: To help consumers make healthier choices, the US Food and Drug Administration (FDA) has been charged with developing a front-of-package label (FOPL) to appear on US packaged foods and beverages. One option being explored is the use of "high-in" FOPLs for added sugar, sodium, and saturated fat using a threshold of ≥20% of the recommended daily value (%DV) per portion/serving size to define "high-in". While research has addressed what FOPL designs are most effective at visually communicating "high-in", less attention has been paid to the nutrient profile model (NPM) used to decide which products should receive these labels.
View Article and Find Full Text PDFJMIR Res Protoc
March 2024
Background: Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people aged 65 years and older, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal posthospital care continuum. This study evaluates the implementation of THRIVE-an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery.
View Article and Find Full Text PDFBackground: Governments globally aim to reduce the intake of unhealthy foods. Many policies exist that aim to address foods high in saturated fat, salt and sugar (HFSS) but the identification of ultra-processed foods (UPF) have presented a greater challenge due to the lack of an appropriate policy definition. To support policymakers, we provide approaches that can support governments to identify both HFSS foods and UPFs.
View Article and Find Full Text PDFBackground: Food additives have been used mainly in the past century to perform specific functions in foods. Some types of food additives have been linked to adverse health outcomes, yet there is little research examining food additives in the US food supply.
Objective: To examine the proportion of products purchased by US households containing four common technical food additives using time-specific food composition data and examine whether purchases have changed over time.
Despite growing evidence that warning labels reduce purchases of sugary drinks, less is known about warnings' impact on purchases of sugary snacks. This paper aimed to experimentally test whether a front-of-package label warning about high sugar content ("sugar warning label") would reduce parents' likelihood of selecting a labeled snack versus a non-labeled snack for their child in a food store setting. Participants (n = 2,219 parents of at least one child aged 1-5y) were recruited via an online panel and asked to complete a shopping task in a virtual convenience store.
View Article and Find Full Text PDFObjective: This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profiling model (NPM) to the food supply in South Africa (SA) and compare its performance against existing NPM as an indication of suitability for use to underpin food policies targeted at discouraging consumption of products high in nutrients associated with poor health.
Design: Cross-sectional analysis of the SA-packaged food supply comparing the CAM to three other NPM: SA Health and Nutrition Claims (SA HNC), Chilean Warning Octagon (CWO) 2019, and Pan-American Health Organisation (PAHO) NPM.
Setting: The SA-packaged food supply based on products stocked by supermarkets in Cape Town, SA.
Background: The health benefits related to intake of whole grain foods are well established. Consumption of whole grains in the US population is low, and whole grain content can vary greatly depending upon the specific products that are purchased.
Objectives: To examine the proportion of products purchased by US households containing whole grain and refined grain ingredients using time-specific food composition data, and examine whether purchases differ between income, race or ethnicity, and household make-up.
The rapid rise in prevalence of overweight/obesity, as well as high prevalence of type 2 diabetes and other nutrition-related noncommunicable diseases, has led the Food Safety and Standards Authority of India (FSSAI) to propose a front-of-package labeling (FOPL) regulation. An effective FOPL system applies a nutrient profile model that identifies foods high in sugar, sodium, and saturated fat that would receive a warning label for consumers to effectively discern between more and less healthy foods. Previous Nutrition Alchemy data collected by the food industry ( = 1306 products) estimated that approximately 96% of foods in India would have at least one warning label based on the FSSAI proposed FOPL.
View Article and Find Full Text PDFBackground: Purchases of foods containing nonnutritive sweetener (NNS) alone or in combination with caloric sweeteners (CS) has increased in recent years in the United States. At the same time clinical evidence is emerging of different cardiometabolic effects of each NNS type.
Objective: To examine the prevalence and volume purchased of commonly consumed types of NNS in packaged food and beverage products comparing 2002 and 2018 using data from nationally representative samples of US households.
The Pan American Health Organization (PAHO) and Chile stage III nutrient profiling systems (NPSs) were applied to packaged beverages/foods sold in Jamaica to: (a) identify products with excess nutrients of concern (NOC) under each NPS; (b) assess differences between these NPS, and (c) discuss the advantages and disadvantages of each NPS when applied to Jamaica's food supply. Data on 6261 branded multi-ingredient packaged products were collected from the city of Kingston in 2018; of these, 4739 products, comprised of 3423 foods (from 15 food groups) and 1316 beverages (from four beverage groups), provided sufficient information. Products containing excessive NOC under each NPS were identified and the proportions of categories with excess NOC were compared using correlation coefficients.
View Article and Find Full Text PDFBackground: Front-of-package warning labels are an increasingly common policy and have been implemented to inform consumers of the nutritional quality of ultra-processed foods. This study examined the proportion of Colombian products that could be subjected to such regulations.
Methods: Two nutrition profile models were compared: the Pan American Health Organization (PAHO) model, and the nutrient profile established under the Chilean food labeling and advertising law (Chilean model).
Background: Recent research suggests that sugar-sweetened beverage (SSB) consumption has been declining among US children aged 2-18 y. However, most studies focused on changes in mean intake, ignore high SSB consumers and do not examine intake among vulnerable groups and, including adolescents, low-income households, and several racial/ethnic minorities.
