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Lozano PM, Bobb JF, Kapos FP, Cruz M, Mooney SJ, Hurvitz PM, Anau J, Theis MK, Cook A, Moudon AV, Arterburn DE, Drewnowski A. Residential Density Is Associated With BMI Trajectories in Children and Adolescents: Findings From the Moving to Health Study. AJPM Focus 2024; 3:100225. [PMID: 38682047 PMCID: PMC11046231 DOI: 10.1016/j.focus.2024.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Introduction This study investigates the associations between built environment features and 3-year BMI trajectories in children and adolescents. Methods This retrospective cohort study utilized electronic health records of individuals aged 5-18 years living in King County, Washington, from 2005 to 2017. Built environment features such as residential density; counts of supermarkets, fast-food restaurants, and parks; and park area were measured using SmartMaps at 1,600-meter buffers. Linear mixed-effects models performed in 2022 tested whether built environment variables at baseline were associated with BMI change within age cohorts (5, 9, and 13 years), adjusting for sex, age, race/ethnicity, Medicaid, BMI, and residential property values (SES measure). Results At 3-year follow-up, higher residential density was associated with lower BMI increase for girls across all age cohorts and for boys in age cohorts of 5 and 13 years but not for the age cohort of 9 years. Presence of fast food was associated with higher BMI increase for boys in the age cohort of 5 years and for girls in the age cohort of 9 years. There were no significant associations between BMI change and counts of parks, and park area was only significantly associated with BMI change among boys in the age cohort of 5 years. Conclusions Higher residential density was associated with lower BMI increase in children and adolescents. The effect was small but may accumulate over the life course. Built environment factors have limited independent impact on 3-year BMI trajectories in children and adolescents.
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Affiliation(s)
- Paula Maria Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Flavia P. Kapos
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke School of Medicine, Durham, North Carolina
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Maricela Cruz
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Philip M. Hurvitz
- Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, Washington
- Center for Studies in Demography & Ecology, University of Washington, Seattle, Washington
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Anne Vernez Moudon
- Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, Washington
| | - David E. Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Adam Drewnowski
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Center for Public Health Nutrition, University of Washington, Seattle, Washington
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Zhang X, Schenk JM, Perrigue M, Drewnowski A, Wang CY, Beatty SJ, Neuhouser ML. No effect of high eating frequency compared to low eating frequency on appetite and inflammation biomarkers: results from a randomized cross-over clinical trial. J Nutr 2024:S0022-3166(24)00228-1. [PMID: 38703890 DOI: 10.1016/j.tjnut.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Eating frequency (EF) focuses on the total number of eating occasions per day and may influence metabolic health. OBJECTIVE We sought to examine the effect of high vs. low EF on appetite regulation and inflammatory biomarkers among healthy adults. METHODS Data are from a randomized, cross-over trial (the Frequency of Eating and Satiety Hormones (FRESH) Study). Participants (n=50) completed two isocaloric 21-day study periods of low EF (three eating occasions/day) and high EF (six eating occasions/day) in random order with a 14-day wash-out period in-between. Participants were free-living and consumed their own food, using study-directed, structured meal plans with identical foods and total energy in both study periods. On days 1 and 21 of each EF period, fasting blood was collected during in-person clinic visits to assess plasma concentrations of ghrelin, leptin, adiponectin, and high-sensitive C-reactive protein (hs-CRP). Linear mixed models with EF, diet order, and period as fixed effects; and participant as random effect estimated the intervention effect. Interaction effects between EF and % body fat were examined. RESULTS Among the 50 participants who completed the trial, 39 (78%) were women, 30 (60%) were Non-Hispanic White, 40 (80%) had a BMI<25 kg/m2, and the mean age was 32.1years. The differences between high vs. low EF in fasting ghrelin (geometric mean difference: 17.76 ng/ml, p=0.60), leptin (geometric mean difference: 2.09 ng/ml, p=0.14), adiponectin (geometric mean difference: 381.7 ng/ml, p=0.32), and hs-CRP (geometric mean difference: -0.018 mg/dl, p=0.08) were not statistically significant. No EF x % body fat interaction was observed on appetite regulation and inflammatory biomarkers. CONCLUSIONS No differences was observed in fasting ghrelin, leptin, adiponectin, and hs-CRP, comparing high vs. low EF. Future studies are needed to understand the physiology of eating frequency and appetite as they relate to metabolic health.
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Affiliation(s)
- Xiaochen Zhang
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, United States, 98109
| | - Jeannette M Schenk
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, United States, 98109
| | - Martine Perrigue
- Department of Nutrition and Exercise Physiology, College of Medicine, Washington State University, 412 E. Spokane Falls Blvd. Spokane, WA, United States, 99202
| | - Adam Drewnowski
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, United States, 98195
| | - Ching-Yun Wang
- Biostatistics Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, United States, 98109
| | - Sarah J Beatty
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, United States, 98109
| | - Marian L Neuhouser
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, United States, 98109.
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Drewnowski A. A novel Nutrient Rich Food (NRFa11.3) score uses flavonoids and carotenoids to identify antioxidant-rich spices, herbs, vegetables, and fruit. Front Nutr 2024; 11:1386328. [PMID: 38699550 PMCID: PMC11063353 DOI: 10.3389/fnut.2024.1386328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Nutrient profiling (NP) models designed to evaluate the healthfulness of plant-based foods ought to incorporate bioactive phytochemicals. Herbs and spices are one food group of current interest. Methods Two new versions of the well-established Nutrient Rich Food (NRF) index were applied to spices, herbs, vegetables, fruit, and other plant-based foods. Analyses used the US Department of Agriculture (USDA) SR-28 nutrient composition database merged with the USDA Expanded Flavonoid database 3.3. The NRF4.3 model was based on protein, fiber, potassium, and vitamin C. The NRFa11.3 model was based on micronutrients with reported antioxidant activity (vitamin C, vitamin E, selenium, copper, and zinc), carotenoids (alpha and beta carotene, beta-cryptoxanthin, lycopene, lutein/zeaxantin) and flavonoids. Saturated fat, added sugar, and sodium were nutrients to limit. The NRF algorithm was based on sums of percent daily values (%DVs) capped at 100%. Results The NRF4.3 model awarded high scores to herbs and spices, cocoa powder, and nuts, but did not discriminate well among vegetables and fruit. The NRFa11.3 model performed better. Green leafy, red orange and cruciferous vegetables had the highest carotenoid content. Highest in flavonoids were cocoa powder, herbs and spices, and berries. Highest combined NRFa11.3 values were observed for herbs and spices, green leafy vegetables, cocoa, nuts, and red-orange and cruciferous vegetables. Discussion Fresh and dry herbs and spices, often ignored by NP models, were particularly nutrient-rich and may provide non-negligible amounts of key phytonutrients to the human diet.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
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Vieux F, Maillot M, Drewnowski A. Dietary Flavonoid Intakes in France Are Linked to Brewed Tea Consumption and to Socioeconomic Status: Analyses of the Third French Individual and National Food Consumption (INCA3) Survey for Children and Adults. Nutrients 2024; 16:1118. [PMID: 38674809 PMCID: PMC11054843 DOI: 10.3390/nu16081118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Flavonoids from green and black tea may benefit cardiovascular health. Brewed tea consumption and flavonoid intake in France have not been previously explored. This study assessed the dietary intake of flavonoids among French children and adults, using 3 days' dietary recall for 3896 persons aged >4 y in the Third French Individual and National Food Consumption Survey (INCA3). Foods consumed by INCA 3 participants were manually matched with the flavonoid content of foods from the French PhenolExplorer database and the US Department of Agriculture expanded flavonoid database (2018 version). The six subclasses of flavonoids were flavan-3-ols, flavanones, anthocyanidins, flavonols, flavones, and isoflavones. Flavonoid intake was stratified by age subgroups (children and adults separately) and examined using socio-demographics and tea consumption patterns. Mean flavonoid intake was 210 mg/d. Flavonoids in the French diet were predominantly flavan-3-ols (147 mg/d), of which tea is the main source. The effects of age, education, income, and socio-professional category (SPC) on flavonoid intake were all significant (p < 0.0001). Brewed tea consumers were 31.88% of French adults and 3.79% of children. Brewed tea consumption and flavonoid intake were highly correlated. The highest brewed tea and flavonoid intakes were found among individuals with the highest SPC and education levels. Flavonoid intake in France was associated with brewed tea consumption and with higher education and income.
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Affiliation(s)
- Florent Vieux
- MS-Nutrition, 27 bld Jean Moulin Faculté de Médecine la Timone, Laboratoire C2VN, CEDEX 5, 13385 Marseille, France; (F.V.); (M.M.)
| | - Matthieu Maillot
- MS-Nutrition, 27 bld Jean Moulin Faculté de Médecine la Timone, Laboratoire C2VN, CEDEX 5, 13385 Marseille, France; (F.V.); (M.M.)
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA 98195, USA
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Wakayama R, Drewnowski A, Horimoto T, Saito Y, Yu T, Suzuki T, Takasugi S. Development and Validation of the Meiji Nutritional Profiling System (Meiji NPS) to Address Dietary Needs of Adults and Older Adults in Japan. Nutrients 2024; 16:936. [PMID: 38612970 PMCID: PMC11013258 DOI: 10.3390/nu16070936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
This study introduces the Meiji Nutritional Profiling System (Meiji NPS), which was specifically designed to respond to age-related shifts in nutrient requirements among Japanese adults (<65 years old) and older adults (≥65 years old). Japan has one of the most aged societies in the world. The health issues of interest are malnutrition and lifestyle-related diseases among adults and frailty among older adults. Two versions of the NPS were developed based on nutrients to encourage (protein, dietary fibers, calcium, iron, and vitamin D), food groups to encourage (fruits, vegetables, nuts, legumes, and dairy), and nutrients to limit (energy, saturated fatty acids, sugars, and salt equivalents). The Meiji NPS for older adults did not include iron or saturated fatty acids. The algorithms were based on the Nutrient-Rich Foods Index (NRF). The convergent validity between the Meiji NPS and the existing NPSs for the same foods was confirmed using Spearman's correlation coefficients (NRF: r = 0.67 for adults and r = 0.60 for older adults; Health Star Rating: r = 0.64 for adults and r = 0.61 for older adults). The Meiji NPS may be useful for nutritional evaluation and reformulation of food products, tailored to adults and older adults to ameliorate health issues in Japan.
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Affiliation(s)
- Ryota Wakayama
- Meiji Co., Ltd., 2-2-1 Kyobashi, Chuo-ku, Tokyo 104-9306, Japan; (T.H.); (T.Y.); (S.T.)
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA;
| | - Tomohito Horimoto
- Meiji Co., Ltd., 2-2-1 Kyobashi, Chuo-ku, Tokyo 104-9306, Japan; (T.H.); (T.Y.); (S.T.)
| | - Yoshie Saito
- Meiji Co., Ltd., 2-2-1 Kyobashi, Chuo-ku, Tokyo 104-9306, Japan; (T.H.); (T.Y.); (S.T.)
| | - Tao Yu
- Meiji Co., Ltd., 2-2-1 Kyobashi, Chuo-ku, Tokyo 104-9306, Japan; (T.H.); (T.Y.); (S.T.)
| | - Takao Suzuki
- Institute for Gerontology, J. F. Oberlin University, 3758 Tokiwa, Machida, Tokyo 194-0294, Japan
| | - Satoshi Takasugi
- Meiji Co., Ltd., 2-2-1 Kyobashi, Chuo-ku, Tokyo 104-9306, Japan; (T.H.); (T.Y.); (S.T.)
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Drewnowski A. Perspective: The Place of Pork Meat in Sustainable Healthy Diets. Adv Nutr 2024; 15:100213. [PMID: 38508316 PMCID: PMC11035016 DOI: 10.1016/j.advnut.2024.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
The food systems sustainability framework has 4 domains: nutrition, economics, environment, and society. To qualify as sustainable, individual foods and total diets need to be nutrient-rich, affordable, environmentally friendly, and socially acceptable. Pork is the most consumed meat globally, providing high-quality protein and several priority micronutrients. With research attention focused on plant-based diets, it is time to assess the place of pork meat protein in the global sustainability framework. First, not all proteins are equal. The United States Department of Agriculture category of protein foods includes meat, poultry and fish, eggs, beans and legumes, and nuts and seeds. These protein sources have different protein digestibility profiles, different per-calorie prices, and different environmental footprints, measured in terms of greenhouse gas emissions. Second, most analyses of animal-source proteins combine beef, pork, and lamb into a single category of red meat. Beef, pork, and lamb have different nutrient profiles, different protein costs, and different impacts on the environment. Future analyses of nutrient density and monetary and carbon costs of alternative diets would do well to separate pork from beef, lamb, and chicken. There are also different profiles of global food demand. Prior analyses of global Food and Agriculture Organization Statistical Database food balance sheets joined with World Bank country incomes have consistently shown that rising incomes across lower- and middle-income countries (LMIC) create a growing demand for meat to replace traditional plant proteins. Most of the observed increase has been for pork and chicken rather than beef. This ongoing LMIC protein transition toward more animal proteins may be irreversible as long as incomes grow. The present analyses explore the place of pork in sustainable healthy diets worldwide, given the need for high-quality protein and the predictable patterns of global food demand.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States.
