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Parajára MDC, Fogal Vegi AS, Machado ÍE, de Menezes MC, Verly-Jr E, Meireles AL. Disability and costs of IHD attributable to the consumption of trans-fatty acids in Brazil. Public Health Nutr 2024; 27:e132. [PMID: 38726481 PMCID: PMC11112431 DOI: 10.1017/s1368980024001101] [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: 10/10/2023] [Revised: 03/25/2024] [Accepted: 05/01/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To estimate the disability and costs of the Brazilian Unified Health System for IHD attributable to trans-fatty acid (TFA) consumption in 2019. DESIGN This ecological study used secondary data from the Global Burden of Disease (GBD) Study 2019 to estimate the years lived with disability from IHD attributable to TFA in Brazil in 2019. Data on direct costs (purchasing power parity: 1 Int$ = R$ 2·280) were obtained from the Hospital and Ambulatory Information Systems of the Brazilian Unified Health System. Moreover, the total costs in each state were divided by the resident population in 2019 and multiplied by 10 000 inhabitants. The relationship between the socio-demographic index, disease and economic burden was investigated. SETTING Brazil and its twenty-seven states. PARTICIPANTS Adults aged ≥ 25 years of both sexes. RESULTS IHD attributable to TFA consumption resulted in 11 165 years lived with disability (95 % uncertainty interval 932–18 462) in 2019 in Brazil. A total of Int$ 54 546 227 (95 % uncertainty interval 4 505 792–85 561 810) was spent in the Brazilian Unified Health System in 2019 due to IHD attributable to TFA, with the highest costs of hospitalisations, for males and individuals aged ≥ 50 years or over. The highest costs were observed in Sergipe (Int$ 6508/10 000; 95 % uncertainty interval 576–10 265), followed by the two states from the South. Overall, as the socio-demographic index increases, expenditures increase. CONCLUSIONS TFA consumption results in a high disease and economic IHD burden in Brazil, reinforcing the need for more effective health policies, such as industrial TFA elimination, following the international agenda.
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Affiliation(s)
- Magda do Carmo Parajára
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Aline Siqueira Fogal Vegi
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Ísis Eloah Machado
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Departamento de Medicina de Família, Saúde Mental e Coletiva, Escola de Medicina, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Mariana Carvalho de Menezes
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Departamento de Nutrição Clínica e Social, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Eliseu Verly-Jr
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana Lúcia Meireles
- Programa de Pós-Graduação em Saúde e Nutrição, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Departamento de Nutrição Clínica e Social, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
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Mulligan C, Vergeer L, Kent MP, L'Abbé MR. Child-appealing packaged food and beverage products in Canada-Prevalence, power, and nutritional quality. PLoS One 2023; 18:e0284350. [PMID: 37134046 PMCID: PMC10156002 DOI: 10.1371/journal.pone.0284350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/29/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Children are frequently exposed to marketing on food packaging. This study evaluated the presence, type and power of child-appealing marketing and compared the nutritional quality of child-appealing vs. non-child-appealing Canadian packaged foods and examined the relationship between nutrient composition and marketing power. METHODS Child-relevant packaged foods (n = 5,850) were sampled from the Food Label Information Program 2017 database. The presence and power (# of techniques displayed) of child-appealing marketing were identified. Fisher's Exact test compared the proportion of products exceeding Health Canada's nutrient thresholds for advertising restrictions and Mann Whitney U tests compared nutrient composition between products with child- /non-child-appealing packaging. Pearson's correlation analyzed the relationship between nutrient composition and marketing power. RESULTS 13% (746/5850) of products displayed child-appealing marketing; the techniques used, and the power of the marketing varied ([Formula: see text] 2.2 techniques; range: 0-11). More products with child-appealing packaging than with non-child appealing packaging exceeded Health Canada's thresholds (98% vs. 94%; p < .001). Products with child-appealing packaging (vs. non-child-appealing) were higher in total sugars (median: 14.7 vs. 9 g/RA; p < .001) and free sugars (11.5 vs. 6.2 g/RA; p < .001), but lower in all other nutrients. There was weak overall correlation between marketing power and nutrient levels. Results varied by nutrient and food category. CONCLUSIONS Unhealthy products with powerful child-appealing marketing displayed on package are prevalent in the food supply. Implementing marketing restrictions that protect children should be a priority.
