Biochemical Composition and Related Potential Nutritional and Health Properties of Sobrassada de Mallorca

'Sobrassada de Mallorca' is an EU PGI (Protected Geographical Indication) -qualified traditional food with important historical, social, and gastronomical relevance. However, its nutritional features are poorly characterized. Here, we studied 15 samples of Sobrassada de Mallorca (SM) and 9 samples of 'Sobrassada de Mallorca de Porc Negre' (SMBP), which are the two types of sobrassada that are PGI-protected. Their composition was assessed under the light of the EU Regulation 1924/2006 on nutrition and health claims (NHC) made on food. Results show the notably high energetic density (588 and 561 kcal/100 g for SM and SMBP, respectively) due to the notable fatty acid (FA) content and the relatively high proportion of unsaturated FAs (≈61% of total FAs) is also noted, mainly oleic acid (39.7 and 45.7%). Moreover, analyses showed that 100 g of both types of 'Sobrassada de Mallorca' present a 'significant' content (at least 15% of the established Nutrient Reference Values) of vitamins A (241 and 232 µg), E (2.67 and 2.67 mg), B3 (3.50 and 2.43 mg), B6 (0.27 and 0.35 mg), B12 (0.65 and 0.56 µg), phosphorus (271 and 186 mg), and selenium (17.3 and 16.2 µg) as defined by the EU standards and, in essence, their associated health benefits can be claimed for both SM and SMBP or foods containing them. In principle, SM and SMBP could be associated with various health claims (HC), including those related to energy-yielding metabolism, normal functioning of the immune system, and reduction of tiredness and fatigue.

Probiotics Supplementation during Pregnancy: Can They Exert Potential Beneficial Effects against Adverse Pregnancy Outcomes beyond Gestational Diabetes Mellitus?

BACKGROUND

Probiotics, as supplements or food ingredients, are considered to exert promising healthy effects when administered in adequate quantity. Probiotics' healthy effects are related with the prevention of many diseases, as well as decreasing symptom severity. Currently, the most available data concerning their potential health effects are associated with metabolic disorders, including gestational diabetes mellitus. There is also clinical evidence supporting that they may exert beneficial effects against diverse adverse pregnancy outcomes. The purpose of the current narrative study is to extensively review and analyze the current existing clinical studies concerning the probable positive impacts of probiotics supplementation during pregnancy as a protective agent against adverse pregnancy outcomes beyond gestational diabetes mellitus.

METHODS

a comprehensive and thorough literature search was conducted in the most precise scientific databases, such as PubMed, Scopus, and Web of Sciences, utilizing efficient, representative, and appropriate keywords.

RESULTS

in the last few years, recent research has been conducted concerning the potential beneficial effects against several adverse pregnancy outcomes such as lipid metabolism dysregulation, gestational hypertensive disorders, preterm birth, excessive gestational weight gain, caesarean risk section, vaginal microbiota impairment, mental health disturbances, and others.

CONCLUSION

up to the present day, there is only preliminary clinical data and not conclusive results for probiotics' healthy effects during pregnancy, and it remains questionable whether they could be used as supplementary treatment against adverse pregnancy outcomes beyond gestational diabetes mellitus.

The Prevalence and Compliance of Health Claims Used in the Labelling and Information for Prepacked Foods within Great Britain

In the EU and Great Britain (GB), all health claims (HCs) on food must be authorised before use and should comply with Regulation 1924/2006. In GB, all HCs, authorised or not, are listed in the Great Britain Nutrition and Health Claims Register. This study reviews the prevalence and compliance of HCs on prepacked foods sold within three GB supermarkets and via their grocery shopping websites. In June 2023, food labels and online product information of 440 products were evaluated across three food categories-dairy and dairy alternatives; fruit juices, fruit juice drinks and fruit smoothies; and teas and infusions. In store, 26.3% of products carried an HC and 28.3% online. The prevalence of HCs was higher when compared with data from 2016. Overall compliance was high, in store (94.3%) and online (90.0%), with no statistically significant difference in overall HC compliance between in store and online products (p = 0.724). The HC violations observed in the present study were due to non-compliant wording of HCs or use of non-authorised HCs. This study demonstrates changes in the HC landscape and the need for continued monitoring of the prevalence and compliance of HCs as consumer trends alter.

Monitoring health and nutrition claims on food labels in Brazil

Introduction

The monitoring of nutrition and health claims on food and beverage labels has been proposed by international and national organizations because it can collaborate with the development of public policies to regulate food labeling and marketing strategies. One way of carrying out this monitoring is by using data collected by private companies.

Objective

To compare information on nutrition and health claims available in a commercial database of a private company that monitors the launch of new foods and beverages in Brazilian food retailers with information on those same claims manually coded by trained research assistants.

Methods

This is a cross-sectional observational study using a data sample of newly launched food and beverages available at a commercial database from 2018 to 2021. We compared the information on health and nutrition claims available on the commercial dataset with reliable information on the same nutrition and health claims manually coded by trained research assistants using a tested taxonomy to classify such claims. We used Gwet's Kappa AC1 with 95% CI and percentage agreement to compare both data sources and calculated sensitivity and specificity of the compared data.

Results

A total of 6,722 foods and beverages were analyzed. Mintel-GNPD presented 36.28% (n = 2,439) of nutrition claims, while in the trained researchers' coding, it was 33.73% (n = 2,267). We found a prevalence of 5.4% (n = 362) for health claims in Mintel-GNPD and 10.8% (n = 723) in the researchers' coding. All subcategories of nutrition and health claims showed high agreement (Kappa >0.81). Health claims presented kappa = 0.89 with 33.7% sensitivity and 98.0% specificity while nutrition claims showed kappa = 0.86 with 92.9% sensitivity and 92.5% specificity.

Conclusion

Nutrition and health claims showed high agreement, with great results in nutrition claims, indicating that Mintel-GPND is suitable for monitoring such claims on food and beverage packaging in Brazil. Additionally, our findings show a high prevalence of nutrition and health claims on food packages launched in the Brazilian food retail, highlighting the need to monitor these to develop public policies to regulate food marketing on packaging in Brazil.

Appethyl® and reduction of body weight: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006

Following an application from Greenleaf Medical AB, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Sweden, the EFSA Panel on Nutrition, Novel Foods and Food allergens (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to Appethyl® and reduction of body weight. Appethyl® is an aqueous extract from spinach leaves standardised by the manufacturing process and its lipase/colipase inhibition capacity in vitro. The Panel considers that the food is sufficiently characterised. A reduction in body weight is a beneficial physiological effect for overweight/obese individuals. The applicant identified a total of three human intervention studies that investigated the effects of Appethyl® on body weight as being pertinent to the claim. In weighing the evidence, the Panel took into account that Appethyl® (5 g/day for 12 weeks) had no effect on body weight as compared to placebo under minimal dietary counselling and moderate physical activity, and that no beneficial physiological effects are to be expected for the target population of overweight/obese individuals from the weight loss that could be attributed to the intervention with Appethyl® under predefined energy restriction and moderate physical activity. The Panel also considered that the effect of Appethyl® (5 g/day for 24 weeks) on body weight maintenance after initial weight loss shown in one study has not been replicated in different settings, which questions the external validity of the results, and that no evidence was provided for a plausible mechanism by which daily consumption of Appethyl® could exert a sustained effect on body weight in humans. The Panel concludes that a cause-and-effect relationship has not been established between the consumption of Appethyl® and a reduction of body weight under the conditions of use proposed by the applicant.

