papagiannis D, Mantzaris DC, Julia C, Hercberg S, Galan P, Fialon M, Gourgoulianis KI. Guideline Daily Amounts Versus Nutri-Score Labeling: Perceptions of Greek Consumers About Front-of-Pack Label. Cureus 2022; 14:e32198. [PMID: 36620800 PMCID: PMC9811601 DOI: 10.7759/cureus.32198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/11/2022] Open
Abstract
Nutrition information is becoming more urgent than ever so that consumers can make informed choices when buying food. This study aimed to investigate consumers' perceptions and behavior of the front-of-pack label (FOPL), between two specific labeling systems, the Nutri-Score and the Guideline Daily Amounts (GDA). This is a post hoc analysis of data from a previous, more extensive cross-sectional study conducted from April 2021 to June 2021. A total of 510 participants were included in the study, of whom 49.6% were women. Participants' perceptions were assessed in nine questions on a five-point Likert scale (1=strongly disagree, 5=strongly agree). Multivariate variance analysis (MANOVA) was performed to test the effects of the label GDA vs. Nutri-Score on the overall positive and negative perceptions. We found that the Nutri-Score label was significantly more understandable (p=0.003), clear, visible, and preferable (p<0.001) than the GDA label, which required more time to be understood. The findings indicate that the interpretive label, Nutri-Score, was superior to the non-interpretive label GDA, in terms of consumers' perception, more visibility, less time-consuming, and reliability. The FOPL can improve the ability of consumers in Greece to understand the healthfulness of food products.
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Penzavecchia C, Todisco P, Muzzioli L, Poli A, Marangoni F, Poggiogalle E, Giusti AM, Lenzi A, Pinto A, Donini LM. The influence of front-of-pack nutritional labels on eating and purchasing behaviors: a narrative review of the literature. Eat Weight Disord 2022; 27:3037-3051. [PMID: 36369593 PMCID: PMC9803757 DOI: 10.1007/s40519-022-01507-2] [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: 09/28/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Front-of-Pack Nutritional Labels are considered a useful tool to help consumers orient themselves in their food choices and direct their behavior toward a healthier diet. FOPNL development and use are part of a framework that includes cognitive, biological, hedonic and cultural aspects, able to affect consumers' eating and purchasing behavior. AIM Given the complexity of the matter, the aim of this narrative review is to analyze the combination of different factors that drive food choices and eating behaviors and to highlight some aspects that are not fully studied. METHODS The authors conducted the research using a top-down approach at first, followed by a bottom-up approach; starting with general considerations about the purchasing process, gradually narrowing the discussion to a specific sub-population, and finally extending the discussion back to more general reasonings about the direction to adopt in future, or at least to evaluate, for effective communication. RESULTS Biases and attitudes toward food products were found to regularly interfere with buying behavior patterns, making it impossible to standardize an average consumer. This reflects in current research, increasing the complexity of the topic. All determinants influencing food choices are often assessed individually rather than in a synergistic and multidimensional context, while the purchasing scenario is characterized by multiple stimuli to which the consumer is subjected. FOPNLs' impact on perceived healthiness has been studied in different conditions, but some population subgroups have not been sufficiently represented. In particular, the effect of FOPNLs on consumers suffering from eating disorders is understudied and needs further attention. Furthermore, some approaches can be compared to "negative nutrition" or "loss-framed communication", putting nutrients out of context, emphasizing losses more than gains and risking promoting negative feelings in consumers. CONCLUSION Due to the heterogeneity of studies, evidence on what works best in driving people to adopt lasting lifestyle changes is still mixed. Science communicators and policymakers should consider the possibility that a multi-component approach incorporating nutrition information and education may be a key strategy to promote consumers' self-consciousness and to support them in their cognitive efforts toward a healthy and sustainable diet. LEVEL OF EVIDENCE Level V, narrative review.
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Affiliation(s)
- Claudia Penzavecchia
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Vicenza, Italy
| | - Luca Muzzioli
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Andrea Poli
- NFI-Nutrition Foundation of Italy, Milan, Italy
| | | | - Eleonora Poggiogalle
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Anna Maria Giusti
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Andrea Lenzi
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Alessandro Pinto
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Lorenzo Maria Donini
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy.