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Affiliation(s)
- Christine Mulligan
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Laura Vergeer
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mary R L'Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Brassard D, Manikpurage HD, Thériault S, Arsenault BJ, Lamarche B. Greater adherence to the 2019 Canada's Food Guide recommendations on healthy food choices reduces the risk of cardiovascular disease in adults: a prospective analysis of UK Biobank data. Am J Clin Nutr 2022; 116:1748-1758. [PMID: 36124644 PMCID: PMC9761735 DOI: 10.1093/ajcn/nqac256] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/10/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Canada's Food Guide (CFG) was profoundly revised in 2019, but the extent to which adherence to recommendations on healthy food choices reduces the risk of cardiovascular disease (CVD) is unknown. OBJECTIVES The aim of this study was to examine how greater adherence to the 2019 CFG's recommendations on healthy food choices influences the risk of incident CVD. METHODS Participants were a sample of adults without history of CVD, diabetes, or cancer from the UK Biobank prospective cohort study. Usual dietary intakes were estimated by modeling data from repeated Web-based 24-h dietary recalls using the National Cancer Institute multivariate method. Adherence to key CFG recommendations on healthy food choices was assessed using the Healthy Eating Food Index (HEFI)-2019, which has a maximum of 80 points. The CVD outcome was a composite of fatal and nonfatal myocardial infarction and ischemic stroke. Cox regression models adjusted via inverse probability weighting were used to estimate CVD risks. Counterfactual models were used to interpret risks of hypothetical changes in the HEFI-2019 score. RESULTS A total of 136,698 participants met the eligibility criteria (55% females; mean age: 57.2 y; range: 40-75 y). During the 11-y follow-up, there were 2843 cases of incident CVD. Compared with no change in the HEFI-2019 score, increasing the HEFI-2019 score of all participants to the 90th percentile of the score distribution (58.1 points) hypothetically reduced the risk of CVD by 24% (RR: 0.76; 95% CI: 0.58, 0.94; absolute risk difference: -0.58%). CONCLUSIONS These results suggest that greater adherence to the 2019 CFG recommendations on healthy food choices reduces the 11-y risk of CVD in middle-aged and older adults.
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Affiliation(s)
- Didier Brassard
- Center of Nutrition, Health, and Society (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Quebec, Canada
| | - Hasanga D Manikpurage
- Research Center, University Institute of Cardiology and Pneumology of Quebec, Laval University, Québec, Quebec, Canada
| | - Sébastien Thériault
- Research Center, University Institute of Cardiology and Pneumology of Quebec, Laval University, Québec, Quebec, Canada
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Laval University, Québec, Quebec, Canada
| | - Benoît J Arsenault
- Research Center, University Institute of Cardiology and Pneumology of Quebec, Laval University, Québec, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Laval University, Québec, Quebec, Canada
| | - Benoît Lamarche
- Center of Nutrition, Health, and Society (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Quebec, Canada
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Potvin Kent M, Pauzé E, Bagnato M, Guimarães JS, Pinto A, Remedios L, Pritchard M, L’Abbé MR, Mulligan C, Vergeer L, Weippert M. Food and beverage advertising expenditures in Canada in 2016 and 2019 across media. BMC Public Health 2022; 22:1458. [PMID: 35915428 PMCID: PMC9340686 DOI: 10.1186/s12889-022-13823-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Food and beverage advertising has been identified as a powerful determinant of dietary intake and weight. Available evidence suggests that the preponderance of food and beverage advertising expenditures are devoted to the promotion of unhealthy products. The purpose of this study is to estimate food advertising expenditures in Canada in 2019 overall, by media and by food category, determine how much was spent on promoting healthier versus less healthy products and assess whether changes in these expenditures occurred between 2016 and 2019.