Biological Activities and Polyphenol Content of Qi Cha Tea®, a Functional Beverage of White Tea Containing Botanicals and Dry Botanical Extracts with European Health Claims

Infusions of Camellia sinensis leaves have been known for their health benefits. The Bio Concentrate Assets® (ABC) method is a method of enriching organic infusion leaves (from Camellia sinensis) with organic dry and concentrated extracts using organic acacia gum, and its application to white tea has provided Qi cha tea®. In the present study, the content of tea polyphenols and caffeine, and the biochemical properties of Qi cha tea® and its botanical constituents (elderberry, tulsi, Echinacea purpurea, orange peel, lemongrass, and acacia gum) were assessed. Antioxidant and cell viability activities were determined by the 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay and MTT (3-(4, 5-dimethyl thiazol-2-yl)-2, 5-diphenyl tetrazolium bromide) assay in human Caco-2 and HCT-116 cell lines, and ascorbic acid and tamoxifen, respectively. The caffeine and polyphenol composition of Qi cha tea® was modified with less caffeine and gallic acid and more epigallocatechin gallate (EGCG) than the original white tea. The majority of the tested botanical samples including Qi cha tea® at 50 µg/mL show similar antioxidant activities, with the exception of Echinacea purpurea. The greatest effect was found for white tea. The antioxidant power of the Qi cha tea® (90% at 50 µg/mL for pressurized liquid extraction (PLE) was divided by approximately a factor of two (61% at 50 µg/mL for pressurized liquid extraction products (PLEP)), which corresponds to the 48.3% (mass/mass) white tea original content in the Qi cha tea®. Qi cha tea® shows the lowest cytotoxic activity in the viability of the two cell lines when compared to white tea. The application of the ABC method to Qi cha tea® using various botanicals and dry extract with acacia gum as blinder has allowed the development of a new innovative functional health beverage that complies with European health claims.

Choline and contribution to normal liver function of the foetus and exclusively breastfed infants: evaluation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006

Following an application from Procter & Gamble BV pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of Belgium, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to choline and contribution to normal liver function of the foetus and exclusively breastfed infant. The scope of the application was proposed to fall under a health claim referring to children's development and health. The Panel considers that choline is sufficiently characterised. The claimed effect proposed by the applicant is contribution 'to normal foetal and infant development, especially liver'. The proposed target population is 'unborn fetuses and breastfed infants'. Choline is involved in the structure of cell membranes, cell signalling, metabolism and transport of lipids and cholesterol and neurotransmitter synthesis. Although choline can be synthesised de novo by the human body, depletion-repletion studies in humans show that low choline intake leads to liver dysfunction and muscle damage, which are reverted by the administration of dietary choline. For these functions, de novo synthesis of choline by the human body is insufficient and choline must be obtained from dietary sources. No human studies have addressed the effect of low maternal dietary choline intake on liver function in the fetus or exclusively breastfed infants. However, the Panel considers that the biological role of choline in normal liver function and dietary choline being essential for the function applies to all ages, including fetus and infants. The Panel concludes that a cause and effect relationship has been established between the intake of choline by pregnant and lactating women and contribution to normal liver function of the fetus and exclusively breastfed infants.

Moringa oleifera Lam. Commercial Beverages: A Multifaceted Investigation of Consumer Perceptions, Sensory Analysis, and Bioactive Properties

This study employs a multidisciplinary approach to evaluate consumers' perceptions and acceptance of Moringa oleifera Lam. beverages, examining sensory attributes, chemical composition, and bioactivities. High-performance liquid chromatography with diode array detection (HPLC-DAD) analyses revealed significant chemovariation in phenolic compositions among commercial moringa beverages. A soluble moringa powder drink exhibited the greatest concentrations of phenolic and flavonoid compounds, along with powerful antioxidant capacity powers assessed with ABTS^•+, DPPH^•, FRAP assays, ^•NO, and H₂O₂ scavenging activities. However, this sample was the least preferred and presented high Cd levels, exceeding WHO-acceptable values of 0.3 mg/kg. Sensory testing indicated that sweet and floral flavors contributed to beverages being liked, while green, grass, herbal flavors, sour, bitter, and precipitate presence were considered unfavorable sensory attributes. Health claims positively influenced acceptance, particularly among women. Consumers associated feelings of health, wellness, relaxation, and leisure with moringa beverages. During purchase, the most observed information included the ingredient list, health benefits, and type/flavor. These findings emphasize the importance of consumer awareness in reading labels, verifying product origins, and ensuring the absence of contaminants. By understanding consumer preferences and the impact of health claims, producers can better tailor M. oleifera beverages to meet consumer expectations while maintaining safety and quality standards.

Resveratrol Food Supplement Products and the Challenges of Accurate Label Information to Ensure Food Safety for Consumers

The food supplement market is growing as many consumers wish to complement their nutrient intake. Despite all the regulations in place to ensure food supplements safety, there are still many cases of irregularities reported especially connected to internet sales. Twenty resveratrol food supplement products sold on the Slovenian market were evaluated on their compliance of declared vs. determined resveratrol content, as well as the compliance of labels with the European Union (EU) and Slovenian regulatory requirements. Both the ingredient contents and food information are important parts of food safety. Analyses of 20 food supplements performed using high-performance thin-layer chromatography (HPTLC) coupled with densitometry showed that 95% of products had contents different from what was declared and 55% of products contained higher contents than declared. In 25% of the products the determined content per unit exceeded the maximum level (150 mg/day) specified in EU novel food conditions for food supplement with trans-resveratrol. Evaluation of the 20 food supplement labels included mandatory and voluntary food information, food supplement information, novel food information, health claims and nutrition claims. Most labels contained the necessary information, but multiple errors were observed ranging from typos to misleading practices. From a food safety perspective there is still a lot of improvement needed in the field of food supplements.

The Power of Suggestion: Subjective Satiety Is Affected by Nutrient and Health-Focused Food Labelling with No Effect on Physiological Gut Hormone Release

Health claims on food labelling can influence peoples' perception of food without them actually eating it, for example driving a belief that a particular food will make them feel fuller. The aim of this study was to investigate whether nutrient and health claims on food labelling can influence self-reported, and physiological indicators of, satiation. A total of 50 participants attended two visits where they were asked to consume a 380 kcal breakfast (granola and yogurt) labelled as a 500 kcal 'indulgent' breakfast at one visit and as a 250 kcal 'sensible' breakfast at the other. The order of the breakfast descriptions was randomly allocated. Participants were unaware that the two breakfasts were the same product and that only the food labels differed. At each visit blood samples were collected to measure gut hormone levels (acylated ghrelin, peptide tyrosine-tyrosine and glucagon-like peptide-1) at three time points: 20 min after arrival (baseline), after 60 min (anticipatory, immediately prior to consumption) and after 90 min (post-consumption). Visual analogue scales measuring appetite (hunger, satiety, fullness, quantity and desire to eat) were completed prior to each sample. Between 60 and 90 min, participants consumed the breakfast and rated its sensory appeal. Participants reported a higher mean change in self-reported fullness for the 'indulgent' than the 'sensible' breakfast from anticipatory to post-consumption (mean difference: 7.19 [95% CI: 0.73, 13.6]; p = 0.030). This change was not observed for the other appetite measures at the other time points or gut hormone levels. This study suggests that nutrient and health claims on food labels may influence satiation as measured by self-reported fullness. It also suggests that the observed differences in satiety scores are not due to changes in the main appetite regulating gut hormones, but are more likely centrally mediated. More high-quality trials are required to confirm these findings.

