Price changes alone are not adequate to produce long-term dietary change

The Relative Costs of High- vs. Low-Energy-Density Foods and More vs. Less Healthful Beverages Consumed by Children

OBJECTIVE

To compare grocery costs between relatively high energy density foods and sugar-sweetened/high-fat beverages and lower energy density foods and more healthful beverages in children's diets.

METHODS

Sixty foods were divided into high and low energy density baskets. Fourteen beverages were designated to either basket based on fat and added-sugar content. Prices were collected at 60 grocery stores and composite costs compared between baskets using Wilcoxon tests.

RESULTS

The cost per kilogram of high energy density foods was greater, but the cost per quart of sugar-sweetened/high-fat beverages was lower than more healthful beverages. The cost per 1000 calories and the cost per serving of the high energy density basket were lower.

CONCLUSIONS

The relative cost of high and low energy density foods in children's diets depends on how cost is quantified. "Pound-for-pound," lower energy density foods and more healthful beverages are generally less expensive, but high energy density foods and less healthful beverages are cheaper per serving. Cost metrics including other factors (e.g. time cost) may further clarify the role of grocery prices in children's diets.

Economic growth and the demand for dietary quality: Evidence from Russia during transition

The increasing incidence of nutrition-related chronic diseases worldwide has raised people's awareness of dietary quality. Most existing studies on the topic of changing nutrition patterns measure dietary quality by single macronutrient indicators or anthropometric outcomes. However, such an approach is often too narrow to provide a picture of overall dietary quality and is sometimes even misleading. This study contributes to the existing literature by taking into account that the analysis of dietary quality comprises two dimensions: the adequate intake of vitamins and minerals, as well as the moderate intake of nutrients that increase the risk of chronic diseases. Thereby, we apply Grossman's health investment model to the analysis of the demand for dietary quality, explicitly addressing the different dimensions of dietary quality and the intertemporal character of health investments. We apply our approach to Russia using data from the Russia Longitudinal Monitoring Survey from 1996 to 2008. Our results show that intake levels of vitamins and minerals as well as saturated and total fatty acids increased after 1998 along with economic recovery, while the intake of fiber decreased. Our econometric results imply an income elasticity of vitamins and minerals of 0.051, and an income elasticity of fats of 0.073. Overall, our results are in line with an ongoing nutrition transition in the Russian Federation, which is marked by decreasing deficiencies in vitamins and minerals, as well as the increasing consumption of fats with its accompanying negative health consequences.

Estimated and forecasted trends in domain specific time-use and energy expenditure among adults in Russia

BACKGROUND

Examination of historical trends and projections in estimated energy expenditure in Russia is important given the country's economic downturns and growth.

METHODS

Nationally representative data from the Russia Longitudinal Monitoring Survey (RLMS) from 1995-2011 was used to determine the metabolic equivalents of task (MET)-hours per week from occupational, domestic, travel, and active leisure physical activity (PA) domains, as well as sedentary leisure time (hours per week) among adults 18-60 years. Additionally, we projected what these values would be like in 2020 and 2030 if observed trends continue.

RESULTS

Among male adults, the largest contributor to total PA was occupational PA followed by travel PA. In contrast, domestic PA followed by occupational PA contributed most to total PA among female adults. Total PA was 282.9 MET-hours per week in 1995 and declined to 231.7 in 2011. Total PA is projected to decrease to 216.5 MET-hours per week in 2020 and to 193.0 MET-hours per week in 2030. The greatest relative declines are occurring in travel PA. Female adults are also exhibiting significant declines in domestic PA. Changes in occupational and active leisure PA are less distinct.

CONCLUSIONS

Policies and initiatives are needed to counteract the long-term decline of overall physical activity linked with a modernizing lifestyle and economy among Russian adults.

Four issues in undernutrition-related health impact modeling

Undernutrition modeling makes it possible to evaluate the potential impact of such events as a food-price shock or harvest failure on the prevalence and severity of undernutrition. There are, however, uncertainties in such modeling. In this paper we discuss four methodological issues pertinent to impact estimation: (1) the conventional emphasis on energy intake rather than dietary quality; (2) the importance of the distribution of nutrient intakes; (3) the timing of both the 'food shock' and when the response is assessed; and (4) catch-up growth and risk accumulation.

Economic determinants of diet in older adults: systematic review

BACKGROUND AND AIMS

Many economic factors are associated with diet, yet the evidence is generally cross-sectional. Older people are considered especially vulnerable to poor diets from negative changes to varied economic factors. This review extends current knowledge on known correlates to decipher actual economic determinants of diet in older adults.

METHODS

Eight bibliometric databases were searched between May and December 2012, supplemented by hand-searches, with no restrictions on publication date or country. Longitudinal studies, or reviews, were eligible when examining diet as a function of change in an economic factor in non-institutionalised adults ≥60 years. Data were extracted using a standardised evidence table and quality assessed before narrative synthesis.

RESULTS

We found nine original studies for inclusion, of which eight examined change from work to retirement and one evaluated a food price intervention. Designs were generally pre-post without controls and varying in follow-up. Studies reported mixed impact on food spending and/or food intake. Retirement was shown to both reduce and have no impact on food spending and to have either positive and negative, or positive and no impact on food intake. Subgroup differences were observed, especially between men and women.

CONCLUSIONS

Despite ample research on economic correlates of older adults' diets, little is still known about actual economic determinants of diet in this population. Studies of retirement suggest divergent effects in some but not all older people. Robust high-quality longitudinal studies to decipher economic drivers of diet must be prioritised in research and policy as firm conclusions remain elusive.