Methods
Estimates of net advertising expenditures for 57 selected food categories promoted on television, radio, out-of-home media, print media and popular websites, were licensed from Numerator. The nutrient content of promoted products or brands were collected, and related expenditures were then categorized as “healthy” or “unhealthy” according to a Nutrient Profile Model (NPM) proposed by Health Canada. Expenditures were described using frequencies and relative frequencies and percent changes in expenditures between 2016 and 2019 were computed.
Results
An estimated $628.6 million was spent on examined food and beverage advertising in Canada in 2019, with television accounting for 67.7%, followed by digital media (11.8%). In 2019, most spending (55.7%) was devoted to restaurants, followed by dairy and alternatives (11%), and $492.9 million (87.2% of classified spending) was spent advertising products and brands classified as “unhealthy”. Fruit and vegetables and water accounted for only 2.1 and 0.8% of expenditures, respectively, in 2019. In 2019 compared to 2016, advertising expenditures decreased by 14.1% across all media (excluding digital media), with the largest decreases noted for print media (− 63.0%) and television (− 14.6%). Overall, expenditures increased the most in relative terms for fruit and vegetables (+ 19.5%) and miscellaneous products (+ 5%), while decreasing the most for water (− 55.6%) and beverages (− 47.5%).
Conclusions
Despite a slight drop in national food and beverage advertising spending between 2016 and 2019, examined expenditures remain high, and most products or brands being advertised are unhealthy. Expenditures across all media should continue to be monitored to assess Canada’s nutrition environment and track changes in food advertising over time.
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Hutchinson J, Tarasuk V. The relationship between diet quality and the severity of household food insecurity in Canada. Public Health Nutr 2022; 25:1013-1026. [PMID: 34551845 PMCID: PMC9991759 DOI: 10.1017/s1368980021004031] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/11/2021] [Accepted: 09/20/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status. DESIGN Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age. SETTING Ten provinces in Canada. PARTICIPANTS Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909. RESULTS Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children. CONCLUSIONS With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.
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Affiliation(s)
- Joy Hutchinson
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Temerty Faculty of Medicine, 1 King’s College Circle, Toronto, ONM5S 1A8, Canada
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Hosseini SH, Farag M, Hosseini SZ, Vatanparast H. Behavioral factors are perhaps more important than income in determining diet quality in Canada. SSM Popul Health 2022; 17:101001. [PMID: 35005185 PMCID: PMC8715369 DOI: 10.1016/j.ssmph.2021.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 11/25/2021] [Accepted: 12/11/2021] [Indexed: 12/01/2022] Open
Abstract
This study examines the importance of income in determining the diet quality of Canadian adults measured based on Nutrient Rich Food Index version 9.3. We used the latest available data on Canadians' consumption of foods and nutrients from the Canadian Community Health Survey-Nutrition 2015. The Canada' Food Guide classification was used for categorizing food groups based on types of food and their healthiness. Unsupervised and supervised machine learning models were employed in order to examine the links between income and the choice of foods. We first employed cluster analysis to identify the dietary patterns among individuals included in the sample and then we examined whether the intakes of various food groups across the identified clusters vary by income levels. Further, we evaluated the association between diet quality and income using Lasso Regression to determine the most important predictors of diet quality among adults in Canada. The results of both cluster analysis and regularized regression model suggested that behavioral factors and cultural backgrounds are more important determinants of diet quality among adults in Canada.
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Affiliation(s)
- Seyed H. Hosseini
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
| | - Seyedeh Zeinab Hosseini
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 4Z2, Canada
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Hernández-Ruiz Á, Díaz-Jereda LA, Madrigal C, Soto-Méndez MJ, Kuijsten A, Gil Á. Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review. Adv Nutr 2021; 12:2435-2494. [PMID: 34192740 PMCID: PMC8634546 DOI: 10.1093/advances/nmab053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 01/16/2023] Open
Abstract
Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.