Marketing techniques, health, and nutritional claims on processed foods and beverages before and after the implementation of mandatory front-of-package warning labels in Peru

In June 2019, mandatory front-of-package warning labels (FOPL) were implemented in Peru. The aim of the study was to describe changes in marketing strategies on packaging: marketing techniques (MT), health claims (HC), and nutritional claims (NC) on the packaging of products frequently consumed by children before and after the FOPL implementation. Product photos were taken pre- (March 2019) and post-implementation (March-October 2020) in three supermarkets in Lima, Peru. Following INFORMAS protocols and Peruvian Technical Norms, the presence of MT, HC, and NC was assessed on all package sides. Products were classified as "high-in" and "not high-in" based on the regulation threshold for critical nutrients. Differences in the proportion of products with each strategy in both periods were evaluated. Also, a subsample of products was matched according to the barcode and exact McNemar test was used to compare proportions of strategies pre/post-implementation. We included 883 and 1,035 products in pre- and post-implementation, respectively. In both periods, MT appeared on almost 70% of all products. The presence of HC increased significantly only for beverages (24.5-38.1%, p < 0.001). In both phases, NC were commonly used on beverages (>80%). Overall, the prevalence of "high-in" products using MT increased (73.6-82.1%, p = 0.007), while use of HC increased among "not high-in" products (32.9-41.6%, p < 0.001). There is a high frequency of MT on all products and NC on beverages. The increase in MT in "high-in" products may be an industry response to minimize the impact of the FOPL on food choices and sales. New regulatory aspects regarding labeling should be implemented to strengthen the current policy.

The Impact of Time on Nutrition and Health Claims on the Irish Marketplace

Since the implementation of Regulation (EC) No 1924/2006 on nutrition and health claims (NHCR) made on food, only 261 health claims have been authorised, suggesting that the regulation creates challenges for the food industry. This study looks at the prevalence of nutrition and health claims labelled on food on the Irish market. Specifically, we compared their prevalence in 2009 with those present on the marketplace in 2022. Food labels of defined food categories were examined in three nationwide supermarkets in Ireland, and data of claims made on these labels were collected. A series of statistical analyses was conducted to compare the results from 2021 with those of 2009. In 2021, around half of the examined products (52.8%) displayed at least one nutrition claim, showing no significant difference with the data collected in 2009 (53.5%). Individual categories, however, did exhibit changes between the two time points. The prevalence of health claims on food has decreased from 21.6% in 2009 to 10.5% in 2021. There will always be a time lag between when a regulation is enacted and what its true impact can be measured. This study provides these data for the impact of time on EU Regulation 1924/2006 on the Irish market.

A Mobile Application for Teaching and Learning Critical Thinking About Health Choices Among Youth in Rwanda: A Digital Tool for Youth Friendly Center Counsellors

Mobile health applications can help to disseminate educational health interventions and be widely used. However, mobile health applications not carefully developed will likely not be adopted by the intended users. This paper describes the methodology used to develop a mobile health application for teaching critical thinking about health to youth attending youth friendly centres in Rwanda. The app includes the adapted content of a children's "health choices book". We adapted the book into audio podcasts to fit the context of young adults. The application was developed following a framework for developing mobile health applications. The framework follows three theories: health belief model, the theory of planned behavior and technology acceptance model. We developed an Android based application which can be freely accessed in the Play store. The content in the app explains the need for critical thinking, the 10 audio podcasts, the support, and chat window where users share their experience of using the app. The app will be piloted in two youth centers in Rwanda.

Development of Healthy Vegan Bonbons Enriched with Lyophilized Peach Powder

Changing nutritional demands, in combination with the global trend for snacking, sets a goal for preparing food products for direct consumption with certain beneficial properties. This study was designed to investigate the quality characteristics of raw vegan bonbons enriched with lyophilized peach powder. Three types of formulations were prepared in which 10%, 20%, and 30% of lyophilized peach powder were, respectively, added. The newly developed vegan products were characterized in terms of their physical (moisture, ash, color, water activity), microbiological, and nutritional characteristics. Their antioxidant activity, flavonoid, and phenolic content were also evaluated. Considering the content of the bonbons, the reported health claims indicate that they are sources of fiber, with no added sugar, and contain naturally occurring sugars. The color measurements demonstrated similarity in the values. This study showed that there is significant potential in the production of healthy snacks for direct consumption, with beneficial properties.

The nutraceutical properties and health benefits of pseudocereals: a comprehensive treatise

This review article depicts the possible replacement of staple cereal sources with some pseudocereals like Chia, Quinoa, Buckwheat, and Amaranth, which not only provide recommended daily allowance of all nutrients but also help to reduce the chances of many non-communicable infections owing to the presence of several bioactive compounds. These pseudocereals are neglected plant seeds and should be added in our routine diet. Besides, they can serve as nutraceuticals in combating various diseases by improving the health status of the consumers. The bioactive compounds like rutin, quercetin, peptide chains, angiotensin I, and many other antioxidants present in these plant seeds help to reduce the oxidative stress in the body which leads toward better health of the consumers. All these pseudocereals have high quantity of soluble fiber which helps to regulate bowel movement, control hypercholesterolemia (presence of high plasma cholesterol levels), hypertension (high blood pressure), and cardiovascular diseases. The ultimate result of consumption of pseudocereals either as a whole or in combination with true cereals as staple food may help to retain the integrity of the human body which increases the life expectancy by slowing down the aging process.

Lifestyle, psychological and socio-demographic drivers in functional food choice: a systematic literature review based on bibliometric and network analysis

Food-related diseases are a topic of concern for the population and institutions; therefore, regulations have been envisaged to improve consumer knowledge about food properties and to guide them towards healthy food consumption. Europe has addressed the use of claims on labels with two important regulations in 2006 and 2012. The use of claims allows for the differentiation of food products, particularly functional foods, i.e., those that can provide health benefits as part of a standard diet. The study aims to describe the interest of researchers on the topic of functional foods and health claims by observing the trend of publications and highlighting the role of the country on the topic through a network analysis. Another objective is to evaluate the role of lifestyle, psychological and socio-demographic predictors in the choice of functional foods bearing label claims or not, using a systematic literature review. To this aims, a bibliometric and a network analysis were assessed. The results reveal a positive trend in publications and a growing interest in the topic, thus showing that socio-demographic characteristics and lifestyle variables partially influence consumer behaviour. In particular, it emerges that educated people and women are more interested in functional foods, showing a higher willingness to pay for them. In addition, physical activity and beliefs regarding the nutritional quality of functional foods are positively correlated with WTP. However, several contradictory results were observed for some variables in the collected studies. For these reasons and considering the high number of functional foods and claims yet to be evaluated, further investigations are recommended.

Use of Dietary Supplements and Perceived Knowledge among Adults Living with Fibromyalgia in Norway: A Cross-Sectional Study

Fibromyalgia syndrome (FMS) is a complex medical condition characterized by widespread musculoskeletal pain. To date, no gold standard treatment has been developed, and persons with FMS often seek alternative methods to control their symptoms, such as dietary supplements (DS). This study aimed to describe the use of DS in persons living with FMS and examine the associations between the use of DS and its potential predictors. We recruited a convenience sample of 504 participants (≥18 years) living with FMS. The main outcome variables included estimated expenditure on DS in the last 12 months in Norwegian kroner (NOK) and the differences between the groups of users and non-users of DS. Of the 504 participants, 430 reported having used DS, and the mean amount of money spent in the previous year was determined to be NOK 2300. The most common DS reported were vitamin D, magnesium, and omega-3 fatty acids. The predictors of being a DS user were high education, high self-reported knowledge of DS but low overall knowledge of health claims. Users of DS marketed for muscles/joints appear to spend more money on DS. The increasing availability of DS and aggressive advertising in the media through health claims stipulate the need for interventions that lead to informed decisions about DS.