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Rosenberg DE, Cruz MF, Mooney SJ, Bobb JF, Drewnowski A, Moudon AV, Cook AJ, Hurvitz PM, Lozano P, Anau J, Theis MK, Arterburn DE. Neighborhood built and food environment in relation to glycemic control in people with type 2 diabetes in the moving to health study. Health Place 2024; 86:103216. [PMID: 38401397 PMCID: PMC10957299 DOI: 10.1016/j.healthplace.2024.103216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/05/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To examine whether built environment and food metrics are associated with glycemic control in people with type 2 diabetes. RESEARCH DESIGN AND METHODS We included 14,985 patients with type 2 diabetes using electronic health records from Kaiser Permanente Washington. Patient addresses were geocoded with ArcGIS using King County and Esri reference data. Built environment exposures estimated from geocoded locations included residential unit density, transit threshold residential unit density, park access, and having supermarkets and fast food restaurants within 1600-m Euclidean buffers. Linear mixed effects models compared mean changes of HbA1c from baseline at 1, 3 (primary) and 5 years by each built environment variable. RESULTS Patients (mean age = 59.4 SD = 13.2, 49.5% female, 16.6% Asian, 9.8% Black, 5.5% Latino/Hispanic, 57.1% White, 20% insulin dependent, mean BMI = 32.7±7.7) had an average of 6 HbA1c measures available. Participants in the 1st tertile of residential density (lowest) had a greater decline in HbA1c (-0.42, -0.43, and -0.44 in years 1, 3, and 5 respectively) than those in the 3rd tertile (HbA1c = -0.37 at 1- and 3-years and -0.36 at 5-years; all p-values <0.05). Having any supermarkets within 1600 m of home was associated with a greater decrease in HbA1c at 1-year and 3-years compared to having none (all p-values <0.05). CONCLUSIONS Lower residential density and better proximity to supermarkets may benefit HbA1c control in people with people with type 2 diabetes. However, effects were small and indicate limited clinical significance.
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Affiliation(s)
| | - Maricela F Cruz
- Kaiser Permanente Washington Health Research Institute, USA.
| | | | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, USA.
| | | | | | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, USA.
| | - Philip M Hurvitz
- University of Washington, Center for Studies in Demography and Ecology, USA.
| | - Paula Lozano
- Kaiser Permanente Washington Health Research Institute, USA.
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, USA.
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, USA.
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Drewnowski A. Alternative proteins in low- and middle-income countries (LMIC) face a questionable future: will technology negate Bennett's law? Curr Dev Nutr 2024; 8:101994. [PMID: 38476727 PMCID: PMC10926128 DOI: 10.1016/j.cdnut.2023.101994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 03/14/2024] Open
Abstract
Rising incomes across low-and middle-income countries (LMIC) lead to a lower consumption of starchy staples and create a growing demand for high-quality animal protein, an observation referred to as Bennett's law. This dietary shift from plant-sourced to animal-sourced proteins has also been referred to as the LMIC protein transition. At this time, there are rising concerns that current livestock production is highly resource intensive and may not meet the growing global demand for high-quality protein. Alternative plant-based proteins, derived from new technologies and often fortified with micronutrients, are intended to close the LMIC nutrient gap. However, data from LMIC suggest that the income-driven selection of animal proteins is aspirational and varies by stage of economic development. Food balance sheets from higher-income countries indicate that meat consumption peaks only at very high incomes. Will plant-based alternative proteins satisfy the growing LMIC demand for animal-sourced foods, thereby negating Bennett's law? Current evidence suggests otherwise.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
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Kapur M, Peña AN, Sreeram N, Bloem MW, Drewnowski A. What Is the Likely Impact of Alternative Proteins on Diet Quality, Health, and the Environment in Low- and Middle-Income Countries. Curr Dev Nutr 2024; 8:102064. [PMID: 38476726 PMCID: PMC10926135 DOI: 10.1016/j.cdnut.2023.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 03/14/2024] Open
Abstract
Alternative protein (AP) foods are proposed to support a global protein transition. Whereas AP food innovation has been a strategy to promote consumption of protein sources with low environmental impact in high-income countries (HICs) diets, their relation to sustainable, high-quality diets in low- and middle-income countries (LMICs) remains to be established. AP foods vary in nutrient profile, processing requirements, costs, and environmental impact. Current literature regarding AP suitability in LMIC contexts is limited. This perspective examined environmental and nutritional metrics that can assess the sustainability of AP in LMICs. Current research areas needed to accurately assess environmental impacts while considering nutritional density were identified. An overview of the usability of relevant AP in both high- and low-resource settings was also explored. Metrics addressing diverse contextual synergies in LMICs, unifying nutritional, environmental, and socioeconomic considerations, were found necessary to guide the integration of AP into LMIC diets.
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Affiliation(s)
- Mansha Kapur
- Department of Biology, Johns Hopkins University, Baltimore, MD, United States
| | - Alexis N. Peña
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Navya Sreeram
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Martin W. Bloem
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, United States
| | - Adam Drewnowski
- University of Washington School of Public Health, Seattle, Washington, United States
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Shen E, Baecker A, Ji M, Negriff S, Paz SR, Bhakta BB, Crawford CL, Drewnowski A, Lewis KH, Moore DD, Murali SB, Young DR, Coleman KJ. Pre-surgical factors related to latent trajectories of 5-year weight loss for a diverse bariatric surgery population. Surg Obes Relat Dis 2024:S1550-7289(24)00041-8. [PMID: 38443200 DOI: 10.1016/j.soard.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Analyzing trajectories of weight loss may address how particular groups of patients respond to metabolic and bariatric surgery. OBJECTIVES The Bariatric Experience Long Term (BELONG) study was designed to use a theoretical model to examine determinants of weight loss and recurrence. SETTING Large integrated health system in Southern California with 11 surgical practices and 23 surgeons. METHODS A total of n = 1338 patients who had metabolic and bariatric surgery were surveyed before surgery to measure factors related to median percent total weight loss (%TWL) over 5 years. Longitudinal weight data were available for n = 1024 (76.5% of the sample). Data were analyzed using latent growth mixture models (GMM) to estimate trajectories of weight change separately for gastric sleeve and bypass operations. These trajectories were then described using relevant variables from the baseline survey. RESULTS For both gastric sleeve (n = 733) and bypass (n = 291) operations, 3 latent trajectories of median %TWL were found corresponding to most, moderate, and least %TWL. Sleeve trajectories were distinguished by body mass index at surgery and geocoded environmental factors. Bypass trajectories varied by self-reported and geocoded environmental factors, comorbidity burden, race, experiential avoidance, and weight control strategies. CONCLUSIONS Future research should examine the role of the built and perceived environment in surgical weight loss. Bariatric practices should focus less on the presurgical period for predictors of long-term weight loss and begin efforts to monitor real-time patient-reported outcomes to help tailor intervention strategies for patients who either do not lose an expected amount of weight or who begin to experience weight recurrence.
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Affiliation(s)
- Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Aileen Baecker
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Ming Ji
- College of Population Health, University of New Mexico, Albuquerque, New Mexico
| | - Sonya Negriff
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Silvia R Paz
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Bhumi B Bhakta
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Cecelia L Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, California
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, Washington
| | - Kristina H Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Darren D Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, Illinois
| | - Sameer B Murali
- Department of Surgery, Center for Obesity Medicine & Metabolic Performance, University of Texas McGovern Medical School, Houston, Texas
| | - Deborah R Young
- College of Population Health, University of New Mexico, Albuquerque, New Mexico
| | - Karen J Coleman
- College of Population Health, University of New Mexico, Albuquerque, New Mexico; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.
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Drewnowski A, Monsivais P, Mognard E, Ismail Noor M, Karim N, Laporte C, Alem Y, Poulain JP. A Short Dietary Assessment Instrument to Evaluate Protein Quality and the Diversity of Protein Sources in Malaysian Diets. Asia Pac J Public Health 2024; 36:36-42. [PMID: 38186372 DOI: 10.1177/10105395231219049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
The diversity of protein food sources, animal and plant, may be a proxy measure of protein quality and adequate protein nutrition. A population-based sample of 1604 Malaysians aged ≥18 y completed one 24-h dietary recall and a new 29-item protein diversity indicator (PDI). Socio-demographic data were obtained by self-report. Mean total protein intakes were 75.2 g/d from 24-h recalls and 74.9 g/d from PDI. Protein diversity indicator-estimated protein intakes were 36.2% from meat and poultry, 8.8% from fish, 16.0% from eggs and dairy, and 39.0% from plants. Intakes of animal proteins varied with socioeconomic status and ethnicity and were associated with higher protein quality, defined as the adequacy of essential amino acids (EAAs) relative to protein requirements. Protein intakes and protein quality in Malaysia were generally adequate. Protein diversity indicator metrics can complement current methods of dietary assessment and may be useful for monitoring protein diversity and quality in other countries currently undergoing nutrition transition.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Pablo Monsivais
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Elise Mognard
- Taylor's Toulouse University Center and Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- University of Toulouse-Jean Jaures and International CNRS Laboratory on Food Culture and Health, Toulouse, France
| | - Mohd Ismail Noor
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norimah Karim
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Cyrille Laporte
- Taylor's Toulouse University Center and Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- University of Toulouse-Jean Jaures and International CNRS Laboratory on Food Culture and Health, Toulouse, France
| | - Yasmine Alem
- Taylor's Toulouse University Center and Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
| | - Jean-Pierre Poulain
- Taylor's Toulouse University Center and Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- University of Toulouse-Jean Jaures and International CNRS Laboratory on Food Culture and Health, Toulouse, France
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12
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Gold JM, Drewnowski A, Andersen MR, Rose C, Buszkiewicz J, Mou J, Ko LK. Investigating the effects of rurality on stress, subjective well-being, and weight-related outcomes. Wellbeing Space Soc 2023; 5:100171. [PMID: 38274306 PMCID: PMC10810484 DOI: 10.1016/j.wss.2023.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Purpose Rates of obesity are significantly higher for those living in a rural versus urban setting. High levels of stress and low levels of subjective well-being (SWB) have been linked to poor weight-related behaviors and outcomes, but it is unclear if these relationships differ as a function of rurality. This study investigated the extent to which living in a rural versus urban county ("rurality") moderated associations between stress / subjective wellbeing (predictors) and diet quality, dietary intake of added sugars, physical activity, and BMI (outcomes). Methods Participants were recruited from urban (n = 355) and rural (n = 347) counties in Washington State and self-reported psychological, demographic, and food frequency questionnaires while physical activity behavior was measured objectively. Findings After controlling for relevant covariates, levels of stress were positively associated with added sugar intake for those living in the urban county while this relationship was non-significant for those residing in the rural county. Similarly, SWB was negatively associated with added sugar intake, but only for urban residents. County of residence was also found to moderate the relationship between SWB and BMI. Higher SWB was inversely associated with BMI for those living in the urban county while no relationship was observed for rural county residents. Conclusions These findings support the hypothesis that the relationships between stress / SWB and weight function differentially based on the rurality of the residing county. This work adds to the growing body of literature highlighting the role stress and SWB play in the rural obesity disparity.
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Affiliation(s)
- Joshua M. Gold
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Adam Drewnowski
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, Washington, USA
| | - M. Robyn Andersen
- Department of Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Chelsea Rose
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, Washington, USA
| | - James Buszkiewicz
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Jin Mou
- MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, USA
| | - Linda K. Ko
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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13
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Jennings-Dobbs EM, Forester SM, Drewnowski A. Visualizing Data Interoperability for Food Systems Sustainability Research-From Spider Webs to Neural Networks. Curr Dev Nutr 2023; 7:102006. [PMID: 37915997 PMCID: PMC10616130 DOI: 10.1016/j.cdnut.2023.102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Food systems represent all elements and activities needed to feed the growing global population. Research on sustainable food systems is transdisciplinary, relying on the interconnected domains of health, nutrition, economics, society, and environment. The current lack of interoperability across databases poses a challenge to advancing research on food systems transformation. Crosswalks among largely siloed data on climate change, soils, agricultural practices, nutrient composition of foods, food processing, prices, dietary intakes, and population health are not fully developed. Starting with US Department of Agriculture FoodData Central, we assessed the interoperability of databases from multiple disciplines by identifying existing crosswalks and corresponding visualizations. Our visual demonstration serves as proof of concept, identifying databases in need of expansion, integration, and harmonization for use by researchers, policymakers, and the private sector. Interoperability is the key: ontologies and well-defined crosswalks are necessary to connect siloed data, transcend organizational barriers, and draw pathways from agriculture to nutrition and health.
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Affiliation(s)
| | | | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
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14
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Ji M, Negriff SL, Slezak JM, Taylor BL, Paz SR, Bhakta BB, Macias M, Arterburn DE, Crawford CL, Drewnowski A, Lewis KH, Moore DD, Murali SB, Young DR, Coleman KJ. Baseline Psychosocial, Environmental, Health, and Behavioral Correlates of 1- and 3-Year Weight Loss After Bariatric Surgery. Obes Surg 2023; 33:3198-3205. [PMID: 37612577 PMCID: PMC10765815 DOI: 10.1007/s11695-023-06791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Weight loss surgery is an effective, long-term treatment for severe obesity but individual response to surgery varies widely. The purpose of this study was to test a comprehensive theoretical model of factors that may be correlated with the greatest surgical weight loss at 1-3 years following surgery. Such a model would help determine what predictive factors to measure when patients are preparing for surgery that may ensure the best weight outcomes. MATERIALS AND METHODS The Bariatric Experience Long Term (BELONG) study collected self-reported and medical record-based baseline information as correlates of 1- and 3-year % total weight loss (TWL) in n = 1341 patients. Multiple linear regression was used to determine the associations between 120 baseline variables and %TWL. RESULTS Participants were 43.4 ± 11.3 years old, Hispanic or Black (52%; n = 699), women (86%; n = 1149), and partnered (72%; n = 965) and had annual incomes of ≥ $51,000 (60%; n = 803). A total of 1006 (75%) had 3-year follow-up weight. Regression models accounted for 10.1% of the variance in %TWL at 1-year and 13.6% at 3 years. Only bariatric operation accounted for a clinically meaningful difference (~ 5%) in %TWL at 1-year. At 3 years after surgery, only bariatric operation, Black race, and BMI ≥ 50 kg/m2 were associated with clinically meaningful differences in %TWL. CONCLUSIONS Our findings combined with many others support a move away from extensive screening and selection of patients at the time of surgery to a focus on improving access to this treatment.