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Affiliation(s)
| | | | - Casandra Madrigal
- Iberoamerican Nutrition Foundation (FINUT), Granada, Spain
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Granada, Spain
| | | | - Anneleen Kuijsten
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), Granada, Spain
- Department of Biochemistry and Molecular Biology II, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Granada, Spain
- Biosanitary Research Institute ibs.GRANADA, Granada University Hospital Complex, Granada, Spain
- CIBEROBN (Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
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Total and whole grain intake in Latin America: findings from the multicenter cross-sectional Latin American Study of Health and Nutrition (ELANS). Eur J Nutr 2021; 61:489-501. [PMID: 34232375 PMCID: PMC8783851 DOI: 10.1007/s00394-021-02635-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/28/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Understanding whole-grain intake and its associated factors is essential to tackle the double burden of malnutrition faced by Latin American countries. This study aimed to characterize total and whole grain intake in Latin American countries and to investigate foods contributing to these intake in the region. METHODS Data were obtained from the multicenter cross-sectional survey Latin American Study of Nutrition and Health (ELANS), including 9128 participants residing in urban areas of eight Latin American countries. Data collection was performed via two household visits using a standardized questionnaire and two 24 h dietary recalls. Usual dietary intake of total grain foods and foods containing whole grains was estimated. The association between the intake of grain food groups and sociodemographic variables was investigated using multiple linear regression models with random intercepts. RESULTS Mean intake of total grain foods and foods containing whole grains was 318.6 g/d and 14.7 g/d, respectively. Total grain foods were less consumed by participants at older ages (-9.8 g/d), and females (-9.9 g/d), and more consumed by those in the lowest socioeconomic category (24.8 g/d). Foods containing whole grains were more consumed by participants at older ages (3.3 g/d), and females (4.0 g/d), while those in the lowest socioeconomic category consumed 2.9 g/d less. Major contributors to energy provided from foods containing whole grains were oatmeal, masa harina, whole-wheat bread, corn chips, and wheat crackers. CONCLUSION The intake of grain foods represented a substantial part of the Latin American population's diet, but the intake of foods containing whole grains was extremely low in all assessed countries.
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Kholina K, Grant A, Waddington M, Egbe M, Grant S, Terashima M, Williams PL. In-store food environment for adults and children in Nova Scotia, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:430-439. [PMID: 33237485 PMCID: PMC8076380 DOI: 10.17269/s41997-020-00431-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 10/06/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This paper examines the retail food environment in grocery and convenience stores across Nova Scotia with specific attention to prominence and promotion of foods and beverages, as well as in-store promotion of foods and beverages to children. METHODS A descriptive cross-sectional analysis of data on the availability, price, prominence, and promotion of foods and beverages classified as "healthier" and "less healthy" was undertaken as a part of a Nova Scotia Consumer Food Environment (NS-CFE) project. Data were collected in a random stratified sample of 47 grocery stores and 59 convenience stores by trained research assistants working in pairs using adapted Nutrition Environment Measures Survey Toronto grocery store (NEMS-S) and NEMS Corner Store (NEMS-CS) tools. RESULTS "Less healthy" snack foods and sugar-sweetened beverages were more prominently displayed than "healthier" options with an exception of cereal, at both grocery and convenience stores (all p < 0.001). Coke™ and fruit juice were more expensive than water in both grocery and convenience stores (both p ≤ 0.05). Significantly more child-specific strategies were used to promote "less healthy" compared with "healthier" options in both grocery and convenience stores (both p < 0.001). CONCLUSION Results of this study demonstrate that "less healthy" options are significantly more prominently displayed and more heavily marketed to all Nova Scotians, including children, in the retail food environment compared with items classified as "healthier". These findings indicate that there is a need for comprehensive structural changes to the retail food environment in Nova Scotia, to support population health.
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Affiliation(s)
- Ksenia Kholina
- Food Action Research Centre (FoodARC) and Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Amy Grant
- Maritime SPOR Support Unit and Nova Scotia Health Authority, Halifax, Canada
| | | | - Manfred Egbe
- Food Action Research Centre (FoodARC) and Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Shannan Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Canada
- Department of Pediatrics, IWK Health Centre and Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Mikiko Terashima
- School of Planning, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Patricia L Williams
- Food Action Research Centre (FoodARC) and Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
- Healthy Populations Institute, Dalhousie University, Halifax, Canada.