Therapeutic Claims in Cannabidiol (CBD) Marketing Messages on Twitter

Although the U.S. FDA has only approved exactly one cannabidiol (CBD) drug product (specifically to treat seizures), CBD products are proliferating rapidly through different modes of usage including food products, cosmetics, vaping pods, and supplements (typically, oils). Despite the FDA clearly warning consumers about unproven health claims made by manufacturers selling CBD products over the counter, the CBD market share was nearly 3 billion USD in 2020 and is expected to top 55 billion USD in 2028. In this context, it is important to assess the presence of health claims being made on social media, especially claims that are part of marketing messages. To this end, we collected over two million English tweets discussing CBD themes. We created a hand-labeled dataset and built machine learned classifiers to identify marketing tweets from regular tweets that may be generated by consumers. The best classifier achieved 85% precision, 83% recall, and 84% F-score. Our analyses showed that pain, anxiety disorders, sleep disorders, and stress are the four main therapeutic claims made constituting 31.67%, 27.11%, 13.77%, and 10.37% of all medical claims made on Twitter, respectively. Also, more than 93% of advertised CBD products are edibles or oil/tinctures. Our effort is the first to demonstrate the feasibility of surveillance of marketing claims for CBD products. We believe this could pave way for more explorations into this indispensable task in the current landscape of social media driven health (mis)information and communication.

Consumer Acceptance and Market Potential of Iodine-Biofortified Fruit and Vegetables in Germany

Biofortification of food crops with iodine is a novel approach to preventing iodine deficiency in humans. The present study analyses the consumer target groups and the market potential of iodine-biofortified fruit and vegetables in Germany. For this purpose, an online survey of 1016 German fruit and vegetable consumers was conducted to investigate the acceptance of different product categories as well as relevant criteria for the market launch. The results show that iodine-biofortified fruit and vegetables are particularly attractive to consumers who purchase at farmers’ markets, organic food shops, and farm stores. Out of this group, 39% of consumers rate such iodine-rich foods as very appealing. They attach importance to food that naturally contains iodine and prefer produce from integrated domestic cultivation. With their focus on sustainability and naturalness, this group of consumers clearly differs from typical users of dietary supplements, who are primarily concerned with health benefits. However, overall about 85% of respondents would prefer biofortified fruits and vegetables to supplements to improve their iodine supply. The greatest market potential for iodine-biofortified fruit and vegetables is to be expected in supermarkets, as this is the preferred food shopping location for most consumers. A total of 28% of those who buy here rate the biofortified foods presented as very appealing. Nevertheless, a successful market launch requires that the benefits of the new products are communicated according to the potential consumer group needs.

Assessment of Knowledge and Self-Reported Use of Nutrition Facts Labels, Nutrient Content, and Health Claims among Saudi Adult Consumers

Background

Few studies have investigated the knowledge and attitudes towards the nutrition facts label, the nutrient content and health claims (NHCs) among consumers from different countries/cultures.

Methods

This cross-sectional study assessed the knowledge and self-reported use of the nutrition facts label and NHCs among Saudi adults. A total of 722 participants were recruited using an online questionnaire.

Results

Total knowledge score was 5.8 ± 2.5/13 points (45%). Approximately, 18%, 77%, and 5% of the participants had low, medium, and high levels of knowledge, respectively. Participants were more knowledgeable on the nutrition facts label (2.6 ± 1.6/5 points) and health claims (2.7 ± 1.2/4 points) versus nutrient content claims (0.5 ± 0.7/4 points). The total use score was 20.1 ± 5.7/30 points (67%); approximately, 2%, 61%, and 37% of the participants were classified as low, medium, and high use level, respectively. Participants’ use of the nutrition facts label, nutrient content claims, and health claims was 10.0 ± 3.1/15, 6.5 ± 2.2/9, and 3.6 ± 1.8/6 points, respectively.

Conclusion

This study highlights the need for more education and public awareness programs to enhance consumer knowledge and use of the nutrition facts label and NHCs, and consequently lead to healthy dietary choices.

Relapse and Treatment Adherence in Patients with Schizophrenia Switching from Paliperidone Palmitate Once-Monthly to Three-Monthly Formulation: A Retrospective Health Claims Database Analysis

PURPOSE

Relapse and treatment adherence to paliperidone palmitate once-monthly (PP1M) and three-monthly (PP3M) formulations in patients with schizophrenia were evaluated and compared using health claims data.

PATIENTS AND METHODS

Data (June 2015─June 2018) obtained from the MarketScan® Multi-State Medicaid Database were retrospectively analyzed. Patients aged ≥18 years with ≥1 claim for schizophrenia diagnosis prior to and/or at index date (i.e., date of first PP3M prescription record for PP3M patients and same month/year as the matched PP3M patients for PP1M patients) and continuous enrollment in the insurance plan for ≥12 months prior to index date (baseline) were included. PP1M cohort included patients who received ≥4 PP1M doses. PP3M patients were matched with PP1M patients (1:3) using propensity score matching and prevalent new user design. Outcome measures were relapse rate, time to relapse, proportion of days covered (PDC), and level of treatment adherence defined by PDC in five levels. Time to relapse was compared by Kaplan-Meier survival curves and log-rank test with the hazard ratio calculated using Cox proportion hazards model; PDC by t-test, and relapse rate and PDC categories by chi-square test.

RESULTS

A total of 1564 patients (428 PP3M and 1136 PP1M) were included. Relapse rate was lower in PP3M cohort (10.5%) compared with PP1M cohort (15.7%). Incidence rate of relapse was 8.98/100 person-years (PY) in PP3M cohort and 13.81/100 PY in PP1M cohort. After a mean (SD) follow-up of 456.1 (240.28) days in PP3M cohort and 465.4 (237.95) days in PP1M cohort, PP3M patients had a significantly lower relapse risk (hazard ratio: 0.65, 95% CI: 0.47, 0.90) than PP1M patients. Treatment adherence was significantly (p<0.0001) higher in PP3M versus PP1M cohort.

CONCLUSION

Risk of relapse was significantly lower, and treatment adherence was significantly higher in PP3M cohort compared with PP1M cohort. Higher treatment adherence was associated with lower relapse rate.

Statistics on the bioactive anthocyanin/proanthocyanin products in China online sales

Due to their potential beneficial effects, anthocyanins and proanthocyanins have attracted great concern worldwide. Recently, anthocyanin/proanthocyanin-related health products have occupied a certain proportion of the market. However, there has not been a systematical assessment on collecting and analyzing the relevant information. In this study, information of anthocyanin/proanthocyanin-related health products on sale on the four major online shopping platforms in China has been collected from November 2020 to February 2021. A total of 144 valid samples from 91 brands were collected, among which blueberries and grape seeds are the main sources of anthocyanins and proanthocyanins, respectively. Besides, the average anthocyanins/proanthocyanins content in these products is 22.71%. Improving eyesight, anti-asthenopia and anti-oxidation are widely mentioned among the anthocyanin-related products, while more proanthocyanin-related products declare for anti-oxidation, whitening & spot lighting, and delay of skin aging & repairing skin damage effects. Among the products, 77.78% are capsules and tablets, and the average unit price of anthocyanins/proanthocyanins is $ 5.26/g. Data analysis shows that searching for high-quality raw materials, researching on the varieties and content of anthocyanins/proanthocyanins, focusing on the intake of specific population, and exploring better storage forms of anthocyanins/proanthocyanins may be important field in the future to promote the development of the anthocyanin/proanthocyanin-related health products.