Changing patterns of fruit and vegetable intake in countries of the former Soviet Union

OBJECTIVE

To assess how the frequency of low fruit and vegetable consumption has changed in countries of the former Soviet Union (FSU) between 2001 and 2010 and to identify factors associated with low consumption.

DESIGN

Cross-sectional surveys. A standard questionnaire was administered at both time points to examine fruit and vegetable consumption frequency. Logistic regression analysis was used to examine the relationship between demographic, socio-economic and health behavioural variables and low fruit and vegetable consumption in 2010.

SETTING

Nationally representative population samples from Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine.

SUBJECTS

Adults aged 18 years and older.

RESULTS

Between 2001 and 2010 notable changes occurred in fruit and vegetable consumption in many countries resulting in a slight overall deterioration in diet. By 2010 in six countries about 40% of the population was eating fruit once weekly or less often, while for vegetables the corresponding figure was in excess of 20% in every country except Azerbaijan. A worse socio-economic situation, negative health behaviours (smoking and alcohol consumption) and rural residence were all associated with low levels of fruit and vegetable consumption.

CONCLUSIONS

International dietary guidelines emphasise the importance of fruit and vegetable consumption. The scale of inadequate consumption of these food groups among much of the population in many FSU countries and its link to socio-economic disadvantage are deeply worrying. This highlights the urgent need for a greater focus to be placed on population nutrition policies to avoid nutrition-related diseases in the FSU countries.

Food expenditures, cariogenic dietary practices and childhood dental caries in southern Brazil

Family expenditures on food for children may represent an important barrier to the adoption of healthy feeding practices in populations of low socioeconomic status. The aim of this study was to explore the relationship between cariogenic feeding practices, expenditures on food for children and dental caries. This cross-sectional study included 329 four-year-old children from São Leopoldo in southern Brazil. Cariogenic dietary practices were assessed at 4 years of age using two 24-hour recalls conducted with the children's mothers. Expenditures on food for children were estimated based on all reported food items and the respective amounts ingested. Early childhood caries and severe early childhood caries were assessed by clinical examination at 4 years of age. Cariogenic dietary habits were not associated with lower food expenditures. On the contrary, in multivariable regression analysis, the intake of chocolate (p = 0.007), soft drinks (p = 0.027) and a higher number of meals and snacks per day (p < 0.001) was associated with greater expenditures on food for children. No statistically significant differences were observed in food expenditures or in the proportion of household income spent on feeding children between caries-free children, those with early childhood caries and those with severe early childhood caries. In conclusion, keeping children free of dental caries does not necessarily increase food expenditures or the proportion of household income spent on feeding children in low-socioeconomic status populations. Some cariogenic dietary practices were associated with greater expenditures on child feeding.

Consumption of soda and other sugar-sweetened beverages by 2-year-olds: findings from a population-based survey

OBJECTIVE

To determine risk factors for consumption of soda and other sugar-sweetened beverages (SSB) among 2-year-old children.

DESIGN

The analysis was performed using three linked data sets: the 2004-2005 Oregon Pregnancy Risk Assessment Monitoring Survey (PRAMS); its longitudinal follow-up, 2006-2007 Oregon PRAMS-2; and 2004-2005 Oregon birth certificates.

SETTING

PRAMS is a surveillance programme supported by the federal Centers for Disease Control and Prevention and implemented by participating state health departments. Using mixed methods, PRAMS surveys women 2-6 months after a live birth. Oregon PRAMS-2 re-interviews respondents shortly after the index child's second birthday. Oregon PRAMS oversamples minority women.

SUBJECTS

Using monthly cohorts, we randomly selected 5851 women from the 2004-2005 birth certificates. In total 1911 women completed both PRAMS and PRAMS-2. The weighted response rate of PRAMS-2 was 43.5%.

RESULTS

Almost half of mothers (49.9%) reported that their child drank SSB on at least 1 d/week. Mothers whose children drank SSB at least once weekly were more likely to have low income (adjusted OR=2.83, 95% CI 2.09, 3.83) and to eat out on ≥2 d/week (OR=2.11 %, 95% CI 1.66, 2.70). Hispanic and non-Hispanic black women were most likely to report that their child drank SSB at least once weekly.

CONCLUSIONS

Half of mothers reported that their 2-year-old children drank SSB at least once weekly. Public health interventions and policies should address childhood SSB consumption including educating health-care providers and parents.

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association

BACKGROUND

Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.

METHODS AND RESULTS

For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies.

CONCLUSIONS

This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Hilar mossy cells share developmental influences with dentate granule neurons

Mossy cells are the major class of excitatory neurons in the dentate hilus. Although mossy cells are involved in a range of physiological and pathological conditions, very little is known about their ontogeny. To gain insight into this issue, we first determined the developmental stage at which mossy cells can be reliably identified with the molecular markers calretinin and GluR2/3 and found that hilar mossy cells were first identifiable around the end of the 1st postnatal week. Birthdating studies combined with staining for these markers revealed that the appearance of mossy cells coincided with the first wave of dentate granule cell production during mid-gestation. Since mossy cells are born as the first granule cells are produced and it is believed that mossy cells originate from the neuroepithelium adjacent to the dentate progenitor zone, we examined to what extent the development of mossy cells is controlled by the same molecular pathways as that of granule cells. To do this, we analyzed the production of mossy cells in Lef1 and NeuroD mutant animals, in which granule cell production is disrupted during precursor proliferation or neuronal differentiation, respectively. The production of mossy cells was almost entirely lost in both mutants. Collectively, these data suggests that hilar mossy cells, unlike CA subfield pyramidal cells, are influenced by many of the same developmental cues as dentate granule cells.