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Carroll N, Sadowski A, Parizeau K, von Massow M, Wallace A, Jewell K, Ma DWL, Buchholz AC, Duncan AM, Chan B, Haines J. Food Skills: Associations With Diet Quality and Food Waste Among Canadian Parents. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:371-379. [PMID: 33526389 DOI: 10.1016/j.jneb.2020.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the association between self-reported food skills and diet quality along with measured food waste among a sample of Canadian parents. DESIGN Cross-sectional data from surveys to assess food skills, 3-day food records to assess the Healthy Eating Index (HEI)-2015, and food waste measured by household waste audits. SETTING Guelph-Wellington, Ontario. PARTICIPANTS Parents (n = 130) with children aged 2-8 years. MAIN OUTCOME MEASURES HEI-2015 scores, daily per capita avoidable and unavoidable food waste (grams). ANALYSIS Linear regression using generalized estimating equations to determine unstandardized β estimates of associations between food skills and dependent variables. Models were adjusted for multiple testing, gender, and level of education. RESULTS Food safety knowledge for cooking hot foods (β = 4.3, P = 0.05), planning (β = 4.5, P = 0.001), and conceptualizing food (β = 4.0, P = 0.03) were positively associated with HEI-2015 scores. Knowledge related to best before dates (β = 25.3, P = 0.05; β = 12.1, P = 0.04), conceptualizing food (β = 34.1, P = 0.01; β = 13.8, P = 0.02), and mechanical techniques (β = 39.2, P = 0.01; β = 20.5, P = 0.004) were associated with more avoidable and unavoidable food waste, respectively. CONCLUSIONS AND IMPLICATIONS Addressing higher-level food skills with a focus on efficient food preparation practices that make use of all edible portions of foods could play an important role in minimizing food waste and improving diet quality. Additional research in other countries and in a larger, more socioeconomically diverse sample is needed to confirm these findings.
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Affiliation(s)
- Nicholas Carroll
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Adam Sadowski
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Kate Parizeau
- Department of Geography, Environment and Geomatics, University of Guelph, Guelph, Ontario, Canada
| | - Michael von Massow
- Department of Food, Agricultural and Resource Economics, University of Guelph, Guelph, Ontario, Canada
| | - Angela Wallace
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Kira Jewell
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - David W L Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Andrea C Buchholz
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Alison M Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Brianne Chan
- Department of Food, Agricultural and Resource Economics, University of Guelph, Guelph, Ontario, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada.
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Dalwood P, Marshall S, Burrows TL, McIntosh A, Collins CE. Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review. Nutr J 2020; 19:118. [PMID: 33099309 PMCID: PMC7585689 DOI: 10.1186/s12937-020-00632-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To describe a-priori diet quality indices used in children and adolescents, appraise the validity and reliability of these indices, and synthesise evidence on the relationship between diet quality and physical and mental health, and growth-related outcomes. METHODS Five electronic databases were searched until January 2019. An a-priori diet quality index was included if it applied a scoring structure to rate child or adolescent (aged 0-18-years) dietary intakes relative to dietary or nutrient guidelines. Diagnostic accuracy studies and prospective cohort studies reporting health outcomes were appraised using the Academy of Nutrition and Dietetics Quality Criteria Checklist. RESULTS From 15,577 records screened, 128 unique paediatric diet quality indices were identified from 33 countries. Half of the indices' scores rated both food and nutrient intakes (n = 65 indices). Some indices were age specific: infant (< 24-months; n = 8 indices), child (2-12-years; n = 16), adolescent (13-18 years; n = 8), and child/adolescent (n = 14). Thirty-seven indices evaluated for validity and/or reliability. Eleven of the 15 indices which investigated associations with prospective health outcomes reported significant results, such as improved IQ, quality of life, blood pressure, body composition, and prevalence of metabolic syndrome. CONCLUSIONS Research utilising diet quality indices in paediatric populations is rapidly expanding internationally. However, few indices have been evaluated for validity, reliability, or association with health outcomes. Further research is needed to determine the validity, reliability, and association with health of frequently utilised diet quality indices to ensure data generated by an index is useful, applicable, and relevant. REGISTRATION PROSPERO number: CRD42018107630 .