The Relationship of Health and Nutrition Claims towards Purchasing Choices among Consumers in Shah Alam, Selangor

Consumers nowadays have more awareness for healthy foods and demanded healthier food choices to avoid health-related problems; therefore, industries had included health and nutrition claims on their products. Health and nutrition claims usually influence consumers' food choice decision. Products with health claim resulted in higher perception of healthiness and nutritional value of the product, even if the product was not considered as a healthy choice. The aim of this study was to assess whether the health and nutrition claims had led to a healthier perception or better evaluation of the product among consumers.

METHODS

A cross-sectional survey was conducted using an online questionnaire on 385 respondents collected through convenience sampling. The survey consisted of four parts: socio-demographic background, health awareness, understanding and usage of health and nutrition claims, and purchase intention measured through the use of a mock packaging. Data collected were analyzed using SPSS version 22.

RESULTS

Most of the respondents aged 18-30 (81.0%) and almost half of them were Malay (45.7%) with bachelor/master or PhD qualification (60.0%). The distribution of household income for all categories was almost similar (18.2-20.8%). There was a significant statistical relationship between health awareness and purchase intention among respondents (r=0.391, p<0.01).

CONCLUSIONS

Health and nutrition claims influenced consumer's perceptions and purchase intention, especially for those who were more concerned about their health, thus, more focus on policy regarding claims is needed.

Nutrition and Health Claims Spectra of Pre-Packaged Foods on Serbian Supermarket Shelves: A Repeated Cross-Sectional Study

Nutrition and health claims (NHCs) are a powerful tool that influence consumers’ final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among different food categories, (ii) to determine the type of NHCs labelled on the examined food products, and (iii) to evaluate the trend in the use of NHCs in comparison to the 2012 survey. The survey was conducted immediately before the full enforcement of the new national legislation on NHCs in 2020. It comprised 3141 pre-packaged food products from 10 product categories. In total, 21.2% of food products contained any claim (19.4% contained any nutrition claim; 8.2% contained any health claim). In comparison to the 2012 survey, we observed a rising trend in the presence of NHCs; the use of nutrition claims on food products increased three times and the use of health claims increased 1.3 times in the 2020 survey. Bearing in mind that NHCs are a powerful tool guiding consumers’ food purchase decisions, NHCs should be supported by precise legislation and strict surveillance by the public health authorities.

Nutrition to Optimise Human Health-How to Obtain Physiological Substantiation?

Demonstrating in an unambiguous manner that a diet, let alone a single product, 'optimizes' health, presents an enormous challenge. The least complicated is when the starting situation is clearly suboptimal, like with nutritional deficiencies, malnutrition, unfavourable lifestyle, or due to disease or ageing. Here, desired improvements and intervention strategies may to some extent be clear. However, even then situations require approaches that take into account interactions between nutrients and other factors, complex dose-effect relationships etc. More challenging is to substantiate that a diet or a specific product optimizes health in the general population, which comes down to achieve perceived, 'non-medical' or future health benefits in predominantly healthy persons. Presumed underlying mechanisms involve effects of non-nutritional components with subtle and slowly occurring physiological effects that may be difficult to translate into measurable outcomes. Most promising strategies combine classical physiological concepts with those of 'multi-omics' and systems biology. Resilience-the ability to maintain or regain homeostasis in response to stressors-is often used as proxy for a particular health domain. Next to this, quantifying health requires personalized strategies, measurements preferably carried out remotely, real-time and in a normal living environment, and experimental designs other than randomized controlled trials (RCTs), for example N-of-1 trials.

Challenges in the design, interpretation, and reporting of randomized controlled clinical studies on the health effects of whole foods

Given the challenges with nutrition research, the Canadian Nutrition Society and Intertek Health Sciences Inc held an expert consultation in late 2019 to discuss the development and implementation of best practices for clinical trials on whole foods. Key challenges in the design, interpretation, and reporting of clinical efficacy studies on whole foods and opportunities for the future development of best practices are reported. Novelty: Outlines existing tools, resources, and checklists for clinical nutrition trials and provides clear and tangible steps to develop best practices for studies on whole foods.

A Cross-Sectional Audit of Nutrition and Health Claims on Dairy Yoghurts in Supermarkets of the Illawarra Region of New South Wales, Australia

Health and nutrition claims are used by consumers to guide purchasing decisions. In consequence, monitoring and evaluation of such claims to ensure they are accurate and transparent is required. The aim of this study was to investigate the use of nutrition and health claims on dairy-yoghurt products within select Australian supermarkets and assess their compliance with the revised Food Standards Code (FSC). Nutrition, health, and related claims on yoghurt products were assessed in a cross-sectional audit of five supermarkets in the Illawarra region of New South Wales. Claim prevalence, type, and compliance were assessed and products were compared against current rating measures. A total of n = 340 dairy yoghurt products were identified. Most products (97.9%) carried at least one nutrition and/or health claim, with nutrition-content claims (93.9%) the most prevalent. Most products (n = 277) met the nutrient profiling scoring criterion; while 87.9% of products did not carry the health star rating. Almost all claims surveyed (97.4%) were compliant with the FSC. Health and nutrition claims are highly prevalent across yoghurt categories, with the majority of these compliant with regulations. The ambiguity surrounding the wording and context of claims challenges researchers to investigate consumers’ interpretations of health messaging within the food environment.

Chondrolia Chalkidikis and Chalkidiki (Greece) to Bear Health Claims according to the European Legislation

The European food legislation authorizes the use of certain health claims based on a scientific basis. This study aimed to evaluate the fatty acid, tocopherol, and polar phenol composition of virgin olive oil (VOO) from cv. Chondrolia Chalkidikis and Chalkidiki regarding the fulfillment of official requirements for the health claims of 'oleic acid', 'vitamin E', and 'olive oil polyphenols'. The examination of representative industrial VOOs from 15 olive mills of the Chalkidiki regional unit showed that the two cultivars yield oils contained the necessary concentrations of the responsible bioactive compounds. This evidence was further substantiated by a four harvest study whereby olives from different maturity stages were sampled from three olive groves. Oils were extracted at a laboratory scale and examined for their content in the above-mentioned three categories of constituents. Oils produced at industrial scale from olives harvested on the 'technological optimum' stage according to the olive grove proprietor were also analyzed. Extra virgin olive oil of the studied cultivars can safely bear the generic claims for 'oleic acid' and 'vitamin E'. The cultivars present great potential regarding the total hydroxytyrosol and tyrosol content of the extracted oil required to attain the third health claim that may be influenced negatively by manufacturing practices.

A Review of the Role of Micronutrients and Bioactive Compounds on Immune System Supporting to Fight against the COVID-19 Disease

Micronutrients are critical for an adequate function of the immune system and play a vital role in promoting health and nutritional well-being. The present work is aimed at reviewing (1) the role of micronutrients in helping the immune system to fight against the COVID-19 disease through the diet with food or food supplements and (2) the potential use of food health claims regarding immune function according to the European Food Safety Authority (EFSA) requirements. Till date, there are some health claims authorized by the European Commission that refer to the role of certain essential nutrients (vitamins B₆, B₉, B₁₂, A, D, C, and Cu, Fe, Se) to contribute to the proper functioning of the immune system. Vitamins D, C, Zn, and Se, have been thoroughly studied as a strategy to improve the immune system to fight against COVID-19 disease. From all the micronutrients, Vitamin D is the one with more scientific evidence suggesting positive effects against COVID-19 disease as it is linked to a reduction of infection rates, as well as an improved outcomes in patients. To validate scientific evidence, different clinical trials are ongoing currently, with promising preliminary results although inconclusive yet.