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Affiliation(s)
- Ming Ji
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Sonya L Negriff
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Jeff M Slezak
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Brianna L Taylor
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Silvia R Paz
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Bhumi B Bhakta
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Mayra Macias
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cecelia L Crawford
- Kaiser Permanente Southern California Regional Nursing Research Program, Pasadena, CA, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
| | - Kristina H Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Darren D Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, IL, USA
| | - Sameer B Murali
- Department of Surgery, Center for Obesity Medicine & Metabolic Performance, University of Texas McGovern Medical School, Houston, TX, USA
| | - Deborah R Young
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
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15
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Poinsot R, Maillot M, Masset G, Drewnowski A. A three-component Breakfast Quality Score (BQS) to evaluate the nutrient density of breakfast meals. Front Nutr 2023; 10:1213065. [PMID: 37841394 PMCID: PMC10569224 DOI: 10.3389/fnut.2023.1213065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Background Nutrient profiling methods can be applied to individual foods or to composite meals. This article introduces a new method to assess the nutrient density of breakfast meals. Objective This study aimed to develop a new breakfast quality score (BQS), based on the nutrient standards previously published by the International Breakfast Research Initiative (IBRI) consortium. Methods BQS was composed of three sub-scores derived from the weighted arithmetic mean of corresponding nutrient adequacy: an eLIMf sub-score (energy, saturated fat, free sugars, and sodium), a PF (protein and fiber) sub-score, and a VMn1 - 14 micronutrient sub-score, where n varied from 0 to 14. The effects of assigning different weights to the eLIMf, PF, and VMn were explored in four alternative models. The micronutrients were calcium, iron, potassium, magnesium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B5, vitamin B6, vitamin B12, vitamin C, and vitamin D. Micronutrient permutations were used to develop alternate VMn1 - 14 sub-scores. The breakfast database used in this study came from all breakfasts declared as consumed by adults (>18 years old) in the French dietary survey INCA3. All models were tested with respect to the Nutrient Rich Food Index (NRF9.3). BQS sensitivity was tested using three prototype French breakfasts, for which improvements were made. Results The correlations of the models with NRF9.3 improved when the VMn>3 sub-score (n > 3) was included alongside the PF and eLIMf sub-scores. The model with (PF+VMn) and eLIMf each accounting for 50% of the total score showed the highest correlations with NRF9.3 and was the preferred final score (i.e., BQS). BQS was sensitive to the changing quality of three prototype breakfasts defined as tartine, sandwich, and cereal. Conclusion The proposed BQS was shown to valuably rank the nutritional density of breakfast meals against a set of nutrient recommendations. It includes nutrients to limit along with protein, fiber, and a variable number of micronutrients to encourage. The flexible VMn sub-score allows for the evaluation of breakfast quality even when nutrient composition data are limited.
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Affiliation(s)
| | | | | | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
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16
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Conrad Z, Drewnowski A, Love DC. Greater adherence to the Dietary Guidelines for Americans is associated with lower diet-related greenhouse gas emissions but higher costs. Front Nutr 2023; 10:1220016. [PMID: 37599695 PMCID: PMC10433380 DOI: 10.3389/fnut.2023.1220016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Few studies have evaluated the sustainability of popular diet patterns in the US, which limits policy action and impedes consumer efficacy to make sustainable dietary changes. This study filled this gap by evaluating the relationship between diet quality, greenhouse gas emissions (GHGE), and diet cost for plant-based, restricted carbohydrate, low grain, low fat, and time restricted diet patterns. Methods Dietary data were retrieved from the National Health and Nutrition Examination Survey (2011-2018, n = 8,146) and linked with data on GHGE and food prices from publicly available databases. Diet quality was measured using the Healthy Eating Index-2015. The present study (1) compared the mean diet quality, GHGE, and diet cost between diet patterns, (2) evaluated the association of diet quality to GHGE and diet cost for each diet pattern, and (3) estimated the contribution of food sources to GHGE and diet cost for each diet pattern. Results Higher diet quality was associated with lower GHGE for the general population and for most diet patterns (p < 0.01) except for the plant-based and time restricted diet patterns (p > 0.05). Higher diet quality was associated with higher cost for the general population and for all dietary patterns (p < 0.01) except the time restricted diet pattern (p > 0.05). Protein foods, mostly beef, accounted for the largest share of GHGE (29-40%) and diet cost (28-47%) for all diet patterns except plant-based. Discussion Higher diet quality was associated with lower GHGE but was often accompanied by higher diet cost. These sustainability trade-offs can help inform major policy discussions in the US and shed light on further research needs in the area of food systems transformation.
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Affiliation(s)
- Zach Conrad
- Department of Kinesiology, William & Mary, Williamsburg, VA, United States
- Global Research Institute, William & Mary, Williamsburg, VA, United States
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - David C. Love
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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17
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Tan D, Drewnowski A, Lê KA. New metrics of dietary carbohydrate quality. Curr Opin Clin Nutr Metab Care 2023; 26:358-363. [PMID: 37249917 PMCID: PMC10256305 DOI: 10.1097/mco.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to introduce novel metrics of dietary carbohydrates quality relevant for products and diets. RECENT FINDINGS Carbohydrate quality has long been associated with a low glycemic index. More recently, novel metrics of carbohydrate quality featuring variations of total carbohydrates-fibers-free sugars ratios have been applied to carbohydrate-rich foods, including grains, beans, vegetables, and fruit. High scoring products had higher levels of health-promoting nutrients (protein, dietary fiber, iron, magnesium, zinc, potassium, selenium, and various B-vitamins) and lower levels of nutrients of public health concern (total sugar, added/free sugars, and fat profile). Cross-sectional studies also found variants of carbohydrate quality metrics to be associated with better markers of cardiometabolic disease, including lower levels of blood triglycerides:high-density lipoprotein cholesterol ratio, homeostatic model assessment of insulin resistance, and SBP. SUMMARY New ratio-based carbohydrate quality metrics are built around high fiber and whole grain content, combined with a low free sugar content. Such metrics allow the identification of food products of higher overall nutritional quality, and are associated with improved diet quality and certain health outcomes.
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Affiliation(s)
- Denise Tan
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore, Singapore
- Science and Technology Department, Nestlé R&D Center (Pte) Ltd., Singapore, Singapore
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | - Kim-Anne Lê
- Department of Nutrition Sciences, Nestlé Research, Lausanne, Switzerland
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18
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Biesbroek S, Kok FJ, Tufford AR, Bloem MW, Darmon N, Drewnowski A, Fan S, Fanzo J, Gordon LJ, Hu FB, Lähteenmäki L, Nnam N, Ridoutt BG, Rivera J, Swinburn B, Veer PV. Toward healthy and sustainable diets for the 21st century: Importance of sociocultural and economic considerations. Proc Natl Acad Sci U S A 2023; 120:e2219272120. [PMID: 37307436 DOI: 10.1073/pnas.2219272120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Four years after the EAT-Lancet landmark report, worldwide movements call for action to reorient food systems to healthy diets that respect planetary boundaries. Since dietary habits are inherently local and personal, any shift toward healthy and sustainable diets going against this identity will have an uphill road. Therefore, research should address the tension between the local and global nature of the biophysical (health, environment) and social dimensions (culture, economy). Advancing the food system transformation to healthy, sustainable diets transcends the personal control of engaging consumers. The challenge for science is to scale-up, to become more interdisciplinary, and to engage with policymakers and food system actors. This will provide the evidential basis to shift from the current narrative of price, convenience, and taste to one of health, sustainability, and equity. The breaches of planetary boundaries and the environmental and health costs of the food system can no longer be considered externalities. However, conflicting interests and traditions frustrate effective changes in the human-made food system. Public and private stakeholders must embrace social inclusiveness and include the role and accountability of all food system actors from the microlevel to the macrolevel. To achieve this food transformation, a new "social contract," led by governments, is needed to redefine the economic and regulatory power balance between consumers and (inter)national food system actors.
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Affiliation(s)
- Sander Biesbroek
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
| | - Frans J Kok
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
| | - Adele R Tufford
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
| | - Martin W Bloem
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287
| | - Nicole Darmon
- Montpellier Interdisciplinary Center on Sustainable Agri-Food Sustems, French National Institute for Agriculture, Food, and Environment, International Center for Advanced Mediterranean Agronomic Studies, French Agricultural Research and Cooperation Organization, Montpellier SupAgro, University of Montpellier, 34090 Montpellier, France
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195
| | - Shenggen Fan
- College of Economics and Management, China Agricultural University, Beijing 100083, China
| | - Jessica Fanzo
- Berman Institute of Bioethics, Nitze School of Advanced International Studies, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205
| | - Line J Gordon
- Stockholm Resilience Center, 106 91 Stockholm, Sweden
| | - Frank B Hu
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115
| | - Liisa Lähteenmäki
- Department of Management, Aarhus School of Business and Social Sciences, Aarhus University, 8000 Aarhus, Denmark
| | - Ngozi Nnam
- Department of Nutrition & Dietetics, University of Nigeria, 410105 Nsukka, Enugu, Nigeria
| | - Bradley G Ridoutt
- Commonwealth Scientific and Industrial Research Organisation, Agriculture and Food, Clayton South, Canberra ACT 2601, Australia
- Department of Agricultural Economics, University of the Free State, Park West, Bloemfontein 9301, South Africa
| | - Juan Rivera
- National Institute of Public Health, 62100 Cuernavaca, Mexico
| | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland 1010, New Zealand
| | - Pieter Van't Veer
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
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19
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Vasiloglou MF, Elortegui Pascual P, Scuccimarra EA, Plestina R, Mainardi F, Mak TN, Ronga F, Drewnowski A. Assessing the Quality of Simulated Food Patterns with Reduced Animal Protein Using Meal Data from NHANES 2017-2018. Nutrients 2023; 15:nu15112572. [PMID: 37299536 DOI: 10.3390/nu15112572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
The nutritional consequences of progressively replacing meat products with plant-based foods need to be systematically evaluated. Modeling analyses provide insights into the predicted food consumption and nutritional adequacy of plant-based diets. We developed a novel methodology to simulate food patterns and evaluate diet quality. Meal data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 was used to create 100 7-day meal plans subject to various nutrient and food group optimization criteria. Omnivore (reference diet), flexitarian, pescatarian, and vegetarian food patterns were modeled using mixed integer linear programming. The modeled food patterns used the 25th and 75th percentiles of the US Usual Dietary Intakes to set the optimization constraints. The diet quality was determined using the Healthy Eating Index 2015 (HEI-2015). The modeled vegetarian, pescatarian, and flexitarian food patterns outperformed the omnivore diet on the HEI-2015, with the vegetarian pattern achieving the highest score (82 for females, 78 for males). Modeled flexitarian patterns, with a 25 to 75% reduction in animal protein, offer viable options for those seeking to reduce but not eliminate their animal protein intake while supporting the transition from omnivore to fully plant-based diets. This methodology could be applied to evaluate the nutrient and diet quality of different dietary patterns with various constraints.
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Affiliation(s)
- Maria F Vasiloglou
- Nestlé Institute of Health Sciences, Nestlé Research, 1000 Lausanne, Switzerland
| | | | - Eric A Scuccimarra
- Nestlé Institute of Health Sciences, Nestlé Research, 1000 Lausanne, Switzerland
| | - Roko Plestina
- Nestlé Institute of Health Sciences, Nestlé Research, 1000 Lausanne, Switzerland
| | - Fabio Mainardi
- Nestlé Institute of Health Sciences, Nestlé Research, 1000 Lausanne, Switzerland
| | - Tsz-Ning Mak
- Nestlé Institute of Health Science Singapore Hub, 29 Quality Road, Singapore 618802, Singapore
| | - Frédéric Ronga
- Nestlé Institute of Health Sciences, Nestlé Research, 1000 Lausanne, Switzerland
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA
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20
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Mendoza-Velázquez A, Guzmán-Rodríguez M, Lara-Arévalo J, Drewnowski A. The Nutrient Rich Food Price Index: a nutrition-relevant adaptation of the Laspeyres price index to track the cost of affordable nutrient density. Front Nutr 2023; 10:1107573. [PMID: 37275634 PMCID: PMC10235757 DOI: 10.3389/fnut.2023.1107573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
Background The Laspeyres price index is the ratio of the current cost of a market basket of commodities or food groups relative to base period prices. Objective To develop a nutrition-relevant version of the Laspeyres price index, using market baskets based on tertiles of the nutrient rich food (NRF9.3) nutrient density metric. Methods Nutrient composition data for 151 foods from the 2012 Mexico national health and nutrition survey (ENSANUT) were merged with food prices and price indices from the national institute of geography and statistics (INEGI). Nutrient Rich Food Index (NRF9.3) was the measure of nutrient density. May 2012 was the base period. Nutrient rich food price index (NRFPI) values were calculated for each tertile of NRF nutrient density scores for each month between June 2011 and March 2022. Results The market basket of foods in the top tertile of NRF nutrient density scores cost more per 100 kcal and had higher NRFPI values compared to foods in the bottom tertile. Higher NRF9.3 scores were correlated with greater monthly inflation. The NRFPI for foods in the top tertile of NRF9.3 scores was marked by seasonal price spikes, and greater volatility compared to foods in the bottom tertile. Conclusion The present adaptation of the Laspeyres Index used market baskets defined by nutrient density tertiles instead of commodity groups. This approach allows for easier tracking of the cost of nutrient dense foods and healthful diets across geographic regions and over time. Applied to Mexico food prices prior to and during the Covid-19 pandemic, the NRFPI was sensitive to time trends, seasonality, and price fluctuations. The new tool may be useful in monitoring the rising cost of healthy foods worldwide.
