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Iris N, Munir F, Daley AJ. Examining young people's views and understanding of traffic light and physical activity calorie equivalent (PACE) food labels. BMC Public Health 2023; 23:1143. [PMID: 37316800 DOI: 10.1186/s12889-023-16019-6] [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: 11/30/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Childhood obesity is a public health challenge in many countries. Food labelling may help children make healthier food choices. Food is typically labelled using the traffic light label system but this is complex to understand. Physical activity calorie equivalent (PACE) labelling may be easier for children to understand and more appealing because it contextualises the energy content of food/drinks. METHODS A cross-sectional online questionnaire was completed by 808 adolescents aged 12-18 years in England. The questionnaire investigated participants' views and understanding of traffic light and PACE labels. Participants were also asked about their understanding of the meaning of calories. The questionnaire explored participants' views about the potential frequency of use of PACE labels and their perceived usefulness in influencing purchasing and consumption decisions. Questions that explored participants' views about the possible implementation of PACE labelling, preferences for food settings and types of food/drinks they may like such labelling implemented, and whether PACE labels would encourage physical activity were included. Descriptive statistics were explored. Analyses assessed associations between variables and tested differences in the proportions of views about the labels. RESULTS More participants reported PACE labels as easier to understand than traffic light labels (69% vs 31%). Of participants who had seen traffic light labels, 19% looked at them often/always. Forty-two percent of participants would look at PACE labels often/always. The most common reason why participants never/would never look at food labels is because they are not interested in making healthy choices. Fifty-two percent of participants said PACE labels would make it easier for them to choose healthy food and drinks. Fifty percent of participants reported PACE labels would encourage them to be physically active. It was perceived that PACE labels could be useful in a range of food settings and on a range of food/drinks. CONCLUSIONS PACE labelling may be easier for young people to understand and more appealing/useful to them than traffic light labelling. PACE labelling may help young people choose healthier food/drinks and reduce excess energy consumption. Research is now needed to understand the impact of PACE labelling on food choice among adolescents in real eating settings.
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Affiliation(s)
- Natalia Iris
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Amanda J Daley
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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Improving the Nutrient Quality of Foods and Beverages Using Product Specific Standards for Nutrients to Limit Will Substantially Reduce Mean Population Intakes of Energy, Sodium, Saturated Fat and Sugars towards WHO Guidelines. Nutrients 2022; 14:nu14204289. [PMID: 36296974 PMCID: PMC9611440 DOI: 10.3390/nu14204289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND International strategies to reduce chronic diseases have called for a reduction in the amounts of saturated fat (SAFA), trans fat (TFA), salt and sugars in the global food supply. This paper describes the development approach and potential impact of a set of standards for these nutrients to drive food (re)formulation. METHODS To set the standards, WHO nutrient guidelines for daily intake were translated into product group specific standards. The impact of reformulation towards these standards on population nutrient intakes was modelled using the food consumption data of five countries: UK, France, US, Brazil and China. The impact of the TFA standards could not be modelled due to lack of data. RESULTS (Re)formulation of foods and beverages towards these standards would substantially decrease mean population intakes of energy, sodium, SAFA and sugars, with reductions up to 30%. CONCLUSIONS These science-based standards for nutrients to limit could drive impactful reductions in energy, sodium, SAFA and sugars in food and beverage products, enabling mean population intakes to move closer to WHO nutrient guidelines.