Pre-Launch Exploration of Consumer Willingness to Purchase Selenium- and Iodine-Biofortified Apples-A Discrete Choice Analysis of Possible Market Settings

Selenium and iodine are essential micronutrients for humans. They are often deficient in food supply due to low phytoavailable concentrations in soil. Agronomic biofortification of food crops is one approach to overcome micronutrient malnutrition. This study focused on a pre-launch exploration of German consumers’ willingness to purchase selenium- and/or iodine-biofortified apples. For this purpose, an online survey was carried out. In this context, consumers were asked to choose their most preferred apple product from a set card of product alternatives in a discrete choice experiment (DCE). The multinomial logit model results demonstrated that German consumers’ have a particular preference for iodine-biofortified apples. Furthermore, apple choice was mainly influenced by price, health claims, and plastic-free packaging material. Viewed individually, selenium did not exert an effect on product choice whereas positive interactions between both micronutrients exist.

Immunomodulating Effects of Fungal Beta-Glucans: From Traditional Use to Medicine

The importance of a well-functioning and balanced immune system has become more apparent in recent decades. Various elements have however not yet been uncovered as shown, for example, in the uncertainty on immune system responses to COVID-19. Fungal beta-glucans are bioactive molecules with immunomodulating properties. Insights into the effects and function of beta-glucans, which have been used in traditional Chinese medicine for centuries, advances with the help of modern immunological and biotechnological methods. However, it is still unclear into which area beta-glucans fit best: supplements or medicine? This review has highlighted the potential application of fungal beta-glucans in nutrition and medicine, reviewing their formulation, efficacy, safety profile, and immunomodulating effects. The current status of dietary fungal glucans with respect to the European scientific requirements for health claims related to the immune system and defense against pathogens has been reviewed. Comparing the evidence base of the putative health effects of fungal beta-glucan supplements with the published guidance documents by EFSA on substantiating immune stimulation and pathogen defense by food products shows that fungal beta-glucans could play a role in supporting and maintaining health and, thus, can be seen as a good health-promoting substance from food, which could mean that this effect may also be claimed if approved. In addition to these developments related to food uses of beta-glucan-containing supplements, beta-glucans could also hold a novel position in Western medicine as the concept of trained immunity is relatively new and has not been investigated to a large extent. These innovative concepts, together with the emerging success of modern immunological and biotechnological methods, suggest that fungal glucans may play a promising role in both perspectives, and that there are possibilities for traditional medicine to provide an immunological application in both medicine and nutrition.

Analytical Assessment According to EFSA Scientific Opinion and International Evidence and Criteria

Caffeine is a food supplement widely consumed by athletes, but it has not been established. So far, the veracity of their labeling in terms of the dosage and cause/effect relationship aimed at the consumer. The aim is to analyze the health claims and the dosage presented on the labeling of caffeine supplements and to evaluate if they follow the European Food Safety Authority (EFSA) and international criteria. A descriptive cross-sectional study of a sample of caffeine supplements was carried out. The search was done through the Amazon and Google Shopping web portals. In order to assess the adequacy of the health claims, the guidelines of reference established by European Food Safety Authority were compared to the Academy of Nutrition and Dietetics, International Olympic Committee, and Australian Institute of Sport guidelines; in addition, recent systematic reviews were addressed. A review of labels of 42 caffeine supplements showed that, in less than 3% of the products were the health claims supported by the recommendations and by the labeled quantity of caffeine. The claims that fully complied the recommendations were, "improves or increases endurance performance", "improves strength performance", or "improves short-term performance". In most cases, the recommended dosage was 200 mg/day for these products, which is the minimum for the caffeine effects to be declared. The rest of the health claims were not adequate or need to be modified. Most of the health claims identified indicated an unproven cause and effect, which constitutes consumer fraud, and so must be modified or eliminated.

Assessment of Health Claims Related to Folic Acid in Food Supplements for Pregnant Women According to the European Regulation

Pregnant women are a vulnerable group with increased nutritional requirements. The daily intake of folic acid, a crucial vitamin for embryonic development, must be reinforced through supplementation, as sometimes diets are not well equilibrated. As consumers increasingly rely on food supplements, it is vital to properly inform them about the health benefits provided by supplements' consumption to ensure their safe use. The objective of this work was to assess the compliance level of health claims related to folic acid in food supplements commercialized in Spain according to the European regulation. Authors performed (1) a review of health-related claims approved for folic acid in Europe, (2) a market research of food supplements commercialized in Spain with those claims, and (3) a selection of food supplements for chemical analysis in the lab to assess these claims. The results showed that nine health-related claims are currently approved for folic acid in Europe. The analytical results for folic acid content in the selected samples were consistent with the declared values and within the tolerance ranges established in the European Guidance document. All samples included accurate dosages and met the legal requirements (European Regulations 1924/2006, 432/2012, 1169/2011) for all approved claims for folic acid.

General scientific guidance for stakeholders on health claim applications (Revision 1)

[Table: see text] The general guidance for stakeholders on the evaluation of Article 13(1), 13(5) and 14 health claims was first published in March 2011. Since then, the Panel on Dietetic Products Nutrition and Allergies (NDA) has completed the scientific assessment of Article 13(1) claims except for claims put on hold by the European Commission, and has assessedadditional health claim applications submitted pursuant to Articles 13(5), 14 and also 19. In addition, comments received from stakeholders indicate that general issues that are common to all health claims need to be further clarified and addressed. This guidance document aims to explain the general scientific principles applied by the NDA Panel for the scientific assessmentof all health claims and outlines a series of steps for the compilation of applications. The general guidance document represents the views of the NDA Panel based on the experience gained to date with the scientific assessment of health claims, and it may be further updated, as appropriate, when additional issues are addressed.The document also aims to inform applicants of newprovisionsin the pre-submission phase and in the application procedure set out in the General Food Law, as amended by the Transparency Regulation. These new provisions are applicable to all applications submitted as of 27 March 2021. The version of this guidance published in 2016 remains applicable for applications submitted before 27 March 2021.

Scientific and technical guidance for the preparation and presentation of a health claim application (Revision 3)

[Table: see text] Upon request from the European Commission, the scientific and technical guidance for the preparation and presentation of an application for authorisation of a health claim initially published in 2007 and subsequently revised in 2011 and 2016 has been updated. This guidance document presents a common format for the organisation of information for the preparation of a well-structured application for authorisation of health claims which fall under Articles 13(5), 14, and 19 of Regulation (EC) No 1924/2006. This guidance outlines: the information and scientific data which must be included in the application, the hierarchy of different types of data and study designs, and the key issues which should be addressed in the application to substantiate the health claim. This guidance has been revised in 2020 to inform applicants of new provisions in the pre-submission phase and in the application procedure set out in Regulation (EC) No 178/2002, as amended by Regulation (EU) 2019/1381 on the transparency and sustainability of the EU risk assessment in the food chain, that are applicable to all applications submitted as of 27 March 2021. The 2016 version of this guidance remains applicable to applications submitted before 27 March 2021.