Objective: The aim was to estimate usual SSB intake from NHANES surveys from 2003-2004 to 2013-2014 to examine shifts at both the median and 90th percentile among US children, evaluating the extent to which intake disparities in total SSBs and subtypes have persisted.
Introduction: Policymakers have focused on the food retail environment for improving the dietary quality for Supplemental Nutrition Assistance Program (SNAP) participants. Yet little is known about where SNAP households make food and beverage purchases or how purchases may vary by store type, SNAP participation, and income level. The objective of this study was to examine the association between SNAP-income status (participant, income-eligible non-participant, higher-income non-participant) and healthfulness of household purchases across store types.
View Article and Find Full Text PDFIncreased interest among consumers in the reduction of dietary sugar intake has led to the wider availability of food products containing non-nutritive sweeteners (NNS). However, the extent to which NNS are currently being used by manufacturers to sweeten processed food and beverage products, and how NNS may be displacing added sugars as a sweetener is unknown. The current study utilized branded food composition databases from Australia, Mexico, New Zealand and the US to determine the percentage of processed food and beverage products for which there are nutrition data containing NNS and to compare total sugar density (g per 100 mL for beverages and g per 100 g for foods) between products with and without NNS.
View Article and Find Full Text PDFIntroduction: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) required major revisions to food packages in 2009; effects on nationwide low-income household purchases remain unexamined.
Methods: This study examines associations between WIC revisions and nutritional profiles of packaged food purchases from 2008 to 2014 among 4,537 low-income households with preschoolers in the U.S.
In order to monitor nutritional changes in the US food supply and assess potential impact on individual dietary intake, an approach was developed to enhance existing standard food composition tables with time-varying product- and brand-specific information for barcoded packaged foods. A "Crosswalk" was formed between barcoded products and USDA foodcodes in a time-specific manner, such that sales-weighted average nutritional profiles were generated for each foodcode based on corresponding products (275,000 to 350,000 per 2-year cycle). This Crosswalk-enhanced food composition table was applied to dietary intake data from the National Health and Nutrition Examination Survey (cycles 2007-2008, 2009-2010, and 2011-2012).
View Article and Find Full Text PDFBackground: Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake.
Methods And Findings: Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015-29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.
Introduction: Previous studies in adolescents were not adequately powered to accurately disentangle genetic and environmental influences on smoking initiation (SI) across adolescence.
Methods: Mega-analysis of pooled genetically informative data on SI was performed, with structural equation modeling, to test equality of prevalence and correlations across cultural backgrounds, and to estimate the significance and effect size of genetic and environmental effects according to the classical twin study, in adolescent male and female twins from same-sex and opposite-sex twin pairs (N = 19 313 pairs) between ages 10 and 19, with 76 358 longitudinal assessments between 1983 and 2007, from 11 population-based twin samples from the United States, Europe, and Australia.
Results: Although prevalences differed between samples, twin correlations did not, suggesting similar etiology of SI across developed countries.
Objective: To compare estimates from one day with usual intake estimates to evaluate how the adjustment for within-person variability affected nutrient intake and adequacy in Mexican children.
Design: In order to obtain usual nutrient intakes, the National Cancer Institute's method was used to correct the first 24 h dietary recall collected in the entire sample (n 2045) with a second 24 h recall collected in a sub-sample (n 178). We computed estimates of one-day and usual intakes of total energy, fat, Fe, Zn and Na.
Little is known regarding the underlying relationship between smoking initiation and current quantity smoked during adolescence into young adulthood. It is possible that the influences of genetic and environmental factors on this relationship vary across sex and age. To investigate this further, the current study applied a common causal contingency model to data from a Virginia-based twin study to determine: (1) if the same genetic and environmental factors are contributing to smoking initiation and current quantity smoked; (2) whether the magnitude of genetic and environmental factor contributions are the same across adolescence and young adulthood; and (3) if qualitative and quantitative differences in the sources of variance between males and females exist.
View Article and Find Full Text PDFBackground: Accurate, adequate, and timely food and nutrition information is necessary in order to monitor changes in the US food supply and assess their impact on individual dietary intake.
Objective: Our aim was to develop an approach that links time-specific purchase and consumption data to provide updated, market representative nutrient information.
Methods: We utilized household purchase data (Nielsen Homescan, 2007-2008), self-reported dietary intake data (What We Eat in America [WWEIA], 2007-2008), and two sources of nutrition composition data.
Recent national surveys suggest that child obesity in the United States may have reached a plateau, but corresponding trends in energy intake have not been examined in depth. This article evaluates medium-term trends in children's reported energy intake by using 4 waves of national dietary surveillance from 2003-2004 to 2009-2010. The analysis uses up to 2 24-h dietary recalls, incorporating methods that address challenges in estimating usual intake, accounting for intraindividual variance and covariates such as the presence of atypical consumption days.
View Article and Find Full Text PDFObjective: Adolescent meningococcal vaccine uptake remains low. We examined vaccine awareness among parents of adolescents and uptake.
Methods: Parents of adolescents aged 11 to 17 years (n = 1281) participated in a statewide survey.
Objective: We compared parental reports of children's height and weight when the values were estimated vs. parent-measured to determine how these reports influence the estimated prevalence of childhood obesity.
Methods: In the 2007 and 2008 North Carolina Child Health Assessment and Monitoring Program surveys, parents reported height and weight for children aged 3-17 years.
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