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Shaw S, Crozier S, Strömmer S, Inskip H, Barker M, Vogel C. Development of a short food frequency questionnaire to assess diet quality in UK adolescents using the National Diet and Nutrition Survey. Nutr J 2021; 20:5. [PMID: 33430892 PMCID: PMC7802176 DOI: 10.1186/s12937-020-00658-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND UK adolescents consume fewer fruits and vegetables and more free sugars than any other age group. Established techniques to understand diet quality can be difficult to use with adolescents because of high participant burden. This study aimed to identify key foods that indicate variation in diet quality in UK adolescents for inclusion in a short food frequency questionnaire (FFQ) and to investigate the associations between adolescent diet quality, nutritional biomarkers and socio-demographic factors. METHODS Dietary, demographic and biomarker data from waves 1-8 of the National Diet and Nutrition Survey rolling programme were used (n=2587; aged 11-18 years; 50% boys; n=≤997 biomarker data). Principal component analysis (PCA) was applied to 139 food groups to identify the key patterns within the data. Two diet quality scores, a 139-group and 20-group, were calculated using the PCA coefficients for each food group and multiplying by their standardised reported frequency of consumption and then summing across foods. The foods with the 10 strongest positive and 10 strongest negative coefficients from the PCA results were used for the 20-group score. Scores were standardised to have a zero mean and standard deviation of one. RESULTS The first PCA component explained 3.0% of variance in the dietary data and described a dietary pattern broadly aligned with UK dietary recommendations. A correlation of 0.87 was observed between the 139-group and 20-group scores. Bland-Altman mean difference was 0.00 and 95% limits of agreement were - 0.98 to 0.98 SDs. Correlations, in the expected direction, were seen between each nutritional biomarker and both scores; results attenuated slightly for the 20-group score compared to the 139-group score. Better diet quality was observed among girls, non-white populations and in those from higher socio-economic backgrounds for both scores. CONCLUSIONS The diet quality score based on 20 food groups showed reasonable agreement with the 139-group score. Both scores were correlated with nutritional biomarkers. A short 20-item FFQ can provide a meaningful and easy-to-implement tool to assess diet quality in large scale observational and intervention studies with adolescents.
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Affiliation(s)
- Sarah Shaw
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK. .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Fulgoni VL, Gaine PC, Scott MO. Comparison of Various Methods to Determine Added Sugars Intake to Assess the Association of Added Sugars Intake and Micronutrient Adequacy. Nutrients 2020; 12:E2816. [PMID: 32938005 PMCID: PMC7551971 DOI: 10.3390/nu12092816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
Different methods for determining the effect of added sugars intake among children and adults on meeting recommended nutrient intakes were compared using 24 h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Four methods were used to determine deciles of added sugars intake (as the percentage of total calories): 1 day intake, 2 day average intake, and individual usual intake (UI) determined with the National Cancer Institute (NCI) and the multivariate Markov Chain Monte Carlo methods. Percentages of the population below the Estimated Average Requirement (EAR) for calcium and vitamin D/above the Adequate Intake (AI) for potassium and dietary fiber for each decile of added sugars intake were assessed with the NCI method. Using regression analyses, added sugars intake deciles (by any method) in children were inversely associated (p < 0.001) with percentages below the EAR/above the AI of vitamin D, calcium, potassium, and fiber. In adults, added sugars intake deciles were inversely associated with meeting recommendations for vitamin D, potassium, and fiber. There were no significant between-method differences for regression coefficients for any nutrients investigated. Overall, these methods showed a similar association of added sugars intake with nutrient inadequacy/adequacy; therefore, method preference may depend more on practical reasons.
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Affiliation(s)
| | - P. Courtney Gaine
- The Sugar Association, Inc., Washington, DC 20005, USA; (P.C.G.); (M.O.S.)
| | - Maria O. Scott
- The Sugar Association, Inc., Washington, DC 20005, USA; (P.C.G.); (M.O.S.)
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Next Steps for Interventions Targeting Adolescent Dietary Behaviour. Nutrients 2020; 12:nu12010190. [PMID: 31936682 PMCID: PMC7019272 DOI: 10.3390/nu12010190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/05/2020] [Indexed: 12/19/2022] Open
Abstract
Adolescents in many countries consume poor quality diets that include high intakes of sugary drinks and fast food and low intakes of vegetables. The aims of this Special Issue on adolescent dietary behaviour were to identify methods and approaches for successful interventions to improve diet quality in this age group and identify at risk subgroups that need particular attention. In total, 11 manuscripts were published in this Special Issue-three qualitative studies which included a systematic review, five cross-sectional studies and three quantitative evaluations of interventions. This Editorial discusses the contribution of the studies and provides suggestions to improve the success of future interventions in adolescents. It is important that adolescents are involved in the design of interventions to improve social and cultural acceptability and relevance. Interventions targeting schools or communities framed within a larger food system such as issues around climate change and the carbon footprint of food may improve engagement. Furthermore, targeting adolescents in areas of lower deprivation is a priority where diet quality is particularly poor. Potentially successful interventions also include environmental policies that impact on the cost and marketing of food and drinks, although evaluations of these were not included in this issue.
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