Comparison of requirements for using health claims on foods in the European Union, the USA, Canada, and Australia/New Zealand

Nutrition is recognized as one of the leading factors influencing the growing incidence of noncommunicable diseases. Despite society experiencing a global rise in obesity, specific populations remain at risk of nutrient deficiencies. The food industry can use health claims to inform consumers about the health benefits of foods through labeling and the broader promotion of specific food products. As health claims are carefully regulated in many countries, their use is limited due to considerable investments required to fulfill the regulatory requirement. Although health claims represent a driving force for innovation in the food industry, the risk of misleading of consumers need to be avoided. The health claim scientific substantiation process must be efficient and transparent in order to meet the needs of companies in the global market, but should be based on strong scientific evidence and plausible mechanisms of actions, to ensure highest level of consumer protection. The objective of this review is to compare the possibilities for using health claims on foods in the European Union, the USA, Canada, and Australia and New Zealand. In particular, we focused on differences in the classification of claims, on the scientific substantiation processes and requirements for health claims use on foods in the selected regions. Reduction of disease risk (RDR) claims are associated with relatively similar procedures and conditions for use, whereas several notable differences were identified for other types of claims. In all cases, RDR claims must be approved prior their introduction to the market, and only a few such claims have been authorized. Much greater differences were observed concerning other types of claims.

Effects of Statistical and Narrative Health Claims on Consumer Food Product Evaluation

This research aims at exploring the underlying mechanisms how consumers respond to statistical and narrative health claims when they evaluate food products. Moreover, personality traits and product-related information are also incorporated to discuss their effects on the relationship between message types and consumers’ food product evaluation. The results indicate that statistical health claims are more persuasive than narrative health claims. In addition, the results show that individuals’ health knowledge, NFC moderate the relationship between message types and product evaluation. It argues that individuals with limited health knowledge evaluate food product more favorably when statistical health claims are used, while individuals with more health knowledge evaluate food product more favorably when narrative health claims are used. Moreover, it reveals that individuals with high NFC evaluate food product more favorably when statistical health claims are used, while individuals with low NFC evaluate food product more favorably when narrative health claims are used.

Carotenoids: Considerations for Their Use in Functional Foods, Nutraceuticals, Nutricosmetics, Supplements, Botanicals, and Novel Foods in the Context of Sustainability, Circular Economy, and Climate Change

Carotenoids are versatile isoprenoids that are important in food quality and health promotion. There is a need to establish recommended dietary intakes/nutritional reference values for carotenoids. Research on carotenoids in agro-food and health is being propelled by the two multidisciplinary international networks, the Ibero-American Network for the Study of Carotenoids as Functional Foods Ingredients (IBERCAROT; http://www.cyted.org) and the European Network to Advance Carotenoid Research and Applications in Agro-Food and Health (EUROCAROTEN; http://www.eurocaroten.eu). In this review, considerations for their safe and sustainable use in products mostly intended for health promotion are provided. Specifically, information about sources, intakes, and factors affecting bioavailability is summarized. Furthermore, their health-promoting actions and importance in public health in relation to the contribution of reducing the risk of diverse ailments are synthesized. Definitions and regulatory and safety information for carotenoid-containing products are provided. Lastly, recent trends in research in the context of sustainable healthy diets are summarized.

Use of Almond Skins to Improve Nutritional and Functional Properties of Biscuits: An Example of Upcycling

Upcycling food industry by-products has become a topic of interest within the framework of the circular economy, to minimize environmental impact and the waste of resources. This research aimed at verifying the effectiveness of using almond skins, a by-product of the confectionery industry, in the preparation of functional biscuits with improved nutritional properties. Almond skins were added at 10 g/100 g (AS10) and 20 g/100 g (AS20) to a wheat flour basis. The protein content was not influenced, whereas lipids and dietary fiber significantly increased (p < 0.05), the latter meeting the requirements for applying "source of fiber" and "high in fiber" claims to AS10 and AS20 biscuits, respectively. The addition of almond skins altered biscuit color, lowering L* and b* and increasing a*, but improved friability. The biscuits showed sensory differences in color, odor and textural descriptors. The total sum of single phenolic compounds, determined by HPLC, was higher (p < 0.05) in AS10 (97.84 µg/g) and AS20 (132.18 µg/g) than in control (73.97 µg/g). The antioxidant activity showed the same trend as the phenolic. The p-hydroxy benzoic and protocatechuic acids showed the largest increase. The suggested strategy is a practical example of upcycling when preparing a health-oriented food product.

What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

OBJECTIVE

Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy.

STUDY DESIGN

Cross-sectional study.

SETTING

Health claims database from a third-party payer.

METHODS

Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression.

RESULTS

A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types (P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time (P = .98).

CONCLUSION

A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

How Is Functional Food Advertising Understood? An Approximation in University Students

In functional food advertising, messages are not always easily understandable for the target audience. Current European legislation, enforced through Regulation 1924/2006, specifies that such messages should be clear and precise so as not to mislead the consumer. The objective of this study was to observe consumers' understanding of messages in functional food advertisements. The methodology used was a self-administered survey filled out by 191 students enrolled in a Degree in Advertising and Public Relations at the University of Alicante (Spain). The results suggest that a large number of students do not know what functional food is and obtain information about these products mainly from labelling/packaging. The major means of communication through which they learn about health benefits via advertising is the internet, followed by television. Most respondents indicated that they understood related advertisements and found it helpful to be given additional information on health benefits. Worthy of note, the greater their level of understanding of the messages, the higher their level of distrust of advertising messages, which they considered to be deceptive or misleading.

The Role of Individual Knowledge in Functional Olive Oil Preferences: Does Self-Coherence Lead to Different Health Attributes Perception?

This study examined whether health cues influence the choices of olive oil consumers with different degrees of knowledge about the nutritional properties of olive oil. To this end, a direct survey on the consumption of healthy extra-virgin olive oil was implemented by examining the stated preferences of a sample of consumers. Two econometric analyses were carried out to identify the drivers of the consumption of olive oil with high polyphenol content. The logistic model was chosen as the most suitable method to answer the research questions. The results revealed a general consensus among consumers regarding the beneficial properties of olive oil consumption. Moreover, the findings show that different degrees of individual knowledge act as distinctive drivers in influencing the health perception of olive oil consumers. Finally, this study verified that, even for healthy foods, consumers’ choices are strongly dependent on their own self-coherence. As a consequence, consumers’ knowledge or beliefs that orientate their attitudes are influenced by different motivations and attributes.

Psyllium: a useful functional ingredient in food systems

Psyllium gum is a hydrocolloid found in the husk of seeds from Plantago ovata. Psyllium husk has been used in traditional medicine in areas of India and China. Its consumption has been shown to provide nutritional benefits, such as the capacity to reduce the glycaemic index, to minimize the risk of cardiovascular diseases, to decrease cholesterol and constipation problems and others. Thus, interest in the incorporation of psyllium in food products is twofold. First, it can be a natural alternative to the use of other gums and hydrocolloids considered additives. Second, it can be used to improve the nutritional properties of products in which it is incorporated. However, for this purpose, it is necessary to add great quantities of psyllium. This review analyses the potential use of psyllium in distinct food products, considering its advantages and inconveniences as well as possible solutions for undesired effects. Among the analyzed products there are bakery products and, in particular, gluten-free breads where psyllium has been used as a gluten substitute. The incorporation of psyllium into dairy products such as yogurts and those derived from fruits, among others, is also addressed.