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Gluten-Free Products: Do We Need to Update Our Knowledge? Foods 2022; 11:foods11233839. [PMID: 36496647 PMCID: PMC9735448 DOI: 10.3390/foods11233839] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
The gluten-free (GF) food market has been growing exponentially in recent years. However, GF products could contribute to imbalanced diets. The main objective of the present work was to perform a temporal nutritional comparison of GF foods over the last nine years. At the same time, the nutritional compositions of 104 GF products currently marketed in Spain were assessed and compared with their gluten-containing counterparts. Diets including GF products and the equivalent diets with homologous products with gluten were compared as well, the subjects being 25 adult celiac patients. A comparison of GF products (GFPs) in 2013 and 2022 showed nutritional differences in the groups of cookies, breakfast cereals, doughs/puff pastries/pizzas, and breads. The pasta group stands out from the rest due to an important decrease in energy, protein, simple carbohydrates, saturated lipids, dietary fiber, and salt. Comparing GF and gluten-containing homologous products in 2022, the major differences were found in protein and salt. Accordingly, GFPs lead to a diet lower in protein and higher in carbohydrates. Despite improvements in the formulation of GF products in recent years, their macronutrient profile maintains marked variation, and they cannot be considered nutritionally equivalent to their gluten-containing counterparts.
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Aliasgharzadeh S, Ebrahimi-Mameghani M, Mahdavi R, Karimzadeh H, Nikniaz L, Tabrizi JS, Pourali F. Prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran: a multi-criteria decision-making approach. BMC Med Res Methodol 2022; 22:293. [PMCID: PMC9666957 DOI: 10.1186/s12874-022-01761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Numerous nutrition-related policy options and strategies have been proposed to tackle hypertension and other risk factors of non-communicable diseases (NCDs). In this study, we developed a comparative analysis using a multi-criteria decision-making (MCDM) model for prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran.
Methods
We employed a combination of Delphi technique and Analytic Hierarchy Process (AHP) method as the methodological tool to prioritize decision alternatives using multiple criteria. The prominent assessment criteria and intervention strategies were derived using a literature review, focus group discussion (n = 11), and a 2-round modified Delphi technique with specialists and experts involved in different stages of health policy-making (round 1: n = 50, round 2: n = 46). Then, the AHP was used to determine the weightage of the selected interventions and develop the decision-making model. The sensitivity analysis was performed to test the stability of the priority ranking.
Results
Nine alternative interventions were included in the final ranking based on eight assessment criteria. According to the results, the most priority interventions to prevent and control hypertension included reformulation of food products to contain less salt and changing the target levels of salt in foods and meals, providing low-sodium salt substitutes, and reducing salt intake through the implementation of front-of-package labeling (FOPL). The results of the sensitivity analysis and a comparison analysis suggested that the assessment model performed in this study had an appropriate level of robustness in selecting the best option among the proposed alternatives.
Conclusion
MCDM techniques offer a potentially valuable approach to rationally structuring the problem, along with the opportunity to make explicit the judgments used as part of the decision-making model. The findings of this study provide a preliminary evidence base to guide future decisions and reforms aiming to improve appropriate population-based interventions for tackling hypertension and other risk factors of NCDs.
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Salt-Related Knowledge, Attitudes, and Behaviors and Their Relationship with 24-Hour Urinary Sodium Excretion in Chinese Adults. Nutrients 2022; 14:nu14204404. [PMID: 36297088 PMCID: PMC9611823 DOI: 10.3390/nu14204404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Salt intake in China is very high, which increases the risk of hypertension and cardiovascular disease. This study aimed to assess the levels of salt-related knowledge, attitudes, and behaviors (KABs) and the factors that influence them and to explore the relationship between the scores of salt-related KAB and 24-h urinary sodium excretion. In 2018, we collected data from 5453 individuals aged 18-75 years from six provinces in China. A face-to-face survey was carried out, focusing on the KAB related to salt reduction. All participants were asked to collect one 24-h urine sample. Of the 5453 participants, 5352 completed urine collection. The mean score for overall KAB was 31.27 (SD = 9.18), which was composed of three elements: knowledge 4.80 (SD = 5.14), attitude 9.33 (SD = 3.93), and behavior 17.14 (SD = 4.43). The average 24-h urinary sodium excretion was 187.70 (SD = 77.48) mmol, which was equivalent to a urinary sodium excretion of 4.32 (SD = 1.78) g/d. We found that salt-related knowledge, attitude, behavior, and overall KAB scores were all inversely associated with 24-h urinary sodium excretion. For every one-point increase in the KAB score, the 24-h urinary sodium excretion decreased by 0.851 mmol (95% CI: -1.095, -0.602). We also found that location (rural/urban), sex, age, and education are associated with salt-related KAB scores. These results suggest that large-scale health education is needed to reduce salt intake in the Chinese population. In particular, efforts should be focused on reaching those who live in rural areas with low educational levels and older people.