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Affiliation(s)
- Alfonso Mendoza-Velázquez
- Dirección General de Investigación Económica, Banco de México, Mérida, México
- Departamento de Economía, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, México
| | - Mariano Guzmán-Rodríguez
- Centro de Investigación e Inteligencia Económica, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, Mexico
| | - Jonathan Lara-Arévalo
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
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Siu K, Drewnowski A. Toward a New Definition of "Healthy" Food: Issues and Challenges. Curr Dev Nutr 2023; 7:100080. [PMID: 37197022 PMCID: PMC10183973 DOI: 10.1016/j.cdnut.2023.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
Dietary Guidelines for Americans (DGA) have become increasingly food-based guidelines. The Healthy United States-Style Eating Pattern features fruits, vegetables, whole grains, and low-fat dairy, with limits placed on added sugar, sodium, and saturated fat. Recent measures of nutrient density have followed suit, incorporating both nutrients and food groups. Most recently, the United States Food and Drug Administration (FDA) has proposed to redefine the concept of a "healthy" food for regulatory purposes. To qualify as healthy, foods will need to contain specific minimum amounts of fruits, vegetables, dairy, and whole grains, with limits placed on added sugar, sodium, and saturated fat. The present concern was that the proposed criteria, formulated by the FDA per Reference Amount Customarily Consumed, were so stringent that few foods would pass. We applied the proposed FDA criteria to foods in the USDA Food and Nutrient Database for Dietary Studies (FNDDS 2017-2018). The criteria were met by 58% of fruits, 35% of vegetables, 8% of milk and dairy products, and 4% of grain products. Many foods commonly considered to be healthy by consumers and the USDA alike did not pass the proposed FDA criteria. Federal agencies seem to define healthy in different ways. Our findings have implications for the formulation of regulatory and public health policies. We recommend that nutrition scientists be involved in the development of federal regulations and policies that affect American consumers and the food industry.
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Affiliation(s)
- Kimberly Siu
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, United States
- Corresponding author.
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
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22
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Conrad Z, Drewnowski A, Belury MA, Love DC. Greenhouse gas emissions, cost, and diet quality of specific diet patterns in the United States. Am J Clin Nutr 2023:S0002-9165(23)46847-5. [PMID: 37075848 DOI: 10.1016/j.ajcnut.2023.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Major policy agendas are calling for accelerated investment in research that addresses the impact of diet patterns on multiple domains of sustainability. OBJECTIVE To evaluate the comparative greenhouse gas emissions, diet cost, and diet quality of plant-based, low grain, restricted carbohydrate, low fat, and time restricted diet patterns on a daily per capita basis. DESIGN Dietary data from the National Health and Nutrition Examination Survey (2013-2016, n=4,025) were merged with data on greenhouse gas emissions (GHGE) and food prices from multiple databases. The Healthy Eating Index-2015 was used to measure diet quality. RESULTS The plant-based diet pattern had the lowest GHGE (3.5 kg CO2eq, 95% CI: 3.3, 3.8 kg CO2eq) and among the lowest diet cost ($11.51, 95% CI: $10.67, $12.41), but diet quality (45.8, 95% CI: 43.3, 48.5) was similar (P>0.005) to most other diet patterns. All of the sustainability impacts of the low grain diet pattern were intermediate. The restricted carbohydrate diet pattern had the highest diet cost ($18.46, 95% CI: $17.80, $19.13) but intermediate diet quality (46.8, 95% CI: 45.7, 47.9) and moderate-to-high GHGE (5.7 kg CO2eq, 95% CI: 5.4, 5.9 kg CO2eq). The low fat diet pattern had the highest diet quality (52.0, 95% CI: 50.8, 53.1) and intermediate GHGE (4.4 kg CO2eq, 95% CI: 4.1, 4.6 kg CO2eq) and diet cost ($14.53, 95% CI: $13.73, $15.38). The time restricted diet pattern had among the lowest diet quality score (42.6, 95% CI: 40.8, 44.6), had GHGE similar to most other diet patterns (4.6 kg CO2eq, 95% CI: 4.2, 5.0 kg CO2eq), and low-to-moderate diet cost ($12.34, 95% CI: $11.38, $13.40). CONCLUSIONS Most diet patterns were associated with sustainability trade-offs. The nature of those trade-offs can help inform discussions on food and nutrition policy in the US, including the National Strategy on Hunger, Nutrition, and Health, and future Dietary Guidelines for Americans.
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Affiliation(s)
- Zach Conrad
- Department of Kinesiology, William & Mary, Williamsburg, VA 23185, USA; Global Research Institute, William & Mary, Williamsburg, VA 23185, USA.
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA.
| | - Martha A Belury
- Program of Human Nutrition, The Ohio State University, Columbus, OH 43221, USA.
| | - David C Love
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21202, USA; Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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23
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Poinsot R, Maillot M, Drewnowski A. Fresh Pork as Protein Source in the USDA Thrifty Food Plan 2021: A Modeling Analysis of Lowest-Cost Healthy Diets. Nutrients 2023; 15:nu15081897. [PMID: 37111116 PMCID: PMC10146423 DOI: 10.3390/nu15081897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The USDA Thrifty Food Plan (TFP) is an estimate of a lowest-cost healthy diet that meets dietary guidelines while respecting existing eating habits. In the US, the TFP provides the basis for federal food assistance. Included in the TFP are protein foods from both animal and plant sources. The present goal was to explore the place of fresh pork among protein foods in the revised TFP 2021. Our analyses used the same databases and the same quadratic programming (QP) methods as had been used by the USDA to develop the TFP 2021. Dietary intakes came from the National Health and Nutrition Examination Survey (NHANES 2015-16); nutrient composition data came from the Food and Nutrient Database for Dietary Studies (FNDDS 2015-16), and national food prices came from the 2021 TFP report. Amounts and prices were for foods as consumed. Our QP Model 1 used USDA modeling categories to replicate the TFP 2021. The non-poultry meat category was then separated into pork and beef. Model 2 examined whether the TFP 2021 algorithm would select pork or beef. Model 3 sought the lowest cost healthy diet, the same as the TFP 2021. Model 4 replaced beef and poultry with pork; whereas Model 5 replaced pork and poultry with beef. Weekly costs were calculated for a family of four and eight age-gender groups. All models met the nutrient requirements. The market basket cost for a family of four in Model 1 was USD 189.88, compared to the purchase price of USD 192.84 in the TFP 2021. In Model 2, fresh pork was selected preferentially over beef. The lowest-cost healthy food plan in Model 3 increased fresh pork to 3.4 lbs/week. Replacing beef and poultry with pork in Model 4 led to a modest decrease in the weekly cost. Replacing pork and poultry with beef in Model 5 led to a major increase in the weekly cost. We conclude, based on TFP-analogous modeling, that fresh pork is the preferred meat source, providing high-quality protein at a low cost. QP methods, as used in the TFP 2021, are a valuable tool for designing food plans that are affordable, acceptable, and nutrient-rich.
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Affiliation(s)
| | | | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA
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24
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Buszkiewicz JH, Hajat A, Hill HD, Otten JJ, Drewnowski A. Racial, ethnic, and gender differences in the association between higher state minimum wages and health and mental well-being in US adults with low educational attainment. Soc Sci Med 2023; 322:115817. [PMID: 36905725 DOI: 10.1016/j.socscimed.2023.115817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND To date, research evaluating the association between minimum wage and health has been heterogenous and varies based on the specific subpopulation or health outcomes under evaluation while associations across racial, ethnic, and gender identities have been understudied. METHODS A triple difference-in-differences strategy using modified Poisson regression was used to evaluate the associations between minimum wage and obesity, hypertension, fair or poor general health, and moderate psychological distress in 25-64-year-old adults with a high school education/GED or less. Data from the 1999-2017 Panel Study of Income Dynamics was linked to state policies and characteristics to estimate the risk ratio (RR) associated with a $1 increase in current and 2-year lagged state minimum wages overall and by race, ethnicity, and gender (non-Hispanic or non-Latino (NH) White men, NH White women, Black, indigenous, or people of color (BIPOC) men, and BIPOC women) adjusting for individual and state-level confounding. RESULTS No associations between minimum wage and health were observed overall. Among NH White men 2-year lagged minimum wage was associated with reduced risk of obesity (RR = 0.82, 95% CI = 0.67, 0.99). Among NH White women, current minimum wage was associated lower risk of moderate psychological distress (RR = 0.73, 95% CI = 0.54, 1.00) while 2-year lagged minimum wage was associated with higher obesity risk (RR = 1.35, 95% CI = 1.12, 1.64) and lower risk of moderate psychological distress (RR = 0.75, 95% CI = 0.56, 1.00). Among BIPOC women, current minimum wage was associated with higher risk of fair or poor health (RR = 1.19, 95% CI = 1.02, 1.40). No associations were observed among BIPOC men. CONCLUSION While no associations were observed overall, heterogeneous associations between minimum wage, obesity, and psychological distress by racial, ethnic, and gender strata warrant further study and have implications for health equity research.
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Affiliation(s)
- James H Buszkiewicz
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heather D Hill
- Daniel J. Evans School of Public Policy and Governance, University of Washington, Seattle, WA, USA
| | - Jennifer J Otten
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, WA, USA; Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Adam Drewnowski
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, WA, USA; Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
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25
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Yu L, Braesco V, Cooper SL, Drewnowski A, Esteves BH, Budelli AL. The Kraft Heinz Company global nutrition targets for the innovation and reformulation of food and beverages: Current and future directions. Front Nutr 2023; 10:1104617. [PMID: 36819696 PMCID: PMC9931893 DOI: 10.3389/fnut.2023.1104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Reformulating packaged foods has the potential to improve the nutrient density of the global diet. The present perspective illustrates The Kraft Heinz Company's approach to product (re)formulation to develop healthier product lines that are lower in saturated fats, total sugars, and sodium, and contain health promoting components. Here we present the rationale for The Kraft Heinz Company's global nutrition targets used for the global innovation and renovation of foods and beverages. The global nutrition targets use a category specific approach to set maximum levels for the main nutrients of public health concern: saturated fat, total sugars and sodium, taking into account product characteristics (typical portion size, eating occasion, role in the diet, etc.) as well as regulatory, technological, sensory and safety constraints. Benchmarking examples illustrate how the nutrition targets are positioned within the United States, France, and Australia. These global nutrition targets serve as part of The Kraft Heinz Company's environmental, social and governance nutrition commitments and demonstrates how the food industry is improving the nutritional value of packaged foods and beverages both now and into the future.