Supermarket Circulars Promoting the Sales of 'Healthy' Foods: Analysis Based on Degree of Processing

The health and wellness food sector grew 98% from 2009 to 2014 in Brazil, the world's fourth-biggest market. The trend has reached supermarket circulars, which recently started to feature whole sections advertising health and wellness-enhancing foods. This study identified food items advertised in circulars' specific sections of two Brazilian supermarket chains (one regional, one national) during a 10-week period. Foods were classified according to degree of food processing and presence/type of claims on their front-of-pack (FoP) labels. Comparison between groups of Unprocessed/Minimally Processed foods vs. Ultra-processed foods and presence/type of claims employed Pearson chi-square test. From the 434 alleged health and wellness-enhancing foods advertised, around half (51.4%) were classified as Ultra-processed. Presence of reduced and increased nutrient-content claims was significantly higher in labels of Ultra-processed foods. Most frequent claims addressed sugar and fibre content. Brazilian supermarket circulars were found to be promoting the sale of Ultra-processed foods in their health and wellness sections, leading to a situation that can mislead the consumer and bring negative health outcomes.

Who Reads Food Labels? Selected Predictors of Consumer Interest in Front-of-Package and Back-of-Package Labels during and after the Purchase

The paper aims to identify selected predictors of food label use to extend our knowledge about consumer behavior related to food purchases. Two types of information were examined: front-of-package (FOP) and back-of-package (BOP), and two contexts of reading labels were distinguished: during shopping and at home. Various types of potential predictors were tested, including demographic (e.g., age, gender, household size, place of living), socioeconomic (e.g., education, professional activity, income), behavioral (e.g., purchasing certain types of products), and psychographic (e.g., importance attached to various types of information) criteria. The survey was conducted with the use of the CAWI (Computer-Assisted Web Interviews) methodology in a sample of 1051 Polish consumers. Quota sampling was applied based on sex, age, education, place of living (urban vs. rural), and region. Descriptive statistics, t-tests, ANOVAs, Pearson correlation coefficients, and multiple and retrograde step regressions were applied. In retrograde step regression models, only one predictor (self-rated knowledge about nutrition healthiness) turned out to be significant for all four measures of label reading. The remaining predictors were specific to selected measures of reading labels. The importance of the information about the content of fat and that about the health effects of consuming a food product were significant predictors of three types of food label use. This study confirms the necessity to investigate reading labels in fine-grained models, adapted to different types of labels and different contexts of reading. Our results show that demographic or socioeconomic variables are not significant predictors of reading food labels for a large group of Polish consumers.

Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods

Dietary carbohydrates are components of healthy foods, but many carbohydrate foods have recently been stigmatized as primary causes of diet-related risk factors for chronic disease. There is an opportunity to enhance efforts within the food landscape to encourage the consumption of higher quality carbohydrate foods. The use of labelling is one strategy that permits consumers to identify healthy carbohydrate foods at the point-of-purchase. This review discusses the regulatory frameworks and examples of associated non-mandatory food labelling claims that are currently employed to highlight healthy carbohydrate foods to consumers. The existing labelling frameworks discussed here align with established measures of carbohydrate quality, such as 1. dietary fibre nutrient content claims and associated dietary fibre-based health claims; 2. the presence of whole carbohydrate foods and ingredients that are intact or reconstituted, such as whole grains; and 3. low glycemic index and glycemic response claims. Standards from Codex Alimentarius, and regulations from Australia and New Zealand, Canada, Europe, and the United States will be used to illustrate the means by which food labelling can be used by consumers to identify quality carbohydrate foods.

Young Adult Identification and Perception of Hashtag-Based Vaping Claims on Instagram

Social media platforms are home to large volumes of ambiguous hashtag-based claims about the health, modified-risk, and cessation benefits of electronic cigarette products (e.g., #Vapingsavedmylife). The objective of this study was to qualitatively explore how young adults interpret these hashtags on the popular platform Instagram. Specifically, we sought to identify if they view these hashtags as making health-related claims, and if they find these claims to be credible and valid. We conducted 12 focus groups in 2018 with non-tobacco users, smokers, dual users, and vapers between the ages of 18 and 24 (n = 69). Using real Instagram posts to guide discussion, participants reflected on the meaning of potentially claims-making hashtags. Participants interpreted the majority of the hashtags as making health-related claims. However, many participants felt that the claims were too exaggerated to be entirely valid. Some participants, including dual users and vapers, argued that smoking and vaping were largely equivalent. Smokers were particularly skeptical of claims. Findings suggest that the U. S. Food and Drug Administration should consider hashtag-based claims in their regulatory efforts. However, further research is needed on how to pragmatically address claims taking the form of hashtags given legal and practical constraints.

Prevalence of Product Claims and Marketing Buzzwords Found on Health Food Snack Products Does Not Relate to Nutrient Profile

Growth in the consumer health and wellness industry has led to an increase of packaged foods marketed as health food (HF) products. In consequence, a ‘health halo’ around packaged HF has arisen that influences consumers at point-of-purchase. This study compared product claims (nutrient content claims (NCC), health claims and marketing ‘buzzwords’) displayed on packaged HF snack products sold in HF stores and HF aisles in supermarkets to equivalent products sold in regular aisles (RA) of supermarkets. Product Health Star Rating (HSR), nutrient profile and price were also compared. Data were collected for 2361 products from three supermarket chains, two HF chains and one independent HF store in Sydney, Australia. Mann-Whitney U tests compared the product claims, HSR, nutrient composition and unit ($) price. HF snacks displayed significantly more product claims per product compared to RA foods (HSR ≤ 2.5), median (IQR) 5.0(4.0) versus 1.0(2) and (HSR > 2.5) 4.0(4.0) versus 3.0(4), respectively (p < 0.001). A significantly different HSR was evident between HF and RA snack products, median 2.5(0) versus 2.0(1.5), respectively (p < 0.001). HF snacks cost significantly more than RA snack foods, irrespective of product HSR (p < 0.001). These findings support the recommendation for revised labelling regulations and increased education regarding consumers food label interpretation.

Prevalence and incidence of narcolepsy in a US health care claims database, 2008-2010

STUDY OBJECTIVES

To determine the prevalence and incidence of narcolepsy using a large US health care claims database.

METHODS

The Truven Health MarketScan Commercial Dissertation Database (THMCDD) was used to estimate prevalence and incidence of narcolepsy, with and without cataplexy, by age groups, gender, and region among patients under age 66 years with continuous enrollment for years 2008-2010. THMCDD contains health claims information for more than 18 million people. Prevalence was expressed as cases/100 000 persons. Average annual incidence (using varying criteria for latency between the diagnostic tests, polysomnograph coupled with multiple sleep latency test [MSLT], and the diagnosis) was expressed as new cases/100 000 persons/year.

RESULTS

There were 8 444 517 continuously enrolled patients and 6703 diagnosed with narcolepsy (prevalence overall: 79.4/100 000; without cataplexy: 65.4/100 000; with cataplexy: 14.0/100 000). On the basis of the three definitions of incidence, overall average annual incidence was 7.67, 7.13, and 4.87/100 000 persons/year. Incidence for narcolepsy without cataplexy was generally several times higher than narcolepsy with cataplexy. Prevalence and incidence were approximately 50% greater for females compared to males across most age groups. Prevalence was highest among the 21-30 years age group, with incidence highest among enrollees in their early 20s and late teens. Regionally, the North Central United States had the highest prevalence and incidence, whereas the West was the lowest.

CONCLUSION

We found greater prevalence and incidence of narcolepsy (including without cataplexy) than most previous studies. The increased proportions in females, enrollees in their early 20s, and US regional differences require further study. Increased awareness and early identification is critical in the management of this burdensome condition.