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Giuberti Coutinho J, Feldenheimer da Silva AC, de Castro IRR, Recine EGIG, Makuta G, Rocha NC, Johns P, Barbosa RBDC. The challenges of front-of-package labeling in Brazil. Front Nutr 2022; 9:921421. [PMID: 36313104 PMCID: PMC9608328 DOI: 10.3389/fnut.2022.921421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/13/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Janine Giuberti Coutinho
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Brazilian Institute of Consumer Protection (Idec), São Paulo, Brazil,*Correspondence: Janine Giuberti Coutinho
| | - Ana Carolina Feldenheimer da Silva
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Department of Social Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, Paraná, Brazil
| | - Inês Rugani Ribeiro de Castro
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Department of Social Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, Paraná, Brazil
| | - Elisabetta Gioconda Iole Giovanna Recine
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Observatory on Food Security Policies and Nutrition (OPSAN), Brasília University (UnB), Brasília, Brazil
| | - Glenn Makuta
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Slow Food Brazil, São Paulo, Brazil
| | - Nayara Cortês Rocha
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,Food the Right to Food and Nutrition Brazil, Brasília, Brazil
| | - Paula Johns
- Alliance for Adequate and Healthy Diets, Brasília, Brazil,ACT Health Promotion, Rio de Janeiro, Brazil
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Maganja D, Trieu K, Reading M, Huang L, Hart AC, Taylor F, Stamatellis S, Arnott C, Feng X, Schutte AE, Di Tanna GL, Ni Mhurchu C, Cameron AJ, Huffman MD, Neal B, Wu JH. Protocol for a novel sodium and blood pressure reduction intervention targeting online grocery shoppers with hypertension - the SaltSwitch Online Grocery Shopping randomized trial. Am Heart J 2022; 252:70-83. [PMID: 35777455 DOI: 10.1016/j.ahj.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND High dietary sodium intake is a leading cause of hypertension. A major source of dietary sodium is salt added to processed food products available in retail food environments. The fast-growing online grocery shopping setting provides new opportunities for salt reduction interventions that support consumers in choosing healthier options. METHODS The SaltSwitch Online Grocery Shopping randomized controlled trial is investigating the feasibility, acceptability, and effectiveness of a novel intervention for lowering salt consumption and blood pressure amongst people with hypertension who shop for groceries online. The intervention is based on a bespoke web browser extension that interfaces with a major retailer's online store to highlight and interpret product sodium content and suggest similar but lower-sodium alternatives. The primary outcome of interest is change in mean systolic blood pressure between individuals randomized (1:1) to the intervention and control (usual online shopping) arms at 12 weeks. Secondary outcomes are diastolic blood pressure, spot urinary sodium and sodium:potassium ratio, sodium purchases, and dietary intake. Intervention implementation and lessons for future uptake will be assessed using a mixed methods process evaluation. Participants with hypertension who shop online for groceries and exhibit high sodium purchasing behavior are being recruited across Australia. A target sample size of 1,966 provides 80% power (2-sided alpha = 0.05) to detect a 2 mm Hg difference in systolic blood pressure between groups, assuming a 15 mm Hg standard deviation, after allowing for a 10% dropout rate. DISCUSSION This trial will provide evidence on an innovative intervention to potentially reduce salt intake and blood pressure in people with hypertension. The intervention caters to individual preferences by encouraging sustainable switches to similar but lower-salt products. If effective, the intervention will be readily scalable at low cost by interfacing with existing online retail environments.
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Affiliation(s)
- Damian Maganja
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Reading
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ashleigh Chanel Hart
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Fraser Taylor
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Steve Stamatellis
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Xiaoqi Feng
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Aletta E Schutte
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Adrian J Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Cardiovascular Division and Global Health Center, Washington University, St. Louis, MO
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology and Biostatistics, Imperial College London, South Kensington, London, United Kingdom
| | - Jason Hy Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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50
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The impact of nutritional warnings on the mental associations raised by advertisements featuring ultra-processed food products. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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