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Affiliation(s)
- Lynn Yu
- The Kraft Heinz Company, Chicago, IL, United States,*Correspondence: Lynn Yu, ✉
| | | | - Sheri L. Cooper
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
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26
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Drewnowski A, Hong BD, Shen E, Ji M, Paz SR, Bhakta BB, Macias M, Crawford CL, Lewis KH, Liu J, Moore DD, Murali SB, Young DR, Coleman KJ. Neighborhood deprivation and residential property values do not affect weight loss at 1 or 3 years after bariatric surgery. Obesity (Silver Spring) 2023; 31:545-552. [PMID: 36627742 PMCID: PMC9877110 DOI: 10.1002/oby.23623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study examined the association between individual- and neighborhood-level sociodemographic factors and surgical weight loss at 1 year (short term) and 3 years (long term). METHODS Data were obtained from the baseline survey of the BELONG (Bariatric Experience Long Term) prospective longitudinal cohort study. Individual-level self-reported data on sex, race and ethnicity, education, and household income were obtained by survey. Data from the 2010 US Census were used to calculate area Neighborhood Deprivation Index score and median value of owner-occupied housing units at the census tract level. RESULTS Patients (N = 1341) had a mean age of 43.4 (SD 11.3) years, were mostly female (86%), were mostly Black or Hispanic (52%), had some college education (83%), and had annual household incomes ≥$51,000 (55%). Percentage total weight loss was 25.8% (SD 9.0%) at year 1 and 22.2% (SD 10.5%) at year 3. Race and ethnicity and age were significant predictors of weight loss at 1 and 3 years with a small effect of self-reported household income at year 1. There were no significant associations between census tract-level Neighborhood Deprivation Index score or value of owner-occupied housing units and weight loss at either time point. CONCLUSIONS Health systems could improve the chances of weight-loss maintenance after surgery by addressing factors related to racial and ethnic disparities and to income disparities.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA
| | - Benjamin D. Hong
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Ernest Shen
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, FL
| | - Silvia R. Paz
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Bhumi B. Bhakta
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Mayra Macias
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Cecelia L. Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, CA
| | - Kristina H. Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, NC
| | - Jialuo Liu
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Darren D. Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, IL
| | - Sameer B. Murali
- Center for Obesity Medicine & Metabolic Performance, Department of Surgery, University of Texas McGovern Medical School, Houston, Texas
| | - Deborah R. Young
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Karen J. Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
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McAuliffe GA, Takahashi T, Beal T, Huppertz T, Leroy F, Buttriss J, Collins AL, Drewnowski A, McLaren SJ, Ortenzi F, van der Pols JC, van Vliet S, Lee MRF. Protein quality as a complementary functional unit in life cycle assessment (LCA). Int J Life Cycle Assess 2022; 28:146-155. [PMID: 36685326 PMCID: PMC9845161 DOI: 10.1007/s11367-022-02123-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
GOAL AND THEORETICAL COMMENTARY A number of recent life cycle assessment (LCA) studies have concluded that animal-sourced foods should be restricted-or even avoided-within the human diet due to their relatively high environmental impacts (particularly those from ruminants) compared with other protein-rich foods (mainly protein-rich plant foods). From a nutritional point of view, however, issues such as broad nutrient bioavailability, amino acid balances, digestibility and even non-protein nutrient density (e.g., micronutrients) need to be accounted for before making such recommendations to the global population. This is especially important given the contribution of animal sourced foods to nutrient adequacy in the global South and vulnerable populations of high-income countries (e.g., children, women of reproductive age and elderly). Often, however, LCAs simplify this reality by using 'protein' as a functional unit in their models and basing their analyses on generic nutritional requirements. Even if a 'nutritional functional unit' (nFU) is utilised, it is unlikely to consider the complexities of amino acid composition and subsequent protein accretion. The discussion herein focuses on nutritional LCA (nLCA), particularly on the usefulness of nFUs such as 'protein,' and whether protein quality should be considered when adopting the nutrient as an (n)FU. Further, a novel and informative case study is provided to demonstrate the strengths and weaknesses of protein-quality adjustment. CASE STUDY METHODS To complement current discussions, we present an exploratory virtual experiment to determine how Digestible Indispensable Amino Acid Scores (DIAAS) might play a role in nLCA development by correcting for amino acid quality and digestibility. DIAAS is a scoring mechanism which considers the limiting indispensable amino acids (IAAs) within an IAA balance of a given food (or meal) and provides a percentage contribution relative to recommended daily intakes for IAA and subsequent protein anabolism; for clarity, we focus only on single food items (4 × animal-based products and 4 × plant-based products) in the current case exemplar. Further, we take beef as a sensitivity analysis example (which we particularly recommend when considering IAA complementarity at the meal-level) to elucidate how various cuts of the same intermediary product could affect the interpretation of nLCA results of the end-product(s). RECOMMENDATIONS First, we provide a list of suggestions which are intended to (a) assist with deciding whether protein-quality correction is necessary for a specific research question and (b) acknowledge additional uncertainties by providing mitigating opportunities to avoid misinterpretation (or worse, dis-interpretation) of protein-focused nLCA studies. We conclude that as relevant (primary) data availability from supply chain 'gatekeepers' (e.g., international agri-food distributors and processors) becomes more prevalent, detailed consideration of IAA provision of contrasting protein sources needs to be acknowledged-ideally quantitatively with DIAAS being one example-in nLCA studies utilising protein as a nFU. We also contend that future nLCA studies should discuss the complementarity of amino acid balances at the meal-level, as a minimum, rather than the product level when assessing protein metabolic responses of consumers. Additionally, a broader set of nutrients should ideally be included when evaluating "protein-rich foods" which provide nutrients that extend beyond amino acids, which is of particular importance when exploring dietary-level nLCA.
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Affiliation(s)
- G. A. McAuliffe
- Net Zero and Resilient Farming, Rothamsted Research, North Wyke, Okehampton, EX20 2SB Devon UK
| | - T. Takahashi
- Net Zero and Resilient Farming, Rothamsted Research, North Wyke, Okehampton, EX20 2SB Devon UK
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU UK
| | - T. Beal
- Global Alliance for Improved Nutrition (GAIN), Washington, DC 20036 USA
- Institute for Social, Behavioral and Economic Research, University of California, Santa Barbara, CA 93106 USA
| | - T. Huppertz
- Wageningen University and Research, Wageningen, The Netherlands
- Dairy Physics and Chemistry, FrieslandCampina, Wolvega, Weststellingwerf The Netherlands
| | - F. Leroy
- Industrial Microbiology and Food Biotechnology (IMDO), Faculty of Sciences and Bioengineering Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | | | - A. L. Collins
- Net Zero and Resilient Farming, Rothamsted Research, North Wyke, Okehampton, EX20 2SB Devon UK
| | - A. Drewnowski
- Department of Epidemiology, University of Washington, Nutritional Sciences, Seattle, WA 98195 USA
| | - S. J. McLaren
- New Zealand Life Cycle Management Centre, Massey University, Palmerston North, New Zealand
| | - F. Ortenzi
- Independent Nutrition and Global Health Consultant, Geneva, Switzerland
| | - J. C. van der Pols
- Faculty of Health, School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059 Australia
| | - S. van Vliet
- Center for Human Nutrition Studies, Utah State University, Logan, UT 84322 USA
| | - M. R. F. Lee
- Harper Adams University, Edgmond, Newport, TF10 8NB UK
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Drewnowski A. Most Plant-Based Milk Alternatives in the USDA Branded Food Products Database Do Not Meet Proposed Nutrient Standards or Score Well on Nutrient Density Metrics. Nutrients 2022; 14:nu14224767. [PMID: 36432454 PMCID: PMC9695877 DOI: 10.3390/nu14224767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Plant-based milk alternatives and plant-based waters are of variable nutritional value. The present objective was to assess nutrient density of all plant-based beverages in the US Department of Agriculture Branded Food Products Database and determine whether plant-based milk alternatives met the proposed nutrient standards. Plant-based milk alternatives (n = 1042) were identified as almond, soy, coconut, cashew, other tree nut, flax/hemp, pea, and oat, quinoa, and rice products. Plant-based waters (n = 550) were coconut, aloe, tree, fruit, and plain. Machine searches of ingredient lists identified products with added sugars, salt, vitamins, and minerals. Plant-based milk alternatives were tested for compliance with previously developed nutrient standards. The Nutrient Rich Food Index (NRF5.3), two versions of Nutri-Score, and Choices International were the nutrient density metrics. Plant-based milk alternatives had mean energy density of 49 kcal/100 g, were low in protein (~1.1 g/100 g), often contained added sugars and salt, and tended to be fortified with calcium, vitamin A, vitamin D, and vitamin B12. Only 117 milk alternatives (11.2%) met nutrient standards and only 80 (7.7%) met the more stringent “best of class” standards for ≥2.8 g/100 g protein and <3.1 g/100 g added sugars. The latter were mostly soy milks. Nutri-Score grades varied depending on whether the beverages were treated as beverages or as solid foods, as is currently required. The highest NRF5.3 scores were given to soy, almond, and tree nut milk alternatives. Plant-based waters had low energy density (~23 kcal/100 g), contained added sugars (4.6 g/100 g), and some had added vitamin C. Applying nutrient standards to plant-based milk alternatives can aid new product development, promote more transparent labeling, and inform potential regulatory actions. Guidance on minimum protein content, maximum recommended amounts of fat, added sugars, and sodium, and consistent fortification patterns would be of value to regulatory agencies and to the food industry.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, P.O. Box 353410, Seattle, WA 98195, USA
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Tassy M, Rytz A, Drewnowski A, Lecat A, Jacquier EF, Charles VR. Monitoring improvements in the nutritional quality of new packaged foods launched between 2016 and 2020. Front Nutr 2022; 9:983940. [PMID: 36386909 PMCID: PMC9664054 DOI: 10.3389/fnut.2022.983940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/17/2022] [Indexed: 08/13/2023] Open
Abstract
Food and beverage companies reformulate packaged foods and to better align their products with public health policies and evolving consumer needs. The nutritional quality of packaged foodscan be tracked using nutrient profiling methods. The present study compared the nutritional quality of packaged foods launched globally between 2016 and 2018 and those launched in 2018-2020, as reported in the Mintel Global New Products Database. Nutrient profiling analyses showed that the nutrient composition of product categories shifted for almost 40% of newly launched products between 2016-2018 and 2018-2020. For example, pizzas that had been assigned to one nutritionally homogenous category in 2016-2018 separated in two nutritionally distinct subgroups in 2018-2020. The new products that were reduced in protein, saturated fat, and sodium were now nutritionally distinct from the traditional pizza offer. By 2018-2020 "best of category" products were significantly lower in sugar and sodium than before; however, no clear trend was observed for saturated fats, proteins, or fibers. The relative speed of product reformulation was category specific. This analysis of the Mintel Global New Products Database suggests that the WHO nutritional recommendations focusing on sugar and sodium reduction did have a positive impact on the composition of new packaged foods, whether through reformulation of existing products, launches of line extensions or new product development.
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Affiliation(s)
- Marie Tassy
- Nestlé Research, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Andréas Rytz
- Nestlé Research, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Adam Drewnowski
- Department of Epidemiology, Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, WA, United States
| | - Alec Lecat
- Nestlé Research, Vers-chez-les-Blanc, Lausanne, Switzerland
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30
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Young DR, Hong BD, Lewis KH, Paz SR, Bhakta BB, Macias M, Crawford CL, Drewnowski A, Ji M, Moore DD, Shen E, Murali SB, Coleman KJ. The association of 1-year weight loss from bariatric surgery and self-reported sleep: a prospective cohort. Obesity (Silver Spring) 2022; 30:2307-2316. [PMID: 36321277 PMCID: PMC9913885 DOI: 10.1002/oby.23543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined the association of weight loss following bariatric surgery with self-reported sleep quality after accounting for other sleep-related factors. METHODS Participants were from the Bariatric Experience Long Term (BELONG) study. Participants completed a survey up to 6 months before surgery and approximately 1 year after surgery. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. One-year percentage total weight loss (%TWL) was determined from electronic medical records. Covariates included demographics, Charlson Comorbidity Index, geocoded variables to assess neighborhood quality, and physical activity. The authors assessed the association between %TWL at 1 year and PSQI component scores with separate cumulative logit models. RESULTS There were 997 participants in the analytic cohort. Participants were 86.2% women, 37.0% Hispanic, and 13.7% Black adults. Mean one-year %TWL was 26.3 (SD 8.7). Each 1% increase in %TWL was associated with a 3% better daytime dysfunction score (odds ratio = 1.03; 95% CI: 1.02-1.05) and a 2% better sleep quality score (odds ratio = 1.02; 95% CI: 1.00-1.03). No significant differences were found for the other PSQI components. CONCLUSIONS Weight loss from bariatric surgery was associated with better self-reported sleep at 1 year. For people undergoing bariatric surgery, there may be an added benefit of better sleep.
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Affiliation(s)
- Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Benjamin D. Hong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kristina H. Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
| | - Silvia R. Paz
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bhumi B. Bhakta
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Mayra Macias
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Cecelia L. Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Darren D. Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, Illinois, USA
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Sameer B. Murali
- Center for Obesity Medicine & Metabolic Performance, Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Mendoza-Velázquez A, Lara-Arévalo J, Siqueira KB, Guzmán-Rodríguez M, Drewnowski A. Affordable Nutrient Density in Brazil: Nutrient Profiling in Relation to Food Cost and NOVA Category Assignments. Nutrients 2022; 14:nu14204256. [PMID: 36296940 PMCID: PMC9611234 DOI: 10.3390/nu14204256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
Affordable nutrient density is provided by low-cost and nutrient-rich foods. We explored nutrient density, cost, and NOVA category assignments within and across food groups in Brazil. The nutrient density of the foods (n = 591) was assessed using the Nutrient Rich Food Index (NRF9.3) based on protein, fiber, vitamin A (RAE), vitamin C, vitamin E (mg), Ca, Fe, K and Mg; and NRF6.3 score for priority nutrients: Ca, Fe, Zn, vitamin A, vitamin B12, and folate. Nutrients to limit (LIM) were saturated fat, added sugar, and sodium. Affordability was defined as the ratio of energy and/or nutrient density of foods and retail price per 100 kcal. Foods were classified as minimally processed (n = 106), processed (n = 188), ultra-processed (n = 286), and culinary ingredients (n = 11). Nutrient density was positively linked to per 100 kcal food cost. Ultra-processed foods (UPF) contained more energy, fat, sugar, and salt and had lower NRF scores compared to minimally processed (MPF) foods. UPF was also less expensive than MPF foods. Nutrient-rich foods below the median per 100 kcal costs included MPF foods, but also processed foods (PF) and UPF. Affordable nutrient-rich foods can be found in the different categories of the NOVA classification.
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Affiliation(s)
- Alfonso Mendoza-Velázquez
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA
- Centro de Investigación e Inteligencia Económica, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla 72410, Mexico
| | - Jonathan Lara-Arévalo
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA
- Correspondence:
| | | | - Mariano Guzmán-Rodríguez
- Centro de Investigación e Inteligencia Económica, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla 72410, Mexico
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA
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Gustafson DI, Decker EA, Drewnowski A, Hamm MW, Hwang J, Merrigan KA. Making Healthy, Sustainable Diets Accessible and Achievable: A New Framework for Assessing the Nutrition, Environmental, and Equity Impacts of Packaged Foods. Curr Dev Nutr 2022; 6:nzac136. [PMID: 36204327 PMCID: PMC9529222 DOI: 10.1093/cdn/nzac136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022] Open
Abstract
There is a growing global consensus among food system experts that diets and how we source our foods must change. The sustainable nutrition community continues exploring the environmental impact and dietary value of foods. Packaged foods have been largely ignored within the dialogue, and if they are addressed, existing frameworks tend to label them all as "ultraprocessed" and uniformly discourage their consumption. This approach lacks the nuance needed to holistically evaluate packaged foods within recommended dietary patterns. Additionally, there is considerable diversity of opinion within the literature on these topics, especially on how best to improve nutrition security in populations most at risk of diet-related chronic disease. In support of addressing these challenges, 8 sustainability and nutrition experts were convened by Clif Bar & Company for a facilitated discussion on the urgent need to drive adoption of healthy, sustainable diets; the crucial role that certain packaged foods can play in helping make such diets achievable and accessible; and the need for actionable guidance around how to recommend and choose packaged foods that consider human, societal, and planetary health. This article summarizes the meeting discussion, which informed the development of a proposed framework based on guiding principles for defining sustainable, nutritious packaged foods across key nutrition, environmental, economic, and sociocultural well-being indicators. Although additional research is needed to substantiate specific metrics in order to operationalize the framework, it is intended to be a foundation from which to build and refine as science and measurement capabilities advance, and an important step toward broader adoption of healthy, sustainable diets.