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Affiliation(s)
- Phoebe Dalwood
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences & Medicine, Bond Universtiy, Robina, Queensland, 4226, Australia
| | - Skye Marshall
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences & Medicine, Bond Universtiy, Robina, Queensland, 4226, Australia.
- Nutrition Research Australia, Sydney, New South Wales, Australia.
| | - Tracy L Burrows
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Ashleigh McIntosh
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences & Medicine, Bond Universtiy, Robina, Queensland, 4226, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, 2308, Australia
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Olm M, Stark RG, Beck N, Röger C, Leidl R. Impact of interventions to reduce overnutrition on healthcare costs related to obesity and type 2 diabetes: a systematic review. Nutr Rev 2020; 78:412-435. [PMID: 31769843 DOI: 10.1093/nutrit/nuz070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
CONTEXT In recent decades, obesity and type 2 diabetes mellitus (T2DM) have both become global epidemics associated with substantial healthcare needs and costs. OBJECTIVE The aim of this review was to critically assess nutritional interventions for their impact on healthcare costs to community-dwelling individuals regarding T2DM or obesity or both, specifically using CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria to assess the economic components of the evidence. DATA SOURCES Searches were executed in Embase, EconLit, AgEcon, PubMed, and Web of Science databases. STUDY SELECTION Studies were included if they had a nutritional perspective, reported an economic evaluation that included healthcare costs, and focused on obesity or T2DM or both. Studies were excluded if they examined clinical nutritional preparations, dietary supplements, industrially modified dietary components, micronutrient deficiencies, or undernutrition; if they did not report the isolated impact of nutrition in complex or lifestyle interventions; or if they were conducted in animals or attempted to transfer findings from animals to humans. DATA EXTRACTION A systematic review was performed according to PRISMA guidelines. Using predefined search terms, 21 studies evaluating food habit interventions or taxation of unhealthy foods and beverages were extracted and evaluated using CHEERS criteria. RESULTS Overall, these studies showed that nutrition interventions and taxation approaches could lead to cost savings and improved health outcomes when compared with current practice. All of the included studies used external sources and economic modeling or risk estimations with population-attributable risks to calculate economic outcomes. CONCLUSIONS Most evidence supported taxation approaches. The effect of nutritional interventions has not been adequately assessed. Controlled studies to directly measure economic impacts are warranted.
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Affiliation(s)
- Michaela Olm
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of General Practice and Health Services Research, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Renée G Stark
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nathanael Beck
- Munich Center of Health Sciences, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany
| | - Christina Röger
- Competence Center for Nutrition and the Institute of the Bavarian State Ministry of Food, Agriculture and Forestry, Freising, Bavaria, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany
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Adherence to Life-Style Recommendations and Attention-Deficit/Hyperactivity Disorder: A Population-Based Study of Children Aged 10 to 11 Years. Psychosom Med 2020; 82:305-315. [PMID: 32251098 DOI: 10.1097/psy.0000000000000787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The incidence of attention-deficit/hyperactivity disorder (ADHD) among children and youth is high, and temporal increases have been paralleled by deteriorating life-styles. Poor diet quality, physical inactivity, poor sleep habits, and sedentary behaviors have all been associated with ADHD. However, no earlier prospective study has examined the independent and combined importance of meeting established life-style recommendations in childhood for ADHD in adolescence. We examined the associations of adherence to life-style recommendations with the incidence of ADHD and the utilization of health services associated with ADHD. METHODS Life-style survey among 10- and 11-year-old students (N = 3436) was linked to administrative health data. Associations between adherence to nine established life-style recommendations with ADHD diagnosis and number of physician visits for ADHD until age 14 years were examined using Cox proportional hazard and negative binomial regression. RESULTS Before age 14 years, 10.8% of students received an ADHD diagnosis. Meeting recommendations for vegetables and fruit, meat and alternatives, saturated fat, added sugar, and physical activity was associated with fewer ADHD diagnoses. Compared with children who met one to three recommendations, meeting seven to nine recommendations was associated with substantially lower incidence of ADHD and fewer physician visits related to ADHD (hazard ratio = 0.42 [95% confidence interval = 0.28-0.61]; rate ratio = 0.38 [95% confidence interval = 0.22-0.65]). CONCLUSIONS Life-style recommendations exist to benefit development and physical health. Their promotion comes at no harm and may have benefits for ADHD. Experimental evidence is needed to clarify the potential bidirectional relationship between ADHD and adverse health behaviors.