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Affiliation(s)
- David I Gustafson
- Adjunct Research Faculty, Biological Systems Engineering, Washington State University, Pullman, WA, USA
| | - Eric A Decker
- Department of Food Science, University of Massachusetts, Amherst, MA, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA; USA
| | - Michael W Hamm
- Department of Community Sustainability, Michigan State University, Lansing, MI, USA
| | - Jane Hwang
- Social Accountability International, New York, NY, USA
| | - Kathleen A Merrigan
- Swette Center for Sustainable Food Systems, Arizona State University, Tempe, AZ, USA
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Cruz M, Drewnowski A, Bobb JF, Hurvitz PM, Moudon AV, Cook A, Mooney SJ, Buszkiewicz JH, Lozano P, Rosenberg DE, Kapos F, Theis MK, Anau J, Arterburn D. Differences in Weight Gain Following Residential Relocation in the Moving to Health (M2H) Study. Epidemiology 2022; 33:747-755. [PMID: 35609209 PMCID: PMC9378543 DOI: 10.1097/ede.0000000000001505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neighborhoods may play an important role in shaping long-term weight trajectory and obesity risk. Studying the impact of moving to another neighborhood may be the most efficient way to determine the impact of the built environment on health. We explored whether residential moves were associated with changes in body weight. METHODS Kaiser Permanente Washington electronic health records were used to identify 21,502 members aged 18-64 who moved within King County, WA between 2005 and 2017. We linked body weight measures to environment measures, including population, residential, and street intersection densities (800 m and 1,600 m Euclidian buffers) and access to supermarkets and fast foods (1,600 m and 5,000 m network distances). We used linear mixed models to estimate associations between postmove changes in environment and changes in body weight. RESULTS In general, moving from high-density to moderate- or low-density neighborhoods was associated with greater weight gain postmove. For example, those moving from high to low residential density neighborhoods (within 1,600 m) gained an average of 4.5 (95% confidence interval [CI] = 3.0, 5.9) lbs 3 years after moving, whereas those moving from low to high-density neighborhoods gained an average of 1.3 (95% CI = -0.2, 2.9) lbs. Also, those moving from neighborhoods without fast-food access (within 1600m) to other neighborhoods without fast-food access gained less weight (average 1.6 lbs [95% CI = 0.9, 2.4]) than those moving from and to neighborhoods with fast-food access (average 2.8 lbs [95% CI = 2.5, 3.2]). CONCLUSIONS Moving to higher-density neighborhoods may be associated with reductions in adult weight gain.
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Affiliation(s)
- Maricela Cruz
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA, 98101, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA, 98195-3410, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA, 98101, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Philip M Hurvitz
- Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, 4333 Brooklyn Ave NE, Seattle, Washington 98195, USA
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, 98195-3410, USA
| | - Anne Vernez Moudon
- Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, 4333 Brooklyn Ave NE, Seattle, Washington 98195, USA
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA, 98101, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - James H. Buszkiewicz
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA, 98195-3410, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Paula Lozano
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA, 98101, USA
| | - Dori E. Rosenberg
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA, 98101, USA
| | - Flavia Kapos
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA, 98101, USA
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA, 98101, USA
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA, 98101, USA
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Furuta C, Jinzu H, Cao L, Drewnowski A, Okabe Y. Nutrient Profiling of Japanese Dishes: The Development of a Novel Ajinomoto Group Nutrient Profiling System. Front Nutr 2022; 9:912148. [PMID: 35967784 PMCID: PMC9372512 DOI: 10.3389/fnut.2022.912148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Government agencies and private companies have supported the development of nutrient profiling (NP) systems to facilitate the selection of nutrient-dense foods by consumers, promote nutritious food development, and limit excessive advertising of products with low nutritional value. While most NP models were developed to assess individual foods, the Ajinomoto Group Nutrient Profiling System (ANPS) was developed to assess the overall nutritional value of cooked dishes that are culturally specific to Japan. Based on the national dietary recommendations and nutritional surveys, target values were created for 13 dish categories, while considering the combinations of meal units. For the ANPS, the four evaluating elements were protein and vegetables, which should be encouraged, and sodium and saturated fatty acids, which should be limited. The ANPS algorithm for dishes was the sum of the scores of individual elements, with a maximum of 10 points per serving. The sum of scores was then multiplied by 2.5 to convert to the 100-point scale. Convergent validity was tested using the nutrient-rich food index (NRF) score of 6.3. In total, 1,089 popular Japanese dishes were evaluated using the ANPS, and the median score of ANPS was 70.0 points (interquartile range, 55–78.8), and the average score was 67.7 (standard deviation, 16.5) points. Since salt intake is a major health risk in Japan, this tool was designed to evaluate sodium content with high sensitivity, and low-salt dishes significantly improved sodium and ANPS scores compared with regular dishes. The Pearson’s correlation coefficient between the total score of NRF 6.3 and ANPS in 1,089 dishes was r = 0.452 (p < 0.0001). This newly developed ANPS could be used to evaluate culture-specific cooked dishes per serving size. It can determine the nutritional values of dishes, with a high sensitivity to sodium content, a major Japanese nutritional issue. Further research is needed to determine the accuracy and usefulness of the ANPS as a system that would lead to changes in eating behavior nationwide.
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Affiliation(s)
- Chie Furuta
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Hiroko Jinzu
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Lili Cao
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Adam Drewnowski
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, WA, United States
| | - Yuki Okabe
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kawasaki, Japan
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Drewnowski A. Matters Arising: Food Compass novelty and NOVA category assignments. Nat Food 2022; 3:581-583. [PMID: 37118608 DOI: 10.1038/s43016-022-00556-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/20/2022] [Indexed: 04/30/2023]
Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA.
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Drewnowski A. Nutrient Profiling of Plant-Based Milk Alternatives and Plant-Based Waters in the USDA Branded Food Products Database. Curr Dev Nutr 2022. [DOI: 10.1093/cdn/nzac059.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess nutrient density of commercially available plant-based milk alternatives and plant-based waters in the US Department of Agriculture (USDA) Branded Food Products Database (BFPDB). Such work is needed to guide new product formulation and potential action by regulatory agencies.
Methods
The current version of the BFPD lists 1,065 plant based (PB) milk alternatives and 558 PB waters. First, machine search of product names and ingredients separated PB milk alternatives into almond, soy, coconut, cashew, other tree nut, flax/hemp, pea, and quinoa and rice products. Product names were used to separate PB waters into coconut waters and other products, Nutrient density metrics were the Nutrient Rich Food Index (NRF), Nutri-Score and the Choices model. Machine searches of ingredient lists were used to identify added vitamins, minerals, and other ingredients.
Results
PB milk alternatives had variable energy density (mean 70 kcal/100 g), contained added sugar and salt, and tended to be fortified with calcium, vitamin A, and vitamins D. Protein content of PB milk alternatives was <2 g/100 g and fortification patterns with vitamins and minerals were highly variable. PB waters had lower energy density (mean 30 kcal/100 g), with added sugar as primary ingredient and were fortified with vitamin C. The NRF, Nutri-Score, and Choices nutrient density scores were higher for soy, almond and pea PB milk alternatives and lower for coconut PB beverages. Even high scoring PB products still fell into the NOVA category of ultra-processed foods.
Conclusions
Nutrient screening of commercially available PB products can help develop a set of standards for the content of energy, fat, sugar and sodium, minimum protein content for milk alternatives and consistent fortification levels for selected vitamins and minerals. Such standards could be adopted by the food industry, regulatory agencies, Access to Nutrition Initiative and the Codex Alimentarius.
Funding Sources
Supported by Société des Produits Nestlé SA.
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Drewnowski A, Detzel P, Klassen-Wigger P. Perspective: Achieving Sustainable Healthy Diets Through Formulation and Processing of Foods. Curr Dev Nutr 2022; 6:nzac089. [PMID: 35711570 PMCID: PMC9197573 DOI: 10.1093/cdn/nzac089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/09/2022] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
Food processing and food (re)formulation can contribute to achieving sustainable healthy diets. Distinct from product formulation, the main purpose of food processing is to provide a stable and resilient supply of safe, shelf-stable, and affordable foods. Although efforts at reformulating processed foods have focused on removing excess added fat, sugar, and salt, product formulation can also take the form of voluntary fortification with protein, fiber, and micronutrients to improve dietary nutrient density and address population health needs. Advances in food technology have also led to the addition of desirable ingredients, including plant-based proteins and fermentation products, to processed foods. Among continuing challenges to product (re)formulation are the need to ensure product safety, maintain sensory appeal, control product cost, assure consumer acceptance, and manage the environmental footprint across the value chain. Voluntary (re)formulation of processed foods by the food industry can help improve diet quality and food security for all.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
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Drewnowski A, Maillot M, Vieux F. Multiple Metrics of Carbohydrate Quality Place Starchy Vegetables Alongside Non-starchy Vegetables, Legumes, and Whole Fruit. Front Nutr 2022; 9:867378. [PMID: 35586739 PMCID: PMC9108865 DOI: 10.3389/fnut.2022.867378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 12/12/2022] Open
Abstract
BackgroundStarchy vegetables, including white potatoes, are often categorized as “lower-quality” carbohydrate foods, along with refined grains, 100% fruit juices, sweetened beverages, and sugars, snacks and sweets. Among “higher-quality” carbohydrates are whole grains, non-starchy vegetables, legumes, and whole fruits.ObjectiveTo apply multiple nutrient profiling (NP) models of carbohydrate quality to foods containing >40% carbohydrate by dry weight in the USDA Food and Nutrient Database for Dietary Studies (FNDDS 2017-18).MethodsCarbohydrate foods in the FNDDS (n = 2423) were screened using four recent Carbohydrate Quality Indices (CQI) and a new Carbohydrate Food Quality Score (CFQS-4). Cereal products containing >25% whole grains by dry weight were classified as whole grain foods.ResultsBased on percent items meeting the criteria for 4 CQI scores, legumes, non-starchy and starchy vegetables, whole fruit, and whole grain foods qualified as “high quality” carbohydrate foods. Distribution of mean CFQS-4 values showed that starchy vegetables, including white potatoes placed closer to non-starchy vegetables and fruit than to candy and soda.ConclusionPublished a priori determinations of carbohydrate quality do not always correspond to published carbohydrate quality metrics. Based on CQI metrics, specifically designed to assess carbohydrate quality, starchy vegetables, including white potatoes, merit a category reassignment and a more prominent place in dietary guidance.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
- *Correspondence: Adam Drewnowski,
| | | | - Florent Vieux
- MS-Nutrition, Faculté de Médecine La Timone, Marseille, France
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Drewnowski A, Gonzalez TD, Rehm CD. Balanced Hybrid Nutrient Density Score Compared to Nutri-Score and Health Star Rating Using Receiver Operating Characteristic Curve Analyses. Front Nutr 2022; 9:867096. [PMID: 35586737 PMCID: PMC9108770 DOI: 10.3389/fnut.2022.867096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNutrient profiling (NP) models that are used to assess the nutrient density of foods can be based on a combination of key nutrients and desirable food groups.ObjectiveTo compare the diagnostic accuracy of a new balanced hybrid nutrient density score (bHNDS) to Nutri-Score and Health Star Rating (HSR) front-of-pack systems using receiver operating characteristic (ROC) curve analyses. The diet-level bHNDS was first validated against Healthy Eating Index (HEI-2015) using data from the 2017–18 National Health and Nutrition Examination Survey (2017–18 NHANES). Food-level bHNDS values were then compared to both the Nutri-Score and HSR using ROC curve analyses.ResultsThe bHNDS was based on 6 nutrients to encourage (protein, fiber, calcium, iron, potassium, and vitamin D); 5 food groups to encourage (whole grains, nuts and seeds, dairy, vegetables, and fruit), and 3 nutrients (saturated fat, added sugar, and sodium) to limit. The algorithm balanced components to encourage against those to limit. Diet-level bHNDS values correlated well with HEI-2015 (r = 0.67; p < 0.001). Food-level correlations with both Nutri-Score (r = 0.60) and with HSR (r = 0.58) were significant (both p < 0.001). ROC estimates of the Area Under the Curve (AUC) showed high agreement between bHNDS values and optimal Nutri-Score and HSR ratings (>0.90 in most cases). ROC analysis identified those bHNDS cut-off points that were predictive of A-grade Nutri-Score or 5-star HSR. Those cut-off points were highly category-specific.ConclusionThe new bHNDS model showed high agreement with two front-of-pack labeling systems. Cross-model comparisons based on ROC curve analyses are the first step toward harmonization of proliferating NP methods that aim to “diagnose” high nutrient-density foods.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
- *Correspondence: Adam Drewnowski,
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Drewnowski A, Maillot M, Papanikolaou Y, Jones JM, Rodriguez J, Slavin J, Angadi SS, Comerford KB. A New Carbohydrate Food Quality Scoring System to Reflect Dietary Guidelines: An Expert Panel Report. Nutrients 2022; 14:nu14071485. [PMID: 35406096 PMCID: PMC9003092 DOI: 10.3390/nu14071485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/11/2022] Open
Abstract
Existing metrics of carbohydrate food quality have been based, for the most part, on favorable fiber- and free sugar-to-carbohydrate ratios. In these metrics, higher nutritional quality carbohydrate foods are defined as those with >10% fiber and <10% free sugar per 100 g carbohydrate. Although fiber- and sugar-based metrics may help to differentiate the nutritional quality of various types of grain products, they may not aptly capture the nutritional quality of other healthy carbohydrate foods, including beans, legumes, vegetables, and fruits. Carbohydrate food quality metrics need to be applicable across these diverse food groups. This report introduces a new carbohydrate food scoring system known as a Carbohydrate Food Quality Score (CFQS), which supplements the fiber and free sugar components of previous metrics with additional dietary components of public health concern (e.g., sodium, potassium, and whole grains) as identified by the Dietary Guidelines for Americans. Two CFQS models are developed and tested in this study: one that includes four dietary components (CFQS-4: fiber, free sugars, sodium, potassium) and one that considers five dietary components (CFQS-5: fiber, free sugars, sodium, potassium, and whole grains). These models are applied to 2596 carbohydrate foods in the Food and Nutrient Database for Dietary Studies (FNDDS) 2017−2018. Consistent with past studies, the new carbohydrate food scoring system places large percentages of beans, vegetables, and fruits among the top scoring carbohydrate foods. The whole grain component, which only applies to grain foods (N = 1561), identifies ready-to-eat cereals, oatmeal, other cooked cereals, and selected whole grain breads and crackers as higher-quality carbohydrate foods. The new carbohydrate food scoring system shows a high correlation with the Nutrient Rich Food (NRF9.3) index and the Nutri-Score. Metrics of carbohydrate food quality that incorporate whole grains, potassium, and sodium, in addition to sugar and fiber, are strategically aligned with multiple 2020−2025 dietary recommendations and may therefore help with the implementation of present and future dietary guidelines.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA;
| | - Matthieu Maillot
- MS-Nutrition, Faculté de Médecine La Timone, CEDEX 5, 13385 Marseille, France;
| | - Yanni Papanikolaou
- Nutritional Strategies Inc., Nutrition Research & Regulatory Affairs, Paris, ON N3L 0A3, Canada;
| | - Julie Miller Jones
- Emerita, Department of Nutrition and Exercise Science, St. Catherine University, St. Paul, MN 55105, USA;
| | - Judith Rodriguez
- Department of Nutrition & Dietetics, Brooks College of Health, University of North Florida, Jacksonville, FL 32224, USA;
| | - Joanne Slavin
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA;
| | - Siddhartha S. Angadi
- School of Education and Human Development, University of Virginia, Charlottesville, VA 22904, USA;
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Khusun H, Februhartanty J, Anggraini R, Mognard E, Alem Y, Noor MI, Karim N, Laporte C, Poulain JP, Monsivais P, Drewnowski A. Animal and Plant Protein Food Sources in Indonesia Differ Across Socio-Demographic Groups: Socio-Cultural Research in Protein Transition in Indonesia and Malaysia. Front Nutr 2022; 9:762459. [PMID: 35242792 PMCID: PMC8886573 DOI: 10.3389/fnut.2022.762459] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Plant-based diets in lower-income countries are often associated with inadequate protein nutrition and adverse health outcomes. Objective To examine the diversity of protein food sources, in both animal and plant, across diverse socio-demographic groups in Indonesia as compared to Malaysia. Design The SCRiPT (Socio Cultural Research in Protein Transition) study was based on population-based samples recruited in Indonesia (N = 1665) and in Malaysia (N = 1604). Data from 24-h in-person dietary recalls in each country were used to construct the frequency counts of protein sources by food group. Protein sources were defined as fish, poultry, red meat (beef, pork, and mutton), eggs, dairy, and plants (cereals, pulses, and tubers). The percent reported frequencies for animal and plant proteins were compared across socio-demographic strata and by country. Analyses were based on one-way Anovas and general linear model regressions adjusting for covariates. Results Animal protein frequency counts were 34% of total in Indonesia, but 50% in Malaysia's. Higher reported consumption frequencies for poultry and red meat in both countries were associated with urban living, greater modernization, and higher socioeconomic status, with stronger social gradients observed in Indonesia. Reported fish consumption was higher in Indonesia than in Malaysia. Fish was more likely to be listed by rural island populations in Indonesia and was associated with lower education and incomes. Consumption frequencies for plant-based proteins were associated with lower socio-economic status in Indonesia and in Malaysia. Conclusions More affluent groups in both countries reported higher frequencies for meat, eggs, and dairy as opposed to fish. Greater economic development in Southeast (SE) Asia is associated with more animal protein, particularly from poultry, which may displace fish, the traditional source of high quality protein for the region.
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Affiliation(s)
- Helda Khusun
- SEAMEO Regional Center for Food and Nutrition (RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Judhiastuty Februhartanty
- SEAMEO Regional Center for Food and Nutrition (RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Roselynne Anggraini
- SEAMEO Regional Center for Food and Nutrition (RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Elise Mognard
- Taylor's Toulouse University Center, Subang Jaya, Malaysia
- Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
| | - Yasmine Alem
- Taylor's Toulouse University Center, Subang Jaya, Malaysia
- Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- CERTOP UMR-CNRS 5044, University of Toulouse Jean Jaurès, Toulouse, France
| | - Mohd Ismail Noor
- Faculty of Health Sciences, Community Health Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norimah Karim
- Faculty of Health Sciences, Community Health Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Cyrille Laporte
- CERTOP UMR-CNRS 5044, University of Toulouse Jean Jaurès, Toulouse, France
| | - Jean-Pierre Poulain
- Taylor's Toulouse University Center, Subang Jaya, Malaysia
- Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
- CERTOP UMR-CNRS 5044, University of Toulouse Jean Jaurès, Toulouse, France
| | - Pablo Monsivais
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Adam Drewnowski
- Department of Epidemiology, Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
- *Correspondence: Adam Drewnowski
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Drewnowski A, Leibel RL, Ravussin E, Redman LM, Schwartz MW, Seeley RJ, Zeltser LM. Misleading or factually incorrect statements in the American Journal of Clinical Nutrition Perspectives article by Ludwig et al. Am J Clin Nutr 2022; 115:591-592. [PMID: 35139163 PMCID: PMC8990102 DOI: 10.1093/ajcn/nqab384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adam Drewnowski
- From the Center for Public Health Nutrition, University of
Washington, Seattle, WA, USA
| | - Rudolph L Leibel
- Naomi Berrie Diabetes Center and Department of Pathology and Cell Biology,
Columbia University, New York, NY, USA
- Division of Molecular Genetics, Department of Pediatrics, Columbia
University, New York, NY, USA
| | - Eric Ravussin
- John S McIlhenny Skeletal Muscle Physiology Laboratory, Pennington
Biomedical Research Center, Baton Rouge, LA,
USA
| | - Leanne M Redman
- John S McIlhenny Skeletal Muscle Physiology Laboratory, Pennington
Biomedical Research Center, Baton Rouge, LA,
USA
| | | | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann
Arbor, MI, USA
| | - Lori M Zeltser
- Naomi Berrie Diabetes Center and Department of Pathology and Cell Biology,
Columbia University, New York, NY, USA
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43
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Greenberg D, Drewnowski A, Black R, Weststrate JA, O'Shea M. A Progressive Nutrient Profiling System to Guide Improvements in Nutrient Density of Foods and Beverages. Front Nutr 2022; 8:774409. [PMID: 35004807 PMCID: PMC8733001 DOI: 10.3389/fnut.2021.774409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Improving the nutrient density of processed foods is one way to bring the global food supply closer to the WHO Sustainable Development Goals. Nutrient profiling (NP) has emerged as the preferred method of monitoring the progress toward product innovation and reformulation. This paper presents PepsiCo Nutrition Criteria (PNC), a new internal NP model that was designed to guide and monitor improvements in nutrient density and overall nutritional quality of foods and beverages. The new PNC NP model assigns food products into four classes of increasing nutritional value, based on the content of nutrients to limit, along with nutrients and ingredients to encourage. The nutrient standards used for category assignment followed those developed by global dietary authorities. Standards are proposed for calories, sodium, added sugars, saturated, and industrially produced trans fats. Also included are minimum values for food groups to encourage, low-fat dairy, and for country-specific gap nutrients. Internal use of the NP model has spurred product changes that are consistent with WHO goals for industry transparency. An audited review of company products showed that 48% met added sugar, 65% met sodium, and 71% met saturated fat goals. By the end of 2020, in the top 26 regions in which products are sold, 48% of the total sales volume of global beverages had 100 kcal or less from added sugars per 355 ml serving representing 80% of beverage volume and over 90% of food volume sold globally. The PNC NP model is not consumer-facing but is specifically intended for internal use to motivate stepwise and incremental product innovation and reformulation. Transparent and published NP models further WHO goals of engaging industry stakeholders in the (re)formulation of processed foods and beverages consistent with public health goals.
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Affiliation(s)
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Richard Black
- PepsiCo, Inc., Research and Development, Purchase, NY, United States
| | - Jan A Weststrate
- PepsiCo, Inc., Research and Development, Purchase, NY, United States
| | - Marianne O'Shea
- PepsiCo, Inc., Research and Development, Purchase, NY, United States
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Kissock KR, Vieux F, Mathias KC, Drewnowski A, Seal CJ, Masset G, Smith J, Mejborn H, McKeown NM, Beck EJ. Correction to: Aligning nutrient profiling with dietary guidelines: modifying the Nutri-Score algorithm to include whole grains. Eur J Nutr 2021; 61:555. [PMID: 34919175 PMCID: PMC8783902 DOI: 10.1007/s00394-021-02779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Katrina R Kissock
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | | | - Kevin C Mathias
- Skidmore College, Health and Human Physiological Sciences, Saratoga Springs, NY, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
| | - Chris J Seal
- Public Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, NE2 4HH, UK
| | | | - Jessica Smith
- General Mills Scientific and Regulatory Affairs, Minneapolis, MN, USA
| | - Heddie Mejborn
- National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Nicola M McKeown
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Eleanor J Beck
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.
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45
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Buszkiewicz JH, Bobb JF, Kapos F, Hurvitz PM, Arterburn D, Moudon AV, Cook A, Mooney SJ, Cruz M, Gupta S, Lozano P, Rosenberg DE, Theis MK, Anau J, Drewnowski A. Differential associations of the built environment on weight gain by sex and race/ethnicity but not age. Int J Obes (Lond) 2021; 45:2648-2656. [PMID: 34453098 PMCID: PMC8608695 DOI: 10.1038/s41366-021-00937-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the built environment (BE) and weight change relationship by age, sex, and racial/ethnic subgroups in adults. METHODS Weight trajectories were estimated using electronic health records for 115,260 insured Kaiser Permanente Washington members age 18-64 years. Member home addresses were geocoded using ArcGIS. Population, residential, and road intersection densities and counts of area supermarkets and fast food restaurants were measured with SmartMaps (800 and 5000-meter buffers) and categorized into tertiles. Linear mixed-effect models tested whether associations between BE features and weight gain at 1, 3, and 5 years differed by age, sex, and race/ethnicity, adjusting for demographics, baseline weight, and residential property values. RESULTS Denser urban form and greater availability of supermarkets and fast food restaurants were associated with differential weight change across sex and race/ethnicity. At 5 years, the mean difference in weight change comparing the 3rd versus 1st tertile of residential density was significantly different between males (-0.49 kg, 95% CI: -0.68, -0.30) and females (-0.17 kg, 95% CI: -0.33, -0.01) (P-value for interaction = 0.011). Across race/ethnicity, the mean difference in weight change at 5 years for residential density was significantly different among non-Hispanic (NH) Whites (-0.47 kg, 95% CI: -0.61, -0.32), NH Blacks (-0.86 kg, 95% CI: -1.37, -0.36), Hispanics (0.10 kg, 95% CI: -0.46, 0.65), and NH Asians (0.44 kg, 95% CI: 0.10, 0.78) (P-value for interaction <0.001). These findings were consistent for other BE measures. CONCLUSION The relationship between the built environment and weight change differs across demographic groups. Careful consideration of demographic differences in associations of BE and weight trajectories is warranted for investigating etiological mechanisms and guiding intervention development.
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Affiliation(s)
- James H Buszkiewicz
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA, USA.
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Flavia Kapos
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Philip M Hurvitz
- Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, WA, USA
- Center for Studies in Demography and Ecology, University of Washington, Raitt Hall, Seattle, WA, USA
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Anne Vernez Moudon
- Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, WA, USA
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Stephen J Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Maricela Cruz
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Shilpi Gupta
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Paula Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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46
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Niles MT, Beavers AW, Clay LA, Dougan MM, Pignotti GA, Rogus S, Savoie-Roskos MR, Schattman RE, Zack RM, Acciai F, Allegro D, Belarmino EH, Bertmann F, Biehl E, Birk N, Bishop-Royse J, Bozlak C, Bradley B, Brenton BP, Buszkiewicz J, Cavaliere BN, Cho Y, Clark EM, Coakley K, Coffin-Schmitt J, Collier SM, Coombs C, Dressel A, Drewnowski A, Evans T, Feingold BJ, Fiechtner L, Fiorella KJ, Funderburk K, Gadhoke P, Gonzales-Pacheco D, Safi AG, Gu S, Hanson KL, Harley A, Harper K, Hosler AS, Ismach A, Josephson A, Laestadius L, LeBlanc H, Lewis LR, Litton MM, Martin KS, Martin S, Martinelli S, Mazzeo J, Merrill SC, Neff R, Nguyen E, Ohri-Vachaspati P, Orbe A, Otten JJ, Parmer S, Pemberton S, Qusair ZAA, Rivkina V, Robinson J, Rose CM, Sadeghzadeh S, Sivaramakrishnan B, Arroyo MT, Voorhees M, Yerxa K. A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic. Curr Dev Nutr 2021; 5:nzab135. [PMID: 34934898 PMCID: PMC8677520 DOI: 10.1093/cdn/nzab135] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.