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Policies to Create Healthier Food Environments in Canada: Experts' Evaluation and Prioritized Actions Using the Healthy Food Environment Policy Index (Food-EPI). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224473. [PMID: 31739397 PMCID: PMC6888279 DOI: 10.3390/ijerph16224473] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 01/08/2023]
Abstract
Food environment policies play a critical role in shaping food choices, diets, and health outcomes. This study endeavored to characterize and evaluate the current food environment policies in Canada using the Healthy Food Environment Policy Index (Food-EPI) to compare policies in place or under development in Canada as of 1 January 2017 to the most promising practices internationally. Evidence of policy implementation from the federal, provincial, and territorial governments was collated and verified by government stakeholders for 47 good practice indicators across 13 policy and infrastructure support domains. Canadian policies were rated by 71 experts from across Canada, and an aggregate score of national and subnational policies was created. Potential policy actions were identified and prioritized. Canadian governments scored ‘high’ compared to best practices for 3 indicators, ‘moderate’ for 14 indicators, ‘low’ for 25 indicators, and ‘very little or none’ for 4 indicators. Six policy and eight infrastructure support actions were prioritized as the most important and achievable. The Food-EPI identified some progress and considerable gaps in policy implementation in Canada, and highlights a particular need for greater attention to prioritized policies that can help to shift to a health-promoting food environment.
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Loewen OK, Ekwaru JP, Ohinmmaa A, Veugelers PJ. Economic Burden of Not Complying with Canadian Food Recommendations in 2018. Nutrients 2019; 11:E2529. [PMID: 31635176 PMCID: PMC6835951 DOI: 10.3390/nu11102529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 11/25/2022] Open
Abstract
Poor diet has been identified as a major cause of chronic disease. In this study we estimated the 2018 economic burden of chronic disease attributable to not complying with Canadian food recommendations. We retrieved the chronic disease risk estimates for intakes of both protective (fruit, vegetables, milk, whole grains, nuts and seeds) and harmful foods (sugar-sweetened beverages, processed meat, red meat) from the Global Burden of Disease Study, and food intakes from the 2015 Canadian Community Health Survey 24-hour dietary recalls (n = 19,797). Population attributable fractions (PAFs) were calculated for all food-chronic disease combinations, and mathematically adjusted to estimate the 2018 annual direct (hospital, physician, drug) and indirect (human capital approach) economic burden for each disease. Not meeting the eight food recommendations was estimated to be responsible for CAD$15.8 billion/year in direct (CAD$5.9 billion) and indirect (CAD$9.9 billion) costs. The economic burden of Canadians under-consuming healthful foods exceeded the burden of overconsumption of harmful foods (CAD$12.5 billion vs. CAD$3.3 billion). Our findings suggest poor diet represents a substantial economic burden in Canada. Interventions may be more effective if they are wide in focus and promote decreased consumption of harmful foods alongside increased consumption of healthful foods, with emphasis on whole grains and nuts and seeds.
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Affiliation(s)
- Olivia K Loewen
- Population Health Research Intervention Unit, School of Public Health, University of Alberta, Edmonton, AL T6G 2T4, Canada.
| | - John P Ekwaru
- Population Health Research Intervention Unit, School of Public Health, University of Alberta, Edmonton, AL T6G 2T4, Canada.
| | - Arto Ohinmmaa
- Population Health Research Intervention Unit, School of Public Health, University of Alberta, Edmonton, AL T6G 2T4, Canada.
| | - Paul J Veugelers
- Population Health Research Intervention Unit, School of Public Health, University of Alberta, Edmonton, AL T6G 2T4, Canada.
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