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Affiliation(s)
- Meredith T Niles
- Department of Nutrition and Food Sciences, Gund Institute for Environment, University of Vermont, Burlington, VT
| | - Alyssa W Beavers
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI
| | - Lauren A Clay
- Health Administration & Public Health Department, D'Youville College, Buffalo, NY
| | - Marcelle M Dougan
- Department of Public Health and Recreation, San José State University, San José, CA
| | - Giselle A Pignotti
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, CA
| | - Stephanie Rogus
- Department of Family and Consumer Sciences, New Mexico State University, Las Cruces, NM
| | | | | | - Rachel M Zack
- Business and Data Analytics, The Greater Boston Food Bank, Boston, MA
| | - Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Deanne Allegro
- Department of Kinesiology, Auburn University at Montgomery, Montgomery, AL
| | - Emily H Belarmino
- Department of Nutrition and Food Sciences, Gund Institute for Environment, University of Vermont,
Burlington, VT
| | - Farryl Bertmann
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT
| | - Erin Biehl
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD
| | - Nick Birk
- Business and Data Analytics, The Greater Boston Food Bank, Boston, MA
| | - Jessica Bishop-Royse
- Faculty Scholarship Collaborative, College of Liberal Arts and Social Sciences, DePaul University, Chicago, IL
| | - Christine Bozlak
- Health Policy, Management, and Behavior, University at Albany- State University of New York, Rensselaer, NY
| | - Brianna Bradley
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | | | - Brittney N Cavaliere
- Institute for Hunger Research & Solutions, Connecticut Food Bank/Foodshare, Bloomfield, CT
| | - Young Cho
- Joseph J Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Eric M Clark
- Department of Plant and Soil Science, University of Vermont, Burlington, VT
| | - Kathryn Coakley
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM
| | | | - Sarah M Collier
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Casey Coombs
- Department of Nutrition, Dietetics and Food Sciences, Utah State University, Logan, UT
| | - Anne Dressel
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Adam Drewnowski
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Tom Evans
- School of Geography, Development and Environment, University of Arizona, Tucson, AZ
| | - Beth J Feingold
- Department of Environmental Health Sciences, University at Albany- State University of New York, Rensselaer, NY
| | - Lauren Fiechtner
- Department of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA
| | - Kathryn J Fiorella
- Department of Population Medicine and Diagnostic Sciences and Master of Public Health Program, Cornell University, Ithaca, NY
| | - Katie Funderburk
- Alabama Cooperative Extension System, Auburn University, Auburn, AL
| | - Preety Gadhoke
- Department of Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John's University (at the time of study administration),
Jamaica, NY
| | - Diana Gonzales-Pacheco
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM
| | - Amelia Greiner Safi
- Department of Population Medicine and Diagnostic Sciences and Master of Public Health Program, Cornell University, Ithaca, NY
| | - Sen Gu
- Department of Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John's University (at the time of study administration),
Jamaica, NY
| | - Karla L Hanson
- Department of Population Medicine and Diagnostic Sciences and Master of Public Health Program, Cornell University, Ithaca, NY
| | - Amy Harley
- Joseph J Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Kaitlyn Harper
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Akiko S Hosler
- Department of Epidemiology and Biostatistics, University at Albany- State University of New York, Rensselaer, NY
| | - Alan Ismach
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Anna Josephson
- Department of Agricultural and Resource Economics, University of Arizona, Tucson, AZ
| | - Linnea Laestadius
- Joseph J Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Heidi LeBlanc
- Department of Nutrition, Dietetics and Food Sciences, Utah State University, Logan, UT
| | - Laura R Lewis
- Community and Economic Development, Washington State University, Port Hadlock, WA
| | - Michelle M Litton
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI
| | - Katie S Martin
- Institute for Hunger Research & Solutions, Connecticut Food Bank/Foodshare, Bloomfield, CT
| | - Shadai Martin
- Department of Family and Consumer Sciences, New Mexico State University, Las Cruces, NM
| | - Sarah Martinelli
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - John Mazzeo
- Master of Public Health Program, College of Liberal Arts and Social Sciences, DePaul University, Chicago, IL
| | - Scott C Merrill
- Department of Plant and Soil Science, Gund Institute for Environment, University of Vermont, Burlington, VT
| | - Roni Neff
- Department of Environmental Health & Engineering, Bloomberg School of Public Health; Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD
| | - Esther Nguyen
- Center for Public Health Nutrition, University of Washington, Seattle, WA
| | | | - Abigail Orbe
- Institute for Hunger Research & Solutions, Connecticut Food Bank/Foodshare, Bloomfield, CT
| | - Jennifer J Otten
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Sondra Parmer
- Alabama Cooperative Extension System, Auburn University, Auburn, AL
| | | | - Zain Al Abdeen Qusair
- Master of Public Health Program, College of Liberal Arts and Social Sciences, DePaul University, Chicago, IL
| | - Victoria Rivkina
- Master of Public Health Program, College of Liberal Arts and Social Sciences, DePaul University, Chicago, IL
| | - Joelle Robinson
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Chelsea M Rose
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | - Mariana Torres Arroyo
- Department of Environmental Health Sciences, University at Albany- State University of New York, Rensselaer, NY
| | - McKenna Voorhees
- Department of Nutrition, Dietetics and Food Sciences, Utah State University, Logan, UT
| | - Kathryn Yerxa
- Cooperative Extension, University of Maine, Orono, ME
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Drewnowski A. Perspective: Identifying Ultra-Processed Plant-Based Milk Alternatives in the USDA Branded Food Products Database. Adv Nutr 2021; 12:2068-2075. [PMID: 34291276 PMCID: PMC8634539 DOI: 10.1093/advances/nmab089] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
This study explored the characteristics of plant-based beverages (PBBs) that are marketed as "milks" in the United States. First, machine searches of product names and ingredients in the USDA Branded Food Products Database (BFPDB) yielded 641 nondairy PBBs that included almond, soy, coconut, cashew, other tree nut, flax/hemp, pea, and quinoa and rice "milks." The products varied in energy density and the majority of PBBs contained added salt (69%) and added sugar (53%). Scores on nutrient density metrics [Nutri-Score, Choices, and the Nutrient Rich Food index 7.3 (NRF7.3)] were higher for almond and pea products and lower for coconut PBBs, which contained saturated fat. Ingredient lists were searched further for added flavors, stabilizers, or preservatives said to be characteristic of the NOVA food classification system's ultra-processed group. Most PBBs (90.1%) and 95% of almond milks met the NOVA criteria for ultra-processed foods, because they were created from food components and contained multiple substances not used in normal cooking. Replacing milk and dairy products with plant-based alternatives will necessarily involve the use of ultra-processed foods.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
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48
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Kissock KR, Vieux F, Mathias KC, Drewnowski A, Seal CJ, Masset G, Smith J, Mejborn H, McKeown NM, Beck EJ. Aligning nutrient profiling with dietary guidelines: modifying the Nutri-Score algorithm to include whole grains. Eur J Nutr 2021; 61:541-553. [PMID: 34817679 PMCID: PMC8783881 DOI: 10.1007/s00394-021-02718-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/18/2021] [Indexed: 01/07/2023]
Abstract
Purpose Whole grains, generally recognised as healthy choices, are not included in most nutrient profiling systems. We tested modifications to the Nutri-Score algorithm to determine whether including whole grains would provide an improved measure of food, and overall diet quality. Methods The whole-grain content of food, with a minimum cut-point of 25%, was added to the algorithm, following similar methods used to score other health-promoting components such as fibre. We applied and compared the original and the modified Nutri-Score to food composition and dietary intake data from Australia, France, the United Kingdom, and the United States. Results At the food level, correlations between whole-grain content and food nutritional score were strengthened using the modified algorithm in Australian data, but less so for the other countries. Improvements were greater in grain-specific food groups. The largest shift in Nutri-Score class was from B to A (best score). At the dietary intake level, whole-diet nutritional scores for individuals were calculated and compared against population-specific diet-quality scores. With modifications, correlations with diet-quality scores were improved slightly, suggesting that the modified score better aligns with national dietary guidelines. An inverse linear relationship between whole-diet nutritional score and whole-grain intake was evident, particularly with modifications (lower whole-diet nutritional score indicative of better diet quality). Conclusion Including a whole-grain component in the Nutri-Score algorithm is justified to align with dietary guidelines and better reflect whole grain as a contributor to improved dietary quality. Further research is required to test alternative algorithms and potentially other nutrient profiling systems. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02718-6.
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Affiliation(s)
- Katrina R Kissock
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | | | - Kevin C Mathias
- Skidmore College, Health and Human Physiological Sciences, Saratoga Springs, NY, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
| | - Chris J Seal
- Public Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, NE2 4HH, UK
| | | | - Jessica Smith
- General Mills Scientific and Regulatory Affairs, Minneapolis, MN, USA
| | - Heddie Mejborn
- National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Nicola M McKeown
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Eleanor J Beck
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.
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Mooney SJ, Song L, Drewnowski A, Buskiewicz J, Mooney SD, Saelens BE, Arterburn DE. From the clinic to the community: Can health system data accurately estimate population obesity prevalence? Obesity (Silver Spring) 2021; 29:1961-1968. [PMID: 34605194 PMCID: PMC8571026 DOI: 10.1002/oby.23273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Health system data were assessed for how well they can estimate obesity prevalence in census tracts. METHODS Clinical visit data were available from two large health systems (Kaiser Permanente Washington and University of Washington Medicine) in King County, Washington, as were census tract-level obesity prevalence estimates from the Behavioral Risk Factor Surveillance System (BRFSS). The health system data were geocoded to identify each patient's tract of residence, and the cross-sectional concordance between census tract-level obesity prevalence estimates computed from the two health systems in 2005 to 2006 and the concordance between University of Washington Medicine and BRFSS from 2012 to 2016 were assessed. RESULTS The spatial distribution of obesity was similar between the health systems (Spearman r = 0.63). The University of Washington Medicine estimates of rank order correlated well with BRFSS estimates (Spearman r = 0.85), though prevalence estimates from BRFSS were lower (mean obesity prevalence = 26% for University of Washington Medicine versus 20% for BRFSS, Wilcoxon rank sum test p < 0.001). Across all data sources, obesity was more prevalent in tracts with less educational attainment. CONCLUSIONS Health system clinical weight data can reliably replicate census tract-level spatial patterns in the ranking of obesity prevalence. Health system data may be an efficient resource for geographic obesity surveillance.
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Affiliation(s)
- Stephen J Mooney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Lin Song
- Seattle-King County Public Health, Seattle, Washington, USA
| | - Adam Drewnowski
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, Washington, USA
| | - James Buskiewicz
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Brian E Saelens
- Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - David E Arterburn
- Kaiser Permanente Washington Research Institute, Seattle, Washington, USA
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Drewnowski A, Henry CJ, Dwyer JT. Proposed Nutrient Standards for Plant-Based Beverages Intended as Milk Alternatives. Front Nutr 2021; 8:761442. [PMID: 34746213 PMCID: PMC8564006 DOI: 10.3389/fnut.2021.761442] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Plant-based beverages (PBB) that are marketed as alternatives to cow milk are gaining in popularity worldwide. Nutrient quality of PBB can be highly variable. Objective: To develop a set of voluntary or mandatory nutrient standards for the PBB product category in order to assist innovation and guide product development and reformulation. Methods: The present goal was to develop standards for PBB energy content, minimum protein content and quality, maximum content for added fat, sugar, and salt, and to suggest fortification levels for selected vitamins and minerals. The standards were based on dietary recommendations and guidelines and current practices of federal agencies in the US. Results: The proposed energy and nutrient content for PBB milk alternatives are maximum 85-100 kcal energy per 100 g; a minimum for 2.2/100 g of high-quality protein, low content of saturated fat (<0.75/100 g) and added sugar (5.3-6.25/100 g) and consistent fortification with calcium, vitamins A, D, B-2, and B-12 at levels comparable to those found in cow milk (1%). Ideally, the protein content ought to be increased (2.8/100 g) and added sugar content reduced even further (2.7-3.1/100 g) for "best of class" products. These proposed standards were applied to the 641 existing PBB products listed in the 2018 version of the USDA Branded Food Products Database (BFPDB). The standards were met by <5% of the PBB on the US market. Conclusion: Often viewed as equivalent to milk in nutritional value, many PBB are often low in protein and are fortified with varying amounts of calcium, and vitamins A and D. Nutrient standards for this category should be adopted by the food industry, by public health regulatory authorities, and by standardization bodies such as the Codex Alimentarius.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Singapore, Singapore
| | - Johanna T. Dwyer
- Frances Stern Nutrition Center Tufts Medical Center and Jean Mayer USDA Human Nutrition Research Center on Aging, Department of Medicine, School of Medicine and Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, United States
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